[Congressional Record (Bound Edition), Volume 147 (2001), Part 9]
[House]
[Page 13025]
[From the U.S. Government Publishing Office, www.gpo.gov]



                    SENATE MANAGED CARE LEGISLATION

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Texas (Mr. Green) is recognized for 5 minutes.
  Mr. GREEN of Texas. Mr. Speaker, I rise tonight to encourage our 
House leadership to bring the Patients' Bill of Rights to the floor as 
soon as possible, hopefully next week.
  The Senate took historic steps before the July 4 recess to pass a 
bipartisan, meaningful Patients' Bill of Rights. The McCain-Kennedy 
compromise legislation includes strong patient protections that will 
ensure high quality health care for millions of Americans with private 
health insurance coverage.
  These protections include:
  Access. Patients will be able to go directly to specialists. Women 
have the right to go to their OB-GYNs, and children directly to their 
pediatricians.
  Communication. The Senate bill eliminates gag clauses which prohibit 
doctors from discussing all the treatment options, even those not 
covered by the plan, with their patients.
  Emergency room care for patients who reasonably believe that they are 
suffering from an emergency medical condition, so they do not have to 
drive by an emergency hospital to go to the one that is on their list.
  Internal-external appeals, which ensures that patients have access to 
timely and appropriate health care.
  And probably the most important is accountability if an HMO's denial 
or delay of treatment causes a person's injury or death.
  Many critics of this legislation say it would result in an onslaught 
of frivolous and expensive litigation, but this compromise bill also 
included many provisions to prevent such lawsuits from taking place.
  For example, the legislation requires patients to exhaust all their 
appeal procedures before they can sue their health plan. By requiring 
that patients utilize an independent review panel, the bill makes sure 
that medical decisions are made in the best interests of medical 
practice in a timely manner.
  In my home State of Texas, we have been using independent review 
organizations, or IROs, as we call them, to resolve HMO and patient 
coverage disputes since 1997, 4 years. These IROs are made up of 
experienced physicians who have the capability and the authority to 
resolve disputes for cases involving medical judgment.
  These provisions have been successful not only because they protect 
patients, but also because they protect the insurers. Plans that comply 
with the independent review organization's decision cannot be held 
liable for punitive damages if they do go to court.
  This plan has worked well. Since 1997, more than 1,000 patients and 
physicians have challenged the decisions of HMO plans. The independence 
of this process is demonstrated by its fairly even split. Of this about 
1,000 appeals, in only 55 percent of these cases did the IRO fully or 
partially reverse the decision of that HMO.
  The Senate legislation protects employers from unnecessary 
litigation.
  Let me go back to the independent review organizations. Fifty-five 
percent of the time, these IROs found that there was something wrong 
with the HMO's decision. I would hope that our medical decisions have a 
better percentage than to flip a coin, so in 55 percent of the cases in 
Texas, either partially or totally the HMO was reversed by the 
independent review organization.
  The bill goes so far because it protects employers against any 
liability unless they are directly participating in the decision on a 
claim for benefits which result in personal injury or death.
  The bill specifically lists a number of areas that are not considered 
direct participation. In other words, as an employer, one could select 
the health plan, choose benefits to be covered under the plan, buy a 
Cadillac plan or a Chevrolet plan, and the employer would not be sued 
for that, or for advocating with the health plan on behalf of the 
beneficiary for coverage.
  I know in my own experience as a small business, oftentimes my 
biggest problem was advocating for our employees with our health 
insurance plan to say it should be covered.
  The only case where an employer would be liable would be if they 
choose to make medical decisions which harm or kill a patient. If the 
employer acts like a doctor, then the McCain-Kennedy bill hold them 
responsible like a doctor.
  Mr. Speaker, I mentioned earlier, we have had many of these same 
provisions in Texas law now for 4 years. Yet, we have not seen a 
barrage of frivolous lawsuits, nor have insurance premiums risen at a 
faster rate than anywhere else in the Nation.
  Mr. Speaker, the Dingell-Ganske bill here in the House is very 
similar to the McCain-Kennedy bill, which is very similar to a law that 
we have had on the books in Texas for 4 years. It contains many of the 
same compromise provisions, which at the same time ensure that these 
protections can be enforced.
  It is time that the House followed suit and passed a real, 
meaningful, strong, bipartisan Patients' Bill of Rights. I urge the 
leadership not to delay in bringing the Dingell-Ganske bill to the 
floor for a vote.

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