[Congressional Record (Bound Edition), Volume 150 (2004), Part 7]
[House]
[Pages 9236-9244]
[From the U.S. Government Publishing Office, www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 4279, PROVIDING FOR DISPOSITION OF 
    UNUSED HEALTH BENEFITS IN CAFETERIA PLANS AND FLEXIBLE SPENDING 
 ARRANGEMENTS; H.R. 4280, HELP EFFICIENT, ACCESSIBLE, LOW-COST, TIMELY 
 HEALTHCARE (HEALTH) ACT OF 2004; AND H.R. 4281, SMALL BUSINESS HEALTH 
                          FAIRNESS ACT OF 2004

  Ms. PRYCE of Ohio. Mr. Speaker, by direction of the Committee on 
Rules, I call up House Resolution 638 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 638

       Resolved, That upon the adoption of this resolution it 
     shall be in order to consider in the House the bill (H.R. 
     4279) to amend the Internal Revenue Code of 1986 to provide 
     for the disposition of unused health benefits in cafeteria 
     plans and flexible spending arrangements. The bill shall be 
     considered as read for amendment. The previous question shall 
     be considered as ordered on the bill and on any amendment 
     thereto to final passage without intervening motion except: 
     (1) one hour of debate on the bill equally divided and 
     controlled by the chairman and ranking minority member of the 
     Committee on Ways and Means; (2) the amendment in the nature 
     of a substitute printed in part A of the report of the 
     Committee on Rules accompanying this resolution, if offered 
     by Representative Rangel of New York or his designee, which 
     shall be in order without intervention of any point of order, 
     shall be considered as read, and shall be separately 
     debatable for one hour equally divided and controlled by the 
     proponent and an opponent; and (3) one motion to recommit 
     with or without instructions.
       Sec. 2. Upon the adoption of this resolution it shall be in 
     order to consider in the House the bill (H.R. 4280) to 
     improve patient access to health care services and provide 
     improved medical care by reducing the excessive burden the 
     liability system places on the health care delivery system. 
     The bill shall be considered as read for amendment. The 
     previous question shall be considered as ordered on the bill 
     to final passage without intervening motion except: (1) one 
     hour of debate on the bill, with 40 minutes equally divided 
     and controlled by the chairman and ranking minority member of 
     the Committee on the Judiciary and 20 minutes equally divided 
     and controlled by the chairman and ranking minority member of 
     the Committee on Energy and Commerce; and (2) one motion to 
     recommit.
       Sec. 3. Upon the adoption of this resolution it shall be in 
     order to consider in the House the bill (H.R. 4281) to amend 
     title I of the Employee Retirement Income Security Act of 
     1974 to improve access and choice for entrepreneurs with 
     small businesses with respect to medical care for their 
     employees. The bill shall be considered as read for 
     amendment. The previous question shall be considered as 
     ordered on the bill and on any amendment thereto to final 
     passage without intervening motion except: (1) one hour of 
     debate on the bill equally divided and controlled by the 
     chairman and ranking minority member of the Committee on 
     Education

[[Page 9237]]

     and the Workforce; (2) the amendment in the nature of a 
     substitute printed in part B of the report of the Committee 
     on Rules, if offered by Representative Kind of Wisconsin or 
     his designee, which shall be in order without intervention of 
     any point of order, shall be considered as read, and shall be 
     separately debatable for one hour equally divided and 
     controlled by the proponent and an opponent; and (3) one 
     motion to recommit with or without instructions.
       Sec. 4. (a) In the engrossment of H.R. 4279, the Clerk 
     shall--
       (1) await the disposition of H.R. 4280 and H.R. 4281;
       (2) add the respective texts of H.R. 4280 and H.R. 4281, as 
     passed by the House, as new matter at the end of H.R. 4279;
       (3) conform the title of H.R. 4279 to reflect the addition 
     of the text of H.R. 4280 or H.R. 4281 to the engrossment;
       (4) assign appropriate designations to provisions within 
     the engrossment; and
       (5) conform provisions for short titles within the 
     engrossment.
       (b) Upon the addition of the text of H.R. 4280 or H.R. 4281 
     to the engrossment of H.R. 4279, H.R. 4280 or H.R. 4281 (as 
     the case may be) shall be laid on the table.
       (c) If H.R. 4279 is disposed of without reaching the stage 
     of engrossment as contemplated in subsection (a), H.R. 4280 
     shall be treated in the manner specified for H.R. 4279 in 
     subsections (a) and (b), and only H.R. 4281 shall be laid on 
     the table.

  The SPEAKER pro tempore. The gentlewoman from Ohio (Ms. Pryce) is 
recognized for 1 hour.
  Ms. PRYCE of Ohio. Mr. Speaker, for the purpose of debate only, I 
yield the customary 30 minutes to my colleague and friend, the 
gentlewoman from New York (Ms. Slaughter), pending which I yield myself 
such time as I may consume. During consideration of this resolution, 
all time yielded is for the purpose of debate only.
  Mr. Speaker, H. Res. 638 provides for separate consideration of three 
different measures. The rule provides that when these measures are 
agreed to, each will be engrossed as one bill and sent to the other 
body.
  Mr. Speaker, this week communities across this country are 
participating in activities associated with Cover the Uninsured Week. 
Why? Well, because almost 44 million Americans have zero health 
insurance.
  These 44 million Americans live in sleepy towns and bustling towns 
all across America in each and every one of our districts. They are 
children and adults. They are families. The majority are hardworking 
men and women just trying to make a living, provide for their families 
and offer their children opportunities they may never have had.
  Yet nearly 44 million of our constituents are living every day 
without health insurance coverage. They are living without the security 
of knowing that they have a family doctor to call upon when they are 
sick and when it comes to time for their annual checkup. They are 
living without the security of knowing that when their child is ill, 
whether it is just a bad bug or a life-threatening ailment, they can 
access emergency care or see a specialist.
  Without a doubt, the major reason people do not have health insurance 
is because they simply cannot afford it. In fact, 71 percent of the 
uninsured forego health insurance because of the cost.
  As I have come to find, for every 1 percent increase in health 
insurance premiums, 300,000 more individuals go without health 
insurance. Whether in the halls of Congress, at the Washington think 
tanks, among not-for-profit organizations, in the boardrooms of 
businesses or at the corner coffee shops, everyone is talking about 
what they believe is the remedy to one of the toughest questions ever 
asked: How do we stop sky-rocketing health insurance costs and get more 
people insured?
  Quite frankly, I think we have talked long enough. Mr. Speaker, it is 
time we place on the table the best market-based solutions to provide 
more Americans with access to quality and affordable health care. So 
here we are.
  Today and tomorrow, this House will debate and consider three 
legislative solutions. These steps in the right direction will address 
this larger challenge by focusing on the three major pieces to the 
puzzle: access, quality and affordability.
  The rule we are debating today will allow us to consider legislation 
to improve upon and strengthen flexible spending accounts, address the 
sky-rocketing costs of medical liability insurance, and allow small 
businesses to join together through association health plans.
  As I begin to talk in greater detail about each of these initiatives, 
they may sound rather familiar to my colleagues and to those watching 
C-SPAN this morning. That is because the House has already considered 
each of these initiatives in one way, shape or form already, but so far 
they are going nowhere in the other body. So let us give them one more 
opportunity.
  The first part of our health security plan will improve upon and 
strengthen flexible spending accounts or FSAs. FSAs allow workers to 
put money from their paychecks into an account, tax free, to pay for 
health care expenses. Employees spend this money on health services, 
giving them responsibility over their own health care decisions and 
spending.
  While FSAs are a great concept and have worked well under current 
law, the money contributed by employees have actually forfeited to the 
employer at the end of the year if it is not used. That means use it or 
lose it.
  Our plan would allow up to $500 of that money to be carried over into 
the following year. If an employee gets to keep $500 in unused money, 
they will have a greater incentive to make wise decisions about their 
spending.
  Mr. Speaker, we see a barrier standing in the way of access to 
quality and affordable health care so we are trying to knock it down. 
It is a solution.
  In the second part of our plan, we will revisit a critical initiative 
to address a growing and dangerous problem in our legal system that 
impacts each and every one of us, if not today, then tomorrow or in the 
future. I am talking about our medical liability system, a system that 
must be reformed if health care in America is to remain affordable.
  The medical liability crisis in America is virtually everywhere, but 
one of the places that we are seeing the most frightening and tangible 
effects of this crisis is in the area of prenatal care and delivery. 
This crisis is turning the very necessary treatment of prenatal care 
into a luxury, sometimes totally unavailable to far too many women.

                              {time}  1045

  It is estimated that about one in 10 obstetricians nationwide have 
actually stopped delivering babies. The crisis is most acute in rural 
areas where obstetricians are already in short supply. In my State of 
Ohio, professional liability insurance premiums have increased by 60 
percent in the past 2 years. Sixty percent. According to a recent 
survey, more than 58 percent of responding Ohio OB-GYNs have been 
forced to make changes to their practice, such as quitting obstetrics 
all together, retiring, or relocating because of the unaffordability 
and unavailability of medical liability insurance. Fifty-eight percent 
of Ohio's obstetricians.
  These statistics reflect the reality of real people in our cities and 
towns who are cutting back their practices or closing up all together. 
Just last month, an article ran in my local paper about a baby doctor 
in Columbus, Ohio, facing the prospect of a third year in which he and 
his OB-GYN partners have seen their malpractice insurance rise by 40 
percent or more. He is leaving his practice to teach residents at the 
local hospital. His two other partners are leaving too, one to an early 
retirement and the other to Utah, where she will not have to pay 
malpractice premiums as large as the ones in Ohio. They say they do not 
have a choice, they have to leave. Together, just this one practice 
will leave 4,500 patients looking for new doctors. That is 4,500 women 
who have relied on these talented doctors for years, in just this 
single practice, with no one to turn to. One of these women is 7 months 
pregnant with her fourth child. At 7 months along, she is looking for 
another doctor to deliver her baby.
  This example is not uncommon to my State. It is not only affecting 
the doctors who currently practice, but it is affecting future doctors 
and patients. Recently, the chairman of an OB-GYN residency department 
in Ohio said he is even unable to train future OB-GYNs. He said that 
due to high liability premiums, it is difficult to find faculty to

[[Page 9238]]

teach obstetrics residents. When counseling his students, he encourages 
them to still choose obstetrics as a profession, but now he offers a 
warning: just pick the right State, a State with good medical liability 
reforms. He also said in the past 2 years not a single one of his OB-
GYN residents set up practice in Ohio.
  The strides our country has made in reducing maternal and infant 
mortality rates through quality prenatal care are now being 
jeopardized. Across America, too many expectant moms are foregoing 
essential prenatal care, and they are asking, who will deliver my baby? 
I am concerned that without a change, the future of pregnant women's 
health is in serious jeopardy.
  The American people are fed up with abusive personal injury 
practices, aggravating frivolous lawsuits, and a health care system 
that is getting more expensive and less accessible as a result. That is 
why we are here today. That is why we must pass this important 
initiative. The Congressional Budget Office estimates that when our 
plan is enacted, premiums for medical malpractice insurance ultimately 
would be an average of 25 to 30 percent less than they are now.
  Mr. Speaker, we see a barrier standing in the way of access to 
quality and affordability in health care, so we are trying to knock it 
down. It is a solution.
  And the third piece of our puzzle will help address skyrocketing 
health care costs where they hurt the most, small businesses. When you 
consider that small businesses employ 50 percent of employees across 
our country, it is troubling to learn that 60 percent of the uninsured 
work for small businesses. They are uninsured because small business 
owners cannot afford to pay the cost of health insurance for their 
workers. The Small Business Health Fairness Act brings the benefits 
enjoyed by corporate America to these small businesses.
  This important initiative will allow small businesses to create 
association health plans, or AHPs. AHPs will enable small businesses to 
join together through existing trade associations to purchase health 
insurance for their workers at a lower cost than what is available to 
them now. It is the wholesale strength-in-numbers approach that will 
allow these groups of small businesses to band together to negotiate 
for lower prices on health insurance than individual employees could 
secure on their own.
  AHPs will save small businesses an average of 13 percent on their 
employee health care costs, which means more small business employees 
will have access to affordable health care coverage. And there is no 
question that 13 percent will be better spent by employers expanding 
their businesses by hiring unemployed Americans.
  Mr. Speaker, once again we see a barrier stand in the way of access 
to quality and affordable health care, so we are trying to knock it 
down. Once again, it is a solution.
  We have laid our common-sense solutions on the table, and now it is 
time to put them to work. I urge my colleagues to join me in 
implementing these critical initiatives that will help control the cost 
of health care in this country.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, two wrongs do not make a right, and three wrongs do not 
make a right, and passing bad legislation a second and third time will 
not make it a good bill. And I do not believe the Senate is going to 
like it a bit better. As a matter of fact, if the problem is the United 
States Senate, the other body, it would seem to me that we could take 
the bill over to the other body and find out exactly what the problem 
is and not take the time of the House over and over passing a bill that 
will go nowhere.
  Last year, the House considered and passed the legislation that is 
identical to two of the bills considered under the rule, and I do not 
believe the people of this great Nation sent us here to change the 
number on a bill and pass it again during the same Congress.
  Instead of playing these legislative games, we should be working on 
the grave issues that face this country. Americans are out of work, the 
Federal deficit is reaching all-time highs, American troops are in even 
greater danger in Iraq, the serious abuses of Iraqi prisoners and the 
failure to find weapons of mass destruction in Iraq should be 
aggressively investigated, and our hard-earned reputation and 
relationships throughout the world are in a shambles. So why, Mr. 
Speaker, are we on the floor of the people's House doing the same thing 
we did last year?
  Why are we wasting valuable time reconsidering the bills that were 
passed and sent to the other body? The bills do nothing to help the 
more than 40 million uninsured Americans. It is shameful, with so many 
issues facing this Nation, that so many pieces of good legislation 
languish while we waste valuable floor time on bills that have already 
been passed and are not expired.
  Why are we not considering bipartisan legislation to expand access to 
preventive health care services and to education programs that help to 
reduce unintended pregnancies, reduce infections of sexually 
transmitted diseases? And why are we not considering legislation that 
would allow children of deployed servicemembers to remain at their 
public schools in the event of a temporary residences change? Why do we 
not consider legislation to keep law enforcement uniforms out of the 
hands of criminals and terrorists? Why are we not on the floor debating 
and passing important bipartisan genetic nondiscrimination legislation?
  This replay game is not even an effort to improve the earlier work. 
The bills are not new and improved. Last year's medical malpractice 
legislation was considered under a closed rule, and this year the same 
malpractice legislation is subject to a closed rule. In the Committee 
on Rules hearing on each of the medical malpractice bills, Democrats 
offered a total of 39 amendments. Zero were made in order. Last year, 
the rule on the association health plans, the AHP bill, was 
restrictive, allowing only one amendment. This year, the same AHP bill 
with a new number is subject to a restrictive rule and again only one 
amendment is made in order.
  I make the point again, Mr. Speaker, there is no change in the bill 
that has already passed the House.
  Mr. Speaker, it does not help the millions of uninsured Americans at 
all. The wealthy are able to take advantage of the health savings 
accounts, but the poor are not. The uninsured will continue to be the 
uninsured.
  H.R. 4281 suffers from the same fatal maladies as last year's bill 
creating the AHPs. The Congressional Budget Office found that under 
this proposal, now this is very important, the Congressional Budget 
Office found that under the proposal passed that the premiums would 
increase for 80 percent of workers in small firms, and that 100,000 of 
the sickest workers would lose coverage all together.
  The bill would eliminate the protection of over 1,000 State consumer 
protection laws and vital State oversight. AHPs are likely to 
destabilize the health insurance market. Over 850 organizations oppose 
this legislation, including the National Governors' Association, the 
National Conference of State Legislators, and the National Association 
of Insurance Commissioners.
  The cure offered by the same medical malpractice bill is worse than 
the disease. Just like last year's bill, the bill ignores the major 
player in rising malpractice insurance premiums: the insurance 
corporations. Why we do that, I do not know; but they are continually 
left out of this equation. Proponents want to blame the jury awards for 
rising insurance premiums, but a study by Americans for Insurance 
Reform reported that rising insurance premiums are in no way tied to 
jury awards.
  Nothing in the bill requires the insurance corporations to lower 
premiums for medical malpractice insurance. Nothing in this bill 
requires the insurance companies to pass along to the physicians any 
savings the corporations might gain from this legislation. And, 
disappointingly, nothing in this bill gets rid of incompetent doctors.

[[Page 9239]]

  Statistics say that 5 percent of doctors are responsible for 54 
percent of all medical malpractice claims paid. Logic cries out that 
those 5 percent of doctors be dealt with. Now, this legislation 
punishes injured patients with valuable claims against negligent or 
reckless physicians and allows repeatedly reckless doctors to continue 
to practice medicine. We should weed out the 5 percent of physicians 
causing most of the harm and who force the insurance to pay again and 
again for their mistakes.
  We should stop playing games and consider legislation that will 
really help patients and that will really aid the doctors in providing 
quality health care. What we need is a reasonable regulation of the 
insurance industry, aggressive removal of bad doctors, and affordable 
prescription drugs.
  Mr. Speaker, my concern goes beyond this obvious waste of time and 
resources and the poor substance of these three bills. Once again, the 
House is denied the opportunity to engage in full and open debate. 
Members are being muzzled. This abuse of process is becoming the norm 
rather than the exception.
  Excluding H. Res. 638, the Committee on Rules has produced 22 rules 
this year: one open rule, 14 restrictive, five closed, and two 
procedurals. Debate is narrowed and stifled. Amendments and policy 
alternatives routinely are made out of order and not allowed on the 
floor. The body is elected to deliberate and debate, but the process is 
becoming much less democratic and much less deliberative.
  This abuse of power and process harms this institution and does 
nothing to help the over 40 million Americans without health care 
insurance. Reconsideration and repassage of these bills is a 
meaningless exhibition of political theater, and I urge my colleagues 
to vote ``no'' on this rule so the House can get down to some serious 
work on behalf of the American people.
  I must also say, Mr. Speaker, that I am particularly aggrieved at the 
portion of this bill that allows the pharmaceutical companies and the 
producers of medical devices to get off without being sued.
  Mr. Speaker, I reserve the balance of my time.
  Ms. PRYCE of Ohio. Mr. Speaker, I am very pleased to yield 2 minutes 
to the gentlewoman from West Virginia (Mrs. Capito), who has such a 
passion for health care concerns for her constituents.
  Mrs. CAPITO. Mr. Speaker, I wish to speak about the medical liability 
reform bill.
  Being from a State like West Virginia, we have been in crisis for 
many years, and I am exceedingly frustrated that we are not able to 
pass this bill and get it to the President for signature. We have 
passed this bill seven times, while our colleagues in the other Chamber 
have not acted on this. As a result, we are a Nation faced with torts 
gone wild.
  Mr. Speaker, the medical liability crisis our Nation is faced with is 
not a recent development. It has been an ever-present problem of 
varying degrees over the last 3 decades. Some States, like California, 
have been proactive and enacted tort reforms 3 decades ago. The 
California reforms, commonly referred to as MICRA, resulted in 
significantly limiting the increase in medical liability premiums as 
compared to the rest of the Nation.
  The other States' premiums have risen over three times as much as 
those in California. Doctors are retiring, moving, and throwing up 
their hands in frustration across this land. Access, affordability, and 
quality of our health care is at stake.
  Mr. Speaker, some State legislatures have acted recently to change 
their respective tort law system for medical liability claims. I am 
proud to say my own State of West Virginia has been a leader in this. 
However, this much-needed reform is now vulnerable to judicial review 
and can be ruled unconstitutional.
  Other States, like Pennsylvania, are specifically prohibited by their 
State constitution from considering such reforms. Mr. Speaker, this is 
why a Federal reform is so desperately needed. This reform will defer 
to State tort law where it is present, but will serve as a backstop for 
States where the respective State supreme court rules against the new 
laws.

                              {time}  1100

  Mr. Speaker, it is time to take control of the health care costs that 
are spiraling out of control due to a legal system gone wild. Our 
Nation's health care is at risk.
  Ms. SLAUGHTER. Mr. Speaker, I yield 6\1/2\ minutes to the gentleman 
from Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentlewoman for yielding 
me this time. I am almost a little embarrassed to be here today. This 
country is dealing with serious problems in Iraq, this country is 
dealing with serious unemployment problems. In Ohio, we have lost 1 out 
of 6 manufacturing jobs. This country is facing incredible confusion 
with the new Medicare bill and seniors are sorting through 50 Medicare 
cards to get a 10 or 15 percent discount while drug prices go up 15 or 
20 percent a year, yet we are here today to debate issues which have 
already passed in the House and bills that clearly will not make a dent 
in the problem of the uninsured, the 40 some million uninsured.
  Instead of debating proven solutions, solutions that we know will 
work, but solutions that just might, they just might hurt the drug 
industry and the insurance industry, they might be bills the insurance 
companies do not like, instead of working on bills that expand access 
to health insurance, the Republican leadership has chosen to pat itself 
on the back. They are frittering away the Cover the Uninsured Week by 
reconsidering bills which have already passed this House, bills that 
cater to the insurance industry, some of the biggest contributors to 
President Bush and the Republican Party, bills that give away the 
Federal Treasury to the drug industry, industries that give tens of 
millions of dollars to Republican leadership and to President Bush, and 
bills that help the HMO industry by sheltering them from liability.
  These bills will not necessarily reduce the number of uninsured, but 
we know they will undermine hard-fought State insurance laws, they will 
cover some small number of employers at the expense of others, they 
will provide tax shelters to people who already have coverage, and they 
will perpetuate the type of high-deductible coverage that actually 
discourages people from seeking preventive care.
  Republican leadership will spend this week, Cover the Uninsured Week, 
trying to cull out the uninsured issue so they can hand out more tax 
breaks to their HMO and insurance companies and prescription drug 
company contributors and butter up more of their campaign contributors.
  The President's budget does not spend a dime on the uninsured, but it 
will cut $24 million from the Medicaid program, clearly a program that 
works and which has helped millions of America's elderly and poor 
families.
  The President's plan will increase the number of uninsured. My 
Republican colleagues would also cut the Medicaid program by billions, 
stripping health insurance coverage from the most vulnerable among us.
  So let me see, the Republican bills protect the drug companies and 
the HMOs from harm they cause their patients, they destabilize the 
entire small group insurance market to buck State insurance laws, and 
they give tax breaks to the already insured. I am sure none of this has 
anything to do with the fact this is an election year, President Bush 
is out raising $200 million, Republican leadership is trying to equal 
that amount of money, and so much of it comes from the drug industry, 
the insurance industry and the HMOs.
  Now, this is my Republican friend's response to the fact that 43 
million people in this country are uninsured. It is outrageous that we 
are voting for a second time on these issues. It is not just futile; 
frankly, it is shameful.
  The other side of the aisle were talking about the malpractice crisis 
for physicians which is very real in many places. The gentlewoman from 
New York said this bill has liability protections, not just helping the 
doctors but for the drug industry?

[[Page 9240]]


  Ms. SLAUGHTER. Mr. Speaker, will the gentleman yield?
  Mr. BROWN of Ohio. I yield to the gentlewoman from New York.
  Ms. SLAUGHTER. Not only for the drug industry, Mr. Speaker, but for 
the people who manufacture medical devices. I know that is hard to 
believe, given that the drug companies just cleaned up from the 
Medicare bill passed here, but they are indemnified in this bill if the 
FDA has approved what they are doing.
  Mr. Speaker, this is the same FDA that just last week threw science 
overboard and declined to approve a drug that has been found safe in 36 
countries and by 24 of 29 scientists that studied it for the FDA. I do 
not trust the FDA anymore. But the FDA gives it approval, and then says 
citizens will have no recourse.
  Mr. BROWN of Ohio. So to make sure I understand this, the FDA, the 
same FDA that has begun to throw overboard science, the same FDA that 
is clamping down on Americans going to Canada for less expensive drugs, 
the same FDA that approves prescription drugs, if they approve them, 
this FDA which is way too controlled by the drug industry, which is 
controlled and influenced by the drug industry, if they approve a new 
drug, even if that drug is found to be unsafe and injures hundreds of 
thousands of people, there is no liability? There is no way to bring 
suit?
  Ms. SLAUGHTER. Mr. Speaker, if the gentleman would continue to yield, 
there is no punitive damage; none. In addition to that, just last week 
it was reported that science in the United States is falling 
considerably behind. We are no longer the leaders. This is the same 
leading by this FDA. I am very sorry to see that in this bill, and I 
believe most Americans will not approve it being in this bill. Frankly, 
I hope the Senate will again refuse to take it up.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, buttressed by our colleagues in the other body who are 
holding all these bills hostages, certainly they would like to have us 
give up, but when 58 percent of the OB-GYNs in Ohio are changing or 
leaving their practices, it is exactly the right time to turn up heat 
on these bills, and that is exactly what we are doing.
  Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from Texas (Mr. 
Sam Johnson).
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I am appalled at some of the 
rhetoric going on around here. The FDA is doing a good job. The FDA is 
controlling drugs. I have seen drugs out of Canada that are not good, 
so I think they are doing a good job.
  Mr. Speaker, I want to say I am here today to support the rule for 
H.R. 4280, the Small Business Health Fairness Act. The state of health 
care in America is reaching a crisis level. Costs continue to escalate 
annually at unprecedented rates. Our employers are being forced to drop 
health care coverage. This disproportionately affects small businesses 
burdened with shopping for health insurance in the costly small group 
markets. Large employers bring bargaining clout to the table when they 
work with insurance companies. Small businesses have fewer employees, 
and thus have little or no bargaining power. Not only that, but large 
employers and unions are exempt from burdensome State mandates already. 
These mandates dictate what health plans must cover and vary from State 
to State. Small employers do not have that luxury.
  We know that more than 60 percent of the uninsured Americans either 
work for a small business or are dependent upon someone who does. The 
clear course of action here is to help our small businesses afford 
health coverage by giving them those same opportunities that unions and 
large businesses have. Association health plans or AHPs do just that. 
Small businesses would be able to group together in bona fide trade 
associations. AHPs would then be able to use economies of scale to 
their advantage and provide more affordable health care for working 
families while avoiding administrative costs of State mandates. 
According to the CBO, AHPs would save small business owners and their 
employees as much as 25 percent on their health insurance.
  I was pleased to see that the Senate task force on the uninsured 
included association health plans in their report just this week. They 
are not the only solution to the uninsured in America, but they are 
certainly an important part of any solution. This is a bipartisan bill. 
The time to act is now. I urge a yes vote on the rule and on the bill.
  Ms. SLAUGHTER. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oregon (Mr. DeFazio).
  Mr. DeFAZIO. Mr. Speaker, the previous gentleman would not yield to 
my colleague, but it is the FDA's own assistant commissioner, Mr. 
Hubbard, who said they have seen no unsafe drugs from Canada but have 
found adulterated drugs in our relatively unregulated secondary 
wholesale market. So the gentleman is wrong on that. He said he has 
seen them. He ought to contact the FDA.
  Mr. Speaker, there is some room for agreement here. There is a 
problem in the affordability of insurance, health insurance for many 
Americans and businesses, medical malpractice insurance for many 
doctors. But guess what? It has spilled over into car insurance, 
homeowners insurance, personal liability insurance. It seems to be a 
big crisis in the health insurance industry. And is it that there is 
this whole new tide of claims in these areas? No, it is because the 
industry mismanaged its funds.
  It is an industry that is exempt from antitrust laws of the United 
States of America. They can and do collude to fix prices, redline 
people, and choose who they want to cover and who they do not. So they 
are sticking it to the docs and the American people and American 
businesses who buy health insurance in all lines of insurance.
  So one logical thing to do would be to subject the health insurance 
industry to the same rules that every other industry in the United 
States of America has to follow, make them follow antitrust laws, do 
not allow them to collude to set prices. But since they are such 
generous contributors to the other side of the aisle and to the 
President, oh, no, we are not going to make them like other industries, 
we are not going to make them competitive, let us give them a little 
gift here. We are going to go after other ways of dealing with this 
problem.
  Of course, the other way of dealing with this problem is exactly the 
same bill passed by the House of Representatives last year which is not 
going to pass the Senate. So why are we here today? We are here today 
because they want to remind their political contributors they did this 
last year and they can do it again this year. The Senate is not going 
to do it. They do not want to really legislate. They do not want to 
come up with compromises that might pass.
  There is a problem in affordability and access. There is a problem 
for both citizens and for docs to get the health insurance that they 
need. We are losing specialties. All those things are true, but their 
conclusion is to bail out their friends, the HMOs, the pharmaceutical 
companies, the insurance industry, not to help the docs, because there 
is not going to be a bill, and not to help the American people get 
affordable health insurance.
  Mr. Speaker, there are better ways to deal with this problem. A 
number of States have adopted things that are called soft caps. The 
bill the other side of the aisle is trying to pass here today was 
brought up by initiative petition in my State. We hear people in 
America want this legislation. Guess what? In my State, which I think 
is a pretty good cross-section, the initiative for hard caps at 
$250,000 when people saw the egregious things that happen to some 
people through negligence, was rejected 4 to 1. The other side of the 
aisle is telling us the American people want this solution. No, the 
American people want access to their doctors, and they want access to 
affordable health insurance. But the other side is not going to do 
either of those things today because it would go against the

[[Page 9241]]

economic interests of some of their most generous political 
contributors.
  This is identical to legislation passed in the House of 
Representatives last year, but here we are doing it again for political 
purposes, not legislative purposes.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Washington (Mr. Nethercutt).
  Mr. NETHERCUTT. Mr. Speaker, Washington State is facing a health care 
crisis because medical liability lawsuits have run amok. We are one of 
19 States in the country that is in a health care crisis. We have lost 
500 doctors because they could not afford medical liability insurance 
in my State. What this means is women who are seeking an OB-GYN in some 
of our communities cannot find one to deliver their babies. That is a 
crisis. Emergency rooms are not able to stay open 24 hours a day; that 
is a crisis. We are losing doctors to Idaho, right across the line from 
my State.
  As a member of the Medical Malpractice Crisis Task Force, I am 
pleased to support H.R. 4280, the Health Act, and pleased to support 
the rule. It is the right thing to do. There is every reason in the 
world that critics of any reform can try to give to mask the concept 
that we have to address the issue of medical liability reform first. We 
will not do that until we pass a bill in this House and we pass a bill 
in the other body so there can be communication and discussion and 
resolution of this problem.

                              {time}  1115

  To do nothing does not solve the problem, Mr. Speaker. So I am 
pleased that this HEALTH Act is being brought up again. We have to make 
sure we establish again and again and again the commitment of the House 
to medical liability reform, because doctors, hospitals, nurses, and 
patients are at risk if we do not change this system, modify this 
system, reform this system with a commonsense proposal that will lower 
costs and premiums so that doctors can stay in business. The damage 
that is being done here is that we are losing very good physicians and 
hospitals are at risk, risking closing, and also nurses are leaving the 
practice. They are going elsewhere because they are concerned about the 
liability insurance that they cannot get in States like mine. I urge my 
colleagues, vote for this measure, vote again in this House to pass it. 
Then let us urge the other body to adopt the same sort of commonsense 
reform. We can do that. I urge my colleagues to support the rule and 
the bill.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from 
Maryland (Mr. Cardin).
  Mr. CARDIN. Mr. Speaker, first let me thank the gentlewoman from New 
York for yielding me this time. I was listening to her comments. I just 
want to concur in that this is a very unusual process. Once again we 
are not going to have full debate and the opportunity to offer 
amendments. Although we might be getting used to it because it seems to 
be the norm around here, we should never be silent as to how this is 
wrong. We should have an opportunity to offer amendments. We should 
have an opportunity for an open process. We should have an opportunity 
to debate a bill on its merits. And we are not going to get that 
chance.
  Mr. Speaker, let me mention just two matters that affect the people 
that I represent in Maryland and the reason I took this time. First, I 
agree with the previous speaker on this side of the aisle that we 
should be doing something to bring down the cost of prescription 
medicines in this country. That is why I will vote against ordering the 
previous question, because I think we should have a debate on the floor 
dealing with the cost of medicines which is still the number one 
problem that I hear when I go to my town hall meetings. The second 
issue deals with these association health plans. I went to the 
Committee on Rules and asked for an amendment that would exempt States 
from these association health plans if the State requested it and they 
had a small-market reform which already provided help for their small 
businesses. In my State of Maryland, the adoption of the association 
health plans will actually be counterproductive. There will be fewer 
companies that will be offering health care benefits than there are 
today. That is why Governor Ehrlich has opposed that plan and many 
other Governors around the Nation have done the same. But I am not even 
going to have an opportunity to offer that amendment that would give 
the States the opportunity to continue their initiative. After all, I 
thought we believed in States rights here and the ability of States to 
be able to move forward with initiatives to cover their uninsured. But 
no, this bill works just the opposite. That is why many of our States 
we have heard from would oppose the association health plans in the way 
that it is currently drafted.
  Mr. Speaker, I regret that the Committee on Rules did not allow that 
amendment to be made in order nor did they allow any amendment to be 
made in order. That is not the way that we should be operating in this 
body. It does not speak to the democratic process. Therefore, I would 
oppose the rule.
  Ms. PRYCE of Ohio. Mr. Speaker, I am very pleased to yield 3 minutes 
to the gentleman from Florida (Mr. Weldon), who, as a doctor, has 
personal knowledge of how this stuff works.
  Mr. WELDON of Florida. Mr. Speaker, I thank the gentlewoman for 
yielding me this time. Yes, I do confess to being a doctor. I practiced 
medicine for 15 years before I was elected to the House of 
Representatives. I still see patients. I see them once a month. I want 
to address the issue in this rule of medical malpractice reform. A lot 
of people when they debate the issues surrounding the need for medical 
malpractice reform and reining in all of these plaintiffs' attorneys 
who are advertising on television, a lot of focus is on the size of the 
judgments and the costs, the legal fees associated with this system. 
But the real burden on our health care system is the high cost of 
defensive medicine.
  What is defensive medicine? I can tell you exactly what defensive 
medicine is because I practiced it for 15 years. I spent daily between 
$300 and $3,000 a day unnecessarily. Primary care providers, they do 
not like to talk about this because it gets them in trouble with their 
insurance companies, not with their medical malpractice insurance 
companies but with the Blue Cross/Blue Shields and the Aetnas. The 
executives of those companies, if they hear doctors saying that they 
are spending money unnecessarily, they get very upset and they try to 
clamp down on it.
  But how does it work? You come in and you have a headache, you have 
just lost your job or you have got problems at home. You order a CAT 
scan, anyway, just because you are worried that you might miss 
something. And you see the next patient and you are worried about this. 
Some of you may listen to me and say, oh, this is just rhetoric, this 
is just hot air. This has been studied scientifically. They studied it 
in California. They studied it before and after the medical malpractice 
reforms went through. They discovered that just in the Medicare plan 
alone that for one diagnosis of heart disease, we are probably spending 
in excess of $600 million a year unnecessarily just within Medicare, 
just within one disease, because of defensive medicine.
  They passed medical malpractice reform in California. They looked at 
a reduction in costs with no increased incidence of complications, what 
we call morbidity and mortality. In other words, quality stayed the 
same and costs went down. The only way to explain that, the researchers 
said, is a reduction in defensive medicine. What does this mean? This 
means if you want to save Medicare money so we can afford prescription 
drugs, pass medical malpractice reform. If you want to reduce the 
number of uninsured, pass medical malpractice reform. If you want to 
reduce the cost of health insurance for American businesses so they can 
be more competitive in the international marketplace, pass medical 
malpractice reform.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself 1 minute. CBO reports that 
proponents of limiting malpractice liability argue greater savings

[[Page 9242]]

in health care, possible through reductions in practice of defensive 
medicine. However, the defensive medicine is motivated less by 
liability than by the physicians, by the money it generates for them. 
And on the basis of existing studies and its own research, the 
Congressional Budget Office says savings from reducing defensive 
medicine would be very small.
  Also, there is no evidence that restriction on tort liability reduced 
medical spending.
  Mr. Speaker, I am pleased to yield 3 minutes to the gentleman from 
Illinois (Mr. Emanuel).
  Mr. EMANUEL. Mr. Speaker, I thank the gentlewoman from New York for 
yielding me this time. I rise in strong support of the motion of the 
gentleman from Texas (Mr. Frost) to move the previous question and 
allow a vote on the two bills that are essential to lowering health 
care costs and helping Americans afford their prescription drugs.
  I would like to note the irony that today in the House of 
Representatives we are dealing with health care, the Senate is dealing 
with health care, and Senator Kerry is dealing with the issue of the 
uninsured and health care. The only person missing from this debate is 
the President of the United States, who still lacks an agenda as it 
relates to health care.
  As we are focusing on health care costs, for the last 6 years the 
cost of prescription drugs in this country have gone up on average 18 
percent. This year alone they are going to go up 18 percent. They are 
projected to go up next year 20 percent. That is five times the rate of 
inflation. The two bills that this motion would bring up on the floor 
would make an immediate and lasting impact on the cost of prescription 
drugs that our seniors are being asked to pay and our taxpayers are 
being asked to also pay. People from around the world come to America 
for their medical care. Yet Americans are forced to go around the world 
for their medications. That is wrong, and we can do better.
  Just recently, the CEOs of Walgreens and CVS now came out in favor of 
allowing people to buy their drugs in Canada and in Europe. Secretary 
of Health and Human Services Tommy Thompson, who has opposed it, now 
supports allowing Americans to buy their prescription drugs in Canada 
and in Europe. The Secretary of Health and Human Services uses Lipitor. 
Where is that made? Ireland. The difference between that Lipitor that 
he buys and the people in Canada and Europe is that in the United 
States that costs 67 percent more here in the United States than it 
does in Europe and Canada, yet it is made from the same factory in 
Ireland and we import it into this country. It is distributed worldwide 
from one country.
  Last year alone we imported $14.5 billion worth of prescription 
drugs. They are safe. The only thing different with those drugs from 
anywhere else in the world is those drugs here in the United States at 
our pharmacy cost 50 to 60 percent more here in the United States than 
they do in Canada and in Europe. It is high time we bring competition 
and choice to market and bring prices down. This legislation would 
allow us to do that.
  In addition to that, half the States in the country now have 
legislation or some ability allowing people to buy prescription drugs 
in Canada and Europe. Congress has passed this on a bipartisan basis. 
It is not a Democrat-Republican issue. It is between right versus 
wrong. It is high time we bring this legislation back up and give 
people real financial relief from a cost where inflation is running 2 
percent, prescription drug costs are running close to 20 percent each 
year for the last 6 years. It is time we bring competition to bear on 
the market and allow prices to drop through choice and through 
competition.
  I would hope that my colleagues on the other side, given that 83 
Members voted for this, allow this legislation to bear so we can 
finally force the other Chamber to allow prescription drugs prices to 
be driven down. This is about cost, cost, cost. When somebody tells you 
it is not about money, it is about money. The prescription drug 
companies have a hold on this Congress. It is time we break the hold 
and allow the voices of our constituents to be heard and the pressure 
on their wallets to be relieved.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  I may have misheard my colleague earlier when I thought she said that 
CBO estimates on the premiums for medical malpractice insurance would 
be very small. If that is the case, I am sorry, but let me just let the 
record stand that CBO estimates predict that under this very act, 
premiums for medical malpractice insurance ultimately would be an 
average of 25 to 30 percent below what they are under current law. 
Twenty-five to 30 percent below the premiums that we have currently is 
not a small amount. It is very, very significant.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, let me yield myself 1 minute to respond 
to my colleague who did misunderstand what I was saying. The speaker 
had said that practicing defensive medicine was one of the reasons that 
the costs were so high. What the CBO has said was that defensive 
medicine is motivated less by liability concerns than the income it 
generates for the physician. On the basis of CBO's own studies and 
research, they believe that savings from reducing defensive medicine 
would be very small.
  Mr. Speaker, I am pleased to yield 2 minutes to the gentleman from 
New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I have been on the floor yesterday as well 
as earlier today essentially pointing out that the Republicans who have 
now said that this is the week of the uninsured, that somehow this is 
the week they are going to pass legislation to help the uninsured are, 
in fact, doing nothing of the kind. We face a health care crisis in 
this country. It is a crisis that is based primarily on cost because 
the cost of health care keeps going up and also because more and more 
people have no health insurance. Nothing that is being presented in 
these bills today and tomorrow is going to do anything major to bring 
costs down for the patients or for those people who are now uninsured.
  I oppose the rule because I think there should be an opportunity to 
bring up some Democratic measures that would do exactly that, reduce 
the costs of health care and also cover more people. Specifically, I 
know it has already been mentioned with regard to cost, is the idea of 
reimportation from Canada and other countries. We all know that that 
saves the consumer money. Why not let us have an opportunity to bring 
that up? The Republicans are wrong in not allowing it to be brought up.
  Secondly, let us amend the Medicare prescription drug bill so that we 
can have negotiated price reductions. Let the Medicare agency, let the 
Federal Government negotiate prices to bring prices down. This is what 
other countries do. This is what we do with our VA and with our 
military. It is a way of lowering costs. But beyond that for the 
uninsured, allow us as Democrats to bring up other measures. We have a 
measure that would allow the nearly elderly, those who are over 55, not 
yet eligible for Medicare, to buy into the Medicare program so that 
they can be insured. That is the second largest group around this 
country that have no health insurance right now.
  In addition to that, we have a very successful bipartisan program 
called S-CHIP that insures a lot of the kids around this country who 
were uninsured. Let us amend that bill. Let us bring up an amendment 
that would allow us to expand the S-CHIP program to cover the parents 
of the kids. These are people that are working, they are lower-income 
but they are working, and they cannot get health insurance on the job.
  Let us also address the problem that small businesses have. The 
Democrats have another proposal, a piece of legislation that would 
increase what small businesses can do in terms of tax deductions if 
they provide health care for their employees. The Republicans do not 
allow us to do this. They are doing

[[Page 9243]]

nothing to deal with the crisis of health care in terms of cost and the 
uninsured.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I will be asking for a ``no'' vote on the previous 
question. If the previous question is defeated, I will offer an 
amendment to the rule that will allow the House to add two more 
important health-related bills to this multibill rule.

                              {time}  1130

  Since we are revoting on health initiatives that have already passed 
the House in some form in this Congress, I think we should take this 
opportunity to consider two other very important pieces of healthcare-
related legislation. My amendment would allow for the consideration of 
a bipartisan drug reimportation legislation. If the purpose of this 
rule and these bills is to restate our commitment to House-passed 
health-related matters, this bill certainly deserves to be included. It 
has been passed several times. Drug reimportation legislation would 
provide relief for millions of Americans including the over 40 million 
uninsured. The House overwhelmingly passed similar legislation last 
year but it is worth considering again, now that the Secretary of 
Health and Human Services has said that he supports reimporting drugs 
from Canada.
  The second bill would amend the Medicare Prescription Drug Act to 
provide for negotiation of fair prices for Medicare prescription drugs. 
I cannot think of a more important correction to the Medicare 
prescription drug bill than fixing the irresponsible language in that 
bill that prohibits the Federal Government from negotiating lower 
prices for prescription drugs for our Nation's senior citizens.
  Let me emphasize that a ``no'' vote on the previous question will not 
stop consideration of the three bills already covered by the rule. It 
will allow the House to add these two important health bills to this 
multibill rule. However, a ``yes'' vote will block Members from 
considering two more critical health initiatives. Again, I urge a 
``no'' vote on the previous question.
  Mr. Speaker, I ask unanimous consent that the text of the amendment 
be printed in the Record immediately prior to the vote on the previous 
question.
  The SPEAKER pro tempore (Mr. LaHood). Is there objection to the 
request of the gentlewoman from New York?
  There was no objection.
  Ms. SLAUGHTER. Mr. Speaker, I yield back the balance of my time.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I cannot stress enough the importance of moving forward 
with these solution-based initiatives. We have a chance here now to 
make a difference in the lives of hardworking Americans across this 
great Nation. So let us put a stop to the politicizing of the plight of 
the uninsured. Let us help the small business owners insure their 
employees. Let us help Americans have more say about how their health 
care dollars are spent. Let us help these pregnant women and their 
babies who have no doctors to deliver them and care for them. Let us 
help the 58 percent of OB-GYNs in Ohio that have to leave or change 
their practices than stay in the profession they have chosen.
  Mr. Speaker, I urge my colleagues in the strongest way to support 
this rule and the underlying legislation.
  Mr. COSTELLO. Mr. Speaker, I rise today to oppose the rule that 
refuses to allow for an open debate or the ability to offer amendments 
to the medical malpractice legislation brought to the floor today by 
the Republican leadership.
  We have a medical malpractice crisis in downstate Illinois. Doctors 
are leaving the area at an alarming rate.
  There is not a simple solution to this complex problem. Some believe 
that restricting or capping damages that victims of malpractice receive 
alone will solve the problem. Others believe that placing restrictions 
on the insurance industry is the answer. There have been many studies 
on the issue reaching conflicting conclusions on the cause of the 
problem or the solution.
  However, one thing is clear. If we do not have the ability to put all 
of the issues on the table for consideration, and if we do not have the 
ability to debate each issue and offer amendments on medical 
malpractice legislation, we will not be able to solve the problem.
  The bill before us today is identical to the bill passed by the House 
that has been tied up in the Senate for months. The bill restricts or 
caps damages that a victim of malpractice can receive. However, the 
bill does nothing to restrict premiums that insurance companies can 
charge doctors or health care providers. It does nothing to stop or 
restrict the frivolous lawsuits that clog our court system and the bill 
does nothing to establish an alternative arbitration system to settle 
claims outside of the court system.
  If we are serious about finding real solutions to the crisis rather 
than scoring political points, the Republican leadership should allow 
for open debate on all points of view and allow members to offer 
amendments to the bill to be considered and vote them up or down.
  Unfortunately, they have restricted debate on the bill and have 
refused to allow any amendments to be offered, debated or considered. 
It is--take it or leave it as is with little debate and no amendments--
no room to compromise.
  I will vote no on the closed rule prohibiting amendments and 
restricting debate, and I will vote to recommit the bill so that we can 
come back to the floor with a bill that fully addresses all issues 
putting everything on the table for consideration and adoption.
  I urge my colleagues to join me.
  Mrs. CHRISTENSEN. Mr. Speaker, the House today considered a rule 
providing for the consideration of three bills that are intended to 
solve our nation's insurance crisis which has reached epidemic 
proportions. Today, an estimated 43 million in the United States have 
no health insurance. About 60 percent of those, approximately 24 
million, are employed by a small business or are a member of a family 
whose income derives in some way from a small business. The 
skyrocketing prices of malpractice liability is driving insurance 
premiums up and making it impossible for employers of 500 or less 
individuals to afford the high cost of health care.
  The bills being debated today while seeking to address these issues 
does so unfortunately, by providing the wrong solutions. Today, the 
House will once again bring up a bill to create Associated Health Plans 
(AHP). Providing a permanent solution to the uninsured is critical to 
our nation's economy because Small Businesses, the engine of our 
nation's economic growth because they create about 75 percent of new 
jobs in America, deserve a sound and permanent solution to the 
affordable health care.
  Mr. Speaker I oppose the rule that will control the disposition of 
these bills primarily because it does not provide for Democrats to 
include their measures in solving the issue of the uninsured. The 
proposed rule only makes in order a substitute amendment and not an 
amendment to the underlying bill. Stacking the deck against the 
Democratic efforts to ensure that the legislation has a sense of 
balance and accurate in addressing the need of the American people.
  Additionally, Mr. Speaker, I must also express my displeasure with 
the majority's efforts to address the current malpractice crisis. As a 
former family doctor I am fully aware of the feeling many doctors have 
about being forced out of practice by very high insurance premiums. The 
Republican bill, H.R. 4280 does not address the problem, however.
  According to the Institute of Medicine, ``At least 44,000 and perhaps 
as many as 98,000 Americans die in hospitals each year as a result of 
medical errors. Deaths due to preventable adverse events exceed the 
deaths attributable to motor vehicle accidents (43,458), breast cancer 
(42,297) or AIDS (16,516).'' The IOM estimates annual costs to the 
economy of medical errors between $17 billion and $29 billion. Congress 
would better serve the public with legislation that promotes patient 
safety, rather than overriding state-law deterrents that help prevent 
patient deaths and injuries.
  Instead of reducing the costs of medical malpractice and defective 
products, the majority's approach would shift costs onto injured 
individuals, their families, voluntary organizations and taxpayers. Not 
only are the provisions unfair to victims, they also sacrifice the 
principles of market economics and private property long professed by 
the bill's conservative advocates.
  Furthermore, punitive damages are rarely awarded in medical 
malpractices cases, but the threat of punitive damages is important to 
deterring reckless disregard for patient safety by HMOs, nursing homes, 
and drug and medical device manufacturers. The $250,000 cap on non-
economic damages awards are for

[[Page 9244]]

non-economic loss (pain and suffering resulting from injuries such as 
lost child-bearing ability, disfigurement, and paralysis) compensate 
for the human suffering caused by medical negligence and defective 
medical products.
  These damages generally account for 35 to 40 percent of a jury's 
award. Typically, such damages exceed $250,000 only in cases of NAIC 
Level 6 injury severity or higher--that is cases involving permanent 
significant injuries. Thus, the cap will not affect patients with minor 
injuries; instead, it targets only victims of injuries such as 
deafness, blindness, loss of limb or organ, paraplegia, or severe brain 
damage. Since the cap makes no allowance for inflation, its arbitrary 
limits become more unjust as each day passes.
  I implore my colleagues to reject this rule and H.R. 4280 and support 
the Conyers-Dingle substitute. The Democratic substitute does not 
restrict the rights of injured patients who file meritorious claims. It 
requires certification, with civil penalties, that a pleading is not 
frivolous, factually inaccurate or designed to harass. It includes a 3-
year statute of limitation; establishes an alternative dispute 
resolution process; limits suits for punitive damages; and applies 50% 
of awards from any punitive damages to a patient safety fund at HHS. 
Finally, it requires insurance companies to develop a plan to give 50% 
of their savings to reductions in medical malpractice rates for 
doctors.
  The Democratic substitute also addresses the causes of rising medical 
malpractice insurance rates by creating a new commission to evaluate 
the causes of the malpractice premium crisis and recommend solutions, 
including a medical reinsurance program, risk distribution among health 
providers and other changes that might avoid such increases in the 
future.
  Because experience has shown that capping damages will not lower 
malpractice insurance rates for doctors, the Democratic substitute 
promotes competition in the marketplace so doctors can get lower 
insurance rates. The five states with the highest malpractice insurance 
premiums in the country in 2002 already had damage caps. Only insurance 
reform will help bring down rates. The Democratic substitute 
specifically requires the newly created commission to study various 
insurance reform proposals, particularly repealing the medical 
malpractice insurance exemption under the McCarran-Ferguson Act (which 
would foster competition).
  Mr. Speaker, we need a real malpractice relief, I urge my colleagues 
to put partisan gamesmanship aside and pass health legislation that our 
nation is so badly in need of.
  The material previously referred to by Ms. Slaughter is as follows:

Previous Question for H. Res. 638 Rule for H.R. 4279, H.R. 4280, & H.R. 
                                  4281

       Strike section 4 and insert the following:
       ``Sec. 4. That upon the adoption of this resolution it 
     shall be in order without intervention of any point of order 
     to consider a bill consisting of the text of H.R. 2427, to 
     authorize the Secretary of Health and Human Services to 
     promulgate regulations for the reimportation of prescription 
     drugs, and for other purposes, as passed by the House. The 
     bill shall be considered as read for amendment. The previous 
     question shall be considered as ordered on the bill and on 
     any amendment thereto to final passage without intervening 
     motion except: (1) one hour of debate on the bill equally 
     divided and controlled by the chairman and ranking minority 
     member of the Committee on Energy and Commerce; (2) an 
     amendment in the nature of a substitute if offered by 
     Representative Dingell of Michigan or his designee, which 
     shall be in order without intervention of any point of order, 
     shall be considered as read, and shall be separately 
     debatable for one hour equally divided and controlled by the 
     proponent and an opponent; and (3) one motion to recommit 
     with or without instructions.
       ``Sec. 5. That upon the adoption of this resolution it 
     shall be in order to consider in the House the bill (H.R. 
     3672) to amend part D of title XVIII of the Social Security 
     Act, as added by the Medicare Prescription Drug, Improvement, 
     and Modernization Act of 2003, to provide for negotiation of 
     fair prices for Medicare prescription drugs. The bill shall 
     be considered as read for amendment. The previous question 
     shall be considered as ordered on the bill and on any 
     amendment thereto to final passage without intervening motion 
     except: (1) one hour of debate on the bill equally divided 
     and controlled by the chairman and ranking minority member of 
     the Committee on Energy and Commerce; (2) an amendment in the 
     nature of a substitute if offered by Representative Dingell 
     of Michigan or his designee, which shall be in order without 
     intervention of any point of order, shall be considered as 
     read, and shall be separately debatable for one hour equally 
     divided and controlled by the proponent and an opponent; and 
     (3) one motion to recommit with or without instructions.
       Sec. 6.(a) In the engrossment of H.R. 4279, the Clerk 
     shall--
       1. await the disposition of all the bills contemplated in 
     sections 2-5;
       2. add the respective texts of all the bills contemplated 
     in sections 2-5, as passed by the House, as new matter at the 
     end of H.R. 4279;
       (3) conform the title of H.R. 4279 to reflect the addition 
     to the engrossment of the text of all the bill contemplated 
     in sections 2-5 that have passed the House;
       (4) assign appropriate designations to provisions within 
     the engrossment; and
       (5) conform provisions for short title within the 
     engrossment.
       (b) Upon the addition of the text of the bills contemplated 
     in sections 2-5 that have passed the House to the engrossment 
     of H.R. 4279, such bills shall be laid on the table.
       (c) If H.R. 4279 is disposed of without reaching the stage 
     of engrossment as contemplated in subsection (a), the bill 
     contemplated in section 2-5 that first passes the House shall 
     be treated in the manner specified for H.R. 4279 in 
     subsections (a) and (b), and all other bills contemplated in 
     sections 2-5 that have passed the House shall be laid on the 
     table.

  Ms. PRYCE of Ohio. Mr. Speaker, I yield back the balance of my time, 
and I move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. SLAUGHTER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.
  The point of no quorum is considered withdrawn.

                          ____________________