The Congressional Record is a unique source of public documentation. It started in 1873, documenting nearly all the major and minor policies being discussed and debated.
“PATIENT PROTECTION ACT OF 1998” mentioning the U.S. Dept of Labor was published in the House of Representatives section on pages H6395-H6417 on July 24, 1998.
The publication is reproduced in full below:
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PATIENT PROTECTION ACT OF 1998
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from Ohio (Mr. LaTourette).
(Mr. LaTOURETTE asked and was given permission to revise and extend his remarks.)
Mr. LaTOURETTE. Mr. Speaker, I want to thank the dean of the House the gentleman from Michigan (Mr. Dingell) and my classmate the gentleman from Iowa (Mr. Ganske) for the opportunity to address my support for the Patient Bill of Rights. I also want to thank the gentleman from Illinois (Mr. Hastert) for doing what he thinks is the right thing.
Obviously there is a slight concern when you endorse a proposal that is labeled the Democratic bill when you are a Republican and vice versa. While I am saddened that this issue has a partisan spin to it, today I am driven to support the initiative that I believe gives the greatest protection and possibility of care for the people that I represent. That bill is Ganske-Dingell.
I want to direct my remarks to the liability provisions, however, relating to employer-provided health care plans. Being a lawyer, I like that profession as well as any other, but I am sensitive to the concerns of small business owners, many of whom administer their own plans, about the liability problem. Some of the calls our office has received have been driven from K Street, but many others have come from business owners who are operating on small margins and who want to do the right thing by their employees.
Last night, therefore, I read and I reread page 66 of the Ganske bill concerning liability, and it only reinforced my belief that employers have been needlessly frightened, similar, I am sad to say, to the shameful way seniors were frightened during the Medicare debates.
The only time that an employer is exposed to liability is when the employer makes discretionary medical decisions. Not a doctor, not a hospital, not a nurse, not an HMO. I cannot even think of one situation where an employer would want to make a medical decision, good, bad or otherwise.
Nevertheless, I would ask the sponsors of the bill to tighten the language of the employers' exception in conference. The one thing that I do know about my profession is that they have a unique ability to take words that seem to say one thing and then get a judge somewhere, usually an appointed one, to interpret them in another.
I urge passage of the substitute and would ask both parties to work diligently in conference to create a product that represents the best of both bills. I would ask that we not be about the business of creating campaign commercials here on the floor today but we be about the business of helping Americans of all ages receive the care that they need.
Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentleman from Arkansas (Mr. Dickey).
Mr. DICKEY. Mr. Speaker, I come here as a former small business owner and as a lawyer. When I first looked at this situation, I looked at it from the doctor's standpoint and I saw a tremendous need, dire circumstances that doctors are facing, even to the extent that we were going to lose doctors presently existing and applicants were not going to apply. And I rushed in with my philosophical approach to this and said, ``We've got to help the doctors at all costs.'' What I found out was that ``at all costs'' meant the cure was going to be worse than the disease, that the small business owners were going to be killed by being put into courtrooms without any type of protection and in greater numbers.
So what I wanted to do was to try to look at the patients and say we need to get them in the treatment room and not in the courtroom. I have looked carefully at this and I can see that the Hastert bill is a perfect solution for this, or maybe not perfect but it is a perfect start. It is something we need to look at. If we do not do this, we are going to have patients who will not have choices because they won't have doctors, and that is serious.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Mrs. Capps).
(Mrs. Capps asked and was given permission to revise and extend her remarks.)
Mrs. CAPPS. Mr. Speaker, on behalf of the patients of the central coast of California and all across America, I rise to say that enough is enough. I have been an elected official for only four months but I have been a nurse for over 30 years. As a nurse I know firsthand the importance of accessible, quality, patient-centered care.
We must pass a bill which is more than a band-aid, which will ensure patients' rights and consumer protection against the abuses of HMOs. For common sense, comprehensive managed care reform, we must guarantee that critical decisions will remain in the hands of doctors and nurses, not insurance companies. We must guarantee access to specialists, so that people can really choose their own doctors. We must guarantee an end to financial incentives to limit medical care. We must guarantee emergency room care so people are not turned away from the hospital door. We must guarantee tough enforcement to hold insurance company bureaucrats responsible for their cost-cutting actions.
The American people deserve a bill with these guarantees, not a Republican bill, not a Democrat bill but a people's bill. The Ganske-
Dingell proposal protects patients with the force of law. This bipartisan bill will allow people to choose their own doctor, end oppressive gag rules so patients can have access to all critical treatment options, and perhaps most importantly give patients legal recourse when insurance companies deny important medical coverage.
Basic patients' rights can mean the difference between life and death. If patients can sue their doctors for poor care, they should be able to sue the insurance bureaucrats who pull the strings and are behind these cost-cutting decisions.
As one of three nurses in Congress, it is my duty to speak out. The leadership bill has huge loopholes which do nothing to prohibit HMOs from denying care. Our health care system needs serious medicine, not a political placebo.
Mr. Speaker, we still have time to act. With 32 days left in Congress, if we do nothing else, we must guarantee real patients' rights for the American people. Let us pass comprehensive, bipartisan managed care reform today.
Mr. HASTERT. Mr. Speaker, I yield 3 minutes to the gentleman from Georgia (Mr. Norwood) who worked on the task force and certainly was the creator of a lot of the thoughtful positions that are included in our plan.
Mr. NORWOOD. Mr. Speaker, it seems to me that it has been years in my life till we get to this day. I have wanted this to happen a long time. I am saddened deeply by what I hear and see happening in this room today. I had hoped that all of us would recognize the importance of protecting human beings' lives, the importance of correcting the malfunctioned ERISA laws of 1974 and could come together and actually offer good patient protections that the people of this country so deserve. But I hear over and over again demagoguery, politicization, misrepresentation, total untruths, just simply getting it wrong and not telling it right, and I am saddened by that.
The Dingell-Ganske bill has good patient protections in it. I do not question that. I know that it does. It is imperfect, however. The Republican bill has excellent patient protections in it, though it, too, is also imperfect.
I want to speak to my friend from Texas who says, oh, all of a sudden the Democrats have realized we need to protect patients. We bring this up today because we are Democrats.
I would remind my friend from Texas that you are the same group that tried to put everybody in the country in managed care 4 years ago, with no thought to any particular patient protections. I have for at least two terms of Congress as a Republican tried to protect patients, and I am delighted that you have joined with us at this late date.
Mr. Speaker, I have spent the last year and a half calling for support to end the ERISA preemption of State medical malpractice law. I pled with the President to add ERISA liability to his advisory committee report in November 1997. He did not. I requested that the President call for ERISA liability reform in his State of the Union address in January of 1998. He did not. I argued day after day with the Republican Working Group to add ERISA liability reform to this bill. They would not. There is a reason for that. It is a big enough reason that we can end up this year with no law, no patient protections over this subject. As much as I am for it, I am for a law this year that will get as many patient protections as we possibly can meet. The task force met me more than halfway with a new proposal that I frankly like very much. It is about liability and it is about suing an HMO. If I could only have one of the two liability provisions, I believe today that I would take our own. I ask you to stop this politicization of this bill and let us work together and pass patient protections.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished gentlewoman from Colorado (Ms. DeGette).
Ms. DeGETTE. Mr. Speaker, I rise today in strong support of the Ganske-Dingell Patients' Bill of Rights, and in equally strong opposition to the Hastert bill. Nothing in the Republican bill would have protected the rights of young Brice Randa from Colorado. Here is a picture of the Randa family, Allen and Jodi with their children Taylor on the left and Brice on the right. Brice died just two months after this picture was taken.
Brice was diagnosed with Lissencephaly, a terrible disease that made Brice's short life limited to breathing tubes, stomach wraps and motor seizures, a disease which eventually killed him. Although it was inevitable, Brice's death is heartbreaking for more than one reason. The tragedy lies in the fact that this family spent the few precious months they had with their son negotiating with the HMOs instead of taking care of their precious little boy. The 16 months the Randas had with Brice were consumed with lawyers filing paperwork and appealing decisions made by their HMO.
The Randas' doctor wrote the HMO begging, ``The family is overwhelmed. We petition for 4 hours per day extra assistance,'' and the HMO denied this.
Under the Republican bill, a health plan can define medical necessity any way it wants, giving families like the Randas no protection from insurance company bureaucrats deciding what medical care is appropriate. Moreover, under the GOP's rules, if the Randas did want an external review of the decision denying the 4 hours a day of care for Brice, they would have to pony up $100 from their pocket just to have the case heard by somebody who would have to follow guidelines set by the very HMO that denied the care in the first place. And if Brice had needed emergency care, the HMO would have had 72 hours to consider an appeal of an emergency care decision. Frankly, this GOP scheme is worse than the status quo. It stabs at the heart of what the debate over HMO reform is really about. On the other hand, the Ganske-Dingell bill ensures that the medical profession will define medically necessary care.
Vote for our alternative. Vote ``no'' on the Hastert bill.
Mr. HASTERT. Mr. Speaker, I yield myself 10 seconds. I just want to remind the gentlewoman from Colorado that if it is emergency care, our patients are in the emergency room immediately, not 72 hours. She is wrong and she misrepresented the facts.
Mr. Speaker, I yield 1 minute to the gentleman from Arizona (Mr. Hayworth).
Mr. HAYWORTH. I thank my colleague from Illinois and I thank the gentlewoman from Colorado, because she unintentionally demonstrates why we should oppose the Dingell bill and support the reasonable, rational, compassionate Patient Protection Act.
You see, Mr. Speaker, we are faced with a choice today. Do we support a true patient bill of rights, or do we support a lawyer's right to bill? I rise with colleagues from both sides of the aisle who say they do not want decisions made by bureaucrats, whether they are Washington bureaucrats or insurance company bureaucrats. Health care decisions should be made by physicians and health care professionals consulting with their patients. That is the element that we preserve, uphold and amplify in the Patient Protection Act. Sadly, endless litigation and lawsuit after lawsuit is provided for in the Dingell substitute. That is what we have to remember; true compassion, not courtroom drama.
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Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Wisconsin (Mr. Kleczka).
Mr. KLECZKA. Mr. Speaker, I rise today in opposition to H.R. 2450, what the Republicans have called the Patient Protection Act, but is better termed the Republican Patient Election Year Posturing Act.
H.R. 4250 is full of hollow promises and empty protections. Republicans call this a managed care reform bill, but in reality it is far from it.
For starters, the Election Year Posturing Act does little to address the serious problems of our current health delivery system and does a lot to maintain the status quo.
Let me detail what the Republican bill does not provide. It does not put medical decisions back in the hands of doctors and, instead, keeps it in the hands of insurance company accountants and their executives, people who we call the bean counters.
It does not give patients access to specialty care where they need it. We heard from our Republican colleague the gentleman from Florida
(Mr. Weldon), a doctor, previously indicating he was on a talk show, and a woman indicated she was in the same Federal health plan as all of us. He asked, ``why did you not choose a different one to get the doctor of your choice?'' She said to him, and hopefully I am quoting this right, she could not afford it.
So the bottom line is we cannot afford it. We get substandard care. I think that is wrong on the part of the Republicans. It does not give patients access to specialty care. It does not provide women undergoing a mastectomy from being pushed out of the hospitals just hours after surgery and does not require insurers to cover reconstruction surgery after mastectomy. It does not allow a woman to choose a gynecologist or other specialist as a primary care doctor.
Let me also indicate that we heard from a trial attorney Republican supporting the Republican bill. He indicated that if one is misdiagnosed and does not get subsequent needed treatment, we are going to give them $500 a day. Oh, well, we will give you $1,000 a day.
But if that is one's mother, and that misdiagnosis or lack of coverage and treatment, like a bone marrow transplant, or needed chemotherapy, is denied, it might be to the insurance company's advantage to give them the $1,000 a day versus having the right to sue the provider and the health care bean counter.
Mr. Speaker, I ask the Members to support the Dingell-Ganske bill.
Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentleman from South Carolina (Mr. Graham).
Mr. GRAHAM. Mr. Speaker, I thank the gentleman for yielding to me.
For any lawyer out there, listen up close. The $500 a day is to ensure prompt payment. The bill ensures treatment. That is the whole point of this bill. If one has a medically urgent situation, one can go to court within minutes of being said no to and get a temporary restraining order ordering the treatment to be given.
Also, the physician and hospital can provide one the treatment and subrogate to one's interest and have an external review of the HMO decision within 6 days. That is when the $500 per day kicks in, to get them to pay.
During the initial waiting period, one is getting the treatment. That is the point. The $500 a day is to ensure payment. Under our bill, one gets treatment from day one, from minute one, because one has avenues to compel them to treat them.
But what about the $500 claim? As a lawyer, one comes in to my office with a $500 claim, no matter how meritorious it is, I am going to say that is very nice, but I have got to make a living and feed my family. I cannot chase $500.
Under the Democratic bill, if we have a small claim, we are not entitled to external review until the significant threshold is passed. Under the Republican bill, if they nickel and dime us for $100, $200,
$500, and that is what happens every day. They nickel and dime us out there. We allow people to go to external appeal no matter how small the claim is if they put up from $25 to $100. The filing fee in South Carolina for tort actions is $35.
So they get an external appeals process and a small claim, then the
$500 a day kicks in plus attorneys' fees, plus the benefit. I will take the case then, because I can get paid, and there is a $500 clock running for the small claims.
So HMOs will not nickel and dime people. That is where the abuse is at. And my colleagues do nothing about that. This really makes them honest. We get the treatment up front. The penalties are significant. We get people what they need, which is health care, not a jury award 4 years later when they are dead.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from Connecticut (Ms. DeLauro).
Ms. DeLAURO. Mr. Speaker, I rise in support of the Ganske-Dingell bill and in opposition of the Republican bill.
For the last 2 years, I have been working on legislation to end the practice of drive-through mastectomies. The bill simply ensures that breast cancer patients are allowed 48 hours in the hospital to recover from this physically and emotionally devastating surgery. It does not seem like much to ask, and yet the Republican leadership has refused to schedule hearings on this important legislation.
The Democratic Patients' Bill of Rights ends the practice of drive-
through mastectomies. The House Republican leadership bill ignores this problem. What is worse, their legislation will actually strip away existing State protections.
My State of Connecticut has led the fight to end outpatient mastectomies. The Connecticut legislature has already acted to outlaw this outrageous practice. But the Republican bill would repeal those hard-fought patient protections.
The Republican bill will not put medical decisions back in the hands of doctors and patients. It makes current problems worse. It eliminates consumer safeguards. In the case of breast cancer patients, this bill is a slap in the face.
Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentleman from Nevada (Mr. Ensign).
(Mr. ENSIGN asked and was given permission to revise and extend his remarks.)
Mr. ENSIGN. Mr. Speaker, I rise in support of the Republican bill today for several reasons. First of all, we have to listen to the other side. These are the people who are now saying that they want the doctors to choose their health care and the type of choices in those health care plans. But these are the same people who 4 years ago or 5 years ago were saying, ``Do you know what? We want everybody to be in nationalized health care, and we want bureaucrats to make those decisions.'' Look beneath the surface.
The Republican plan contains medical malpractice and medical savings accounts, two things that I strongly support. In the final bill, they probably will not be able to be included because the President has said he would veto the bill over those two provisions, unfortunately, because they would help bring costs down. But we could still have good patient protections in this bill if it is enacted even if we have to drop those provisions.
In the State of Nevada, we got together, Republicans and Democrats alike, and enacted patient protections similar to what are in the Patients' Bill of Rights that we have on the floor today. This was authored, by the way, by a Nevada Democrat State legislator. We ought to do the same thing here. Put common sense together; put party politics aside.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from Connecticut (Mrs. Kennelly).
Mrs. KENNELLY of Connecticut. Mr. Speaker, the 161 million Americans in managed care today deserve to know that their health care comes first.
For 18 years, I have represented Hartford, Connecticut, the insurance capital of the world. So I know how managed care came into being. Health insurance premiums were rising at double-digit rates, 17 percent in 1988, 21 percent the following year, 17 percent again in 1990.
The industry responded to rein in the costs, and it worked. But it so often happens in reform, once a balance is reached, some people do not know when to stop. So now profits became the prize.
Yes, we have stable prices, but they have come at a terrible cost. That is what we are addressing today, the cost of our confidence that we will get the health care that we need, that we deserve, and that we pay for.
Specialist treatment, continuity of care, emergency room treatments are not options. They are not frills, as some managed care companies seem to believe. When patients are denied adequate care by arbitrary decision-makers, they must have recourse.
Mr. Speaker, we must put patients first again in this bill. H.R. 3605 offers real relief at modest cost, and I urge my colleagues to do this today.
Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentlewoman from Kentucky (Mrs. Northup).
Mrs. NORTHUP. Mr. Speaker, we all know that, in this fast-emerging change in health care that there have been abuses by HMOs, and we are proud to be here today to deal with those and to address those and make sure that there is the important level of care that every American deserves. We are going to deal with that today.
But we should not let this be an excuse for huge new Federal controls of the delivery of health care. That is what people that believe in a big bureaucracy dealing with health care support. We should not also make this an excuse to give the trial attorneys a huge new cut of our medical premiums. Medical money needs to go to medical care and not to trial attorneys.
I am proud that I am not on the trial attorneys' side and not on their team. It is no wonder that the team that is on their side is supporting this substitute here today.
The SPEAKER pro tempore (Mr. Foley). The gentleman from Michigan (Mr. Dingell) has 16\1/2\ minutes remaining. The gentleman from Illinois
(Mr. Hastert) has 17\3/4\ minutes remaining.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Rhode Island (Mr. Kennedy).
Mr. KENNEDY of Rhode Island. Mr. Speaker, today I stand on behalf of Kathryn Carberry in my State of Rhode Island. She was released too quickly from the hospital because her insurance company denied her treatment for a breast operation that she had and continued treatment for that.
I also stand on behalf of Deborah Kushner's little boy who was nearly killed because her HMO denied treatment in an emergency room.
The Republican leadership have refused any committee debate with full and free testimony because they are afraid of these stories. Now they come up with a bill that is a product of the HMO industry itself.
We have waited for managed care reform, so why should we settle for the HMO's own plan. This bill leaves out so many crucial provisions, it is almost laughable. Where is the provision against drive-through mastectomies that could have saved Ms. Carberry's life. It is not in there. Where is the prudent layperson for Mrs. Kushner's son? It is not in there. Where is the provision to hold accountable these HMOs? It is not in there.
Every other product in this country can be held liable but managed care organizations. It is time we put a stop to managed care organizations who are practicing medicine without a medical license.
Mr. HASTERT. Mr. Speaker, I yield myself 5 seconds. I would just like to recommend to the gentleman from Rhode Island that he read the right bill.
Mr. Speaker, I yield 1 minute to the gentleman from North Carolina
(Mr. Ballenger).
Mr. BALLENGER. Mr. Speaker, I support the Patient Protection Act. While the bill is not perfect, it is an important step in ensuring access to health care insurance for many people who are currently without it.
As a small business officer of a company which self-insures its 200 employees, the unlimited liability of the Dingell bill is frightening. We insure all of our employees currently, but if big government Dingell bill were to become law, we would be forced to give our employees the money and let them buy their own insurance at, obviously, a higher cost. Many businesses would have to do the same.
The Dingell bill encourages patients to sue after a denial of coverage occurs rather than bringing a quick appeals process that would help the patient get coverage for care in a timely fashion.
Also, the Congressional Budget Office has estimated that the Dingell bill will increase the cost of health care and not make it more affordable. On behalf of the American people who need affordable care, oppose this substitute.
In the United States today, there are more than 42 million Americans without health insurance--many of whom are employed, or have a family member employed, by a small business that cannot afford to offer health care coverage for its employees.
The Patient Protection Act addresses the lack of coverage of these individuals in several ways, including the creation of association health plans which will be governed by uniform standards. These plans would allow small businesses, trade associations, labor unions and professional associations to pool together to obtain the same economies of scale, purchasing clout and administrative efficiencies, that employees of large employers benefit from. Association health plans will have the freedom and flexibility to design more affordable benefit options. This will allow small businesses to offer their workers access to the same benefit choices regardless of where they live. At the same time, these plans must meet strict new solvency standards to protect patients' interests and ensure that their benefits are paid.
I want to mention just very briefly that I appreciate that authors of this bill attempt to deal with the issue of confidentiality of medical information. It's a complicated issue, and one that has to be dealt with carefully. I do have some concerns with what is in the bill, in terms of its potential risk to employers and the lack of clarity, particularly with regard to two areas in my committee's jurisdiction, workers compensation and occupational safety and health. I hope that these are issues that we can address during the conference to ensure that the medical confidentiality provisions work well, and do not inadvertently create problems in these areas.
Accessible, affordable, quality health care is very important to all Americans. I have been contacted by many constituents who are demanding that we act in their interest. So, with their letters and concerns in mind, I support this important piece of legislation and urge my colleagues to do the same.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Texas (Mr. Green).
(Mr. GREEN asked and was given permission to revise and extend his remarks.)
Mr. GREEN. Mr. Speaker, for many months, a lot of Members have been working for this debate today. What is frustrating is the debate we have now.
I rise in support of the Dingell-Ganske amendment. But instead of a real debate and a committee process we have, the Republican leadership is forcing this weak fig leaf bill through which will do little to give the American people what they really need for their health insurance.
In fact, it will hurt State laws now in effect. In my home State of Texas, this Republican bill would override State law on mammogram screening, Alzheimer's treatment, and prostate cancer screening, and many more.
On page 187 of their bill, because some of us had a chance to skim their bill that was released last night, line 19 exempts these State protections. So maybe they ought to read their bill before they defend it.
I think it is ironic they talk about this being a trial lawyer bill, Mr. Speaker, and I ask unanimous consent to place in the Record a letter from the American Medical Association, who typically does not support the trial lawyers. It was sent to me yesterday, talking about the reasons that the Republican bill is so bad and the Dingell-Ganske amendment is so good.
The letter referred to is as follows:
American Medical Association,
Chicago, IL, July 23, 1998.Hon. Gene Green,House of Representatives, Rayburn House Office Building,
Washington, DC.
Dear Congressman Green: The American Medical Association
(AMA) recognizes that changes may be offered to H.R. 4250, the House Republican
``Patient Protection Act of 1998,'' when it is brought to the House floor, to begin to address some of the serious concerns with the legislation as introduced. We urge Members of Congress to take the time to fully explore whether any such amendments correct the problems outlined below. As you may know the AMA has carefully reviewed and lent its full support to H.R. 3605, the ``Patients' Bill of Rights Act of 1998.'' We believe that H.R. 3605 provides comprehensive and meaningful patient protections that should be enacted before Congress adjourns this fall.
On behalf of the 300,000 physician members of the AMA and the millions of patients we serve, we strongly urge you to oppose H.R. 4250, as introduced, and to vote in favor of the Ganske-Dingell substitute (text of H.R. 3605). In our view, only H.R. 3605 would provide meaningful patient protections to address existing abuses in managed health care.
There are ten reasons to vote against H.R. 4250 and to vote for H.R. 3605.
Reason #10: ``The Devil is in the Details''--Here are the facts.
H.R. 4250 claims to offer ``similar'' protections to those extended in H.R. 3605, but the legislative language of H.R. 4250, at nearly every turn, clearly favors health plans and insurance companies at the expense of patients. These problems are much more than just ``technical drafting matters.'' In fact, Members of Congress have not had time to fully understand critical differences in the two bills since last Friday's introduction of the House Republican bill. By contrast, H.R. 3605 was drafted and introduced earlier this year, with ample time for public examination; its provisions ensure that patients would receive medically necessary covered services. H.R. 4250 would continue to allow insurance companies and health plans to put their financial bottom-line ahead of patient care.
Reason #9: H.R. 4250 would allow health insurance companies to decide what is medically necessary; H.R. 3605 would restore physician medical decision-making.
By retaining the power to define what is and what is not medically necessary, under H.R. 4250, health plans--not physicians--would continue to decide all patient health care decisions, Linda Peeno, MD, a former HMO medical director, described this retained control ``as a health plan's smart bomb capability'' in testimony before the House Commerce Committee. Consequently, the external appeals process proposed by H.R. 4250 would be of little or no value if the health plan were always allowed to define what is medically necessary or appropriate. By contrast, H.R. 3605, promotes good medical practice by specifically prohibiting health plans from practicing medicine by substituting their decisions for the patient-specific medical judgments of the treating physician.
Reason #8: The internal and external review process in H.R. 4250 does not require health plans to use physicians with the appropriate medical specialty training to review treatment denials. H.R. 3605 is clear that only ``clinical peers''--physicians with similar specialty training will review other physicians' medical decisions.
As an example, only cancer specialists should review cancer treatment. Reviewers must have the right specialty training to decide life and death issues. Only H.R. 3605 would provide this critical patient protection.
Reason #7: H.R. 4250 would require patients to pay for the privilege of an external review of treatment denial; H.R. 3605 imposes no such fees on patients seeking to exercise their rights.
Patients should not have to pay to have a treatment denial reviewed.
Reason #6: H.R. 4250 does not contain several key physician choice provisions that are included in H.R. 3605.
H.R. 4250 does not include a provision found in H.R. 3605 that would allow a patient in the midst of serious illness or pregnancy to continue a relationship with a physician who leaves or is forced to leave a health plan network. The House Republican bill also does not provide patients with critical ongoing access to specialists for chronic conditions (such as asthma, diabetes, etc). H.R. 4250 also does not require plans to disclose to prospective enrollees the adequacy of the physician network to serve a given patient population. H.R. 2605 provides both access to necessary specialty care and disclosure of the plan's physician mix to patients.
Reason #5: H. R. 4250 would provide a huge loophole for plans to circumvent the point of service provisions.
Under the terms of H.R. 4250, employers would not have to offer employees point of service coverage if they could prove that the plan's premiums would increase by 1%. The AMA has always said that patients may choose to bear reasonable additional costs to obtain a point of service option that would ensure greater choice of physicians. This opt-out provision of H.R. 4250 could effectively ``gut'' the concept of a point of service option for many plan participants.
Reason #4: H.R. 4250 would delay the effective date of patient protections for up to two years after the date of enactment. H.R. 3605 would provide for nearly immediate implementation of most patient protections.
The evidence is overwhelming that patients need and are demanding protections now. The delayed effective date in H.R. 4250 is an opportunity for more legislative mischief by health plans seeking passage of ``gutting'' amendments before patient protections are actually offered to patients. H.R. 3605 would generally extend all patient protections soon after enactment.
Reason #3: H.R. 4250 does not adequately protect the broadest possible range of ``medical communications,'' nor would it ensure all necessary emergency care. It even cuts back on the Balanced Budget Act's antigag clause/practices and prudent layperson provisions that cover Medicare patients.
On anti-gag practices, H.R. 4250 does not include the words
``otherwise restrict'' medical communications. The omission of these key words would allow health plans to continue to gag physicians. The ``prudent layperson'' provision for emergency services in H.R. 4250 does not include ``severe pain'' in the definition of what a reasonable person would think requires immediate treatment.
Reason #2: H.R. 4250 creates a new federal preemption of state patient protections laws for association health plans and would override many of the patient protections laws already enacted by some 43 states.
Association health plans would be exempt from state patient protection requirements. H.R. 4250 also lacks express language recognizing the authority of state legislators to regulate the health care delivery practices of such entities for state residents.
Reason #1: H.R. 4250 does not hold health plans properly accountable for making medical treatment decisions that result in patient injury or death.
The managed care liability issue is about basic fairness and holding health plans accountable for their conduct. No other industry in America enjoys the special legal protections currently extended to health plans. Members of Congress have spoken out against special legal protections for tobacco companies. Why should health plans continue to be given special liability protections? The AMA continues to lobby for tort reforms, but we have never advocated that patients should be denied adequate compensation for true medical negligence. The damages and penalties in H.R. 4250 fall far short of providing patients with proper compensation for preventable injuries and death.
Again, we urge you to vote for a House floor procedure rule that will allow a vote on H.R. 3605, and to vote for passage of H.R. 3605.
Respectfully,
E. Ratcliffe Anderson, Jr., MD.
{time} 1245
Parliamentary Inquiry
Mr. DINGELL. Mr. Speaker, I have a parliamentary inquiry.
The SPEAKER pro tempore (Mr. Foley). The gentleman will state it.
Mr. DINGELL. Mr. Speaker, who has the right to close debate on this bill?
The SPEAKER. As stated on page 567 of the House Rules and Manual, the Chair will assume that the manager of a measure is representing the committee of jurisdiction, even where the measure called up is unreported.
House Resolution 509 specifically named Mr. Hastert as the manager of this bill; Mr. Hastert called up the measure; and Mr. Hastert is a member of the committee having primary jurisdiction over the bill. As such, the gentleman from Illinois has the right to close.
Mr. HASTERT. Mr. Speaker, I yield three minutes to the gentleman from California (Mr. Thomas), Chairman of the Subcommittee on Health Care of the Committee on Ways and Means.
(Mr. THOMAS asked and was given permission to revise and extend his remarks.)
Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding me time.
Mr. Speaker, one of the things we have to make sure we do not do is revise history. I think it might be useful just to remember where the prudent layperson language in the Republican provision and in the Democrat provision came from. It came from the changes that were made in the Medicare program.
I think when you examine the gag rule provision, it is in the Democratic bill, it is in the Republican bill, it came from the Medicare revisions. If you recall, I said, prior to the election, the Democrats were accusing the Republicans of trying to destroy Medicare. After the election we sat down and put together a prudent package to preserve and protect Medicare. We included a number of provisions that were applicable only to Medicare because it was a bill dealing with Medicare. That was in 1997.
We then began in the Subcommittee on Health a series of hearings about the problems that were out in the current marketplace because of the distortion of the rapid movement to managed care. We began examining the Medicare changes to find what we could include in the package.
You have heard repeatedly that somehow the Republican plan was thrown together in a couple of days. That is pre-election rhetoric. It simply is not the truth.
We include significant patient protections; they include some patient protections.
We include the opportunity to get health care, make it more affordable, make it more accessible. Do not believe me, believe the Congressional Budget Office. They looked at their bill. They evaluated it. They priced it out. They said if the Democrat's bill were law, premiums would cost more. Health care costs would go up.
The Congressional Budget Office looked at our bill, they examined it, they priced it. The nonpartisan fiscal analyst said if the Republican bill became law, health care costs, premiums, would go down.
In addition to that, a provision that they had said is a poison pill, it would kill the bill, the medical malpractice provision that is in the Republican bill, it is not in the Democratic bill, that that measure alone, reforming medical malpractice, would save, directly save the Federal Government and the Medicare and Medicaid program, $1.5 billion a year over a 10 year period; $1.5 billion.
Where is that money going to come from? It is going to come from money that does not go to trial lawyers. Why do they call it a poison pill? Frankly, given the way their bill is structured, it is the trial lawyers who are going to be the main beneficiaries of those premiums going up. CBO says their plan increases premiums. CBO says our plan reduces premiums.
Yes, it is important to address the changes in the health care market today about patient protections. It is also important to make sure that health care is affordable for more Americans. Our plan does it; their's does not.
Mr. DINGELL. Mr. Speaker, I yield one minute to the distinguished gentleman from Michigan (Mr. Levin).
(Mr. LEVIN asked and was given permission to revise and extend his remarks.)
Mr. LEVIN. Mr. Chairman, let me give you a real live example of the major differences between these two bills. Twenty-five years ago one of my constituents was diagnosed with multiple sclerosis. A battery of medications have been developed in recent years that can often slow the course this disease, but it is expensive. His doctor prescribed the medication, but then the HMO said, ``You need another opinion.''
The day after he went to that second doctor, he received a letter from the HMO stating no way would they pay for the drug. So my constituent called that second neurologist and he said he had not even spoken to the HMO.
Then the HMO said the reason my constituent was denied access to the drug was that he was at stage seven of MS, and there was no published research about the use of this drug on stage seven MS. So even though two doctors believed that he would benefit from the medication, they were overruled by the HMO.
Ganske-Dingell, the Patients' Bill of Rights Act, would help avoid situations like this. Vote for Ganske-Dingell.
Mr. HASTERT. Mr. Speaker, I yield three minutes to the gentlewoman from Connecticut (Mrs. Johnson) a member of the Subcommittee on Health of the Committee on Ways and Means, and distinguished for her work on health care for many, many years.
Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman from Illinois for yielding me time, who has done such an outstanding job in leading this task force and developing this bill.
This is indeed an historic day for the U.S. House of Representatives. We are going to pass legislation that forcefully protects patients' needs, puts physicians back in charge of medical decisions, holds insurance companies accountable for quality care and gives millions of uninsured Americans access to affordable health coverage. We have heard the many concerns of the American people and are acting to address them directly and realistically.
Key to the reforms in this bill is the strong internal and external appeals mechanism that guarantees physicians will control medical decisions. Both the internal and external appeals process, in both of those processes, the physician must review the decision. It is physician-controlled and physician-directed, both within the plan and in the independent external review process. This guarantees that physicians, not HMO bureaucrats, will control medical decisions.
Both the internal and external appeal decisions are governed by strict time frames within which decisions must be made. Patients will no longer be kept in limbo while bureaucrats delay. Rather, physicians will make timely decisions about lifesaving medical treatments. This will inject fairness and objectivity into our medical system.
Accountability is key to this legislation. I have worked with the bill's sponsors to insert an important provision that will force public accountability of the insurance companies on this very issue, because we will now report publicly the results of these appeals processes. In other words, if the plan denies a patient care and that decision is overturned on external appeal, people will know it. They can change plans. They will not buy that plan. The market will deliver a far more devastating verdict to that plan than the courts could over many years.
The external and internal appeals, because they are physician-
controlled, they are patient-oriented, will bring timely decisions and access to specialty care, in the right way, to the people without raising costs, but improving quality of care.
Coupled together, the provisions in this bill are what we need to restore fairness and quality to our health care system. This is a good bill that not only provides the consumer protections the American people have been looking for, but it expands access to all those that are too often ignored, the uninsured in America, and prevents an increase in costs that would merely drive people out of the system.
I urge support of this legislation.
Mr. DINGELL. Mr. Speaker, I yield one minute to the distinguished gentleman from Maryland (Mr. Cardin).
Mr. CARDIN. Mr. Speaker, let me thank my friend from Michigan for yielding me this time and congratulate him on his leadership.
Mr. Speaker, we have a clear choice. If you want to provide protection for your constituents for full access to emergency care with symptoms with severe pain; if you want to provide your constituents with a choice of doctors within their HMOs, access to specialists like cancer specialists, women adequate care for mastectomies and the right for reconstructive surgery, that will provide continuing care if the HMO drops a doctor so you can continue to see that doctor until you get to a new doctor; if you want to provide your constituents with clinical trials and experimental treatment which may be the only way to save their life; if you want them to have the latest drugs that your doctor thinks are needed; if you want to make sure that an HMO has enough doctors and locations so your constituents can get to see the doctor; if you want to provide all these protections to your constituents, then you must vote for the Ganske-Dingell substitute, because the Republican bill does not provide those protections to your constituents and does not provide for adequate enforcement.
The choice is clear. I urge my colleagues to support the amendment.
Mr. HASTERT. Mr. Speaker, I would inquire as to the remaining time.
The SPEAKER pro tempore (Mr. Foley). The gentleman from Illinois (Mr. Hastert) has 10\3/4\ minutes remaining and the gentleman from Michigan
(Mr. Dingell) has 12\1/2\ minutes remaining.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from California (Mr. Waxman).
Mr. WAXMAN. Mr. Speaker, today this House has a very basic decision to make: Are we going to pass effective and enforceable legislation to ensure a patient bill of rights for people in this country? Are we going to agree to the Ganske-Dingell proposal which is going to give people the rights they need to deal with arbitrary and unfair treatment by big insurance companies and HMOs? Or are we going to rush through a Republican leadership bill that is designed to do just one thing, fool people into thinking that something is being done to help them just long enough to get through the next election? Because that is exactly the issue before us.
Are we going to pass legislation that requires HMOs to have an adequate number and variety of health care providers so that people can get the services they need and are paying for? The Ganske-Dingell bill does that. The Republican leadership bill does not.
Are we going to be sure that people can get to a specialist if they need one? Ganske-Dingell says yes. The Republican bill does not.
Are we going to let insurance companies make the decisions about what medical patients need? Ganske-Dingell says decisions belong to the patients and their doctors. The Republican bill does not. That is why the doctors support the Ganske-Dingell legislation.
Today this House has a very basic decision to make: are we going to pass effective and enforceable legislation to ensure a patient bill of rights for people in this country?
Are we going to agree to the Ganske-Dingell proposal which is going to give people the rights they need to deal with arbitrary and unfair treatment by big insurance companies and HMO's?
Or are we going to rush through a Republican leadership bill that is designed to do just one thing: fool people into thinking that something is being done to help them just long enough to get through the next election.
Because that is exactly the issue before us.
Are we going to pass legislation that requires HMO's to have an adequate number and variety of health care providers so that people can get the services they need--and are paying for? The Ganske-Dingell bill does that. The Republican leadership bill does not.
Are we going to be sure that people can get to a specialist if they need one? Ganske-Dingell says yes. The Republican bill does not.
Are we going to let insurance companies make the decisions about what medical care patients need? Ganske-Dingell says that decision belongs to the doctor and the patient. The Republican bill does not. It actually increases the power of insurance companies to decide what is medically necessary. Since when did insurance bureaucrats become qualified to be doctors?
Are we going to override the protections the States have enacted to assure people health benefits and give them some consumer protections? Ganske-Dingell builds on and strengthens them. The Republican leadership bill actually takes away the protections that are there.
And are we going to make sure that people have an effective way to enforce the rights we are giving them, or not? Ganske-Dingell says if you can't enforce it, you don't have it. The Republican leadership bill sneaks in language that makes sure the insurance companies decision about what is medically necessary is not going to be challenged.
We owe the American people legislation that works to protect their rights. We need to level the field between big insurance and their desire to profits, and patients who depend on their insurance and HMOs for their health care. We owe people a way to make sure they get the medical services they need from their HMO or any other health plan.
This debate should be about patients, not profits.
The Republican leadership bill is on this floor today only for one reason: after months of opposition and working hand in hand with big insurance to kill any patient bill of rights, they noticed the polls told them the American people were demanding action.
So Mr. Gingrich and his allies have responded with a cynical bill that is designed to look like it's doing something when it is not.
They've made sure that this bill didn't get looked at by the Committees or the public. They've made sure that we vote on this before anyone has a chance to know what it really does.
They claimed to have privacy protections--but actually they made it OK to sell medical records. When they were caught, they changed it.
They claimed to make sure emergency care would be covered if a prudent person would think it was necessary. But they actually weakened the protections we already have in law for Medicare beneficiaries. They said severe pain wouldn't be a reason to go. They said the HMO could make you foot most of the bill if you didn't go to their facility. In other words, they gutted the protections.
Well they got caught again, so they changed it.
How many things are in this bill that haven't been found yet? It's a cynical way to deal with people's lives and health care.
Does anyone believe that a Republican leadership that has urged insurance companies to spend money to defeat these bills is actually going to write a good one? Does anyone believe that after they've fought it every step of the way, they've suddenly seen the light?
Let's adopt the bill that works. Let's adopt the bill that has been endorsed by the doctors and the nurses and the patients. Let's adopt the Ganske-Dingell bill.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from New Jersey (Mr. Pascrell).
(Mr. PASCRELL asked and was given permission to revise and extend his remarks.)
Mr. PASCRELL. Mr. Speaker, a question was asked a few seconds about whose side are we on.
The average CEO from an HMO makes $6 million a year. It goes up to
$20 million a year. You are asking us whose side we are on?
A woman in my district recently summed up the problems with our current managed care system in a conversation with me. She asked if there was a way she could get into Medicare early because she thought she could receive better care under her Medicare than under her current health insurance program.
All across my State of New Jersey, patients are being denied their basic rights, and I think that is what this argument and debate is all about. New Jerseyans who benefit from some of the strongest patient protections in the country would lose under the original bill.
Benefits and services such as bone marrow transplants, diabetic supplies, mammogram and prostrate screenings and minimum maternity stays would all be in jeopardy for thousands of patients in our State. Let us do the right thing today.
Mr. HASTERT. Mr. Speaker, I yield 4\1/2\ minutes to the gentleman from Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Speaker, as we close down this debate and come toward the end of what, for me, has been a long time coming, I want you to know I am not only saddened by the debate but I am exhilarated by this debate also because it is with great pleasure I see each side of the aisle trying to outdo the other on patient protections, and Lord knows that has been a long time coming.
It is often asked of me why would a conservative Republican like myself, why would you be involved in something like this? Why would you want to deal with national standards? I think that is a reasonable question, and I think it is a fair question.
The answer is pretty clear. What I want to do is take health care out of the ERISA laws that should never have been put in the ERISA laws, that never was about health care but always about your pension plans, but we cannot do that.
{time} 1300
But we cannot do that. The other option is to do nothing, and we all know that is wrong, and the other option then is to set some national standards, and that is where I am, and that is where we are in this debate today.
We have today one of the reasons I might mention that I am involved in this is that we have today the best medical care, best trained physicians, best technology in the world, but it does no good to have any of that if we are denied our care. We all can agree, I believe, on that.
I have been in Congress 3\1/2\ years. There is a lot I do not know, but I will tell my colleagues one thing I do know something about. I know something about treating patients. I have been doing that all of my adult life. In fact, I have been doing that longer than any of my colleagues have been in Congress, except maybe the gentleman from Michigan (Mr. Dingell). Generally speaking, that is all I know, And I have in every sense since I have come to this town tried to say that there are serious problems out there that are occurring that we must address. Thank God we are. It is a contest of who is addressing them best, perhaps.
Mr. Speaker, I remember seeing patients back when there really was a doctor-patient relationship, back when there was a free market, before the 1973 HMO Act, before the 1974 ERISA Act. Things are not better today for patients. Maybe our skills are better, maybe our technology is better, but people have been denied the benefits that are in their plan. I thank my colleagues for joining with us, I thank them for joining with us to try to address that, and we are going in the end to address that, I believe, in a very correct manner.
One of the other reasons I have been so interested in this is that in 1994 I did not like Clinton care. Do my colleagues want to know why? Clinton care was a program to deny patients' choice of doctor and of hospital. It was a program that would deny them care and rationed care, and it was a program designed to use untrained and less trained people to take care of patients. Guess what? They won. That is exactly what we have today. The big difference is Mr. Clinton would have used Federal bureaucrats; today we use corporate bureaucrats. I promise my colleagues, a patient that has been denied care and their child has died does not care whether it was a corporate bureaucrat or whether it was a Federal bureaucrat.
Mr. Speaker, we have before us today, I say to my colleagues, two bills, and we are debating actively on who has done the best job. These bills are fighting to see who can protect patients most. I think that is wonderful.
Let me just simply close by saying that there are many things that are similar. There are many very good protections in the Republican bill, and I certainly do not oppose the liability part, except I am scared that it will kill the bill for this Congress and we will have no protections.
Vote against the motion to recommit, vote for this bill, and work with us to make it all better.
Mr. DINGELL. Mr. Speaker, I yield 30 seconds to the distinguished gentleman from New York (Mr. Schumer).
(Mr. SCHUMER asked and was given permission to revise and extend his remarks.)
Mr. SCHUMER. Mr. Speaker, I want to thank the gentleman for yielding me this time. I want to say that the American people are clamoring for real reform of HMOs. If we pretend to give them reform, if we offer a phoney solution, they will not be fooled. The Dingell-Ganske substitute will make a true difference to millions of families. Let us go the real way. Let us really help people and not just make it appear we are.
Let us support Dingell-Ganske and make a difference for the millions who are suffering under the yoke of unfair HMOs.
Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentlewoman from Washington (Ms. Dunn), a member of our leadership.
Ms. DUNN. Mr. Speaker, I thank the gentleman for yielding me this time.
I rise today to say to American families who are worried about their health care coverage, we understand your fears and your anxieties, and help is on the way.
H.R. 4250, the Republican plan to make health care more accessible and strengthen patient protection, is a sensible approach to the problems facing Americans, especially working women.
Mr. Speaker, 80 percent of all the health care decisions in this country today are made by women. As a result, women view health care as a consumer issue, not a political issue. That is why the Republican plan addresses the need to expand access to health care for those who cannot afford it, or are uninsured by their employers. H.R. 4250 makes some important reforms that will allow small businesses, an area of our economy increasingly dominated by women, to ban together to purchase health care coverage.
One of the biggest obstacles to health coverage for small business women and their employees is cost. By allowing these small businesses to join together and pool their resources, they will be able to purchase health care at the same discounted rates enjoyed now by big business.
In addition, our Patient Protection Act will give our Nation's women direct access to their OB-GYN. These physicians are extremely important to the lives of every woman and they should not be considered specialists. We should demand that the essential care that they give be accessible without having to jump through bureaucratic hoops.
The Republican plan will also help our Nation's mothers get easier access to pediatricians for the care of their children. Once again, the care given to our Nation's youth is critical to fostering a healthy childhood and it must be available without delay.
Whether it be expanding access to health care for America's small business women or ensuring that mothers and children have the care that they deserve when they need it, the Republican health care plan is right for our Nation's families.
Mr. Speaker, I urge my colleagues to support H.R. 4250 and help give families the peace of mind they so richly deserve.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from Oregon (Ms. Hooley).
Ms. HOOLEY of Oregon. Mr. Speaker, I thank the gentleman for the leadership he has shown on this issue.
Let me tell my colleagues a little bit about this issue. I look at these two bills and I see mirror images. The Hastert bill takes us a step backwards, at least in Oregon, in protecting patients, and the Ganske-Dingell bill moves that agenda forward.
I want to tell my colleagues how backwards this takes us. In Oregon, our State has already adopted model patient protections. Make no mistake: I would like to see us move forward on patient protection. This, in fact, moves Oregonians backwards. It repeals protections Oregonians already have been guaranteed by the State. Cervical cancer, mammogram screenings, minimum maternity care, mastectomy stays, breast reconstruction, alcoholism and drug abuse treatment, well child care.
In the last session of the Oregon legislature they worked in a bipartisan fashion, held extensive hearings, took the data and opinions of everyone concerned, and what they got was a model piece of legislation. They had hearings on it. What a contrast to this.
Please support the Ganske-Dingell bill.
The SPEAKER pro tempore (Mr. Foley). The gentleman from Illinois (Mr. Hastert) has 9 minutes remaining; the gentleman from Michigan (Mr. Dingell) has 4 and a quarter minutes remaining.
Mr. HASTERT. Mr. Speaker, I yield 15 seconds to the gentleman from Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Speaker, let us try to get this straight. The Federal law known as ERISA is what preempts State laws. It is not this bill; it is the ERISA law that preempts State laws.
Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the gentlewoman from California (Ms. Pelosi).
(Ms. PELOSI asked and was given permission to revise and extend her remarks.)
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding and for his tremendous leadership in providing access to quality health care for all Americans.
I rise in strong opposition to the Republican bill and in strong support of the Ganske-Dingell bill.
Mr. Speaker, I rise in strong support of the Patients' Bill of Rights, the substitute to the fatally flawed Republican HMO protection bill. The manner in which this legislation is being rushed through by the leadership should tell us clearly that they want to avoid real scrutiny, and given their bill, that is understandable.
With the health care system transforming around us, the most important decision we have to make in writing health care reform legislation is: What interests are we going to protect? Do we stand with patients trying to access quality care and needed specialty services? Or do we craft legislation which gives cover to the industry and considers patients second?
The Democratic Patients' Bill of Rights is true patient protection that will make a difference in the lives of every American.
The contrasts between the Republican and Democratic plan are many and stark. I want to focus on three issues which are very important to constituents in my district.
First, OB/GYN services are among the most personal, and important, health care services. This area of health care goes to the heart of the treasured doctor-patient relationship. When that relationship is full of trust and honesty, it can lead to better diagnosis, treatment, and comfort in the medical care setting.
The Democratic plan gives women direct access to OB/GYN services, without limitations that can stand in the way of receiving services, such as limits on the number of visits to the doctor. The Republican plan does not guarantee this coverage for all health insurance consumers.
Second, I am often approached by people in my district who depend on access to clinical trials. People with AIDS, breast cancer, and other health problems know that the cure for their diseases has not been found yet.
Their hope is their ability to participate with others in the search for medical answers. The Democratic plan promotes access to clinical trials that may provide people access to new, life-saving therapies. The Republican plan fails to do this.
Third, the Dingell-Ganske substitute, but not the Republican bill, permits individuals to sue the health plans under State law for personal injury or wrongful death.
We need health care legislation that puts patients, not HMOs, first. And we need enforcement mechanisms that make those protections real. The Republican plan falls far short on both counts. It is cover for the health industry and for Republicans, not tangible protection for consumers.
I urge my colleagues to support real protection for patients by voting for the Democratic substitute.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Rhode Island (Mr. Weygand).
(Mr. WEYGAND asked and was given permission to revise and extend his remarks.)
Mr. WEYGAND. Mr. Speaker, I thank the gentleman for yielding me this time.
I was just very interested, being a former small business owner, when the gentleman just came up a little while ago and mentioned that this bill does not preclude many of the State requirements that the gentlewoman from Oregon (Ms. Hooley) just mentioned.
Let me tell my colleagues what this bill does. It shifts small businesses who, like myself, belong to an association health care plan. It took all of the care of my employees and puts it now into ERISA.
This is what it is going to do for those people in the State of Rhode Island. It is going to remove the requirement that there be a well child care program, mammography screening, minimum maternity stays, minimum mastectomy stays, breast cancer reconstruction, cervical cancer screening, diabetic supplies, alcoholism treatment, drug abuse treatment, home health care, off-label drug use, newborn sickle cell testing and blood lead screening, removes patient rights from small business owners and employees of small businesses. This bill does that. The Ganske-Dingell bill does not. Please support the Ganske-Dingell bill.
Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr. Shadegg).
Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding me this time. I would like to engage in a colloquy with the gentleman from California (Mr. Thomas), the chairman of the Subcommittee on Health from the Committee on Commerce.
It is my understanding that the gentleman, along with most of our Republican colleagues and leaders, would agree with me that the biggest problem with health care today is that the Tax Code encourages employers, and not individuals, to be the purchasers of health care. Indeed, employers have a tax incentive to offer health care benefits for their employees, and individuals do not have that same benefit, so they are discouraged from purchasing their own health care.
Mr. THOMAS. Mr. Speaker, will the gentleman yield?
Mr. SHADEGG. I yield to the gentleman from California.
Mr. THOMAS. Mr. Speaker, I would inform the gentleman that the Subcommittee on Health is a subcommittee of the Committee on Ways and Means.
In looking at the Tax Code, we are very concerned about what has happened. Clearly, there are some advantages to managed care and HMOs in dealing with treating the patient, but I think it is fairly obvious that most employers turned to a controlled cost structure, as well. The employed had no ability to control the rising costs, 18\1/2\ percent a year in 1988. What they did was determine, I will take a health care that gives me a fixed dollar amount per employee.
Mr. SHADEGG. Mr. Speaker, I know the gentleman would agree with me that this legislation today, the Republican legislation before us today, takes important steps toward solving these problems, but that there is also agreement on the part of the gentleman and on the part of our Republican leadership that the best long-term solution would be to adopt reforms which make it possible, and indeed, encourage, individuals, whether they are employees of a company or the self-
employed, or for that matter unemployed, to purchase their own health insurance without having to go through their employer and get the same tax advantage as their employer currently gets under the law.
Mr. THOMAS. Mr. Speaker, if the gentleman will continue to yield, I could not agree with the gentleman more. The current system is fatally flawed. What we are doing is simply working on the edges. The only way to fundamentally deal with the problems in our health insurance area is to empower consumers, empower them with the wherewithal to purchase the insurance, and just as importantly, empower them with the knowledge to make choices. They have neither of those in today's current system. It needs fundamental reform beginning with the Tax Code, and with the collection of data, to make those changes possible.
Mr. SHADEGG. Mr. Speaker, I understand there is a commitment on the part of the Members to move that as soon as possible.
Mr. THOMAS. Mr. Speaker, I would tell the gentleman that I have no interest in playing on the margin; I want to go to the heart of the problem and change it.
Mr. SHADEGG. Mr. Speaker, I thank the gentleman very much.
The SPEAKER pro tempore. The gentleman from Illinois (Mr. Hastert) has 2 minutes remaining and has the right to close; the gentleman from Michigan (Mr. Dingell) has 8 minutes remaining.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the distinguished gentleman from New York (Mr. Engel).
(Mr. ENGEL asked and was given permission to revise and extend his remarks.)
Mr. ENGEL. Mr. Speaker, I rise in strong support of the Ganske-
Dingell bill and in opposition to the Republican bill.
The Democratic Patients' Bill of Rights takes health care decisions away from insurance company bureaucrats and gives them back to doctors and patients.
The Republican bill is a sham--it will actually turn the clock back on health care consumers and is another empty political promise from this GOP Congress.
The Republican bill covers too few people, provides too few patient protections and contains unnecessary and irrelevant provisions.
The Democratic bill:
First, returns health care decisions to health care professionals and their patients. The Republican bill does not.
Second, the Democratic plan guarantees patients the right to see a specialist when they need to do so. The Republican bill does not.
Third, the Democratic bill guarantees an end to financial incentives to limit medical care. The Republican bill does not.
Fourth, the Democratic bill guarantees tough enforcement that will hold insurance companies responsible for their actions. The Republican bill does not.
Fifth, the Democratic bill guarantees emergency care. The Republic bill does not.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the distinguished gentleman from Illinois (Mr. Poshard).
(Mr. POSHARD asked and was given permission to revise and extend his remarks.)
Mr. POSHARD. Mr. Speaker, I rise in strong support of the Ganske-
Dingell bill.
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Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the distinguished gentlewoman from Texas (Ms. Jackson-Lee).
(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)
Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in strong support of the Ganske-Dingell bill that does not hurt Texas.
Mr. Speaker, thank you for the opportunity to speak on this important issue today. Mr. Speaker, I am deeply concerned that after spending the last full year blocking any type of adequate health care reform the legislation that is on the floor today is an unacceptable proposal to Americans' very real health care reform concerns. Once again, Mr. Speaker, the House Republican leadership has allowed the insurance industry and its powerful lobbyists to make the rules!
H.R. 4250 may give the appearance of reform, but there is no substance to this bill. There is no provision for specialty care, no provision for needed drugs and clinical trials, and no effective mechanism to hold plans responsible when plan abuse inevitably kills or injures someone.
Instead of protecting patients who desperately need help, the bill here on the floor protects the insurance industry! H.R. 4250 has serious and apparent flaws and I urge my colleagues to oppose this bill.
This bill does not provide enforceable guarantees to protect consumers from bureaucratic abuses. It does not allow patients to seek recourse for denial of care which may result in injury or death. In addition, the Republican bill which would be more aptly named as the Patient Propaganda Act, Insurance Industry Protection Act or the Profit Protection Act does not guarantee patients access to needed care outside of their managed care plan, does not guarantee the right of patients to see a specialist and does not guarantee access to all necessary prescription drugs. Unfortunately, this bill does nothing to prohibit or prevent HMOs from offering bonuses to doctors for denying necessary care. By contrast the Patients' Bill of Rights Act allows patients access to specialists, and protects the doctor-patient relationship.
The Democratic Patients' Bill of Rights, in contrast is supported by over 300 health related organizations including the Children's Defense Fund, the National Partnership for Women and Families, the National Association of Children's Hospitals, the American Medical Association, and the National Breast Cancer Association. In addition, the American Public Health Association who represents more than 50,000 public health professionals, believes that H.R. 4250 provides inadequate protection of personal health data and may lead to undesirable uses of private information.
H.R. 4250 will allow health insurance companies, not doctors to decide what is medically necessary. In testimony before the House Commerce Committee, Dr. Linda Peeno, a former HMO medical director described the control that health insurance companies would have over our health as ``a health plan's smart bomb capability.'' External appeals will be of no value if the health plan itself is always allowed to decide and define what is medically necessary or appropriate. By contrast, our democratic bill specifically prohibits health plans from practicing medicine by substituting their decisions for the doctors.
And what about the gag rule? H.R. 4250 does not adequately protect the broadest possible range of ``medical communications'' and it would not ensure necessary emergency care! Because H.R. 4250 does not include the words ``otherwise restrict'' medical communications, because of this important omission, health plans can continue to silence physicians. Imagine, even with severe pain, there is no requirement for an insurance plan to allow treatment! In fact, this bill still does not deal with Americans' concerns with gag clauses, yet the bipartisan Ganske-Dingell bill extends the prohibition on gag clauses to subcontracts--in other words, assuring that health care professionals in all types of managed care will be protected and that patients will be protected.
Because we are about women's health concerns, the Dingell-Ganske bill prohibits drive-through mastectomies and requires coverage for reconstructive surgery after a mastectomy. H.R. 4250 does not even include anything close to this type of protection for women. As an advocate of women's rights, I am concerned that the Republican plan does not allow women to choose their obstetrician or gynecologist as a primary care physician, and it also does not allow a woman undergoing an active cause of treatment in her last trimester of pregnancy to continue with her doctor if her employer changes plans.
As a concerned parent and Chair of the Congressional Children's Caucus, I wonder about the children that would not receive adequate care under the Republican bill, in that it does not guarantee access to pediatric specialists.
I urge my colleagues to oppose the Republican plan. We must provide our country's citizens with adequate health care. Our President strongly endorses this plan, and as an article in the July 3, New York Times states, doctors and advocates for consumer groups prefer the Patients' Bill of Rights over the Republican plan, and the New York Times itself said that the Democratic bill seems to be far more prescriptive.
One of the letters I received recently is from a Texas woman, a senior citizen who has worked a lifetime in the medical profession. She told me that she had worked during an era when a doctor saved a gravely ill child--sutured bleeding patients--sat at the bedside of someone's dying loved one knowing there was nothing further he could do except to be there--and then see those same physicians feeling badly in accepting fresh garden vegetables or a dozen eggs with a pound of butter as a payment for his services.
She spoke of a time when doctors were able to act for the benefits of their patients alone, when insurance companies could not deny sick and dying patients their only hope for treatment and cure, based only on greed and profit. The Democratic Patients' Bill of Rights is the only plan guaranteeing that doctors and patients make medical decisions, not insurance bureaucrats!
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to my good friend, the gentleman from Pennsylvania (Mr. Doyle).
(Mr. DOYLE asked and was given permission to revise and extend his remarks.)
Mr. DOYLE. Mr. Speaker, I urge my colleagues to vote for Dingell-
Ganske.
Mr. Speaker, I rise to urge my colleagues to vote for real patient protection legislation, in the form of the Dingell-Ganske Patients' Bill of Rights.
The Dingell-Ganske bill is a bipartisan effort to put healthcare decisions back into the hands of doctors and nurses, not insurance companies. It would guarantee emergency care and access to specialists, and retain for doctors the right to speak freely with patients about their medical treatment.
Contrary to the claims of the insurance industry, these important patient protections can be guaranteed without radically increasing costs. We need to continue to get the news out about the recent Congressional Budget Office study, showing that the average policyholder will pay only an additional two dollars a month for these protections.
The Republican leadership bill would leave treatment decisions in the hands of the insurance companies and would not guarantee the right to see a specialist. This is not real reform at all.
I'm sorry to say that the Republican leadership bill still bears the faint aroma of something drafted by industry lobbyists behind closed doors. Even after last-minute changes last night, the Republican bill would still work to actually tear down existing patient protections. In my home state of Pennsylvania, and around the country, existing state patient protection laws would be preempted by this Republican leadership bill.
For example, H.R. 4250, the Republican leadership bill, would override Pennsylvania's medical records confidentiality law. There would be nothing to stop your health plan from sharing your medical information with other organizations, such as your employer. Should an employer have unfettered access, or any access at all, to every employee's health information? I don't think so. On this and a number of other issues, H.R. 4250 is more than just a sop to the issue of HMO reform, it's a bad bill, and we must vote to reject it.
Today, we have a choice between real reform, or a watered-down, half-
hearted motion designed simply to provide political cover to the Republican party. I urge my colleagues on both sides of the aisle to support the bipartisan Patients' Bill of Rights. Thank you, and I yield the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished gentleman from New Jersey (Mr. Menendez).
Mr. MENENDEZ. Mr. Speaker, I thank the gentleman from Michigan (Mr. Dingell) for yielding me this time.
Mr. Speaker, when Republicans seek to avoid reform, they raise the specter of Big Government. Yet it is the Republican majority's lack of governmental intervention that has let the abuses take place over the years of their majority in the HMOs across the country. It is only when Democrats clamored for patient protection that they came forth with the fig leaf they produced today.
One mother in my district came to me because her child had been denied necessary rehabilitative treatment after surgery, and now that child will live with the damaging effects of this denial for the rest of his life. The Republicans' bill gives that family no relief, no enforcement mechanism. That is not family values.
Today HMOs have all of the protection and none of the responsibility. We want to give patients protection. We want to make sure HMOs are responsible for their actions. We want to preserve what is trusted by Americans, their relationship with their doctor. We want to give them those choices. We want to make sure that a doctor is making those decisions.
Mr. Speaker, that is why I join the gentleman from Iowa (Mr. Ganske), a Republican, in supporting the Ganske-Dingell bill.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the distinguished gentleman from Indiana (Mr. Visclosky).
(Mr. VISCLOSKY asked and was given permission to revise and extend his remarks.)
Mr. VISCLOSKY. Mr. Speaker, I rise in support of the Ganske-Dingell substitute.
Mr. Speaker, I rise this morning as a co-sponsor of the bipartisan Patients' Bill of Rights and a believer in the notion that doctors should make decisions about their patients' medical treatments, not insurance companies. Today's managed care plans are run by insurance industry bureaucrats whose first concern is the bottom line for insurance companies, not quality care for patients. These insurance industry bureaucrats seek to maximize profits for insurance companies by restricting treatment to patients and preventing doctors from providing proper care.
In addressing this situation, the bipartisan bill, which is the basis of the Dingell/Ganske substitute, offers its protections to patients, who need to know that their insurance companies are not interfering with their access to quality health care. This bill is dramatically different than the Republican bill which seeks only to protect the insurance industry.
Currently, 125 million Americans are enrolled through their employers in self-insured health plans, in which the insurance companies cannot be held liable for their decisions to restrict medical treatment, even if those decisions directly result in the death or maiming of the patient. The Congress should eliminate this legal protection for insurance companies, so that insurance companies can be held legally accountable for their decisions, just like everyone else. The bipartisan bill would offer Americans the legal protections of their individual states in holding insurance companies accountable for their decisions. The Republican bill on the other hand, would go the other way by restricting patients' legal rights and increasing the number of patients who are not protected by state malpractice laws from insurance companies.
Americans need to know that they have access to adequate internal and external appeals processes if their insurance company denies them coverage for a treatment. While the bipartisan bill provides for an external review that is truly independent and bases the definition of medical necessity on ``generally accepted principles of professional medical practice,'' the Republican bill would allow the insurance company to determine what is considered medically necessary and who performs the external review.
Americans need to know that they have access to emergency care when it is necessary, and we should encourage people to go to the emergency room when they experience severe chest pain--a sign of a possible heart attack. But the Republican bill fails to guarantee payment for care in such cases, leaving the health of Americans at risk. That's why the President of the American College of Emergency Physicians has said that the Republican bill ``will not bring peace of mind to anyone seeking emergency care when they need it.''
Americans need to know that their insurance companies are not restricting the range of treatments that their doctors are allowed to discuss, and are not offering financial incentives to doctors to limit patient care. While the bipartisan bill provides strong protections to patients in both of these circumstances, the Republican anti-gag provision is riddled with loopholes, and their bill doesn't even address the problem of financial incentives designed to limit care.
Americans need to know that they will have access to a specialist when it is needed and not become a victim of managed care bureaucrats. The bipartisan bill provides this protection to patients; the Republican bill does not.
With a set of consumer protections so weak as to be almost meaningless, the Republican bill is a cynical attempt to include erroneous provisions that have absolutely nothing to do with the problems of managed care such as provisions that would allow companies unrestricted access to your personal, confidential medical information and that would allow wealthy Americans to set up tax shelters through medical savings accounts.
Mr. Speaker, the American people deserve strong protections from the insurance bureaucrats who seek to do nothing more than maximize profits by restricting care. Please join me in voting for real protections for patients and against further protections for insurance companies, and vote for the bipartisan substitute and against the Republican bill.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Georgia (Mr. Lewis).
Mr. LEWIS of Georgia. Mr. Speaker, we need a real Patients' Bill of Rights. I know because I have heard from the people in my district.
A mother told me her daughter had a mastectomy. The mother begged, pleaded to keep her daughter in the hospital for just one night. She needed to be there, but the insurance company sent her home.
I have heard from a doctor, a doctor who had to fight the insurance company to get coverage to treat his cancer.
Mr. Speaker, too many patients are paying more and are getting less. Under the present system, too many patients are getting a raw deal. They need a fair deal. They need a good deal. They need a better deal.
The differences are clear. Democrats are concerned about protecting patients. Republicans are concerned with protecting big business and insurance companies. The system is broken. It needs help. It needs a doctor. The Republicans are only offering a Band-Aid.
We need a bill to let doctors make medical decisions. The Democratic bill makes sense. If we can choose who fixes our car when it is broken, then we should be able to choose who would care for us when we are sick.
If insurance companies want to tell us that we cannot see a doctor, that we cannot get treatment, then they must be held accountable. The doctors and nurses on Main Street should make the decisions about our health care, not the insurance company and wheelers and dealers on Wall Street.
The Democratic bill protects patients. The Republican bill does not. Mr. Speaker, we need a real patient's protection act and we need it now. Not tomorrow, not next week, not next year, but now.
Mr. Speaker, we should vote for a real patient protection bill and we need it now. Vote for the Ganske-Dingell bill.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Michigan (Mr. Bonior).
Mr. BONIOR. Mr. Speaker, after ignoring the public outcry for months, the Republicans have rushed to the floor with a midnight deal that does nothing to end HMO abuses. We might as well call the Republican bill the Insurance Company Protection Act, because that is all it does. It does not protect patients.
These are the same insurance companies that have spent millions on TV ads to kill HMO reform and the same insurance companies that cut corners with people's lives. When insurance companies play doctor, and that is what they are doing, people get hurt, people die.
Under the Republican bill, many HMOs can still limit what doctors can tell their patients. Under the Republican bill, HMOs can still restrict patients' access to emergency rooms. If patients have a heart attack and the ambulance speeds to a hospital close by but outside their network, they can get stuck with a $4,000, $5,000, $6,000 emergency room bill. It is enough to give them another heart attack.
Under the Republican bill, patients have little access to specialists or freedom to choose their own doctor. Under the Republican bill, HMOs can release private medical records without the patient's permission.
Under the Republican bill, it even gives HMOs the authority to define
``medical necessity.'' And if an HMO denies necessary medical care, the HMO cannot be sued for damages. That is not reform. That is reprehensible. But that is what the Republicans propose. They are telling our constituents: Take two aspirins and call us after the election.
The President has made it very clear, he will veto this sham reform. I urge my colleagues to stand firm today. Support the Dingell-Ganske bill for real HMO reform and patient protections.
Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the distinguished gentleman from Illinois (Mr. Davis).
(Mr. DAVIS of Illinois asked and was given permission to revise and extend his remarks.)
Mr. DAVIS of Illinois. Mr. Speaker, I rise in favor of the Dingell-
Ganske bill.
Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished gentleman from Missouri (Mr. Gephardt) the minority leader, for purposes of concluding debate.
(Mr. GEPHARDT asked and was given permission to revise and extend his remarks.)
Mr. GEPHARDT. Mr. Speaker, the bill that the Republican leadership has brought to the floor is what happens when they bring a bill that they really do not believe in, when they bring a bill that is really designed to be political cover to address an area they really genuinely do not believe needs to be treated with legislation.
It is a fake. It is a fig leaf. It is a sham. It is a subterfuge. It is a charade. It is cosmetic. It is ineffective. And it will not work to solve the real problems and the real concerns that the American people have in this area.
If Republicans really believed in their bill and thought that it had merit, they would have had extensive hearings in the committee and allowed doctors and nurses, senior citizens and patients, consumers, health care company officials and others to come and testify and tell us in the Congress their feelings, pro and con, about the bill.
If they really believed in their bill and what it did, they would not have been writing it at midnight last night, changing it, trying to shove things into it to try to attract the last few votes on their side to be able to pass the bill. They would have proudly stood for their bill as an effective answer.
Mr. Speaker, I just ask Members today to ask themselves one simple question: Where are the doctors and nurses on this piece of legislation? Which piece of legislation do they support, the people who, on a daily basis, give their lives and their careers to help get people well?
Mr. Speaker, they are for the Patients' Bill of Rights, the patient protection act written by the gentleman from Michigan (Mr. Dingell) and the gentleman from Iowa (Mr. Ganske). They are against this sham, this political fig leaf that has been put up on the other side.
Why is that the case? Let me give just three quick, simple reasons. First, the Republican bill does not guarantee that if our doctor says we need to see a specialist, that we will actually be able to see that specialist. Just imagine if a patient has cancer and their doctor says they need to see an oncologist. If the Republican bill passes, there will be no guarantee in the law that patient will be able to see that oncologist.
Secondly, the idea of what is medically necessary will still, under the Republican bill, be up to bureaucrats in insurance companies who have their eyes on the bottom line, the profit line, and not on what is good medical care.
Finally, no enforcement. No enforcement. This is a bill with rhetoric but without a remedy. What we need in this area is to be able to know that if the medical necessity is not observed, if the guarantee of the plan is not observed, that patients have some place to go to get a remedy.
What physicians say to me is, ``I am accountable for my health care decisions every day, every minute of every day. But now we have some bureaucrat at the end of an 800-number who can make medical decisions that are just as important as my decisions, and they are not in any way accountable to anybody for the decisions they make.'' That is the heart of this bill, and that is why the Democratic bill is the only good bill before us today.
Let me end with this. Members are voting today on the rights and the ability of flesh and blood human beings in their district. Make no mistake about this, they care about this bill. This really counts in their lives. When Americans need the Bill of Rights, they need it.
Mr. Speaker, I sat with my son when he was sick in the hospital and talked to other parents of kids who had cancer and they would say, ``My policy did not cover, my policy did not work on the treatment, the experimental treatment that my son or daughter needed.'' Let me tell my colleagues that when one is sitting in that hospital room and they have a loved one in front of them who is dying because they cannot get the treatment that they have paid for, they will want this Patients' Bill of Rights and they will want it now.
Mr. Speaker, I urge my colleagues to vote against this fig leaf. Vote for a good bill.
Mr. HASTERT. Mr. Speaker, I yield such time as he may consume to the gentleman from Florida (Mr. Mica).
(Mr. MICA asked and was given permission to revise and extend his remarks.)
Mr. MICA. Mr. Speaker, I rise in support of the Republican alternative and against the Democrat, more regulatory, bureaucratic, and more litigious approach.
Mr. HASTERT. Mr. Speaker, I yield such time as he may consume to the gentleman from Georgia (Mr. Linder).
(Mr. LINDER asked and was given permission to revise and extend his remarks.)
Mr. LINDER. Mr. Speaker, I rise in favor of the Republican alternative.
Mr. HASTERT. Mr. Speaker, I yield the balance of my time to the gentleman from Georgia (Mr. Gingrich), Speaker of the House.
Mr. GINGRICH. Mr. Speaker, let me thank my colleagues and let me thank the gentleman from Illinois (Mr. Hastert) and everyone who served on the Health Task Force for developing the Patients' Protection Act.
Let me remind everyone that this is not a new process for us. We founded the Health Reform Task Force in 1991. We developed a series of reforms which included Medical Savings Accounts, which included preventive care for diabetes, for prostate cancer, for colorectal cancer, for breast cancer.
We have moved a series of initiatives on child health. We moved a series of initiatives to expand access to health insurance for small business. And now we are back working in the same general direction which is really to do three things: To make sure that every citizen has access to health care; to make sure that it is the most modern and best health care in the world; and to lower its costs.
Let us be clear about the choices here. The Dingell bill is a well-
meaning bill, if one is a trial lawyer.
{time} 1330
The Dingell bill is terrific for trial lawyers. The Dingell bill is about trial lawyer enrichment. We are better on every count. We save money. The Dingell bill costs money. So we make it easier to buy health insurance and expand the coverage. We have provisions so that more people can get covered by health insurance.
The Dingell bill will actually take a million and a half people out of health insurance and put them on the taxpayer. So they have less health insurance for fewer people at greater cost.
Our bill says if someone gets sick and they have a reasonable layman's standard, they go to the emergency room and they are automatically covered. It then says if that individual is not in an emergency situation, but that individual does not agree, they can get, within 72 hours, an internal review. And if they do not agree with that, they can get, within 72 hours, an external review. They do not have to go to a trial lawyer.
And the review, by the way, is done by appropriate medical professionals of comparable specialties. So medical people make medical choices in our bill. Trial lawyers make litigation choices in the Dingell bill.
This is not a complicated issue. This is an issue of the trial lawyers seeking to enrich themselves at the expense of everybody else in this country by having more lawsuits over a longer period of time and a more jammed courtroom. We have a proposal which says more patients have more rights by appealing against the HMO, appealing against the insurance company, and appealing directly to an independent council of medical professionals.
Now, let us say the medical professionals decide, yes, the patient deserves the coverage, and the HMO says we are not going to do it. At that point, under our plan, that individual goes to court with a presumption that the HMO is guilty. The judge is now looking at an independent medical panel having said, yes, the patient should get this treatment. So we give the American people better treatment, faster, with medical specialties, at lower cost.
But we do one thing that our good friends cannot stand: We do not make the trial lawyers richer. We also have malpractice reform, which is what every doctor has told us for 20 years they want.
So I would say the vote on Dingell is very simple: If we want better patient protection, vote ``no''. If we want lower cost, vote ``no''. If we want more people covered by health insurance, vote ``no''. If we want medical doctors making medical decisions, vote ``no''. But if Members really think they owe it to the trial lawyers to give them a new chance to get richer, vote ``yes''.
Mr. SERRANO. Mr. Speaker, I rise in strong support of H.R. 3605, the Dingell-Ganske Patients' Bill of Rights, and in equally strong opposition to H.R. 4250, the pale shadow of reform offered by the Republican leadership.
The American people have called on us to rein in the managed care companies that are putting profits ahead of people, denying and delaying care and causing real harm. We have heard from patients with terrible stories of injury and death caused by the decisions of arrogant, unfeeling insurance company bureaucrats intent on their corporate bottom line. We have heard from doctors who have been forced to beg for permission to treat their patients according to their professional judgment. We have heard from nurses who daily see and deal with the results of denial and delay. We have even heard from former HMO employees about what they had to do--until they couldn't stomach it any more--to keep their jobs.
While it is gratifying that Republican leaders have finally listened to the American people and scheduled floor debate on managed care reform, this is a holly exercise. Their useless bill, which is likely to pass, will be vetoed. We know that already. So this is not serious attempt to accomplish meaningful reform, it is an attempt to give Republican candidates cover on an issue that is critical to millions of Americans, to permit Republicans to claim they have done something about health care.
In stark contrast, the Dingell-Ganske bill would provide meaningful, enforceable patient protections and quality health care. It would let doctors and patients make medical decisions and end financial incentives to limit medical care. It would guarantee access to specialists outside the HMO, to emergency services, to the full range of prescription drugs, and to clinical trials. It would end excessive use of cost-cutting devices such as outpatient mastectomies and drive-
by deliveries. Most important, it would be enforceable.
The Interreligious Health Care Working Group supports legislation that includes ``patient access to information; choice of providers and plans; access to emergency services; participation in treatment decisions; respect and nondiscrimination; confidentiality of health information; and complaint and appeal procedures'' as well as credible means of enforcing those rights. H.R. 3605 meets this standard. H.R. 4250 does not.
The Consumer Federation of America supports legislation that includes
``holding managed care companies accountable; requiring an external grievance and appeals system; comprehensive information disclosure; quality assurance programs; and protection of the doctor-patient relationship in a manner that allows advocacy on behalf of patients and prohibits improper physician incentive plans.'' H.R. 3605 meets this standard. H.R. 4205 does not.
Similarly, the American Federation of Teachers, Families USA, the Lutheran Office for Governmental Affairs, Consumers Union, and others that have outlined principles for addressing problems in the managed care industry find H.R. 4250 sadly lacking in both protections and enforcement. They all support H.R. 3605.
The American Medical Association--the AMA, Mr. Speaker--lists 10 reasons to vote against the Republican leadership's bill and for the Patients' Bill of Rights. I won't list them all, but I should mention a couple of key issues. AMA Reason No. 9 is ``H.R. 4250 would allow health insurance companies to decide what is medically necessary * *
*'' AMA Reasion No. 7 is ``H.R. 4250 would require patients to pay for the privilege of an external review of treatment denial; H.R. 3605 imposes on such fees * * *'' AMA Reason No. 4 is ``H.R. 4250 would delay the effective date of patient protection for up to 2 years * * * H.R. 3605 would peovide for nearly immediate implementation * * *''. Finally, and perhaps most importantly, AMA Reason No. 1 is ``H.R. 4250 does not hold health plans properly accountable for making medical treatment decisions that result in patient injury or death.''
Of course, Mr. Speaker, the Republican leadership doesn't stop at offending the American people by offering only a hollow promise of reform, it throws in posion pills that have been considered and rejected before. Exempting Association Health Plans (AHAs) and Multiple Employer Welfare Arrangements (MEWAs) from state law would deny millions of Americans coverage under many of the patient protection laws already enacted by 43 states. That includes my own state of New York, which has been a pioneer in establishing patient protections. Expanding the availability of medical savings accounts (MSAs) would give tax breaks to the healthy and wealthy while increasing costs of health insurance for the sicker and poorer.
It is obvious that this is a political exercise. The Republican leadership's bill was introduced only last week and has not been examined in a single hearing or subjected to amendment by any committee. It hasn't been scored by the Congressional Budget Office. As the AMA writes, ``In fact, Members of Congress have not had time to fully understand critical differences in the two bills since last Friday's introduction of the House Republican bill''. Not surprisingly, then, the bill has been a work in progress, subjected to numerous changes--changes that sound like improvements but are largely cosmetic--in attempts to attract enough votes to pass the bill without actually accomplishing anything that would annoy the Republicans' friends in the insurance industry.
I urge my colleagues to support meaningful, enforceable reform, not posturing. Support the Dingell-Ganske Patients' Bill of Rights and reject the Republican leadership's Managed Care Reform Lite.
Mr. TURNER. Mr. Speaker, Democrats initiated the effort in this Congress to protect patients and their doctors from interference by insurance company bureaucrats. The Dingell-Ganske bill provides these protections and eliminates the complete exemption from accountability that many HMOs enjoy today under the Federal ERISA law.
The Republican bill, on the other hand, is an effort to preserve the insurance companies' shield of protection from accountability for their mistakes. It creates a Federal bureaucracy in the Department of Labor and a complex appeals process diagrammed here on this chart to my right. Look at this. And endless maze of bureaucratic nightmare is created by the Republican bill.
Consider the example of Phyllis Cannon. In September of 1991, Ms. Cannon was diagnosed with leukemia. On August 10 of 1992, her doctor sought approval from her HMO for a bone marrow treatment. 43 days later, her doctor pleaded for authorization to treat her life-
threatening condition and it was again denied. By the time the HMO finally agreed to authorize treatment, it was too late and Phyllis Cannon died.
Could she have gone through this maze under the Republican bill and done any better? I think not. And if she had made it through the maze under the Republican bill, after her death she would have been entitled to only $500 per day. Under the Republican bill, the total recovery for her family would have amounted to only $20,000.
Is this what we call protecting patients? Vote against this Republican bill. Vote for the Ganske-Dingell bill and prevent this kind of endless bureaucratic interference with medical decisions from happening to the patients of this country.
Mr. THOMPSON. Mr. Speaker, I rise today as the Representative from Mississippi's 2d Congressional District in support of H.R. 3605, the bipartisan Dingell-Ganske Patients' Bill of Rights. This bill guarantees that decisions will remain in the hands of doctors and nurses, not insurance companies; that people will have access to specialists; that there will be protection for women after mastectomy
(minimum hospital stay); and the ability to hold plans accountable when abusive practices kills or injure patients.
I oppose the Republican HMO health care bill. Mr. Speaker, I am in support and committed to passing major managed care legislation. However, I do not support the Republican bill that covers too few people, provides limited patient protections, and contains unnecessary and irrelevant provisions. It undermines existing state consumer protections, leaves patients and small businesses with fewer protections than they already have. The Republican bill is being pushed through the House with almost no debate and virtually no amendments allowed in an attempt to stop the only real bipartisan managed care reform bill--the Dingell-Ganske Patients' Bill of Rights--from passing. Mr. Speaker, the Republicans are playing politics with the lives of Americans. Let's stop this ridiculous rhetoric and pass some meaningful legislation.
As I close, I would like to once again express my support for H.R. 3605 and thank Representative Dingell and Representative Ganske for their work in bringing this legislation forth to protect the interests of patients. I urge my colleagues to support this bill.
Mr. COYNE. Mr. Speaker, I rise in support of H.R. 3605, the bipartisan Patients' Bill of Rights. Today we have a tremendous opportunity to protect our constituents' right to receive quality health care.
More than half of all Americans are not offered a choice of health care providers by their employer. Under current law, many consumers have little recourse if their HMOs or insurance companies do not protect their most basic health care rights. I believe Congress must act to guarantee these rights.
I am proud to be an original cosponsor of the bipartisan Ganske-
Dingell bill (H.R. 3605). It would ban ``gag rules'' and contracts in which doctors are paid less if they refer to needed specialists or suggest expensive treatment, guarantee access to specialty and emergency care, protected medical confidentiality, and give patients access to a free, timely appeals process if their HMOs deny them benefits. If patients are harmed by decisions made by their HMOs, they will be allowed to take the HMO to court and recover damages. H.R. 3605 also provides for speedy implementation. Americans need relief from badly managed care now, not 2 years from now.
On the other hand, H.R. 4250, the Republican alternative, is a step in the wrong direction. It actually weakens the protections patients have under current law. The association health plan proposal would increase the number of patients who are not allowed to sue their health plans if they are harmed or killed by decisions made by the plan. The bill also undermines current laws which protect medical confidentiality, allowing almost any insurance company official access to a wide range of personal medical records. By expanding medical savings accounts, they encourage wealthy, healthy people to ``opt out'' of the current health insurance coverage insurance system, increasing the price of health insurance for everyone else. Finally, the Republican bill would maintain the status quo in which insurance companies, not doctors, decide what is
``medically necessary,'' and health plans can continue giving doctors financial incentives to deny necessary care.
I urge my colleagues to join me in supporting H.R. 3605, the Patients' Bill of Rights. We owe it to our constituents to use this opportunity to enact real reform.
Mr. BENTSEN. Mr. Speaker, I rise today to express my strong support for H.R. 3605, the bipartisan Patients' Bill of Rights, that is sponsored by Representatives Dingell and Ganske. Today, we will consider two different approaches to reform managed health care plans. I am a strong supporter and co-sponsor of H.R. 3605 because I believe that this bill provides essential consumer protections to all Americans. I urge my colleagues to reject the Republican leadership sponsored legislation, H.R. 4250, and vote for the real Patients' Bill of Rights.
Today, there are more than 160 million Americans enrolled in managed care plans, such as health maintenance organizations (HMOs). Of these enrollees, approximately 125 million Americans are enrolled in managed care health plans that are governed by federal law, the Employee Retirement and Insurance Security Act (ERISA). Under ERISA, these Americans cannot seek legal remedy if their health plans denies or delays access to care. In a time when many Americans believe that their health plans are arbitrarily denying care and services, the Dingell-
Ganske substitute bill would ensure that health plans must provide an appeals process to their decisions. Under the Dingell-Ganske bill, patients would be guaranteed the right to seek both an internal and external appeals process with a deadline for decisions to be made. If both of these appeals are denied, consumers would have the right to hold their plans accountable for their decisions through a legal case in our court system. In my state of Texas, where a new law has recently been approved to provide this legal right for consumers under state-
based health plans. This legislation would simply ensure that ERISA-
based health plans are held accountable by consumers.
The Dingell-Ganske bill provides critical reforms that patients need. It guarantees that decisions will remain in the hands of doctors and nurses, not insurance companies. It guarantees access to specialists and ensures that doctors and nurses can talk freely with patients without interference from their health plans. The Dingell-Ganske bill also prohibits the use of financial incentives to limit medical care. The Dingell-Ganske bill also ensures that patients can seek care in emergency rooms without prior approval and when they are suffering severe pain.
I would like to highlight one main difference between these bills. The Dingell-Ganske substitute includes an important provision to ensure that all Americans can enroll in cutting-edge clinical trials if they need them. As the sponsor of legislation to ensure that Medicare beneficiaries can enroll in clinical trials, I believe we must guarantee this right to ensure that patients have access to the best, most-advanced care. As the Representative for the Texas Medical Center, where many of these clinical trials are conducted, I believe that this guarantee must be included as any consumer-protection legislation. The Dingell-Ganske substitute would require managed care plans to pay for the routine costs associated with clinical trials. The Republican majority legislation does not include this critical provision.
Finally, I would like to highlight one other critical point about the Patients' Bill of Rights. I believe the Patients' Bill of Rights is a cost-effective, reasonable approach to provide uniform federal standards for managed care health plans. I believe that consumers are willing to pay for these protections. The Congressional Budget Office has estimated that the Patients' Bill of Rights would add a total of $2 per month for these protections. Let me repeat that, for $2 per month, patients can be guaranteed real protections. I believe that consumers believe that this small price is worth its guarantees to ensure that consumers receive the health care services they need and deserve.
I urge my colleagues to reject the Republican leadership bill and vote for the Patients' Bill of Rights.
Mr. COSTELLO. Mr. Speaker, I rise today in strong support of the Dingell Patients' Bill of Rights. The Republican plan tries to give the appearance of reform without actually doing so. The Republican plan does not limit HMOs' and insurance companies' use of improper financial incentives to limit needed care, does not give access to specialists, does not allow women to choose their obstetrician or gynecologist as a primary care doctor and what is most important, the Republican bill provides no effective mechanism to hold HMOs accountable when a patient is killed or injured.
The American people have waited long enough to be granted the ability to sue HMO's when a patient or family member is injured or killed due to the negligence of their health plan. They deserve the right to take legal action. HMO's should not be exempted from legal liability. Most industries in the U.S. today have responsibility to provide safe products and safe work places and can be subjected to legal recourse if they intentionally harm an individual. HMO's are no different; we must pass legislation to make them responsible for their actions!
The Republicans use of scare tactics claiming that the Democratic bill will escalate the cost of managed care plans is bogus. Last week, the Republicans' own Congressional Budget Office (CBO) released an analysis of the Patients' Bill of Rights discrediting Republican claims. The CBO estimates that the Democratic proposal costs only $2 more a month for patients with managed care plans. The CBO also estimates that the Democratic provision allowing patients to sue their health plans will increase premiums by just 1.2%. That is a small price to pay to make sure HMO's understand they will face legal liability.
The Democratic bill has been endorsed by the American Medical Association, American Nurses Association, American Cancer Society, and the American Trial Lawyers Association. It's time we hold health plans accountable for their actions and give the American public back their right to quality health care. I strongly urge my colleagues to support the Ganske-Dingell substitute.
Ms. McCARTHY of Missouri. Mr. Speaker, I rise today to speak in favor of H.R. 3605, the Dingell-Ganske Patients' Bill of Rights, of which I am a co-sponsor. I urge my colleagues on both sides of the aisle to join me in support of this bipartisan bill. This bill guarantees that medical decisions will be made by doctors and their patients, not by insurance companies. It ensures that doctors can inform patients of all of the treatment options available to them so that patients can make educated choices regarding their health care. It guarantees that a patient who goes to an emergency room with severe pain will be treated.
The Patients' Bill of Rights also extends important protections to women. This bill allows women direct access to obstetric and gynecological care, and it allows women to designate their own gynecologist as their primary care provider. This provision allows a woman to continue to be treated by a doctor with whom she has become comfortable and who knows her personal medical history.
Further, the Dingell-Ganske bill provides patient protection at an affordable price. The Congressional Budget Office has reported that most individuals would only pay about $2 more per month in premiums as a result of the Patients' Bill of Rights. The peace of mind and security that will result from this bill are well worth this small amount.
Last year, my home state of Missouri enacted legislation that ensure a patient's right to emergency room care, to choose a doctor, and to know about all of the options available to them for treatment, regardless of the cost. In addition, the Missouri law provides for well-child care, mammography screening, drug abuse and alcohol treatment, bone marrow transplants, and breast reconstruction.
With this legislation, Missouri took great strides to guarantee access to specialists and provide more rights for patients. If the Gingrich-Hastert bill is enacted, Missouri's law will be over-ridden, and the rights of the people of my state will be taken away. We must not let this happen. Instead, we should recognize successful efforts like Missouri's at the state level to guarantee patients basic rights and follow this lead by passing the Dingell-Ganske bill.
We must guarantee that insurance companies are held accountable for their actions when they deny patients the health care they need. We must guarantee that when patients need to go to the emergency room, they can go without worrying whether their insurance will allow them to be treated for their medical emergency. We must guarantee that doctors and not insurance companies are making the decisions about what is medically necessary for their patients.
In my district, at the Children's Mercy Hospital, social workers are fighting the current system to ensure that patients receive the care they need. For example, one little boy with an amputated arm needed a special kind of prosthesis. His insurance company deemed the special arm not medically necessary and refused to pay. The social worker at Children's Mercy was able to secure outside charitable funding for this little boy to get the arm he needed, but not all hospitals are able to provide this service, and frankly, they shouldn't have to.
Join with me in supporting H.R. 3605 and grant America's patients the basic medical rights they deserve.
Mr. OWENS. Mr. Speaker, I rise to oppose H.R. 4250, the Republican so-called Patient Protection Act and to voice my enthusiastic support for H.R. 3605, the Patients' Bill of Rights Act. H.R. 4250 was conceived in the back room of the Speaker's special 15-member Task Force on Health Care and unveiled just last week. Although the bill was referred to several committees, in a transparently desperate political maneuver, the Republican leadership has put the bill on a fast-track basis and side stepped the traditional deliberative process. I am pleased, however, that many of the provisions that are included in several Democratic bills, including my own bill (H.R. 1191, the Patient and Health Care Professional Protection Act), have been included in today's Patient Protection Act. Yet, this bill, H.R. 4250, falls disgracefully short on
``protections'' for patients and health care workers. The authors of H.R. 4250 took great care to ensure the protection of the owners of the commerce of health care--managed care companies. At a time when the health care industry is completely re-engineering itself and a record 160 million Americans have fallen susceptible to the cost-saving strategies characterized by too many managed care plans, we must not support this phony ``Patients' Bill of Rights.'' We wish to note also that irrational Medicaid rate reductions by state Governors are also jeopardizing the health of patients.
Disappointingly, most of the new Federal protections in H.R. 4250, would cover merely 48 million Americans in self-insured, employer-
sponsored health plans that fall under the purview of ERISA (the Employee Retirement Income Security Act of 1974). However, there are more than 160 million Americans who have private health insurance. Congress must act to ensure the protection of a broader range of health care consumers, including Medicaid recipients.
In addition, H.R. 4250 contains a bogus grievance mechanism for patients who my have disputes with their HMOs. Under the bill, a so-
called internal and external appeals process would be established, Upon first glance, it appears that H.R. 4250 adequately provides for a fair process whereby patients can appeal any denials of care. However, upon a closer look at the bill language, it is clear that the so-called external process is not very independent of the HMO with whom the patient is in dispute. H.R. 4250 would stack the cards in favor of the HMO from the onset. An independent medical expert would be required to examine the dispute on the merits of whether or not the HMO followed its own rules. The independent medical expert would not be authorized to determine that the medical procedure is indeed, necessary. To add insult to injury, the bill would permit health plans to charge up to
$100 to a patient who pursues the external appeals route.
Unlike the Democratic substitute (H.R. 3605 sponsored by Representatives Dingell and Ganske), H.R. 4250 would not allow patients to sue their health plans. (Currently ERISA does not permit patients in employer-sponsored plans to sue their health plans.) Republicans have demonized the right to sue as some kind of payoff to the trial lawyers of America. On the contrary, the right to sue is an appropriate remedy which allows for maximum enforcement against health plans, especially when great injury or death results from their cost-cutting decisions. Any true patient protection bill and patient advocacy language would arm the patient with this basic tool of American civil rights.
Moreover, H.R. 4250 contains no protection for the very individuals who are on the front lines of the health care delivery system--nurses, doctors, and other health care professionals. The bill does not have whistleblower protections for health care workers who are in the best position to witness and report patient safety concerns. The Service Employees International Union, the organization that represents the largest number of health care professionals in the country (1.3 million members) states, ``In a recent national survey of health care professionals, nearly 1 out of 4 reported that `employees are penalized for, or afraid to speak up about problems in their workplace' '' Yet, H.R. 4250 ignores this fact by not protecting workers from discharge, demotion, or harassment when they decide to stand up for patient care.
It should be noted that my bill, H.R. 1191 which was originally introduced in the 104th Congress and reintroduced on March 20, 1997, addresses these issues and accomplishes the following: Provides strong whistleblower protection for nurses and doctors; ensures that managed care plans mandate that adequate staffing guidelines are implemented in every hospital across the country (This would stop the current practice of replacing registered nurses and licensed practical nurses with unlicensed aides.); mandates the compilation of public, uniform, national patient-outcome data collection and analysis; assures than no patient is denied care for non-medical reasons; establishes a Federal mechanism for the emergency investigation of egregious hospital cases involving death or life-threatening situations; and establishes well-
funded, consumer-dominated, non-governmental genuine health care advocacy groups in each state.
Finally, H.R. 4250 would prematurely expand access to medical savings accounts (MSA). MSAs are tax-exempt savings accounts which may be used to pay for medical expenses. The Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191) authorized a limited number of MSAs (750,000) under a demonstration program beginning on January 1, 1997. Many Members and consumer groups were vehemently opposed to the demonstration program, citing that MSAs work for those that are more healthy and more rich. The vast expansion of MSAs under H.R. 4250 is reckless and extreme given that the impact of the 1997 demonstration program has yet to be studied.
Health care is big business. Spending for health care totals approximately $1 trillion every year in the United States. Competition within the health care industry is fierce, and Congress has the unequivocal role in assuring that cutting costs and increasing one's profits are not priorities at the expense of patient care quality and safety. When I recently convened an extensive health care empowerment conference in my district, my constituents demanded reform. The 11th Congressional District Advisory Committee and the HMO Consumer Advisory Committee called for the formation of an ``HMO Certification Council'' to give a seal of approval to managed care plans. The conference participants stated their desire for greater access to doctors. The conference participants also called for the passage of state legislation that would hold managed care companies accountable and permit wronged patients to sue these companies. And when a group of nurses visited me two years ago and conducted a rally at the Capitol, they demanded protection for themselves and their colleagues and freedom to advocate on behalf of their patients. I urge my colleagues to carry out the will of the American people, and not the wishes of greedy American businesses. Vote ``no'' on H.R. 4250, and vote ``yes'' on H.R. 3605, the Democratic Dingell-Ganske substitute.
Mr. PAYNE. Mr. Speaker, I rise in support of the Patients' Bill of Rights, the Dingell-Ganske substitute. I do so because the substitute lives up to its name. Improving health care quality is what this debate is supposed to be about and that is what the Patients' Bill of Rights does.
This measure enjoys broad bipartisan support from the AFL-CIO to the American Medical Association. Unlike H.R. 4250, the Patients' Bill of Rights allows states to continue on their current course of expanding health care coverage to the uninsured and improving health care quality.
The bill ensures that treatment discussions stay between the doctor and their patient. It also requires that health plans have an adequate number and variety of health providers. This provision is especially important to me because African Americans and other minorities are consistently discriminated against in the treatment and provisions of care.
The Patients' Bill of Rights has critical safeguards to protect patients and providers from discrimination. Mr. Speaker, I urge my colleagues to protect the public health and support the Patients' Bill of Rights. Vote yes on the Dingell-Ganske substitute.
Mr. SANDLIN. Mr. Speaker, I rise in strong support of the Dingell-
Ganske substitute and in opposition to H.R. 4250, the so-called Patient Protection Act. That bill does not protect patients. In fact, several provisions of their bill would harm patients. H.R. 4250 was rushed to the floor with no hearings, no markup, and not even so much as a CBO cost estimate until minutes ago.
One of the most critical differences in the two alternatives before us is who makes decisions. As we increase access to health care, we must not allow unqualified parties to make critical decisions about patient treatment. Patients need to feel confident that their doctors are giving them all necessary information and not restricting information because of requirements issued by a health insurance provider. Patients should make critical decisions about their health care with the advice of their doctor. These decisions should not be overridden or limited by insurance company bureaucrats. The Patients' Bill of Rights allows patients to make their critical care decisions.
As a strong supporter of local control, I support the Dingell-Ganske substitute because, unlike H.R. 4250, it will not override protections already enacted by the states. In my home state of Texas, the following protections would be overridden by H.R. 4250: well-child care; mammography screening; minimum maternity stays; breast reconstruction; diabetic supplies; prostate cancer screening; home health care; mental health care; alcoholism treatment; drug abuse treatment; Alzheimer's disease; formula for PKU; TMJ disorders; and bone mass measurement. The federal government should not be in the business of overriding state legislatures' decisions about consumer protections.
Recently, I received a letter from two Republican members of the Texas legislature who were instrumental in the passage of recent Texas laws that provide strong consumer protections. I quote from that letter:
In 1995 managed care reform opponents called the patient protection act a billion-dollar health care tax, and in 1997 they claimed health care costs would skyrocket upwards of 30 percent. However, multiple independent studies, including an actuarial analysis by Milliman and Robertson, of Scott and White's HMO, show costs have increased by about 34 cents per member per month.
H.R. 4250, the House GOP bill, would weaken Texas' independent review provisions. Apparently, H.R. 4250's independent review is not binding compared to the Texas law that requires managed care organizations to provide care deemed appropriate by the independent review organization.
We also are concerned that H.R. 4250 weakens current Texas law regarding emergency care and gag clauses. As we understand it, the bill waters down Texas' prudent lay person by allowing a health plan to override the treatment decision by the emergency department physician. The gag clause provision does not protect health care providers from retaliation when they act as advocates for their patients.
One of the most important provisions of this legislation ensures that a new Texas law will not be overturned. That provision declares that the Employee Retirement Income Security Act of 1974 does not prevent a patient from suing his or her HMO in state court for personal injury or wrongful death damages. This provision makes insurance companies accountable for their actions. The laws in this country make every other industry accountable for their actions. If automobile manufacturers produce an inferior product that harms people, they are accountable for that damage. Doctors are accountable for the medical decisions they make that harm their patients. Why then are insurance companies not accountable for the decisions they make that harm the health of patients?
Allegations that the Dingell-Ganske substitute would make employers liable are simply not true. Clearly, employers cannot be held liable for the decisions of insurance companies and/or the decisions of others. The Dingell-Ganske substitute does not create a new right of action. It simply removes the provision of ERISA that protects insurance companies from being sued. It specifically states that employers cannot be held liable unless they exercise discretionary authority to make a decision on a claim for benefits covered under the plan. During the course of the last six months, I have met with many representatives of the business community. I have repeatedly asked them to bring me language that they believe would prevent employers from being sued and assured them that I would work with Mr. Dingell and Mr. Ganske to address their concerns. Not one of those people has taken me up on my offer. That is because there is no employer liability in the bill. Their answer instead is to oppose the entire bill and support H.R. 4250, and threaten Members who support Dingell-Ganske.
One of the most disturbing provisions of H.R. 4250 will severely undermine the patient's right to private medical records. This bill allows for the release and use of confidential health information without the patient's consent. Once that information is released, it can be sold without the patient's consent or knowledge. And once again, H.R. 4250 would preempt state laws that already have strong medical privacy protections. That's wrong and this Congress should not be subjecting the American people to such an outrageous position.
Mr. Speaker, I urge my colleagues to support the Dingell-Ganske substitute and oppose the disingenuous attempt by supporters of H.R. 4250 to pull the wool over the eyes of the American people.
Mr. MORAN of Virginia. Mr. Speaker, there must be certain provisions included in patients rights legislation in order to ensure true protections. For all health plans, there should be an outside review appeals mechanism. Patients should have the right to appeal adverse coverage decisions made by their health plans. Women should be able to choose their OBGYNs as their primary care physician, and chronically ill patients should not have to get referral from a primary care physician every time they need to see the specialist who treats their chronic illness. States should be able to protect consumers from breaches to consumer privacy. The Ganske-Dingell substitute provides these vital protections and more.
Although I have concerns about a provision in the bill which deals with the certification of class action law suits, I feel that the true protections the Ganske-Dingell substitute would provide are of greater benefit to health care consumers, our constituents, than my concerns could justify opposing the substitute. I am hopeful that the authors of this legislation would consider working to address these concerns in conference, but with the assurance of the patient protections guaranteed in the Ganske-Dingell substitute I am pleased to support its passage.
Ms. CHRISTIAN-GREEN. Mr. Speaker, as a physician, it is very important to me that we pass meaningful managed care reform, and that means passing the Ganske-Dingell bill.
Anyone who has heard me speak on health care issues has heard my concern about those Americans who are under or un-insured, because they are denied access to medical care.
Well Mr. Speaker, what the current managed care system has done is made a bad system worse.
Now even people who have insurance under managed care are being denied access to needed and appropriate medical care.
Mr. Speaker this has to change and the Ganske-Dingell bill--the Patients' Bill of Rights is the bill which will provide that access.
Further Mr. Speaker, if a health plan makes a decision about patient care and something goes wrong, it must be liable. To do anything less is patently unfair.
Mr. Speaker and colleagues, lets fix the mangled care system. Pass the Ganske-Dingell bipartisan bill.
Mr. CONYERS. Mr. Speaker, I rise today to oppose the Republican attack on the health care of millions of Americans. The Republican bill, which had no public hearings, no committee markup, and no CBO estimate of its costs is a slapdash, thrown together, cynical attempt to satisfy the American people's hunger for real managed care reform.
This Republican bill is a lie. It is titled the Patient Protection Act, but it has nothing to do with patient protection. This bill is all about protecting insurance companies from angry and injured patients who have been denied care because, in the view of their insurance company, their treatment was not ``medically necessary.'' Why are the Republicans trying to keep insurance companies from being held accountable for their mistakes? No other industry has the right to the same immunity from suit that insurance companies have, and no other industry should have that immunity. The thousands of men, women, and children across this country who have been hurt by an insurance company decision are crying out for justice, and we as their representatives should provide them with a way to achieve that justice.
The Dingell bill provides them with this justice. This bill will ensure that the next time an insurance bureaucrat has to decide whether a child he has never seen needs life saving treatment, he will think twice, instead of denying the treatment out of hand.
We need to reform the insurance industry, and make insurance companies care about the health of the patients that they cover. Our bill does this. Don't vote for the Republican's cynical lie. I urge my colleagues to support the Dingell bill, and provide Americans with the health justice they need and deserve.
Ms. LEE. Mr. Speaker, I rise in strong support of H.R. 3605, The Patients' Bill of Rights. Today we see appalling, devastating problems with HMO's. Instead of concern for patients, too many HMO's focus on making money at the expense of quality health care. They have denied medical procedures that they decide ``unnecessary'', even though patients' lives may have depended on them. They have refused to pay for medical procedures for children with terrible deformities, calling the operations ``cosmetic''. They have even taken away a doctor's right to authorize crucial procedures, dangerously yielding the most important decision-making responsibilities to a bureaucrat in an office building 3,000 miles away.
The Patients' Bill of Rights is a comprehensive bill which makes certain that health care providers do what is in the best interests of their customers, not their profits. It guarantees basic rights for all patients, placing health, well-being, and safety above all else, and valuing the patient-doctor relationship. Among the most important aspects of the bill is that it allows doctors, not insurance companies, to make crucial decisions regarding the health of patients. Another important safeguard in the bill guarantees that individuals are covered for all emergency services. No one should have to worry about insurance coverage for life-saving emergency care.
Furthermore, and very significant, the Patients' Bill of Rights calls for internal and external appeals processes to adequately address patients' grievances. These processes are crucial because they ensure that insurance companies are held accountable for providing quality care to people, or required to pay the consequence.
In contrast, H.R. 4250, the Republican version of a healthcare bill, is a vague and inadequate measure that fails to address many of the vital problems in the healthcare industry. Failing to focus on the needs of patients, it favors the multibillion-dollar insurance industry. Under H.R. 4250, insurance companies will not be held accountable for decisions that cause injury to a patient. Crucial health decisions will continue to be made by the patient's insurance company rather than the doctor. The Republican plan does not put patients first, but rather, serves insurance companies' interests at the cost of quality health care.
Furthermore, whereas the Patients' Bill of Rights expands healthcare to include provisions for patients who are seriously ill or require the expertise of the specialist, such as victims of HIV and cancer, the Republican plan puts at risk even the most basic and necessary measures. In my home state of California, current benefits such as mammography and cervical cancer screening, prenatal care, and mental health care could be overridden by H.R. 4250. It is unthinkable to me that these essential, preventative measures are threatened in this legislation. This would be a drastic step backward in caring for our people, and a further example of cutting cost at the expense of patient care.
Mr. Speaker, I have heard some of my colleagues on the other side of the aisle connect our current U.S. health care system to capitalism, stating that capitalism produces excellence in health care. This misguided mentality is frightening to me. Capitalism affords excellent healthcare only to the select few who are able to pay the most for it, and leaves all others without. This principle of the profit-making, market system is a devastating policy for health care. Health care is not a luxury to be afforded to the highest bidder. Providing health care is not about striving to make the greatest amount of money.
Health care is a basic right that all Americans deserve, yet the United States is the only Western industrialized country that does not have a national health program. In a wealthy nation such as ours, it is incredible to me that there are so many who lack access to this fundamental necessity. The Republican plan will serve only to increase the rift between those who have access to health care and those who are left behind, neglected and trapped without adequate care.
I urge your opposition of H.R. 4250 and support of H.R. 3605, the Patients' Bill of Rights.
Mr. ALLEN. Mr. Speaker, I rise in support of the Ganske-Dingell substitute to H.R. 4250, the Republican HMO health care bill.
We have an opportunity in this Congress to enact real reform in our health care system. Months ago, Democrats introduced the Patients' Bill of Rights Act to protect patients against HMO abuses. Now that we are a few months away from an election, the Republicans have decided that they need their own version of a managed care ``reform'' bill.
This republican bill is being rushed to the House floor without the benefit of even one public hearing or any committee mark-up. As of 1 a.m. this morning, this bill was still being drafted.
While the Republican leadership has been willing to spend more than a year and millions of dollars on committee investigations, they are not willing to allow even one hearing on legislation which could significantly affect Americans' lives.
Health care financing is in transition. Private and public purchasers of health care are turning to managed care.
The shift to managed care has raised concerns about the implications for health care quality. I believe that managed care must be more than managed cost.
Last month I held community health care forums in my district. This was an opportunity for my constituents to come and share their experiences. I wanted to hear from them about health care costs, quality and access for Maine children and families.
I did not hear the managed care horror stories to the extent that many of my colleagues have heard. Maine has been slow to move to managed care. People did, however, express their fears about this system.
I heard from a mother who works an extra job to pay for an indemnity health insurance policy for her daughter who has a severe disability. It was clear that purchasing this health plan was a financial hardship for this family. This mother was too fearful to move to a managed care plan which may be less expensive because it could limit the care that her daughter needs.
Others also shared their concerns about managed care. Could some of the same horror stories that they hear about on the national news happen to them?
My constituents are not alone in their fears about managed care. There is a crisis of confidence in American health care:
Eighty percent of all consumers believe that insurance plans often compromise the quality of care to save money.
The worst problems are often reported by those who need good care the most--those with chronic conditions who experienced an illness serious enough to require hospitalization. More than one half of this group reported problems with their health insurance.
36 percent said that their condition worsened as a result of the insurance problem.
35 percent said the problem led to an additional condition,
And 17 percent developed permanent disabilities. Problems ranged from delays in care to failure to refer to a specialist to problems with payment, billing, and coverage.
As I mentioned, Maine has not moved to managed care as rapidly as other areas. Furthermore, strong patient protections have been enacted at the state level. However, because of federal preemptions to state protections, at least 250,000 people in Maine are left unprotected. My constituents recognize that we need a national solution to a national problem.
The Republican legislation only applies to Americans in self insured plans. They ignore two-thirds of Americans with private health insurance. This means that Americans with individual policies, state and local government employees and people whose employers purchase coverage through an HMO or insurance policy are left unprotected. 113 million Americans are left out in the cold by the Republican bill.
The Republican bill is clearly designed for political cover rather than real patient protections. For example, the Republican bill does not:
Provide patients with access to clinical trials;
Permit doctors to prescribe prescription drugs that are not on an HMO's predetermined list;
Provide ongoing access to specialty care;
Protect health care workers who report quality problems;
Provide choice of doctors within a plan; or
Hold managed care plans accountable when a patient is injured by a plan's decision to withhold or limit care.
By contrast, the Patients' Bill of Rights Act does provide all of these protections.
In addition to empty promises, the Republican bill is laced with poison pills such as healthmarts and malpractice limits.
I plan to hold more community health care forums in my district during the August in district work period. It is my sincere hope that I will be able to assure my constituents that they do not need to fear the health care system in this country.
The American people have been clear. They want real protections. They do not want a watered down bill. They want the Ganske-Dingell substitute, the Patients' Bill of Rights Act.
Ms. KILPATRICK. Mr. Speaker, I rise today in strong, unequivocal and clear support of H.R. 3605, the Democratic Patient Protection Act, and oppose H.R. 4250, the Republican Politician Protection Act. The Republican Politician Protection Act provides too few patient protections, undermines existing state consumer protections, has not had a single hearing or mark-up, and contains unnecessary and irrelevant provisions. It is time that we, the Congress, stopped playing games with the health care of our constituents and get down to the real business of providing both doctors and patients with the protections that they need and deserve. I recently had a meeting with the Michigan State Medical Society, an organization made up of doctors in the State of Michigan, and they wholeheartedly endorse the Democratic Patient Protection Act, among more than 50 consumer protection, labor union, and health care organizations.
Let me take a minute to explain to you three key differences between the Democratic Patient Protection Act and the Republican Politician Protection Act:
The Republican Politician Protection Act allows medical insurance companies to give your confidential medical records to another agency--
another insurance company, mortgage company, credit bureau, pharmacy, or health care bureaucrat--without your consent. This means that anyone--a person applying for a mortgage, someone looking to peer through your medical history before you start a job, a person looking for negative health information against a potential candidate for Congress--could have access to your medical records. The Democratic Patient Protection Act protects the confidentiality of your medical records. No one would be allowed to review or transfer your records without your express and written consent.
The Politician Protection Act usurps and supersedes state consumer protections. Mr. Speaker, before I was elected to this august body, I served for 18 years as a state legislator in the great State of Michigan. I abhorred and detested those rules, laws and regulations that superseded our rules, laws and regulations that were democratically arrived at and after many hearings, debate, and votes. Ostensibly, the Republican Party is one of respecting the rights of states to make the best decisions for themselves--or has posited themselves as such. The Republican Politician Protection Act would not allow states to decide for themselves the best consumer protections for their citizens. The Democratic Patient Protection Act does not usurp state law.
The Republican Politician Protection Act does not allow patients to sue their health insurance plans for wrongdoing. The Republican Politician protection act allows persons to sue for fiduciary damages, but not for pain and suffering or punitive damages. What does this mean? Well, it means that if your doctor in a managed care plan recommends that you have an additional mammogram, but the plan refuses to pay for it and the patient dies as a result, the family could sue for the cost of the mammogram. The Democratic Patient Protection Act will ensure that patients can sue for compensatory and punitive damages, and let a jury--the same juries who register to vote and send us to Congress--
decide the merits of these issues.
Adoption of the Democratic Patient Protection Act would be only a first step toward solving our health care crisis. We still need to address the more than 4 million families, women, children and adults over the past decade who do not have any health insurance. Guess who is footing the bill when these uninsured women, children and adults show up at the hospitals of our nation? That's right, you and I. Access to quality health care, before catastrophic diseases attack, has been proven to prolong the length and quality of life of Americans. The challenge of serving those persons who do not have access to health care is one of the many unfinished tasks facing us as a Congress and as a nation as we consider the reform of our health care system.
If you think that you don't know someone who is medically underserved, think again. The usual person who is defined as
``medically underserved'' is poor, elderly, has no health care, and does not have access to primary care physicians. In our land of plenty, over 43 million people are medically underserved, and only 24 percent of those persons are served through community health centers. What happens to more than three quarters of these people who do not have access to health care is simply this: immunizations are not given, and babies fall ill to preventable diseases; elderly citizens do not get their high blood pressure or diabetes cared for, and end up in the hospital, or women do not get a life-saving mammogram. Not having any health care, in our land of plenty, is almost criminal.
Taxpayers want, and need, long-range solutions to the challenge of access to affordable, quality health care. Taxpayers deserve an investment of resources and commitment to the goal of health care for all. It is the job and duty of Congress to address this issue now. The doors of health care must remain open to protect the public health, prevent disease, improve our quality of life and save scarce taxpayer dollars. Congress can, and must, improve access to health care for all. The Democratic Patient Protection Act is a strong, aggressive step toward the much needed reform of our health insurance system, but it is only a first step. I urge all of my colleagues to reject the Republican Politician Protection Act and vote for the Democratic Patient Protection Act.
The SPEAKER pro tempore (Mr. Kolbe). The question is on the amendment in the nature of a substitute offered by the gentleman from Michigan
(Mr. Dingell).
The question was taken; and the Speaker pro tempore announced that the noes appeared to have it.
Mr. DINGELL. Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
The vote was taken by electronic device, and there were--yeas 212, nays 217, not voting 6, as follows:
YEAS--212
AbercrombieAckermanAllenAndrewsBaeslerBaldacciBarciaBarrett (WI)BecerraBentsenBermanBerryBilbrayBishopBlagojevichBlumenauerBoehlertBoniorBorskiBoswellBoucherBoydBrady (PA)Brown (CA)Brown (FL)Brown (OH)CappsCardinCarsonClayClaytonClementClyburnConditConyersCostelloCoyneCramerCummingsDannerDavis (FL)Davis (IL)DeFazioDeGetteDelahuntDeLauroDeutschDicksDingellDixonDoggettDooleyDoyleEdwardsEngelEshooEtheridgeEvansFarrFattahFazioFilnerForbesFoxFrank (MA)FrostFurseGanskeGejdensonGephardtGoodeGordonGreenGutierrezHall (OH)Hall (TX)HamiltonHarmanHastings (FL)HefnerHilliardHincheyHoldenHooleyHornHoyerJackson (IL)Jackson-Lee (TX)JeffersonJohnJohnson (WI)Johnson, E. B.KanjorskiKapturKennedy (MA)Kennedy (RI)KennellyKildeeKilpatrickKind (WI)KleczkaKlinkKucinichLaFalceLampsonLantosLaTouretteLeachLeeLevinLewis (GA)LipinskiLofgrenLoweyLutherMaloney (CT)Maloney (NY)MantonMartinezMascaraMatsuiMcCarthy (MO)McCarthy (NY)McDermottMcGovernMcHaleMcIntyreMcKinneyMcNultyMeehanMeek (FL)Meeks (NY)MenendezMillender-McDonaldMiller (CA)MingeMinkMoakleyMollohanMoran (VA)MorellaMurthaNadlerNealOberstarObeyOlverOrtizOwensPallonePascrellPastorPaynePelosiPeterson (MN)PickettPomeroyPoshardPrice (NC)RahallRangelReyesRiversRodriguezRoemerRothmanRoukemaRoybal-AllardRushSaboSanchezSandersSandlinSawyerSchumerScottSerranoShermanSisiskySkaggsSkeltonSlaughterSmith, AdamSnyderSprattStabenowStarkStenholmStokesStricklandStupakTannerTauscherTaylor (MS)ThompsonThurmanTierneyTorresTownsTraficantTurnerVelazquezVentoViscloskyWatersWatt (NC)WaxmanWexlerWeygandWiseWoolseyWynn
NAYS--217
AderholtArcherArmeyBachusBakerBallengerBarrBarrett (NE)BartlettBartonBassBatemanBereuterBilirakisBlileyBluntBoehnerBonillaBonoBrady (TX)BryantBunningBurrBurtonBuyerCallahanCalvertCampCampbellCanadyCannonCastleChabotChamblissChenowethChristensenCobleCoburnCollinsCombestCookCookseyCoxCraneCrapoCubinCunninghamDavis (VA)DealDeLayDiaz-BalartDickeyDoolittleDreierDuncanDunnEhlersEhrlichEmersonEnglishEnsignEverettEwingFawellFoleyFossellaFowlerFranks (NJ)FrelinghuysenGalleglyGekasGibbonsGilchrestGillmorGilmanGingrichGoodlatteGoodlingGossGrahamGrangerGreenwoodGutknechtHansenHastertHastings (WA)HayworthHefleyHergerHillHillearyHobsonHoekstraHostettlerHoughtonHulshofHunterHutchinsonHydeInglisIstookJenkinsJohnson (CT)Johnson, SamJonesKasichKellyKimKing (NY)KingstonKlugKnollenbergKolbeLaHoodLargentLathamLazioLewis (CA)Lewis (KY)LinderLivingstonLoBiondoLucasManzulloMcCollumMcCreryMcDadeMcHughMcInnisMcIntoshMcKeonMetcalfMicaMiller (FL)Moran (KS)MyrickNethercuttNeumannNeyNorthupNorwoodNussleOxleyPackardPappasParkerPaulPaxonPeasePeterson (PA)PetriPickeringPittsPomboPorterPortmanPryce (OH)QuinnRadanovichRamstadRedmondRegulaRiggsRileyRoganRogersRohrabacherRos-LehtinenRoyceRyunSalmonSanfordSaxtonScarboroughSchaefer, DanSchaffer, BobSensenbrennerSessionsShadeggShawShaysShimkusShusterSkeenSmith (MI)Smith (NJ)Smith (OR)Smith (TX)Smith, LindaSnowbargerSolomonSouderSpenceStearnsStumpSununuTalentTauzinTaylor (NC)ThomasThornberryThuneTiahrtUptonWalshWampWatkinsWatts (OK)Weldon (FL)Weldon (PA)WellerWhiteWhitfieldWickerWilsonWolfYoung (AK)
NOT VOTING--6
FordGonzalezHinojosaMarkeyYatesYoung (FL)
{time} 1352
Messrs. WHITE and EHLERS changed their vote from ``yea'' to ``nay.''
Ms. BROWN of Florida, Mr. SCHUMER and Mr. BOYD changed their vote from ``nay'' to ``yea.''
So the amendment in the nature of a substitute was rejected.
The result of the vote was announced as above recorded.
personal explanation
Mr. HINOJOSA. Mr. Speaker, during rollcall vote No. 336, The Dingell Substitute to H.R. 4250, I was unavoidably detained. Had I been present, I would have voted ``yes.''
The SPEAKER pro tempore (Mr. Kolbe). Pursuant to House Resolution 509, the previous question is ordered on the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was read the third time.
Motion to Recommit Offered by Mr. Berry
Mr. BERRY. Mr. Speaker, I offer a motion to recommit.
The SPEAKER pro tempore. Is the gentleman from Arkansas opposed to the bill?
Mr. BERRY. Yes, Mr. Speaker, in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to recommit.
The Clerk read as follows:
Mr. Berry moves to recommit the bill H.R. 4250 to the Committee on Ways and Means and to the Committee on Education and the Workforce with instructions to report back the same to the House forthwith with the following amendments to the portions of the same within their respective jurisdiction:
Page 38, beginning on line 9, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 39, beginning on line 16, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 48, beginning on line 17, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 53, beginning on line 17, strike ``meets, under the facts and circumstances at the time of the determination, the plan's requirement for medical appropriateness or necessity'' and insert ``is, under the facts and circumstances at the time of the determination, medically necessary and appropriate''.
Page 60, line 17, strike all that follows the first period.
Page 60, after line 17, insert the following new subparagraph:
``(V) Medical necessity and appropriateness.--The term
`medically necessary and appropriate' means, with respect to an item or service, an item or service determined by the treating physician (who furnishes items and services under a contract or other arrangement with the group health plan or with a health insurance issuer providing health insurance coverage in connection with such a plan), after consultation with a participant or beneficiary, to be required, according to generally accepted principles of good medical practice, for the diagnosis or direct care and treatment of an illness or injury of the participant or beneficiary.''.
Page 227, strike line 1 and all that follows through page 233, line 3, and insert the following (and conform the table of contents accordingly):
Subtitle C--Deduction for Health Insurance Costs of Self-Employed
Individuals
SEC. 3201. DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF-
EMPLOYED INDIVIDUALS.
(a) In General.--The table contained in subparagraph (B) of section 162(l)(1) of the Internal Revenue Code of 1986 is amended to read as follows:
In the case of taxable years beginning in The applicable
calendar year: percentage is:
1999, 2000, and 2001................................60 percent
2002................................................70 percent
2003 or thereafter...............................100 percent.''
(b) Effective Date.--The amendment made by subsection (a) shall apply to taxable years beginning after December 31, 1998.
Mr. BERRY (during the reading). Mr. Speaker, I ask unanimous consent that the motion to recommit be considered as read and printed in the Record.
The SPEAKER pro tempore. Is there objection to the request of the gentleman from Arkansas?
Mr. HASTERT. Mr. Speaker, I object.
The SPEAKER pro tempore. Objection is heard.
The Clerk will continue to read.
The Clerk continued reading the motion to recommit.
Mr. HASTERT. Mr. Speaker, I reserve all points of order.
The SPEAKER pro tempore. The gentleman reserves a point of order.
The gentleman from Arkansas (Mr. Berry) is recognized for 5 minutes.
Mr. BERRY. Mr. Speaker, my motion makes the following two important changes: It strikes the Medical Savings Account provision from the Republican bill, saving billions of dollars a year.
The money saved in the MSA will be used to accelerate the health insurance deduction for the self-employed. This helps small businessmen by increasing the deduction for expenditures on health insurance to 60 percent in the next 3 years, 70 percent in the year 2002, and 100 percent thereafter.
The current deduction is 45 percent and will not increase to 100 percent until the year 2006.
It amends the Republican bill by putting the decision of ``medical necessity'' back in the hands of doctors. The new language allows for the doctor and the patient, not the insurance companies, to determine the proper care and treatment for the patient.
{time} 1400
It also makes sure the care they receive is consistent with good medical practice, not insurance profits. The Republican version leaves this decision up to the insurance companies. The Republican bill would create a system where the insurance company would win every time. The deck is stacked against the patients before they even get in to see their doctor.
The bill would allow insurers to develop their own definitions and methods for determining medical necessity, which would make it virtually impossible for enrollees to challenge the plan's decision. A plan could define medical necessity to essentially be nothing more than the care defined under whatever treatment guidelines and utilization protocols the plan adopts, even if the guidelines and protocols are not backed up by any clinical evidence or good professional practice. Plans would always win under this scenario. The Republican bill would allow insurers to overturn physicians' treatment decisions on the basis of completely arbitrary standards that are not based on any credible medical evidence.
I do not think that that is the kind of care that we want for our families, our children, our parents or our friends. But that is just what this Republican bill would allow.
I yield to the gentleman from Michigan (Mr. Dingell).
Mr. DINGELL. Mr. Speaker, I thank the gentleman for yielding to me. I would observe that here we are discussing the fundamental difference between the two bills. If you want to provide protection for the doctor-patient relationship, vote for the motion to recommit, because the motion to recommit assures that it will be medical necessity decided by the doctor that determines the course of treatment of a patient of an HMO, not some curious, insurance-oriented approach which would be decided by the Republican plan.
One of my friends who is one of the outstanding physicians and surgeons in the 16th District called me to tell me about something that happened to him recently. He was made an examiner of medical claims. He was fired by the HMO. The reason was that he was making medical decisions, not insurance decisions. That is exactly the issue which is before us.
If you want the doctor to decide what you and your family and your constituents are going to receive in the way of medical care, vote for the motion to recommit. If you want to have an unelected, unaccountable health care bureaucrat appointed by a health insurance company or an HMO, then vote against it. And what you will be doing, you will be vesting in the HMO the power to make a medical decision instead of seeing to it that that medical decision is made by the doctor in concert with his patient. Medical necessity should be decided by a doctor who is trusted by the patient, not by an unknown voice on the telephone who is neither doctor nor accountable, a health care bureaucrat. That is the point of this amendment.
If you believe in the doctor-patient relationship and if you believe it is worth protecting, then vote ``aye'' on the motion to recommit. That is what is at stake, the doctor-patient relationship, and the doctor making a decision with regard to what constitutes medical necessity and what constitutes the need of the patient. To vote ``no'' on this motion to recommit is to assure that medical necessity is decided by an anonymous voice on the telephone belonging to no one with a relationship to the patient.
Point of Order
The SPEAKER pro tempore (Mr. Kolbe). Does the gentleman from Illinois insist on a point of order?
Mr. HASTERT. Mr. Speaker, I insist on a point of order.
The SPEAKER pro tempore. The gentleman will state his point of order.
Mr. HASTERT. I yield to the gentleman from California (Mr. Thomas).
The SPEAKER pro tempore. The Chair will recognize the gentleman from California (Mr. Thomas) on the point of order.
Mr. THOMAS. Mr. Speaker, contained among the numerous provisions in the motion to recommit is striking the medical savings accounts. Notwithstanding the gentleman's representation that this will save billions of dollars a year, the Congressional Budget Office says that simply is not so. In fact, it will save less than $1 billion a year. That is the point on which the point of order turns, because the gentleman's addition of the acceleration of the self-employed deduction in fact scores more than $1 billion and therefore is subject to a 303 Congressional Budget Act point of order. It in fact increases the budget before the final budget is adopted in a given fiscal year. It applies clearly in this particular instance. A point of order, therefore, lies against the gentleman and I would urge the Chair to sustain the 303(a) Congressional Budget Act point of order.
The SPEAKER pro tempore. The gentleman from California has made a point of order.
Does the gentleman from Arkansas (Mr. Berry) wish to be heard on the point of order?
Does the gentleman from Maryland (Mr. Cardin) wish to be heard on the point of order?
Mr. CARDIN. Yes, I do, Mr. Speaker.
The SPEAKER pro tempore. The gentleman from Maryland is recognized on the point of order.
Mr. CARDIN. If I understand the gentleman from California's point is that the striking of the medical savings account provision would not save as much money as accelerating the self-employed insurance deduction by 4 years.
Mr. Speaker, I would like to include in the Record a document that has been received from the Joint Committee on Taxation that shows that striking the medical savings account provision will save $4.1 billion, the self-employed health insurance deduction would cost $3.4 billion, for a net revenue savings to the treasury of $687 million.
The SPEAKER pro tempore. The gentleman from Maryland may insert the documents after the point of order but not during debate on the point of order.
Is there any other Member who wishes to be heard on the point of order?
Mr. CARDIN. Mr. Speaker, on that point, if I am correct, the point of order is being raised as it relates to having----
The SPEAKER pro tempore. That is correct. The Chair must rely on what is being said to the Chair and so insertion into the Record during the debate on the point of order is not in order at this time.
Mr. CARDIN. I would just quote into the record the document from the Joint Committee on Taxation dated July 23, 1998, and would be glad to make it available to the Parliamentarian.
The SPEAKER pro tempore. Does any other Member wish to be heard?
Mr. THOMAS. Mr. Speaker, on the point just registered, this is the House and not the Senate. The Senate just read 10-year numbers, the House operates on 5-year numbers, and the point of order still stands.
Mr. CARDIN. Mr. Speaker, let me put into the record the 5-year numbers. The 5-year numbers on striking the medical savings account provision would save $1.3 billion, the self-employed would cost $1.2 billion, for a net savings to the treasury of $56 million.
The SPEAKER pro tempore. Is there any other Member who wishes to be heard on the point of order? If not, the Chair is prepared to rule.
Mr. THOMAS. Mr. Speaker, the gentleman is reading from a document that I do not believe is current. Would he cite the number and the date?
Mr. CARDIN. If the gentleman would yield, it is dated July 23, 1998.
Mr. THOMAS. I tell the gentleman the numbers I just read come from a Joint Tax Committee publication July 24, 1998. But the gentleman is not bad being only one day behind.
Mr. CARDIN. Mr. Speaker, I have the July 25 numbers.
The SPEAKER pro tempore. Does the gentleman from Illinois insist upon his point of order?
Mr. HASTERT. Mr. Speaker, I insist on my point of order.
The SPEAKER pro tempore. Does any other Member wish to be heard on the point of order? Is there anybody else who wishes to be heard on the point of order? If not, the Chair is prepared to rule.
The amendment proposed in the motion to recommit would strike one of the revenue provisions from the bill. The amendment also would insert an alternate revenue change. In this latter respect, the amendment
``provides an increase or decrease in revenues'' within the meaning of section 303 of the Budget Act.
Because this revenue change would occur during fiscal year 1999, a year for which a budget resolution has yet to be finalized, the amendment violates section 303(a)(2) of the Act.
The point of order is sustained.
Mr. CARDIN. Mr. Speaker, this is not the point raised in the objection by the Member. I do not know how the Chair can on its own use as a basis for an appeal that was not raised and we did not have a chance to argue the point on. That is blatantly against the rules of the House, and I appeal the ruling of the Chair.
The SPEAKER pro tempore. The question is, Shall the decision of the Chair stand as the judgment of the House?
Motion to Table Offered by Mr. Armey
Mr. ARMEY. Mr. Speaker, I move to table the appeal.
The SPEAKER pro tempore. The question is on the motion to table offered by the gentleman from Texas (Mr. Armey).
The question was taken; and the Speaker pro tempore announced that the ayes appeared to have it.
Recorded Vote
Mr. ACKERMAN. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 222, noes 204, not voting 9, as follows:
AYES--222
AderholtArcherArmeyBachusBakerBallengerBarrBarrett (NE)BartlettBartonBassBatemanBereuterBilbrayBilirakisBlileyBluntBoehlertBoehnerBonillaBonoBrady (TX)BryantBunningBurrBurtonBuyerCallahanCalvertCampCampbellCanadyCannonCastleChabotChamblissChenowethChristensenCobleCoburnCollinsCombestCookCookseyCoxCraneCrapoCubinCunninghamDavis (VA)DealDeLayDiaz-BalartDickeyDoolittleDreierDuncanDunnEhlersEhrlichEmersonEnglishEnsignEverettEwingFawellFoleyFossellaFowlerFoxFranks (NJ)FrelinghuysenGalleglyGanskeGekasGibbonsGilchrestGilmanGingrichGoodlatteGoodlingGossGrahamGrangerGreenwoodGutknechtHansenHastertHastings (WA)HayworthHefleyHergerHillHillearyHobsonHoekstraHornHostettlerHoughtonHulshofHunterHutchinsonHydeInglisIstookJenkinsJohnson, SamJonesKasichKellyKimKing (NY)KingstonKlugKnollenbergKolbeLaHoodLargentLathamLaTouretteLazioLeachLewis (CA)Lewis (KY)LivingstonLoBiondoLucasManzulloMcCollumMcCreryMcDadeMcHughMcInnisMcIntoshMcKeonMetcalfMicaMiller (FL)Moran (KS)MorellaMyrickNethercuttNeumannNeyNorthupNorwoodNussleOxleyPackardPappasParkerPaulPaxonPeasePeterson (PA)PetriPickeringPittsPomboPorterPortmanPryce (OH)QuinnRadanovichRamstadRedmondRegulaRiggsRileyRoganRogersRohrabacherRos-LehtinenRoukemaRoyceRyunSalmonSanfordSaxtonScarboroughSchaefer, DanSchaffer, BobSensenbrennerSessionsShadeggShawShaysShimkusShusterSkeenSmith (MI)Smith (NJ)Smith (OR)Smith (TX)Smith, LindaSnowbargerSolomonSouderSpenceStearnsStumpSununuTalentTauzinTaylor (NC)ThomasThornberryThuneTiahrtUptonWalshWampWatkinsWatts (OK)Weldon (FL)WellerWhiteWhitfieldWickerWilsonWolfYoung (AK)
NOES--204
AbercrombieAckermanAllenAndrewsBaeslerBaldacciBarciaBarrett (WI)BecerraBentsenBermanBerryBishopBlagojevichBlumenauerBoniorBorskiBoswellBoucherBoydBrady (PA)Brown (CA)Brown (FL)Brown (OH)CappsCardinCarsonClayClaytonClementClyburnConditConyersCostelloCoyneCramerCummingsDannerDavis (FL)Davis (IL)DeFazioDeGetteDelahuntDeLauroDeutschDicksDingellDixonDoggettDooleyDoyleEdwardsEngelEshooEtheridgeEvansFarrFattahFazioFilnerForbesFrank (MA)FrostFurseGejdensonGephardtGoodeGordonGreenGutierrezHall (OH)Hall (TX)HamiltonHarmanHastings (FL)HefnerHilliardHincheyHinojosaHoldenHooleyHoyerJackson (IL)Jackson-Lee (TX)JeffersonJohnJohnson (WI)Johnson, E. B.Kanjorski KapturKennedy (MA)Kennedy (RI)KennellyKildeeKilpatrickKind (WI)KleczkaKlinkKucinichLaFalceLampsonLantosLeeLevinLewis (GA)LipinskiLofgrenLoweyLutherMaloney (CT)Maloney (NY)MantonMartinezMascaraMatsuiMcCarthy (MO)McCarthy (NY)McDermottMcGovernMcHaleMcIntyreMcKinneyMcNultyMeehanMeek (FL)Meeks (NY)MenendezMillender-McDonaldMiller (CA)MingeMinkMoakleyMollohanMoran (VA)MurthaNadlerNealOberstarObeyOlverOrtizOwensPallonePascrellPastorPaynePelosiPeterson (MN)PickettPomeroyPoshardPrice (NC)RahallRangelReyesRiversRodriguezRoemerRothmanRoybal-AllardRushSaboSanchezSandersSandlinSawyerSchumerScottSerranoShermanSisiskySkaggsSkeltonSlaughterSmith, AdamSnyderSprattStabenowStarkStenholmStokesStricklandStupakTannerTauscherTaylor (MS)ThompsonThurmanTierneyTorresTownsTraficantTurnerVelazquezVentoViscloskyWatersWatt (NC)WaxmanWexlerWeygandWiseWoolseyWynn
NOT VOTING--9
FordGillmorGonzalezJohnson (CT)LinderMarkeyWeldon (PA)YatesYoung (FL)
{time} 1428
So the motion to table was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Motion to Recommit Offered by Mr. Berry
Mr. BERRY. Mr. Speaker, I offer a motion to recommit.
The SPEAKER pro tempore (Mr. Kolbe). Is the gentleman still opposed to bill?
Mr. BERRY. Mr. Speaker, in its current form, I am.
The SPEAKER pro tempore. The Clerk will report the motion.
The Clerk read as follows:
Mr. Berry moves to recommit the bill H.R. 4250 to the Committee on Education and the Workforce with instructions to report back the same to the House forthwith with the following amendments:
Page 38, beginning on line 9, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 39, beginning on line 16, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 48, beginning on line 17, strike ``does not meet the plan's requirements for medical appropriateness or necessity'' and insert ``is not medically necessary and appropriate''.
Page 53, beginning on line 17, strike ``meets, under the facts and circumstances at the time of the determination, the plan's requirement for medical appropriateness or necessity'' and insert ``is, under the facts and circumstances at the time of the determination, medically necessary and appropriate''.
Page 60, line 17, strike all that follows the first period.
Page 60, after line 17, insert the following new subparagraph:
``(V) Medical necessity and appropriateness.--The term
`medically necessary and appropriate' means, with respect to an item or service, an item or service determined by the treating physician (who furnishes items and services under a contract or other arrangement with the group health plan or with a health insurance issuer providing health insurance coverage in connection with such a plan), after consultation with a participant or beneficiary, to be required, according to generally accepted principles of good medical practice, for the diagnosis or direct care and treatment of an illness or injury of the participant or beneficiary.''.
Mr. BERRY (during the reading). Mr. Speaker, I ask unanimous consent that the motion be considered as read and printed in the Record.
The SPEAKER pro tempore. Is there objection to the request of the gentleman from Arkansas?
Mr. HASTERT. Mr. Speaker, I object.
The SPEAKER pro tempore. Objection is heard.
The Clerk will continue reading the motion.
The Clerk continued reading the motion.
Mr. HASTERT. Mr. Speaker, I reserve a point of order against the motion.
The SPEAKER pro tempore. The gentleman from Arkansas (Mr. Berry) is recognized for five minutes on his motion to recommit.
Mr. BERRY. Mr. Speaker, my motion to recommit is the same as the last motion, but deals solely with the definition of ``medical necessity.'' The motion to recommit will allow the doctor to determine what care is medically necessary. The doctor, not the insurance company, not a Federal bureaucrat, not a state bureaucrat, but the doctor, the person who went to medical school for many years to learn how to take care of you, would make that decision.
The motion to recommit would make sure that the health care that they receive from their managed care company is consistent with good medical practice, not accounting profit principles.
The motion to recommit will make sure that the decisions insurance companies are making regarding what it is or is not to be provided are supported by credible medical evidence. The motion to recommit puts medical care where it belongs, in the hands of doctors, not in the hands of Republican special interest friends.
The SPEAKER pro tempore. Does the gentleman from Illinois (Mr. Hastert) insist on his point of order?
Mr. HASTERT. Mr. Speaker, I withdraw my point of order.
The SPEAKER pro tempore. Does the gentleman from Illinois (Mr. Hastert) wish to be heard on the motion to recommit?
Mr. HASTERT. I do.
The SPEAKER pro tempore. Is the gentleman opposed to the motion?
Mr. HASTERT. I am opposed to the motion.
The SPEAKER pro tempore. The gentleman from Illinois (Mr. Hastert) is recognized for five minutes.
Mr. HASTERT. Mr. Speaker, I yield to the gentleman from Georgia (Mr. Gingrich), the Speaker of the House.
Mr. GINGRICH. Mr. Speaker, let me recapture for everybody we were are at here, because I think you have to put in context this interesting and inventive motion to recommit.
First of all, under the Patient Protection Act that will come to final passage, anybody who has a practical layman's feeling that they need emergency care, has a presumption they need it, automatically, you walk in, you say ``I have heart pain,'' or ``I have a chest pain,'' and you are covered.
When you walk in, under the Patient Protection Act, a medical doctor on the site looking at the patient makes a decision, do you need further treatment? For example, if it turns out you over-ate and in fact need bicarbonate, you probably do not get an MRI. But if they think you have a severe heart problem or they think you might have cancer, you immediately have an opportunity for whatever emergency room treatment is necessary on a medical basis defined by the medical doctor.
If you find out you have a longer-term problem, under the Patient Protection Act, if you happen to belong to an HMO that does not agree you should be treated, you immediately have an appeal internally, and within 72 hours they have to say ``yes,'' or ``no, you should get this.''
If you do not agree when they say no, you have an immediate external appeal to a medically appropriate group of specialists who fit the same topic, and they, within 72 hours, have to say yes, in fact you have pancreatic cancer, you deserve and need chemotherapy, period.
At that point, if the HMO is truly stupid, it can say they are not going to give it to you anyway, in which case you can go to court carrying with you the medical doctors who have already said you are right.
Now, that is what we do, notice at every stage; medical doctor, medical doctor, medical doctor.
But there is one hook, as I read this quite inventive proposal. I believe, and I am not a lawyer, I am just a historian, and for everybody who is grateful for a nonlawyer as Speaker, I understand it has been a rare event, but, anyway, as I understand this, from the brief few minutes we have had to look at it, this would in essence eliminate the concept of insurance coverage.
This would allow you, as worded, to walk in and have a doctor say,
``You know, I know you never paid for this insurance, I know you are not covered for this at all, but I am now going to do the following 12 medically necessary things.'' A terrific idea. It bankrupts every insurance company in America, it eliminates the employer-based system, it guarantees you go to government health care, and, literally, I do not know why you guys wrote it this way, this has no meaning in the real world, except that you would be required to get everything open-ended as long as you found a doctor somewhere who said you should get it.
Now, this is in fact one of the nuttiest expansions of the right to charge for health care I have ever seen, and I am sure it is just because they got their earlier motion, which was clever and well-
crafted, ruled out of order and they had to rush something to the floor.
I would encourage all of you, unless you want to bankrupt the whole country, just simply vote no. The details will come out later when they have a chance to rewrite it.
The SPEAKER pro tempore. Without objection, the previous question is ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that the noes appeared to have it.
Mr. BERRY. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 205, nays 221, not voting 9, as follows:
YEAS--205
AbercrombieAckermanAllenAndrewsBaeslerBaldacciBarciaBarrett (WI)BecerraBentsenBermanBerryBishopBlagojevichBlumenauerBoniorBorskiBoswellBoucherBoydBrady (PA)Brown (CA)Brown (FL)Brown (OH)CappsCardinCarsonClayClaytonClementClyburnConditConyersCostelloCoyneCramerCummingsDannerDavis (FL)Davis (IL)DeFazioDeGetteDelahuntDeLauroDeutschDicksDingellDixonDoggettDooleyDoyleEdwardsEngelEshooEtheridgeEvansFarrFattahFazioFilnerForbesFoxFrank (MA)FrostFurseGanskeGejdensonGephardtGoodeGordonGreenGutierrezHall (OH)Hall (TX)HamiltonHastings (FL)HefnerHilliardHincheyHinojosaHoldenHooleyHoyerJackson (IL)Jackson-Lee (TX)JeffersonJohnson (WI)Johnson, E. B.KanjorskiKapturKennedy (MA)Kennedy (RI)KennellyKildeeKilpatrickKind (WI)KleczkaKlinkKucinichLaFalceLampsonLantosLeeLevinLewis (GA)LipinskiLofgrenLoweyLutherMaloney (CT)Maloney (NY)MantonMartinezMascaraMatsuiMcCarthy (MO)McCarthy (NY)McDermottMcGovernMcHaleMcIntyreMcKinneyMcNultyMeek (FL)Meeks (NY)MenendezMillender-McDonaldMiller (CA)MingeMinkMoakleyMollohanMoran (VA)MorellaMurthaNadlerNealOberstarObeyOlverOrtizOwensPallonePascrellPastorPaynePelosiPeterson (MN)PickettPomeroyPoshardPrice (NC)RahallRangelReyesRiversRodriguezRoemerRothmanRoukemaRoybal-AllardRushSaboSanchezSandersSandlinSawyerSchumerScottSerranoShermanSisiskySkaggsSkeltonSlaughterSmith, AdamSnyderSprattStabenowStarkStenholmStokesStricklandStupakTannerTauscherTaylor (MS)ThompsonThurmanTierneyTorresTownsTraficantTurnerVelazquezVentoViscloskyWatersWatt (NC)WaxmanWexlerWeygandWiseWoolseyWynn
NAYS--221
AderholtArcherArmeyBachusBakerBallengerBarrBarrett (NE)BartlettBartonBassBatemanBereuterBilbrayBilirakisBlileyBluntBoehlertBoehnerBonillaBonoBrady (TX)BryantBunningBurrBurtonBuyerCallahanCalvertCampCampbellCanadyCannonCastleChabotChamblissChenowethChristensenCobleCoburnCollinsCombestCookCookseyCoxCraneCrapoCubinCunninghamDavis (VA)DealDeLayDiaz-BalartDickeyDoolittleDreierDuncanDunnEhlersEhrlichEmersonEnglishEnsignEverettEwingFawellFoleyFossellaFowlerFranks (NJ)FrelinghuysenGalleglyGekasGibbonsGilchrestGillmorGilmanGingrichGoodlatteGoodlingGossGrahamGrangerGreenwoodGutknechtHansenHarmanHastertHastings (WA)HayworthHefleyHergerHillHillearyHobsonHoekstraHornHostettlerHoughtonHulshofHunterHutchinsonHydeInglisIstookJenkinsJohnson (CT)Johnson, SamJonesKasichKellyKimKing (NY)KingstonKnollenbergKolbeLaHoodLargentLathamLaTouretteLazioLeachLewis (CA)Lewis (KY)LivingstonLoBiondoLucasManzulloMcCollumMcCreryMcDadeMcHughMcInnisMcIntoshMcKeonMetcalfMicaMiller (FL)Moran (KS)MyrickNethercuttNeumannNeyNorthupNorwoodNussleOxleyPackardPappasParkerPaulPaxonPeasePeterson (PA)PetriPickeringPittsPomboPorterPortmanPryce (OH)QuinnRadanovichRamstadRedmondRegulaRiggsRileyRoganRogersRohrabacherRos-LehtinenRoyceRyunSalmonSanfordSaxtonScarboroughSchaefer, DanSchaffer, BobSensenbrennerSessionsShadeggShawShaysShimkusShusterSkeenSmith (MI)Smith (NJ)Smith (OR)Smith (TX)Smith, LindaSnowbargerSolomonSouderSpenceStearnsStumpSununuTalentTauzinTaylor (NC)ThomasThornberryThuneTiahrtUptonWalshWampWatkinsWatts (OK)Weldon (FL)Weldon (PA)WellerWhiteWhitfieldWickerWilsonWolfYoung (AK)
NOT VOTING--9
FordGonzalezJohnKlugLinderMarkeyMeehanYatesYoung (FL)
{time} 1455
Mr. BLAGOJEVICH changed his vote from ``nay'' to ``yea.''
So the motion to table the appeal of the ruling of the Chair was rejected.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
The SPEAKER pro tempore (Mr. Kolbe). The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that the ayes appeared to have it.
Mr. DINGELL. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 216, nays 210, not voting 9, as follows:
YEAS--216
AderholtArcherArmeyBachusBakerBallengerBarrett (NE)BartlettBartonBassBatemanBereuterBilbrayBilirakisBlileyBluntBoehlertBoehnerBonoBryantBunningBurrBurtonBuyerCallahanCalvertCampCanadyCannonCastleChabotChamblissChristensenCobleCoburnCollinsCombestCookCookseyCoxCraneCubinCunninghamDannerDavis (VA)DealDeLayDiaz-BalartDickeyDoolittleDreierDuncanDunnEhlersEhrlichEmersonEnglishEnsignEverettEwingFawellFoleyFossellaFowlerFoxFranks (NJ)FrelinghuysenGalleglyGekasGibbonsGilchrestGillmorGilmanGingrichGoodeGoodlatteGoodlingGossGrahamGrangerGreenwoodGutknechtHansenHastertHastings (WA)HayworthHefleyHergerHillHillearyHobsonHoekstraHornHostettlerHoughtonHulshofHunterHutchinsonHydeInglisIstookJenkinsJohnson (CT)Johnson, SamJonesKasichKellyKimKing (NY)KingstonKnollenbergKolbeLaHoodLargentLathamLaTouretteLazioLeachLewis (CA)Lewis (KY)LivingstonLoBiondoLucasManzulloMcCollumMcCreryMcDadeMcHughMcInnisMcIntoshMcKeonMetcalfMicaMiller (FL)Moran (KS)MyrickNethercuttNeumannNeyNorthupNorwoodNussleOxleyPackardPappasParkerPaxonPeasePeterson (PA)PetriPickeringPittsPomboPorterPortmanPryce (OH)QuinnRadanovichRamstadRedmondRegulaRiggsRileyRoganRogersRohrabacherRos-LehtinenRoyceRyunSalmonSaxtonScarboroughSchaefer, DanSchaffer, BobSensenbrennerSessionsShadeggShawShaysShimkusShusterSkeenSmith (MI)Smith (NJ)Smith (OR)Smith (TX)Smith, LindaSnowbargerSolomonSouderSpenceStearnsStumpSununuTalentTauzinTaylor (NC)ThomasThornberryThuneTiahrtTraficantUptonWalshWampWatkinsWatts (OK)Weldon (FL)Weldon (PA)WellerWhiteWhitfieldWickerWilsonWolfYoung (AK)
NAYS--210
AbercrombieAckermanAllenAndrewsBaeslerBaldacciBarciaBarrBarrett (WI)BecerraBentsenBermanBerryBishopBlagojevichBlumenauerBonillaBoniorBorskiBoswellBoucherBoydBrady (PA)Brady (TX)Brown (CA)Brown (FL)Brown (OH)CampbellCappsCardinCarsonChenowethClayClaytonClementClyburnConditConyersCostelloCoyneCramerCrapoCummingsDavis (FL)Davis (IL)DeFazioDeGetteDelahuntDeLauroDeutschDicksDingellDixonDoggettDooleyDoyleEdwardsEngelEshooEtheridgeEvansFarrFattahFazioFilnerForbesFrank (MA)FrostFurseGanskeGejdensonGephardtGordonGreenGutierrezHall (OH)Hall (TX)HamiltonHarmanHastings (FL)HefnerHilliardHincheyHinojosaHoldenHooleyHoyerJackson (IL)Jackson-Lee (TX)JeffersonJohnson (WI)Johnson, E. B.KanjorskiKapturKennedy (MA)Kennedy (RI)KennellyKildeeKilpatrickKind (WI)KleczkaKlinkKucinichLaFalceLampsonLantosLeeLevinLewis (GA)LipinskiLofgrenLoweyLutherMaloney (CT)Maloney (NY)MantonMartinezMascaraMatsuiMcCarthy (MO)McCarthy (NY)McDermottMcGovernMcHaleMcIntyreMcKinneyMcNultyMeehanMeek (FL)Meeks (NY)MenendezMillender-McDonaldMiller (CA)MingeMinkMoakleyMollohanMoran (VA)MorellaMurthaNadlerNealOberstarObeyOlverOrtizOwensPallonePascrellPastorPaulPaynePelosiPeterson (MN)PickettPomeroyPoshardPrice (NC)RahallRangelReyesRiversRoemerRothmanRoukemaRoybal-AllardRushSaboSanchezSandersSandlinSanfordSawyerSchumerScottSerranoShermanSisiskySkaggsSkeltonSlaughterSmith, AdamSnyderSprattStabenowStarkStenholmStokesStricklandStupakTannerTauscherTaylor (MS)ThompsonThurmanTierneyTorresTownsTurnerVelazquezVentoViscloskyWatersWatt (NC)WaxmanWexlerWeygandWiseWoolseyWynn
NOT VOTING--9
FordGonzalezJohnKlugLinderMarkeyRodriguezYatesYoung (FL)
{time} 1512
Mr. PAUL changed his vote from ``present'' to ``nay.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________
