[Pages H5196-H5212]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

BIPARTISAN PATIENT PROTECTION ACT

The SPEAKER pro tempore. Pursuant to House Resolution 219 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the State of the Union for the consideration of the bill, H.R. 2563.

{time} 1451

In the Committee of the Whole

Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union for the consideration of the bill
(H.R. 2563) to amend the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to protect consumers in managed care plans and other health
coverage, with Mr. LaHood in the chair.
The Clerk read the title of the bill.
The CHAIRMAN. Pursuant to the rule, the bill is considered as having
been read the first time.
Under the rule, the gentleman from Louisiana (Mr. Tauzin), the
gentleman from Michigan (Mr. Dingell), the gentleman from Ohio (Mr.
Boehner), the gentleman from California (Mr. George Miller), the
gentleman from California (Mr. Thomas), and the gentleman from
California (Mr. Stark) each will control 20 minutes.
The Chair recognizes the gentleman from Louisiana (Mr. Tauzin).
Mr. TAUZIN. Mr. Chairman, I yield myself 3 minutes.
Mr. Chairman, on behalf of the Committee on Energy and Commerce, I am
pleased to open this debate on the Patient Protection Act. As you know,
the gentleman from Georgia (Mr. Norwood); the gentleman from Iowa (Mr.
Ganske); my friend, the gentleman

[[Page H5197]]

from Michigan (Mr. Dingell); and the gentleman from Arizona (Mr.
Shadegg) are all distinguished Members of the Committee on Energy and
Commerce. And they, along with many others, have labored for a long
time on this legislation, or various versions of it.
I want to also commend the work of the Speaker and the gentleman from
Kentucky (Mr. Fletcher) and the other committees of jurisdiction,
because all of them have made significant improvements in the base text
of this bill.
A concern of all of us is the needs of American families for health
coverage and health care. Let me make a point that I think is
incontrovertible, and that is that the most important patient
protection in America is access to affordable health insurance, to
health coverage, and to care.
Mr. Chairman, new costs and new litigation and new bureaucracy can,
we know, raise the cost of health care, and, therefore, the cost of
health insurance. Costs will either drive a reduction in benefit or
drive a reduction in coverage; and so, as we debate this legislation,
let us not pretend that litigation and bureaucracy and mandates are
free. While they may provide some protection for a patient, if they
raise the cost of insurance and coverage too high for other patients,
then other families lose, and those rights to coverage are lost to
Americans.
The Congressional Budget Office does not ignore these facts. They
state clearly that a significant portion of increased costs will be
borne by the purchasers switching to less expensive plans or cutting
back on benefits or, worse yet, dropping coverage. That is a sobering
point. It means that real families would do with fewer benefits and
less coverage.
According to the President's Statement of Administration Policy on
the Senate bill, for example, employers already faced an estimated 10
to 12 percent premium increase this year alone. The statement also
notes that employers tend to drop coverage for their workers, for
roughly 500,000 individuals, when health care premiums increase by a
mere 1 percent. Some estimates have put the number of individuals whose
insurance would drop by this bill as high as 6.5 million. That is
simply unacceptable.
Employer-sponsored health care, remember, is voluntary, it is not
mandatory; and we should not make employers choose between reducing
benefits and maintaining health coverage for their employees. Employer-
sponsored health insurance is still voluntary in America, and
increasing health costs will prompt employers to drop coverage or
insurance.
The legislation that does the best job of preserving access to
insurance and minimizing costs, while protecting patients' rights to
their coverage, is obviously the best balanced bill; and that is what
we will search for today. That means both eliminating unnecessary
bureaucracy, litigation and cost; and that is why we will support the
amendment the gentleman from Georgia (Mr. Norwood) has worked out with
the President of the United States to, in fact, amend this section to
make sure we do not unnecessarily drive up insurance costs. I want to
commend my friend, the gentleman from Georgia (Mr. Norwood), for that
excellent work.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Ohio (Mr. Brown).
Mr. BROWN of Ohio. Mr. Chairman, I thank my friend from Michigan for
yielding me time.
Mr. Chairman, in case the President has forgotten, the House of
Representatives is the people's House. The people's House. It is not
the insurance industry's House. We do not report to Aetna or to
Prudential or to Blue Cross/Blue Shield or to Golden Rule; we report to
the people, our districts, and the people of this country. Our job is
to do what is in the best interests of the individuals we serve. It is
not to sustain the health insurance industry's privileged position
above the law.
For over 4 years, my friends, the gentleman from Michigan (Mr.
Dingell) and the gentleman from Iowa (Mr. Ganske), have been repeating
the same simple message: if HMOs face no consequences when they put
consumers through the wringer, then HMOs will continue to put consumers
through the wringer.
Making HMOs face the consequences is not going to lead to
skyrocketing insurance rates. For example, in the 3 years Texas has
allowed HMO enrollees to sue, there has been only a handful of
lawsuits. The right has not led to a flood of lawsuits or to higher
premiums; it has led to legitimate health insurance, insurance that
actually covers what it says it will cover. The key to addressing the
problems so many of our constituents face when dealing with their
insurer is to hold HMOs accountable for their actions.
There is only one bill on the floor today that does not emasculate
the external review and right to sue provisions to the point of
meaningless mess. The Ganske-Dingell bill is the only bill on the floor
today that does what it says it will do. It changes the rules of the
game so that HMOs will not cheat the public. Unfortunately, the
Fletcher bill and the Norwood-Bush bill cheat the public to protect
insurance company HMOs.
For more than 4 years, the public has been asking us to do something
about HMOs that treat enrollees like an unwanted liability, rather than
a paying patient. Putting the shoe on the other foot, making HMOs
liable for the harm they do, is the best way to change their behavior.
This is our chance to do the people's bidding. Let us do it.
Mr. TAUZIN. Mr. Chairman, I am pleased to yield 2 minutes to the
gentleman from Florida (Mr. Bilirakis), the chairman of the
Subcommittee on Health of the Committee on Energy and Commerce.
Mr. BILIRAKIS. Mr. Chairman, I thank the gentleman for yielding me
time.
Mr. Chairman, I rise today in support of patients. I rise today in
support of Americans who deserve a health care system that works for
them. My work in this body, as so many know, has focused on health care
issues, and I have worked hard with many of my colleagues to improve
the quality of health care for all Americans.
One of the most important things we can do this Congress is pass
strong patient protection legislation which can be signed into law. We
must work to ensure that a Patients' Bill of Rights will become law.
Two years ago this Chamber hosted a similar debate which most of you
remember. We are back again considering legislation to improve the
quality and availability of health care for all Americans. Enactment of
patient protections would immediately improve the quality of care for
millions of Americans, and that is why we must work together to secure
passage of patient protection legislation this year.

{time} 1500

In past debates, I chastised an administration that stubbornly,
stubbornly rejected anything short of its own proposal for health
reform. I argued that ``The price of such intransigence would again be
paid by patients across the country,'' and it was.
Now I am proud to stand before my colleagues today and support
patient protection legislation that has bipartisan support and, most
importantly, the support of a President who was willing to listen and
to compromise. The leadership of President Bush, of the gentleman from
Illinois (Mr. Hastert), the Speaker of the House, and of the gentleman
from Georgia (Mr. Norwood), my very good friend, have been invaluable
in getting us to this point.
As I quoted in a recent Dear Colleague: ``It is not enough to do
good; one must do it the right way.'' Compromise is the right way, and
I support patients' rights by supporting the amendments to the Ganske
bill. An all-or-nothing attitude is unacceptable. Let us do good for
our constituents now.
I challenge those who support patients' rights. Put people ahead of
politics and work with us, not against us, to achieve this goal.
Mr. DINGELL. Mr. Chairman, I yield myself 3 minutes.
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. Mr. Chairman, in the 40-plus years I have served here, I
have never seen such a remarkable situation. Last night, we were
presented with a piece of legislation that no one had ever seen before.
The proponent thereof could not explain it, did not

[[Page H5198]]

know what is in it. We will see it later today. I hope at that time he
has a better appreciation of what his proposal does.
It will be offered as an amendment to the bill, H.R. 2563, the
Bipartisan Patient Protection Act. It is my hope that the House will
pass this bill, send it to the Senate, and we can afford American
patients a decent level of protection.
One thing has remained constant: We need strong, enforceable,
meaningful patient protections. The base bill is a good bill. It is the
right one for millions of Americans who suffer denial, delay, and
injuries at the hands of HMOs who are, like foreign diplomats, totally
exempt from lawsuits, a unique class in our society.
This bill would have seen to it that the rights of Florence Corcoran,
who lost her baby due to a bad HMO medical decision, would have had
relief. It would have helped Basile Pappas, who was denied proper
treatment, and it would have prevented permanent quadriplegia as a
result of an HMO's refusal to approve covered treatment. The bill would
have helped another gentleman, Mr. Lancaster, who was arbitrarily
denied coverage for in-patient psychiatric treatment and instead was
sent home, where he committed suicide.
None of these protections in the bill means anything without the
ability to see to it that they are enforced. Enforcement of rights is
everything, and rights without a measure to enforce them are totally
meaningless.
HMOs that make bad medical decisions should be treated no differently
than any other wrongdoer, and when they engage in the practice of
medicine, they should be treated the same as doctors. But they seek
special treatment, an exemption from meaningful litigation and, indeed,
an exemption from responsibility.
If the Norwood amendment passes, which we saw for the first time in
printed form this morning about 8 o'clock, HMOs would be held to
different and looser standards than doctors and hospitals. The so-
called ``remedy'' would actually wipe away State laws that protect
patients against wrongdoings now and would roll back the law. The
Norwood remedy is a sham, because in almost all instances, consumers
would never see the State court which is the best place for them to be.
Indeed, patient protections now will not work if the flawed Norwood
review process is put in place. The Norwood amendment would reduce the
role of external reviewers and delay care to patients.
This House should pass H.R. 2563 without the cynical protections
sought by the White House and Republican leaders and without the
budget-breaking tax breaks and without a last-minute rewrite of
consumer protections.
Mr. Speaker, I urge the adoption of the legislation and rejection of
the Norwood amendment.
Mr. TAUZIN. Mr. Chairman, I am pleased to yield 2 minutes to the
gentleman from North Carolina (Mr. Burr), the vice chairman of the
Committee on Energy and Commerce.
(Mr. BURR of North Carolina asked and was given permission to revise
and extend his remarks.)
Mr. BURR of North Carolina. Mr. Chairman, today will be a heated
debate. We will hear people criticized today that just yesterday were
praised.
To the Members in this Chamber, do not lose focus on one thing. There
is one Member who has had his eye on the American people for years on
this issue. His name is Dr. Charlie Norwood. For those who criticize
him today, but praised him yesterday, let no person believe that he is
not doing what he thinks is in the best interest of every American.
The fact is that we do have new legislation. This institution can
perfect things that are flawed, and I believe today that we are doing
that. We will start with a base bill that incorporates the thoughts of
many good colleagues, but because of the need to extend patient
protections today to the American people, the gentleman from Georgia
was brave enough to negotiate with the President until they came to an
agreement on a piece of legislation he could sign and that protection
could be extended.
This is not about who wrote it or whose amendment it is. Yes, it is
about what it says, but it is about whether it can be signed into law.
This bill, amended by the Norwood language and, hopefully, several
other amendments, can be signed into law and extended to the American
people today; and this body will make a mistake if it does not support
the Norwood amendment and provide patient benefits for the American
people.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Ohio (Mr. Strickland).
(Mr. STRICKLAND asked and was given permission to revise and extend
his remarks.)
Mr. STRICKLAND. Mr. Chairman, the American Medical Association has
said it well when they asked the question, Why should we oppose the
Norwood amendment? They said we should because it overturns the good
work done by States in protecting patients.
We should oppose the Norwood amendment because it reverses developing
case law that allows patients to hold plans accountable when they play
doctor. We should oppose the Norwood amendment because it contains
overly broad language that will remove most cases to Federal court. We
should oppose it because it raises barriers for patients to make their
case in court. And we should oppose it because it provides patient
protections, but does not allow the enforcement of those rights in
court.
We are dealing with life-and-death matters today. In southern Ohio,
Patsy Haynes, a 31-year-old mother who needs a bone marrow transplant
in order to live, is being denied that transplant because of her
insurance company. We need the right for the Patsy Haynes families and
every other family to go to court and to get what they rightly deserve.
The American people deserve no less.
The CHAIRMAN. Without objection, the gentleman from North Carolina
(Mr. Burr) controls the time.
There was no objection.
Mr. BURR of North Carolina. Mr. Chairman, I yield 2 minutes to the
gentleman from Ohio (Mr. Traficant).
(Mr. TRAFICANT asked and was given permission to revise and extend
his remarks.)
Mr. TRAFICANT. Mr. Chairman, President Clinton's first act was to
create a high-profile commission headed by now Senator Clinton to fix
health care. Eight years, and nothing.
President Clinton promised to raise minimum wage. Eight years,
nothing.
President Clinton said he would fix prescription drugs, and 8 years,
nothing.
President Clinton had to be embarrassed to sign into law Republican
reform of IRS and welfare. The truth is, the Democrats had 50 years to
reform welfare, IRS, Social Security, Medicare, health care,
prescription drugs. Nothing.
I will vote for President Bush's plan today, and I will vote for the
Norwood amendment for four reasons. Number one, what good is a Cadillac
insurance policy if your company goes out of business?
Number two, Americans will lose their insurance if costs are
prohibitive.
Number three, increased costs will force small employers especially
to cancel plans, give bonuses, and we will have more uninsured.
Finally, the heavy liability factor will force major manufacturers to
leave America like rats fleeing a ship on fire to countries with no
insurance, no regulations, no IRS, no liability, no pensions, and wages
of $1 an hour.
We have 43 million uninsured. I do not want any more uninsured
Americans in my district.
I will vote today for the only practical reform health care plan to
get a vote, and that is the President's, as has been tailored by the
Norwood amendment. I commend the gentleman from Georgia and I commend
the Republican Party for coming forward with a plan, like it or not.
The Democrats failed to perform.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from New Jersey (Mr. Pallone).
Mr. PALLONE. Mr. Chairman, it upsets me a great deal to hear my
Republican colleagues on the other side say that their plan today is
going to provide more access for the uninsured, more access to health
care, and somehow, the President is going to sign this. How cynical.
The President has never signed an HMO reform bill. The President has
no

[[Page H5199]]

intention of signing a bill. If that were the case, then why are they
mucking it up?
He talks about bureaucracy, mucking up this bill with all the things
that are unrelated to HMO reform: malpractice, medical malpractice,
MSAs, medical savings accounts. These things do not belong in this
bill. These things are being put in this bill today so when it goes to
conference, the bill is killed and is dead just like it was 2 years
ago.
They talk about providing more people access to care or somehow, they
are going to redress the denial of care. Well, then, if that is the
case, why in the world are they putting in these roadblocks so that if
I am denied care, I cannot even get to an external review panel that is
going to be independent and is going to reverse that denial of care?
They put in so many roadblocks in here, nobody is ever going to be
able to reverse a denial of care. Forget the courts. That is not the
issue.
Mr. TAUZIN. Mr. Chairman, I yield myself 30 seconds.
Mr. Chairman, let me take this 30 seconds to introduce the gentleman
from Georgia (Mr. Norwood), my friend. Many of us claim ownership of
legislation around here, correctly and incorrectly, but if there is one
person in this Chamber who owns the issue of patient protections, it is
the gentleman from Georgia (Mr. Norwood). He wrote the first bill.
I saw his first draft. We read it together on an airplane coming back
from Boston Harbor where we demonstrated against the awful IRS and
income tax together. But as we rode back, I saw the first rough draft
of this bill.
Mr. Chairman, the gentleman from Georgia (Mr. Norwood) owns this
issue, no matter how many other people claim it. The gentleman from
Georgia has been a stalwart to get this issue to the President.
Mr. Chairman, I yield 5 minutes to the gentleman from Georgia (Mr.
Norwood), a member of the Energy and Commerce Committee.
Mr. NORWOOD. Mr. Chairman, I thank the gentleman very much for
yielding me the time, and I am very grateful for the opportunity to
perhaps straighten out a little bit maybe of what has been said.
I say to my colleagues, the first thing is I believe in my soul that
the President of the United States does, in fact, want a bill to
protect patients. I do not have any doubt about it. He has told me that
on many occasions, all the way back to governor.
I also respect the office of the Presidency, and I believe that
unless we get his signature, we are going to be continuing to do the
same thing that we have done now for 6 years.
This is not just about passing a bill. This is about changing the law
of the land so patients can be protected in a health care system that
has radically changed over the last 30 years.
I make no apologies to any of my colleagues. I think my colleagues
know pretty well where I come from on this issue. I have great
affection and respect for the gentleman from Iowa (Mr. Ganske) and the
gentleman from Michigan (Mr. Dingell) and the gentleman from Arizona
(Mr. Berry). I basically support the bill. Why in the world would I
not? I helped write the bill. I am not against that bill at all. What I
am against is not having a change in the law.
Now, what I have done is, I have tried to figure out to the best of
my ability what could we do to acquire the signature of the President
of the United States and, at the same time, maintain at least what I
humbly think is the reason all of this got started.

{time} 1515

I am real excited, I have to say, I am real excited that in our bill,
in the Ganske-Dingell-Berry bill, that the President is willing to sign
our patient protections. All of us know how important those are. Some
of us know, as well as I know, what is in there. I am very pleased
about that.
I am very pleased that now the President is willing to sign, for
example, our access pieces. I am excited about that. Those are off the
table now. The problem is, for the President, that he wants to sign a
bill that he can have some input into. Now, that is fair.
There are some poison pills for this President in our bill, as were
potentially poison pills in the Norwood-Dingell bill a couple of years
ago that President Clinton would not have signed. I fought a lot of
people to make sure those poison pills in the Norwood-Dingell bill were
not there. Guess who I fought. I fought my friend, the gentleman from
Illinois (Mr. Hastert). I fought almost every Member of the Republican
Conference, and I stayed steady to a principle that I believed we
should have, which is there should be some limit on liabilities.
It is totally unfair to people to put their profession, their
business, their family, their wealth in a position where they could
lose it all just because somebody may have a particularly talented
trial lawyer. That is not fair. But I never would put those in or go
along with putting those in the Norwood-Dingell bill because I knew
President Clinton would not sign that. I was trying to get this law
changed because we are now in the sixth year.
Patients are not any better off today after 6 years than we were 5
years ago, and it is time to bring this gridlock to an end. I have
looked for a way with this President that we might take some poison
pills out for him. The founders said, if we want a law of the land, the
President of the United States has to sign it. For a President of the
United States to sign a bill, he is going to participate. This
President feels very strongly that we should have the bill, but he
wants some protections in there.
So we were getting from him an agreement to sign a bill that does
what? It gives us the patients' protections exactly like we wrote. It
gives us an external review panel made up of independent people. That
is so important for the patients, and we need that signed.
It is a bill that says, for the first time in years, every American
in this country can choose their own doctor. That is so important. Does
it say what we are trying to do or what the President is trying to do:
that we are not going to hold HMOs liable for their actions when they
deny care, when they deny a benefit or delay a benefit and they kill or
harm some of the people that have been used up here as an example? Does
anybody really believe that I want to do that? That I do not want to
hold their feet to the fire?
I promise I want to put their feet in the fire on this; but there is
a way to do that where we also can get this bill signed and achieve our
other things.
We will talk about the amendment later. But I want everyone to
understand I support this bill. But I support one even more that will
go into law.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Iowa (Mr. Ganske).
Mr. GANSKE. Mr. Chairman, I would say that it is a privilege to
follow my good friend, the gentleman from Georgia (Mr. Norwood) up
here. He has been a stalwart in fighting for patient protections, even
if I have had to take a little Maalox over the last few days.
We will debate the Norwood amendment in a little more detail, but I
do want to read a letter from the New Jersey Medical Association dated
August 2, 2001. ``The Coldest Day in August,'' is how it is titled by
Dr. Angelo Agro, president of the Medical Society of New Jersey.
It says: ``Across the Nation patients are waking up to the coldest
day in August on record because policy makers are swaying to the needs
of the mighty HMO industry rather than those of patients and healthcare
providers. The proposed compromise by Representative Charles Norwood
leaves New Jersey patients in the cold and drives physicians into the
freezing snow.
``In New Jersey the compromise undermines and very likely preempts
the landmark Healthcare Carrier Accountability Act signed just this
week by acting Governor Donald DiFrancesco. The proposed plan will drag
most claims to out-of-state courts through an anemic Federal legal
process. Furthermore, it stacks the system against patients through an
appeals process and gives no remedy to patients once their physicians
have provided needed care.
``As physicians and as patients advocates, we urge our New Jersey
Congressional Delegation to continue its outstanding record on patient
protection by opposing this emasculated version of the Patients' Bill
of Rights.''

[[Page H5200]]

That is signed Angelo Agro, M.D., president of the Medical Society of
New Jersey.
We can have differences of opinion, but this does make a difference
in a terms of a policy.
There are a number of issues, but the one with which I am most
concerned is that the Norwood amendment would preempt new State laws in
10 States: Arizona, California, Georgia, Louisiana, Maine, New Jersey,
Oklahoma, to name several. This is on page 20, line 20 through 22.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Arkansas (Mr. Snyder).
Mr. SNYDER. Mr. Chairman, I thank the gentleman from Michigan for
yielding time to me.
As a family practitioner, I have had the experience of thinking a
patient needs to have counseling. I have to take them into a room, have
them dial a 1-800 number to their insurance company, have the clerk who
picks up the phone at the end make the decision about whether they get
counseling, who they see, and how many sessions they get.
That is practicing medicine. That is delivering medical care. That is
why it is my opinion that the Norwood amendment destroys this bill.
Please read page 15. I know my Republican colleagues had a caucus this
morning. They discussed this State preemption issue. Please read page
15 of the Norwood amendment.
It clearly states: ``Yes, States can continue to have the liability
provisions for the delivery of medical care,'' but then it defines that
anything that the insurance company has to do with making decisions
about claims determinations is not medical care.
The example I gave, the 800 number, they say, No, that is not medical
care. Mr. Chairman, that is medical care. When that clerk at the end of
the phone makes decisions, they should be held just as liable as the
family doctor.
The Norwood amendment destroys the growing protections that are
developing in State law. This amendment needs to be voted down.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from California (Mrs. Capps).
Mrs. CAPPS. Mr. Chairman, I rise in support of the Ganske-Dingell
Patients' Bill of Rights. This bill gives the American people strong,
enforceable protections from the abuses and hard edges of the HMOs. It
returns control of medical decisions to doctors and their patients, and
takes it out of the hands of the bean counters. It guarantees patients
access to health care they desperately need.
I am a nurse. We nurses and our patients are particularly pleased by
the whistleblower protections included in Ganske-Dingell. They would
protect a nurse or other health professional who wants to blow the
whistle on substandard care to a regulatory agency or accreditation
body.
I want to urge my colleagues to oppose the amendments to weaken this
underlying bill. Ganske-Dingell holds HMOs accountable when they harm
patients by denying them care. HMOs have been willing to trade patient
safety for lower costs and higher profit margins. Ganske-Dingell gives
patients the tools they need to protect themselves.
With all due respect to our colleague, the gentleman from Georgia
(Mr. Norwood), his amendment would eliminate this essential protection.
That weakens State laws and would dilute the ability to effectively
enforce the Patients' Bill of Rights. His amendment would give the HMOs
special protections that no other business or industry has.
This bill should be about protecting patients, not HMOs. Mr.
Chairman, I urge my colleagues to support the bill and oppose the
Norwood, Fletcher, and Thomas amendments.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentlewoman from California (Ms. Eshoo).
Ms. ESHOO. Mr. Chairman, I thank the gentleman for yielding time to
me.
Mr. Chairman, I rise in support of the bill offered by the gentleman
from Iowa (Mr. Ganske) and the gentleman from Michigan (Mr. Dingell),
which is the real patient protections bill.
For many years, we have been trying to bring the pendulum back to the
center to bring some accountability to the process of health care,
where patients are enrolled with an insurer to give them the kind of
rights that they need; to bring the physician and the patient
relationship back to the sacred center where it belongs.
Last night something happened. The gentleman from Georgia (Mr.
Norwood), a dentist, brokered something with the White House, and we
are being asked to trust.
I want to tell the Members something, I want to verify for my
constituents. This is the group that has voted to permit more arsenic
in drinking water. This is the group that supports offshore oil
drilling. This is the group that wants to drill in ANWR. This is the
President that rejects a global warming treaty. This is the group that
will not ratify biological warfare bans.
Do Members know what? I do not trust that record. I do not think this
is the group I want to go with. I want real patient protection rights.
We should reject this attempt to dress it up as something that it is
not.
Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished
gentleman from Arkansas (Mr. Berry).
Mr. BERRY. Mr. Chairman, I thank the gentleman for yielding time to
me. I thank the ranking member, the gentleman from Michigan (Mr.
Dingell), the gentleman from New Jersey (Mr. Andrews), the gentleman
from Iowa (Mr. Ganske), and all the people who have worked so hard on
trying to get a legitimate Patients' Bill of Rights on this floor so we
could vote on it, so the American people would have what they have
tirelessly asked for, and that our people could get the health care
they have paid for.
It is unbelievable to me that today we are going to allow an
amendment to this bill that will make it possible once again for the
insurance companies to mistreat, abuse, take advantage of the American
people for time immemorial, it appears, right now.
We are going to be standing here a year from now, and we are going to
see these same pictures the gentleman from Iowa (Dr. Ganske) has been
showing us ever since I have been in this House. They are horrible
pictures. The thought of an insurance company doing this to a child is
unbearable and unbelievable to all of us.
But we are going to take up an amendment today and a bill today that
would make it possible for the insurance companies to continue to do
this, only with more impunity. We are not going to be able to hold them
accountable for anything. We are going to supersede State law; and to
make matters even worse, Mr. Chairman, this bill is going to cost $20
billion, and we are going to use the magic pay-for card to pay for it.
I do not know where this card money comes from, but we are going to
start issuing them to anyone. Anytime we have a bill and we do not know
where to get the money for it, get the magic pay-for card for it.
Members can see it, surely. All we have to do is present it and
everything is already all right. We are not even going to pay for this
bill.
We had the pay-fors in this bill last night, and the Committee on
Rules took it out. It is unbelievable that we would allow the insurance
companies to continue to take advantage of the American people.
Mr. Chairman, I urge our Members not to vote for this terrible piece
of legislation.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Maryland (Mr. Hoyer).
Mr. HOYER. Mr. Chairman, I rise on behalf of this bill.
What is this bill? It is the bill that the gentleman from Georgia
(Mr. Norwood) got on the floor and said he supports. It is a bill that,
in 1999, 275 of us voted for in a bipartisan fashion, and in a
bipartisan fashion for 24 months we have labored to pass that bill. We
did pass it, and it was bottled up in conference committee because the
Republican leadership did not want it to become law.
The gentleman from Georgia (Mr. Norwood) wants a bill that can be
signed. I agree. But the way to get a bill that can be signed is to
show where the bill ought to be, and those 275 of us for the underlying
bill should vote for that bill today and send it to conference, have
the conference work on it, and let the President come to the
conference; not, with all due respect to my friend, the gentleman from
Georgia (Charlie Norwood), one Member, but to the conference, to the
Senate and

[[Page H5201]]

House, after they have worked their will and passed a real Patients'
Bill of Rights.

{time} 1530

Let us adopt the base bill and reject the three amendments.
Mr. Chairman, the American people need and deserve a real Patients'
Bill of Rights.
This legislation ensures that doctors make medical decisions, not
insurance company bureaucrats.
It gives every American the right to choose his or her own doctor. It
ensures broad access to specialists. It prohibits incentives to limit
care. And, yes, it allows patients to hold managed care companies
accountable when they make decisions that injure or kill.
Responsibility! What's more American than that? Yet, the Republican
leadership has fought legal liability tooth and nail.
They said strong liability provisions would cause insurance premiums
to skyrocket. But that didn't happen in Texas, where then-Governor Bush
let a Patients' Bill of Rights become the law in 1997 without his
signature.
They claimed that managed care liability would cause people to lose
their insurance. But that didn't happen in Texas.
And they said strong liability provisions would open the floodgates
of litigation. But that didn't happen. Only 17 lawsuits have been filed
under the Texas law in 4 years.
Today, they're trying to gut meaningful reform with these amendments.
Arbitrary damage caps are a perfect example. I'm always amazed that
some of the same people who think a jury is perfectly competent to
decide whether a man or woman lives or dies is somehow incompetent to
decide whether a person has been injured by negligence and the extent
of the injured party's damage.
I urge my colleagues to vote for this bipartisan bill and to vote
against these amendments. Let's level the playing field between
patients and their doctors and managed care companies.
Mr. TAUZIN. Mr. Chairman, I am pleased to yield 3 minutes to the
gentleman from Arizona (Mr. Shadegg), a distinguished member from the
Committee on Energy and Commerce who has put a great deal of effort in
this compromise.
Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me this
time. And I rise in strong support of this legislation, and I rise in
strong support of the gentleman from Georgia (Mr. Norwood).
Make no mistake about it, there is no greater champion of patients'
rights in this country than the gentleman from Georgia. And anybody who
says that the agreement that the gentleman from Georgia negotiated with
the President last night does not protect patients, does not know this
issue and is just playing politics.
Well, it is time for politics on this issue to end and for substance
to emerge. Let us talk about what is in this bill.
Number one, every single patient protection in the original Norwood-
Dingell bill and in the original Ganske-Dingell bill is in this bill.
The patient protections are there.
So comes the criticism on liability. Well, let us talk about
liability. For those who say this protects plans from being sued, they
are not being honest, because whether the external review panel sides
with a patient and says the plan was wrong, or whether the external
review panel sides with the plan and says the plan was right, that
individual can have a lawsuit. They have a right to recover damages.
Let us talk about the current state of the law. The current state of
the law in America is atrocious. It says if a health care plan injures
someone through their negligence, through their conduct, they are
immune. That is dead wrong. I know the Corcoran case inside out and
backwards, and it is time to reverse that precedent.
The reality is both sides agree that that policy of absolute immunity
for HMOs that hurt people must end. This bill strikes a fair balance.
It says that an external review panel, made up of expert doctors who
are practicing physicians, will review the decision of the plan and
will decide if the plan was right or if the plan was wrong. If they
decide the plan was wrong, yes there is a lawsuit and that individual
will recover damages.
But let us look at the flip side of that issue. Let us say they
decide the plan was right, and many would say that is a reasonable
structure; that the panel second-guessed, reviewed through experts, the
current status, where plans can simply deny care and walk away, but
under that set of circumstance, even if this expert panel made up of
doctors says the plan was right, that individual can still go to court.
The AMA, when I argued this issue with them last year, said, well, what
if the plan was wrong. It is a shocking lack of faith with doctors, but
they won. The AMA is getting what they want. Even when the panel says
the plan was right, the individual can go to court and sue. That is
liability, that is fair, that is a very reasonable compromise.
This is a good bill, and I urge my colleagues to support it.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the gentlewoman from
Florida (Mrs. Meek).
Mrs. MEEK of Florida. Mr. Chairman, I stand in strong opposition to
the Norwood amendment because I have been there and I have done that
and I have seen what happens when HMOs are in charge of health care,
particularly in lower-income communities. It is a scam. Wake up, before
this comes into our community.
The President cannot make government. He cannot make legislation. He
is in the executive branch. So let us be sure that we do our job and he
does his. Whoever heard of that before?
Two obvious examples stand out here. Our people need to be treated
fairly. We need a patients' bill of rights. We need the Dingell bill,
and we need it now. And we need to stop this frustration of going
through all this nomenclature of medical terms. We just need to get a
patients' bill of rights that is fair to all patients, that will treat
everybody the same, and be sure they have some redress.
I do not trust insurance companies. Why should I? They have never
been fair to the people I represent. Do you think I am going to do it
now? No. Be sure that you support the Dingell bill, it is the bill that
is happening.
Mr. TAUZIN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Louisiana (Mr. Cooksey).
Mr. COOKSEY. Mr. Chairman, this is an important piece of legislation
because it is important for the health care of the Americans who need
good quality health care.
Long before I was a Member of Congress, I was a physician. And when I
finished medical school, I guess I was somewhat idealistic because I
expected to always be in an examining room with a patient and have that
sacrosanct physician-patient relationship in which I was trying to make
a diagnosis and carry out a treatment, whether in the examining room or
the operating room.
But over the years, we have evolved to a system that we have HMOs and
HMO regulators; we have government regulators; we have a whole litany
of people that are in that examining room, if not in body, in spirit.
And these people are, in effect, practicing medicine or having a
disproportionate influence on the practice of medicine when they have
never gone to medical school. They do not know what medicine is about.
Unfortunately, some of these groups that are there in spirit are mean
spirited. So we do need reform. We do need patient protection. And this
piece of legislation will ensure that, number one, the employer-based
system will be intact and will not be undermined. And, number two, it
will go a long ways towards reestablishing the patient-physician
relationship and getting all of those other people out of the examining
room, whether they are there in spirit or in reality.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the gentlewoman from
New York (Mrs. McCarthy).
Mrs. McCARTHY of New York. Mr. Chairman, the last 24 hours of game-
playing with people's lives by the leadership has left a huge mark on
the House of Representatives.
Let us look at the score card in the last 24 hours. This week,
special interest groups have two wins and the American people have
zero. Yesterday, with the energy people, the oil companies won; today,
with the so-called patients' bill of rights, insurance companies,
unfortunately, are going to win again.
Under the House leadership bill and the so-called patients' bill of
rights, many of our constituents are going to have to have their health
care needs compromised. However, there are a few good things in this
package.
We have been working very hard to make sure our hospitals get prompt

[[Page H5202]]

pay. In other words, the HMOs and the insurance companies have been
holding back the monies to our hospitals. That is pure wrong. Our
nurses and our health care people need the whistle-blower protection
act, and that will be in there.
But all in all, despite these good provisions, it is clear that
special interests are the real winners in this deal. And I am sure of
one thing: we need campaign finance reform to get the special interests
out of this Congress.
Oppose the Norwood amendment and support the Ganske-Dingell bill. It
puts patients' interests first, not special interests.
Mr. TAUZIN. Mr. Chairman, may I inquire of the chairman who has the
right to close on this portion?
Mr. DINGELL. Mr. Chairman, how much time do we both have?
The CHAIRMAN. The gentleman from Michigan (Mr. Dingell) has 3 minutes
remaining and the gentleman from Louisiana (Mr. Tauzin) has 1 minute
remaining. The gentleman from Louisiana has the right to close.
Mr. DINGELL. I will respect that, of course, Mr. Chairman.
Mr. Chairman, I yield 1 minute to the gentlewoman from the Virgin
Islands (Mrs. Christensen).
Mrs. CHRISTENSEN. Mr. Chairman, this doctor stands with America's
doctors and our patients in support of H.R. 2563. The base bill is not
about suing, it is about making sure that insurance companies and HMOs
are held accountable when they prevent a patient from getting the care
they need.
We must reject the killer amendments which would shield the HMOs from
the same accountability that every doctor and hospital as well as every
other business is liable for, for our protection. And the HMOs must be
laughing at the $1.5 million cap that is proposed. With their profits,
that figure is so small it will be no incentive for them to change at
all.
We have fought for more than 5 years for a bill that will protect
patients. We have one, and we must not pass a last-minute dead-of-night
deal to help the President avoid the decision of signing or vetoing, if
that is his choice, legislation which the American people
overwhelmingly support.
Our constituents have been waiting too long for relief from profit-
driven medical decisions that put them and their loved ones at risk.
Let us vote down all amendments and give America a real Patient
Protection Act, H.R. 2563.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from California (Mr. Schiff).
Mr. SCHIFF. Mr. Chairman, I thank the gentleman for yielding me this
time.
Two years ago, when I was a State Senator in California, I worked
with my colleagues there to pass one of the strongest patient bill of
rights packages in the Nation. Other States, Texas, New Jersey, about
30 in number, have adopted similar strong patient protections. But now,
under the most recent capitulation to the insurance industry, these
strong patient bill of rights protections around the Nation are
preempted by Federal law.
Brought to us by those strong champions of States' rights, this
capitulation threatens to take away hard- fought patient protections
enacted around the Nation. The new policy evidently is: we believe in
States' rights, except where they collide with the rights of the
insurance industry, and then the heck with the States. That is no kind
of policy for this country.
I urge support for the Dingell-Ganske patient bill of rights that
protects and preserves the relationship between patient and physician.
It has doctors making medical decisions, not insurance company
bureaucracies. It is the real patient bill of rights, the one we have
fought for for 6 years, the one we must pass for this country.
Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Illinois (Mr. Davis) for purposes of concluding the
debate on this side.
Mr. DAVIS of Illinois. Mr. Chairman, I support patients' rights, but
I do not want to support putting a cap on unnecessary pain and
suffering. I support patients' rights, but I do not support greed and
unaccountability. I support the rights of patients to interact with
their doctors to make decisions.
I can tell my colleagues that the doctors in my district support
Dingell-Ganske. They have been calling all day saying do not vote for
Norwood, vote for Dingell-Ganske.
I follow the doctors in my community, and I urge all of us to vote
for Dingell-Ganske.
Mr. TAUZIN. Mr. Chairman, I yield myself such time as I may consume.
Six years, when the gentleman from Georgia (Mr. Norwood) began this
crusade for patient protections, he, through an exercise of
extraordinary courage and conviction, has been willing to take on
Members on both sides of this aisle. He has taken on his own party. Now
he takes on Members of the other party who disagree with him today.
He has shown extraordinary courage and conviction, and he is
determined that when we get through today with the amendment that he
will offer in agreement with the President of the United States to make
sure this bill is signed into law, he has determined this bill will do
the following things when we get through today:
It will preserve the right of patients to choose their own doctors
and to have the customary patient-doctor relationship.
Secondly, it will extend the patients the right to have an external
medical review of HMO decisions.
And, third, it will guarantee patients the right to sue HMOs, to hold
them accountable in both State and Federal Court, under the agreement
he has reached with the President.
The gentleman from Georgia is to be commended for this 6-year fight.
If we do it right today, we will put a bill on the President's desk
that he will sign into law and these 6 long years will have been worth
his courageous effort that has been carried forth with so much
conviction.
Mr. Chairman, I yield back the balance of my time.
Mr. THOMAS. Mr. Chairman, I yield myself such time as I may consume.
A few decades ago there was a song, and it went a little bit like
this: ``Love and marriage, love and marriage, go together like a horse
and carriage.'' Well, for the last several years we have been hearing
Norwood-Dingell, Norwood-Dingell, a team that made health care
reformers tingle.

{time} 1545

And yet today we find ourselves on the floor with a choice.
Ironically that choice is to take a giant step toward making law in
this area, or to keep alive a very divisive political issue.
In my opinion, there is no Member of the House of Representatives who
wants a law more than the gentleman from Georgia (Mr. Norwood). In my
opinion, there are some individuals here today who are enormously
disappointed in the fact that the gentleman from Georgia (Mr. Norwood)
wants a law because they certainly want to perpetuate a divisive
political issue.
In listening to the way in which the gentleman from Georgia (Mr.
Norwood) has been described, a Member got up recently and said he is a
dentist. I do not think that was quite said in a way that would
indicate that he has some knowledge in terms of the medical profession
or that based upon his experience in dealing with HMOs, he wanted to
make a change. I think it was done deliberately. I think it was done on
purpose.
If Members really look at the underlying bill and the bill that will
remain if the Norwood amendment is adopted, we have 95 percent the same
bill. What is the difference? With the Norwood amendment, it has a
chance to become law. Without it, it does not.
Well, I will simply leave Members with this. If Members had to think
of a word to match with Norwood, the one that comes to mind to me is
``sincerity.''
If Members have to match a behavior to coincide with what is being
exhibited on the other side of the floor, I have to think of a black
widow and her mate.
I am pleased today that this very, very difficult issue will be
resolved. It will be resolved by those people who stand with the
gentleman from Georgia (Mr. Norwood) and his amendment, and then stand
with the amended Ganske-Dingell-Norwood bill. It is time that we end
this division.
Mr. Speaker, the gentleman from Georgia (Mr. Norwood), as he did in
offering leadership at the beginning, is

[[Page H5203]]

again offering leadership. All Members have to do is follow the
leadership of the gentleman from Georgia.
Mr. Chairman, I reserve the balance of my time.
Mr. ANDREWS. Mr. Chairman, I yield myself 2 minutes.
Mr. Speaker, a person goes to her primary care provider, and the
primary care provider notices a lesion on the patient's skin. She says
that she thinks that the patient ought to see a specialist to see what
the lesion is. Her managed care plan says, no, we do not want you to do
that because it does not fit our model of what ought to happen.
The patient does not see the specialist. It turns out the lesion is
malignant and becomes metastatic cancer. The patient dies. The
patient's estate sues the HMO under the laws of New Jersey or one of
the other progressive States that has adopted patients' rights
legislation.
Understand this: Under the Norwood amendment that will be coming
forward in a few minutes, that claim is barred. Wiped out. No more. The
Norwood amendment is a step backward. It does not intend to be, but it
is, make no mistake about it.
Rights that the various States have given to consumers in the last
few years are repealed. Whether it is by intent or sloppy drafting,
they are repealed.
If Members believe in states' rights and the right of States to make
decisions that affect their own communities, then Members should not
federalize health care law. Then we should have not have one national
decision that governs what ought to happen here. Members should reject
the Norwood amendment, as the New Jersey Medical Society does for that
reason, and Members should vote for the underlying base bill.
Mr. THOMAS. Mr. Chairman, I ask unanimous consent to yield the
balance of my time to the gentlewoman from Connecticut (Mrs. Johnson)
to control the time.
The CHAIRMAN. Is there objection to the request of the gentleman from
California?
There was no objection.
Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself such time
as I may consume.
Mr. Chairman, I rise in strong support of the Norwood amendment, and
I thank the gentleman from Georgia for his leadership. There has been
no Member in this body who has been more dedicated to the issue of
patients getting access to care and having the right to sue when their
HMO denies them access to needed care. I commend the gentleman for
that.
Mr. Chairman, I commend him particularly today for having the courage
to help this House find a way to not only provide these rights to
patients, these critical rights to access to specialty care, access to
emergency room care, but also access to the right to sue, to provide
these critical rights in a way that does two things. First, it restores
power and control over our health care system to the doctors of
America. That is what patients want. They want to have the right to the
care their doctor recommends.
The Norwood amendment makes very clear that patients must exhaust the
external panel review process so that the record shows doctors' review
of doctors' decisions. In this era of exploding medical options,
increasingly complex care, frankly we are going to need to have doctors
reviewing doctors' recommendations to ensure that the patients'
interests are best served.
Mr. Speaker, exhausting that panel review before patients get lawyers
involved is critical. Otherwise we will do what the Dingell-Ganske bill
does: We will simply take power from HMOs and give it to lawyers. This
is not progress. This is not progress.
We want to return that power to doctors, and the Norwood amendment
does that very clearly and very directly, and backs it up with a system
that has two advantages. First of all, it shields the employer far more
effectively than any other bill, by clarifying that patients can sue
only the dedicated decision-maker who must be bonded.
Therefore, employers can have confidence that they will not have to
drop their plans out of fear of being sued. That is a tremendous
strength of this Norwood amendment.
Second, the Norwood amendment is a simpler judicial process, a
simpler legal system so that the costs do not explode. If the costs
explode and the price of access to care and access to the right to sue
is losing your health insurance, this is not progress.
Already premiums are rising rapidly. We see that: 15 to 20 percent
this year when a 10-13% increase was expected and after double digit
increases last year. In good conscience we must not add costs that do
not benefit patients. We know from the history of malpractice insurance
with doctors that until States controlled costs by adding tort reform
or committees through which these proposed suits had to pass for
approval, costs were extraordinary. Premiums leapt every year. And who
paid? The employer and the employee. That is what is happening now.
Employees are facing higher costs.
So the Norwood amendment not only guarantees these rights of access
that are so critical to the quality of care and the right to sue, but
it does it in a way that restores power to the doctors of our health
care system. It does it through a legal structure that controls costs
and protects employers who don't make medical decisions.
Mr. Speaker, those are my goals. The Norwood amendment fulfills them,
and I commend the gentleman for his hard work.
Mr. Chairman, I am pleased to support the Norwood amendment. It puts
in place strong patient protections in a responsible way.
Our goals are twofold: to guarantee patients access to the care they
need and to guarantee patients right to sue if they are denied that
care by their HMO. These patient rights are critical. Critical--but we
must guarantee them without causing health care costs to skyrocket.
Even without this legislation, premium costs are rising 15 to 20
percent a year and employees are carrying higher and higher copayments
and deductibles. We must not, indeed we cannot, in good conscience
further increase costs without knowing for certain that the benefit
will be directly realized by patients.
I support the Norwood amendment because it guarantees the rights
patients need to access specialists and emergency room care, to elect
an OB/GYN or pediatrician as one's primary care physician, and other
rights of access. It also provides the crucial right to sue one's HMO,
but it would do this in a way that we know from experience with
certainty will contain costs.
Under this amendment, patients will have the ability to hold plans
accountable for poor medical decisions. But it is designed in a way
that is straightforward and provides limits on liability, which allows
employers to plan for their obligations and continue to offer health
care coverage to their employees. In the end, this is the best result
for patients.
The Ganske-Dingell liability construct is completely unworkable and
will promote litigation years into the future that will only benefit
trial lawyers, and not patients.
We must learn from history, when malpractice liability skyrocketed,
it drove good doctors out of certain practices and sent premiums
skyward. Only when states stepped in and limited liability did costs
come under control and Americans no longer faced prohibitive increases
in health care costs. Unless we limit liability in our Patients' Bill
of Rights, we will set off a similar cycle of escalating costs.
Even before we get to the issue of the size of malpractice judgments,
there is the problem of limiting other litigation to which health
plans, providers, and employers are exposed. Under the Ganske-Dingell
bill, there will be a virtual explosion of litigation activity, because
the language of the bill is so complex and subject to so many different
interpretations! In contrast, under the Norwood amendment, the rules
are clearly written, the lines of liability are clearly spelled out,
and most importantly the causes of action available to patients are
very clearly defined.
On this last point about causes of action, I would like to point out
that under the Ganske-Dingell bill the availability of a cause of
action depends on the interaction of state law and the 19 pages of
requirements outlined in the bill. That alone will result in years of
litigation just to determine jurisdiction and the elements of a cause
of action. And that's before we even get to the patient's case.
I want to make one other point about simplicity versus complexity.
Under the Ganske-Dingell approach, there are two groups that can be
held liable for plan decisions--the `'designated decisionmaker'' and a
``direct participant'' in the decision. There are two separate
processes for holding these different actors liable, and they are
inconsistent. This alone will foster litigation, because plaintiffs
will name everyone possible and the courts will have to sort out the
liability.
In contrast, the Norwood amendment requires the naming of a
designated decisionmaker and requires that the decisionmaker be bonded
so that a plaintiff is assured of being able to recover damages.

[[Page H5204]]

The Norwood amendment is better for patients for another reason.
Under the Norwood amendment, an external appeals process is used and it
must be completed before filing suit. There is an exception that allows
the patient to get an injunction from a court if irreparable harm will
result from delay.
The benefit of requiring this external review is that doctors will be
reviewing doctor decisions. The process is faster. In the end, if the
external reviewers agree with the treating doctor's decision, the
patient gets care immediately. Isn't that what this is all about?
Getting the right care to the patient? And if the plan still refuses
coverage, the patient has a good medical record to use in litigation,
while still being able to get care and hold the plan liable for payment
in the end as well as damages.
The message I have is quite simple: we can improve the health
delivery system and protect patients; hold health plans accountable,
and provide relief to the uninsured.
To this end, the Norwood amendment puts patients first. It will:
ensure patients have a process to address benefit denials through an
internal and external appeals process; grant access to emergency care
services, regardless of cost; provide clear information to plan
participants about their benefits and rights; allow parents to
determine their child's caregiver; ensure women have hassle-free access
to their obstetrician or gynecologist; allow sick or disabled
individuals hassle-free access to the specialists they need; advance
the goals of FDA modernization by granting access to approved,
lifesaving products; ban gag clauses and incentives to deny care; treat
cancer patients with new technologies, drugs and biologics; and hold
health plans accountable for the decisions they make.
Let's stop the partisanship. Let's stand up for patients, not
Washington divisiveness.
Consider your options and then make the right decision. Vote for the
best choice.
Mr. Chairman, I yield 3 minutes to the gentlewoman from Washington
(Ms. Dunn).
Ms. DUNN. Mr. Chairman, they say that success has many parents, and
certainly in this very important debate over the Nation's health care,
we have found many of those parents.
I think today that special credit ought to go to the gentleman from
Georgia (Mr. Norwood) and to President Bush. Through the whole decade
of the 1990s we debated these health care issues; only now have we been
able to put in place the people who understand that they may have to
give up a little to get a lot.
As of last night, we are thrilled that these parties have come
together and provided us with what I think is a very good piece of
legislation.
What do we mean when we talk about patient protection? What is the
Patients' Bill of Rights supposed to add up to? I want to speak to it
from the point of view of a woman.
Woman usually schedule their children and their family's health care.
What are they looking to be protected from as we look at their health
coverage? Everybody supports improving patient protections like
prohibiting gag clauses which prevent doctors from talking to their
patients about options in their health care that might not be covered
by their particular plan. We do this in this bill.
Women are interested in finding a way to get immediate access to
their pediatrician or OB-GYN. We do that in this bill. We do not
require a gatekeeper to allow that person to pass through to where she
needs to end up.
She is looking for a review process of people like physicians who
really care about her best health interests. She wants her family to be
safe and well cared for. We provide this kind of recourse in this bill,
a truly independent group of health caregivers who are willing to talk
with the individual, know her history and her family's history and want
the best for her instead of requiring her to pass on to litigation and
the courts.
We are looking for access to affordable health care. She often pays
the bills. One way we provide accessibility to health care is by
expanding medical savings accounts, something which is very popular in
this Nation, which allows catastrophic coverage for people who
generally are healthy. This woman wants to control costs and keep
premiums affordable for her family.
We support medical malpractice reform. That is in this legislation.
The physicians I represent already feel under siege by excessive
regulations and spiraling liability insurance costs. Often they feel
compelled to do tests that may not help this woman, but will keep these
physicians out of court.
Today, we take the first step in reducing frivolous litigation by
passing the Thomas malpractice reform amendment.
Mr. Chairman, I think it is time that we pass patient protection. It
has been almost a decade that we have debated it. We have heroes now
with us who have taken all of their time, all of their caring,
President Bush and the gentleman from Georgia (Mr. Norwood). I
congratulate them for their leadership roles by ending gridlock and by
placing the American people first.
Mr. ANDREWS. Mr. Chairman, I yield myself 10 seconds.
Mr. Chairman, the gentlewoman from Connecticut is exactly right:
Putting decisions back in the hands of doctors is what we are trying to
do, which is why the American Medical Association strongly opposes the
Norwood amendment and supports the underlying bill.
Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts
(Mr. Tierney), a small business owner.
Mr. TIERNEY. Mr. Chairman, for 5 years-plus Democrats and some
Republicans have worked towards a Patients' Bill of Rights. The real
heroes in this one are the gentleman from Iowa (Mr. Ganske) and the
gentleman from Michigan (Mr. Dingell). On the Senate side, they are
Senators Edwards, Kennedy, and McCain. Central to the effort is the
need to stop unfair denial of access to medical care.

{time} 1600

Story after story has been heard in the past of people of all ages
being denied appointments with specialists, being denied the right to
seek emergency care when they reasonably believed they had an
emergency. It is important when it is your child, and it is important
when it is your parent.
Also central has been the need to hold HMOs accountable for their bad
decisions that unfairly denied people the benefit of their doctor's
advice or the care that they needed. Doctors and nurses have been held
responsible for their actions but impersonal HMOs have been allowed to
deny care, act arbitrarily and with impunity without being held
accountable.
In all that time, the person who is now President of the United
States first vetoed the Patients' Bill of Rights in Texas, then he
opposed it and allowed it to become law only because it had a veto-
proof majority and he did not even sign it. Then, of course, he took
credit for it during the campaign. The majority of Republicans and
Republican leadership resisted true patients' bill of rights reform
vigorously. But in 1999, 68 people on the Republican side voted with
Ganske and Dingell, they voted with the American people and with
patients, they voted with the health care community of doctors and
nurses. Then the GOP leadership in the Senate passed an HMO relief
bill. The Senate and the House leadership conspired to let that good
bill, the Ganske-Dingell bill, die in conference.
This year, the Senate passed the Ganske-Dingell bill as the Kennedy-
Edwards-McCain bill. The White House panicked, the leadership over the
other side panicked, and now they have found a way to kill true managed
care reform. Under the guise of passing something that will not be
vetoed, they attempt to bring forward a poison pill and provisions that
give us a choice that is unpalatable. They want to gut patient
protections, abandon patients and protect HMOs' bad practices. They
want to pass a bad House bill, then let that die in conference when the
Senate holds firm seeking real patient protection.
Mr. Chairman, this amendment is a joke. When people get a chance to
read it, they will only be heroes that are consistent with where they
have been, not those that have moved around and found themselves with
the President's bad acts.
Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself 15 seconds.
I would like the record to note that actually we have more physicians
and direct providers of health care supporting our bill and who were
involved in the writing of the Fletcher-Johnson bill than in the other
bill.
Mr. Chairman, I yield 2 minutes to the gentleman from Illinois (Mr.
Crane).
(Mr. CRANE asked and was given permission to revise and extend his
remarks.)
Mr. CRANE. Mr. Chairman, I thank the gentlewoman for yielding me this
time.

[[Page H5205]]

Mr. Chairman, I rise in support of the Thomas-Lipinski-Fletcher
amendment that will be offered later in the debate. I believe that any
patient protection legislation must also address the needs of the
uninsured. The Congressional Budget Office estimates that for every 1
percent increase in health insurance premiums, 200,000 to 300,000
individuals will lose their health insurance.
The underlying Ganske-Dingell bill is estimated to increase health
insurance premiums by 4 percent. That is 800,000 to 1.2 million more
Americans that will be added to the estimated 42.6 million Americans
that are without health insurance. We must include provisions that will
make health insurance more accessible and affordable to individuals.
I have long been a proponent of medical savings accounts. Individuals
should be able to have access to quality health care and make their own
provider choices. MSAs allow individuals to save, tax free, for their
health care needs and shop around for the best quality care at the best
prices.
The amendment makes structural changes to MSAs that will improve
their effectiveness and make them more widely available. MSAs are
making health insurance affordable for the first time to many Americans
since MSA insurance policies usually cost about half of what the
average HMO policy costs.
According to the Internal Revenue Service, 31.5 percent of all of
those who established an MSA were previously uninsured. MSAs help bring
these uninsured Americans into the insurance pool as opposed to being
exposed to the risks of uninsured health care costs which are the
source of nearly half of all bankruptcies in the entire United States.
In contrast, the underlying Ganske-Dingell bill makes only cosmetic
changes to MSAs. The underlying bill only provides for a 2-year
extension, raises the cap on MSAs from 750,000 to 1 million, and
expands the definition of small businesses from 50 employees to 100
employees.
I urge my colleagues to support the Thomas-Lipinski-Fletcher
amendment.
Mr. ANDREWS. Mr. Chairman, I yield 2 minutes to the gentlewoman from
California (Ms. Solis), who joins with the American Medical Association
in opposition to the Norwood amendment.
Ms. SOLIS. Mr. Chairman, I thank the gentleman for the opportunity to
shed some light on what I believe my constituents in California are
deeply concerned about.
Two years ago we passed some major, major HMO reform legislation.
This new proposal that is before us will rip apart those very pieces of
legislation that were put together very carefully over the past 2 and 3
years through negotiation with the stakeholders, with insurance, with
doctors, with patients, with advocates. This legislation now would go
back to the heart of our State and take away those assurances that many
people in that State right now have protections for.
I cannot stand here today as a new Member of Congress and vote for a
piece of legislation that is so deadly, because if someone becomes ill
under this proposal after 6 years because someone has injected them
with tainted blood, they cannot go back and sue that particular health
care or insurance group that is providing coverage. That is disastrous.
I know that people in my State and this country do not want to stand
for that.
As one of the new Members of Congress, I ask my colleagues to vote
against the Norwood amendment, the proposal that Mr. Bush is putting
before us today and our colleagues from the right.
Mr. ANDREWS. Mr. Chairman, I yield 2 minutes to the gentleman from
California (Mr. George Miller), ranking member of the full committee.
(Mr. GEORGE MILLER of California asked and was given permission to
revise and extend his remarks.)
Mr. GEORGE MILLER of California. Mr. Chairman, I thank the gentleman
for yielding time.
Something very terrible happened last night. Up until last night, we
had a competing contest over the question of protection of patients'
rights when they engage their HMOs, when they were denied service and
in that effort they were harmed, they were injured or they died and
whether or not somebody would have to accept responsibility for that.
Then last night at the White House, negotiations took place and we
went from a patients' protection bill to an insurance company
protection bill. We changed the standard of care within an HMO from
that of what a doctor, a medical professional, owes you to now a
standard of care that an insurance claims processor owes you. A doctor
can make a horrible mistake, an HMO can make a horrible mistake, an HMO
can make a callous indecision about your care and their standard is
that of an insurance claims processor. When people pay their insurance
premiums, when people go to an HMO, when they engage their medical
expertise, they do not believe they are engaging an insurance
processor. But the insurance companies, the HMOs, have rigged this bill
and rigged this language so that is now the standard of care.
Next time you go to visit your HMO, tell them you only want to pay
them what you would pay an insurance claims processor because that is
the standard of care. This bill and the Norwood amendment shows such
insensitivity to families that have to try and negotiate, negotiate to
get care, to get satisfaction, to get treatment for their family
members. Maybe too many Members of Congress have not done this. I know
what it looks like up close and personal when you are trying to
negotiate with these people and you are denied care and you are delayed
care.
This amendment is like some medical Bull Connor that is going to keep
families from having access to care, from access to justice. It is
unbelievable. It is unbelievable that we would do this to America's
families at the end of this debate and we would so enhance the
insurance companies to damage families and damage the people we love.
Mr. ANDREWS. Mr. Chairman, I yield 1 minute to the gentleman from
Tennessee (Mr. Ford), who joins with the health care providers and
families of America.
Mr. FORD. Mr. Chairman, what happened last night, if the President is
watching or the White House is watching, y'all did one heck of a job on
my friend, the gentleman from Georgia (Mr. Norwood), who has been a
champion, a stalwart on behalf of patients and consumers across this
Nation, not just in Georgia. For those of you who thought what might
have happened in Florida was good, what happened last night was that
much better.
Everyone will recite some of the legal things and the legal changes
in this bill, but the truth still stands. The only bill on this floor
that will be considered today that provides clear and enforceable
rights for patients, clear lines of accountability for decisions made
by either employers or insurance companies is the Ganske-Dingell-Berry
legislation.
I have great respect for the gentleman from Georgia (Mr. Norwood) and
will continue to hold him in high regard. I have great respect for the
gentlewoman from Connecticut (Mrs. Johnson) and the gentleman from
Kentucky (Mr. Fletcher). But for those of you interested in providing
clear patients' rights, enforceable patients' rights, holding those
accountable, those who make medical decisions, you have one clear
choice, the American Medical Association's choice, Republican Members
in the Senate including Mr. McCain, and those of us on our side: the
Ganske-Dingell-Berry bill.
Vote for patients, not the insurance companies.
Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 2 minutes to the
gentleman from Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Chairman, I am always stimulated to respond when my
friend, the gentleman from California (Mr. George Miller), stands up
and does always such a good job, but maybe a little clarification would
be in order.
I think all of you know that the good work in the bill that has been
done by all of us solves a lot of problems because just of the external
review. You get most things corrected there, which has always been our
intent. But to say that a patient that has been denied care and is then
harmed has no recourse through our amendment is just not true. If they
are denied care through our amendment, they have a cause of action and
they have a cause of action, most of them, in the States, which is
where we want to be, they

[[Page H5206]]

have a cause of action for the denial or the delay of care.
Let me further say to you, and I think I can say this also for the
President, we want to be as sure as we possibly can we do not preempt
other causes of action at the State level. I know that can be debated
whether the language actually does that or does not, but that is pretty
common as I understand it between lawyers for one set of lawyers to
believe language says one thing and another set of lawyers believes
language to say the other, but you just need to know my intent is to
make sure at every way I can do that we do not preempt other causes of
action at the State level and that is going to be my intent through
conference. I am happy that the President agrees that that is our
intent. If for some reason when we get into conference that that
language is not worked out, I am going to be in there slugging out for
it, because that is my intent as well as it is your intent.
Just do not say there is no recourse for a patient who is harmed,
that is denied care or delayed care. There is recourse.
Mr. ANDREWS. Mr. Chairman, I yield myself 1 minute.
I appreciate the fact that the gentleman from Georgia's intent is not
to preempt these claims; but with all due respect, that is not what his
language says. On page 15, line 16, delivery of medical care claims are
preserved but everything else is not. Is not.
I yield to the gentleman from California (Mr. George Miller).
Mr. GEORGE MILLER of California. Mr. Chairman, I thank the gentleman
for yielding. I think also if you read the language that they borrowed
from the ERISA statute, they now have taken the determination that it
is not a standard of medical care no matter how flawed the process is,
no matter how egregious the medical malpractice is. The question will
be not with the medical professionalism, but it will be whether it
passes the review of an insurance industry muster of the acceptable
standard of claims.
It is very clever what you have done here, but you have moved from a
medical standard to an insurance claims processor on whether or not I
have had medical malpractice. You do not get to review the medical
standard.
Mr. ANDREWS. Reclaiming my time, this with all due respect is what
happens when you start drafting a bill at midnight and finish at 7
o'clock in the morning.
Mr. Chairman, I yield 1 minute to the gentlewoman from Florida (Ms.
Brown), a fighter for working families in Florida and throughout the
United States.
Ms. BROWN of Florida. Mr. Chairman, during last year's campaign, a
patients' bill of rights was the top priority of the American public.
But just like the Presidential election, the American people are not
getting what they voted for.
The President and the leadership of this House is pushing amendments
that are a complete sham on the American people. Instead of a patients'
bill of rights, they are pushing an HMO bill of rights. The Republican
amendments side with special interests over patients, provide special
protections for the HMOs, and roll back patient protections.
In last year's election, the Green Party candidate claimed that there
was not a dime's difference between the Democrats and the Republicans.
I can guarantee Mr. Nader and the rest of the American public if we had
a fair election, we would really be debating a patients' bill of rights
and also a prescription benefit for our seniors.

{time} 1615

The American people deserve quality health care. I ask my colleagues
to do the right thing for their constituents, not the big insurance
companies. Vote for a real Patients' Bill of Rights. Put the doctors
back in charge of medical care, with insurance company accountability,
that sometimes kills and harms patients.
Mr. ANDREWS. Mr. Chairman, I am pleased to yield 1 minute to the
gentleman from New York (Mr. Israel), who has listened to the doctors
and patients of Long Island.
Mr. ISRAEL. Mr. Chairman, I thank the gentleman for yielding me time.
Mr. Chairman, I have only been here in Congress for months, but I
have already learned some interesting lessons. Only in Congress can we
weaken patient protections, and call it stronger; only in Congress can
we protect the HMOs, and call it a Patients' Bill of Rights; and only
here can we protect profits, and say we are protecting patients.
Mr. Chairman, I believe in compromise. I came here to try and
compromise. But the only thing compromised in the majority's bill is
the fundamental right of doctors, nurses, and their patients. The only
true Patients' Bill of Rights, Mr. Chairman, is Ganske-Dingell-Berry,
and that is what we should pass today.
Mrs. JOHNSON of Connecticut. Mr. Chairman, it is my pleasure to yield
2 minutes to the gentleman from Arizona (Mr. Hayworth).
Mr. HAYWORTH. Mr. Chairman, I thank my colleague for yielding me
time.
Mr. Chairman, I listened with great interest to what has slowly
evolved into sloganeering, rather than finding solutions here on the
House floor.
It has been interesting, Mr. Chairman, to hear talk about coming
together to find some solutions, and now to hear the refrain from the
left, it is kind of like that old country song, ``That Is My Story, and
I Am Sticking to It.'' It is almost the equivalent of legislative
hypochondria.
Now, look: we have a solution and a commonsense compromise crafted by
the gentleman from Georgia, the President of the United States, and
thoughtful Members from both sides of the aisle. And one thing I agree
with is my colleague from Florida, who said put doctors in charge of
health care, that is absolutely right. The tragedy of the product
offered from the left is that it again seeks to put the trial lawyers'
lobby in charge.
Now, like any good piece of legislation, we have come together here.
There is quality care here, there is a level of care here, there is an
appeals process here. There is a protection device to ensure the
sanctity of the relationship between the physician and the patient.
That is the key.
But, again, the left will tell us, no, the trial lawyers' lobby must
be there, solutions need to come in court rather than in the clinics;
and, worse yet, if we come together, no, no, we cannot have that,
because it is much more enticing to have an issue than a solution. It
is much more politically feasible to continue to indulge in rhetoric,
rather than deal with a real solution.
Now something has been crafted to find the hard-won compromise, to
deal first with health care, and to say both to insurance companies and
to the trial lawyers, neither group gets in the way, quality health
care is dependent on the sanctity of the physician-patient
relationship.
Mr. ANDREWS. Mr. Chairman, I yield myself 15 seconds.
I agree with my friend from Arizona that doctors should be the
decisionmakers, which is why the AMA today said, ``Representative
Norwood made a sincere effort to find a workable compromise, but the
resulting effort is seriously flawed, and we oppose it. It helps HMOs
more than it helps patients.''
Mr. Chairman, I am pleased to yield 1 minute to my friend, the
gentleman from Tennessee (Mr. Clement).
Mr. CLEMENT. Mr. Chairman, I thank the gentleman for yielding me
time.
Mr. Chairman, this is a serious matter. We have heard from doctors,
patients all over the country, and we want some relief now. I was
hoping the conversation that the gentleman from Georgia (Mr. Norwood)
had with the President would bring about some fruition. Unfortunately,
we now feel like we have been whitewashed, we have not solved the
problem, that we have caved in.
Therefore, I do not think any of us have a choice but to go along
with Ganske-Dingell, which is a bipartisan approach, in order to solve
some of these difficult problems that so many people are having with
HMOs.
Just think of someone in their 20's that is injured, has a couple of
children, sustains a terrible injury, loses income, debts to pay,
extended health care services, theoretically going to live for 40 to 50
years. They are not going to get the help that they need under the
Norwood bill. That is why we need to get behind the Ganske-Dingell

[[Page H5207]]

legislation, which is bipartisan legislation that will solve this
difficult problem, and let the patients and doctors be in control of
their health care once and for all.
Mr. ANDREWS. Mr. Chairman, it is my pleasure to yield 1 minute to the
gentleman from New Jersey (Mr. Holt), who echos the views of the New
Jersey Medical Society in opposing the Norwood amendment.
Mr. HOLT. Mr. Chairman, I thank the gentleman for yielding me time.
Mr. Chairman, my wife is a general practice physician. It is kitchen
table conversation for us to talk about the change in recent years in
the doctor-patient relationship and what has made it so difficult to
practice medicine.
Well, the Ganske-Dingell bill addresses that. This hurried bill, this
amendment that was thrown together in the middle of the night last
night, is no help. It is not a compromise. It puts HMOs in a unique
privileged position in American law, and that is why the AMA, the New
Jersey Medical Society, patients groups and individual doctors and
patients all across America understand that we should go with the
Dingell-Ganske approach to patient protection so that we can restore
the doctor-patient relationship.
Mr. ANDREWS. Mr. Chairman, I yield myself 30 seconds.
Mr. Chairman, the New Jersey Medical Society, in a statement by its
President, my dear friend, Dr. Angelo Agro, assisted by my friend, Dr.
Joseph Riggs, has called this ``the coldest day in August.''
The gentleman from Iowa (Mr. Ganske) read earlier from it, but I
wanted to make clear: ``The basis for the New Jersey Medical Society's
opposition is their correct conclusion that the Norwood amendment wipes
out the very strong patient protection law which we in New Jersey
enacted last week.''
Mr. Chairman, I yield 2 minutes to my friend, the gentleman from
Massachusetts (Mr. Tierney).
Mr. TIERNEY. Mr. Chairman, I thank the gentleman very much for
yielding me time.
Mr. Chairman, I would like to provide a copy of correspondence made
available from three notable professionals in health care law and
policy, Sarah Rosenbaum, David Frankfort, and Rand Rosbenblatt from the
George Washington University School of Public Health and Health
Services, Rutgers University School of Law in Camden, in the latter two
cases, and make it available to the gentleman from Georgia and others,
because I think now, in the light of day, as opposed to the midnight
oil burning at the White House, you can see that reasonable
professionals that deal with this every day indicate that this
particular amendment that is going to be proposed would change the law
to the detriment of patients, would change the law to the detriment of
those people that rely on this body to protect their interests.
It establishes an entirely new level of policy here where, no longer
is the standard of care what is existing in the medical profession,
but, as the gentleman from California (Mr. George Miller) says, what
goes on in the insurance industry. It goes beyond that and just
basically makes sure that States that have protective rights in there
get those thrown out the window, so that all the States, whether it is
Massachusetts, whether it is New Jersey, whether it is Florida, they
put in protections for their particular people, for patients in their
State, they are now out the window, thanks to the largess of the
gentleman from Georgia and the White House.
That is wrong. I do not think that is what the gentleman intended,
and I would expect upon reading it and now being knowledgeable of it,
the gentleman would change his mind.
Mr. GEORGE MILLER of California. Mr. Chairman, will the gentleman
yield?
Mr. TIERNEY. I yield to the gentleman from California.
Mr. GEORGE MILLER of California. Mr. Chairman, I think it is a very
important point the gentleman is making, and that is that what we are
doing here is without consultation, but one session at the White House,
decisions made in the dark of night, we are overturning, as they point
out, 200 years, 200 years, of a standard of care that individuals and
their families knew they had when they engaged the medical profession,
a hospital, the health care organization, the standards of a medical
professional. If your doctor, your health care provider, violated that
standard, you could get redress.
Now we are moving from that standard to the standard of a health
insurance claims processor in the review. So no matter how flawed, no
matter how flawed this review is, if it passes insurance company tests,
it is fine; not the standard of care of the medical profession that we
have had for 200 years protecting families in this country.
Mr. TIERNEY. Mr. Chairman, reclaiming my time, it goes beyond that.
No longer will you have to have a proximate cause be the conduct of
decisionmakers, but the cause. In a complex area like health care, that
is a dangerous thing, and I think the gentleman would agree.
Mr. ANDREWS. Mr. Chairman, I yield 1 minute to the gentleman from New
York (Mr. Engel).
Mr. ENGEL. Mr. Chairman, I thank the gentleman for yielding me time.
Mr. Chairman, the Hippocratic Oath says, ``First do no harm.'' But
HMO corporate charters say, First give no treatment and see what
happens next.
I have supported the passage of a patients' bill of rights, and I
will continue to do so until this Congress acts in a responsible manner
and passes a strong, meaningful and enforceable patients' bill of
rights.
But what we are being forced to do today is a travesty for the
American people, who are going to believe they will now have rights and
can stand up to HMOs when they are harmed. Instead, they will continue
to be deprived of the type of care that every American is entitled to
receive.
If we weaken the Ganske-Dingell bill with the Norwood amendment, we
will continue to have HMOs deny care and go unpunished. We will
continue to have doctors making decisions based on profit margins, not
patient needs. We will continue to have HMOs pressuring doctors to deny
referrals; to skimp on care; and to fear retribution by corporate
executives, who are concerned with profits, not patients.
We need to pass legislation that gives doctors the power to provide
the care that they have sworn to provide. I am not concerned with
closed-door agreements, legislative victories, or making good on
campaign promises. I am concerned about patients.
So I urge everyone to vote against the Norwood amendment and the
Thomas amendment and vote for the Ganske-Dingell patients' bill of
rights and reject the majority's attempts to pass an HMO bill of
rights.
Mr. ANDREWS. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, it is very important for the Members to understand that
the Norwood amendment, which will be presented as a patients' bill of
rights, is most certainly not a patients' bill of rights. It is a
mirage. It appears to be a refuge from mistreatment by managed care
companies, but it most certainly is not.
In order to get to court to get the law enforced if an HMO does
something wrong, you first have to go through an external review
process, and, if you lose the external review process, the Norwood
amendment vests that process with unprecedented powers in American law.
It says if you lose, there is something called a rebuttable presumption
against you. That means instead of having to move the ball to the 50-
yard line on the field, you have to move it to your opponents's 10- or
20-yard line.
He who has the burden of proof loses, and you would lose in most
cases if you had to bring the suit this way.
Second, if you are lucky enough to get past that one, you then have
this new Federal cause of action, and we will talk about this later.
But it appears that if the HMO is the sole cause of your injury, you
can recover; but if it is one of many causes of your injury, you
cannot, because the original bill says that your injury has to be a
proximate cause, not the proximate cause, which is in the bill drafted
in the wee hours of the morning that is before us tonight.
If, by some chance, you are able to overcome these problems and win,
we have an artificial limitation on what you can recover. If you buy a
defective toaster and it blows up and ruins your eyesight, you are able
to recover whatever the value of your injury happens

[[Page H5208]]

to be. But if you are denied the right to see an oncologist by an HMO,
we put a price tag on that. It cannot be worth anything more than $1.5
million.
Then there is the problem of the hospital and the doctor sitting
side-by-side at the defense table next to the HMO. The hospital and the
doctor will have their claim against them decided under State law.

{time} 1630

But the HMO has an exalted, special status. The HMO has this new
overnight, ready-mix cause of action. The doctor and the hospital will
have their claims decided under State evidence laws, State procedure,
State discovery, State privileges.
We do not know what will apply to the HMO, because it is not in the
bill; we will make it up as we go along. And when you get to the point
where the verdict has been rendered, if, let us say, there is a $10
million verdict and there is what is called joint and several
liability, which means the patient can go after any of the three
defendants to collect, well, you can collect an unlimited amount
against the doctor, and you can collect an unlimited amount against the
hospital, but we, with our one-size-fits-all solution, all of us
States' rights advocates say, you can only collect $1.5 million against
the HMO.
This is a Pandora's box. If my colleagues believe in the rights of
doctors, listen to the American Medical Association, which rejects the
Norwood amendment. If my colleagues believe in States' rights, listen
to the coalition of groups that support the underlying bill.
Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself such time
as I may consume.
Let me set the record straight on a couple of specific things. First
of all, there is nothing in the amendment at all that changes the
standard of care, and all of the heated speeches of the other side that
implied that were simply wrong. We do not change the standard of care.
Secondly, according to a Department of Justice letter, both the
Norwood language and the Ganske-Dingell language contain express
provisions which preserve certain traditional State law causes of
action concerning the practice of medicine or the delivery of medical
care. The language of both these underlying bills, both the underlying
bill and the amendment, indicates that these provisions would allow,
for example, claims under the Texas statute as interpreted in corporate
health to go forward.
Mr. Chairman, I yield the remainder of my time to the gentleman from
Louisiana (Mr. McCrery).
Mr. McCRERY. Mr. Chairman, I thank the gentlewoman for yielding.
First of all, let me explain so everybody understands, there is no
limitation in the Norwood amendment for economic damages. In other
words, a plan, a person, a patient who was injured by a health plan's
actions can recover the full extent of his economic damages, all his
medical bills, all his lost wages, future lost wages. That is not at
issue. That is not limited under Norwood.
What is limited under Norwood is what we call ``general damages,''
pain and suffering, mental anguish, things that cannot be quantified
and punitive damages.
Mr. Chairman, the Norwood amendment is the best thing that this House
has before it today to solve the problem of HMO abuse, of patients not
having real access to recovery under Federal law today. I agree that it
is not sufficient. Federal law today is not sufficient to allow a
patient to redress wrongs done by a health plan.
But the Ganske-Dingell bill goes way too far. It really endangers the
health care system as we know it. It will increase the costs of the
health care system, and that is the last thing we need in this country.
When we talk about damages and unlimited damages and we keep talking
about the AMA, I will refer my colleagues to some testimony by the AMA.
In 1996, Dr. Nancy Dickey, the then-Chair of the AMA board of trustees
testified, ``Placing limits on punitive damage awards without
simultaneously addressing noneconomic damages would lead to gaming of
the system. If only punitive damages are capped, leaving noneconomic
awards with no ceiling, plaintiffs' lawyers would simply change their
complaints to plead greater economic damages.''
The Norwood amendment rightly takes account of that reality and does
place a limitation on noneconomic damages as well as punitive damages.
Mr. Chairman, the Norwood amendment seeks to give patients redress
and yet not clog the courts, not open wide the gates of litigation. The
Norwood amendment will allow patients to get that relief most quickly.
They do not have to go through the courts. We provide for an expedited
review by a panel of physicians and, after all, I think that is what
everybody has been begging for is for doctors to make medical
decisions. The Norwood amendment does that.
It is the superior bill before us. Let us adopt that and do something
for patients in this country.
Mr. BOEHNER. Mr. Chairman, I yield myself 3 minutes.
Mr. Chairman, just 6 months into his Presidency, President Bush has
worked with the gentleman from Georgia (Mr. Norwood) and the gentleman
from Kentucky (Mr. Fletcher) to bring 6 years of gridlock to an end.
I remember when I met the gentleman from Georgia in the autumn of
1994 down in Georgia; he was running his first campaign. As we went
around his district that day, his constituents were eager for health
care reform, and I think Americans today are just as eager for reform
of the health care system. Families are worried about soaring costs,
they are worried about declining access, and they are worried about
access to quality health care. I think they want a reasonable solution.
Seven years later, families are still waiting for that solution. The
number of uninsured Americans remains very high, at some 43 million
today, and health care costs are on the rise once again. Cost and
access remain the top two health care concerns of most Americans.
But Americans today are also concerned about the quality of coverage
they receive for managed care, and they want a comprehensive solution
to the problems that they see each and every day. But as much as they
want a solution, they want a balanced approach that will let patients
hold their health plans accountable without sending costs spiraling
into the stratosphere and increasing the ranks of the uninsured.
There is no one, no one in this Congress over the last 6\1/2\ years
who has done more to bring this issue to our attention and to bring it
to the attention of the American people than the gentleman from Georgia
(Mr. Norwood). He has put his heart and his soul into trying to find a
compromise, trying to find a solution for this problem that we have
been locked in over the last 6 years. I think what he wants and what he
has said oftentimes to all of us is that he wants a bill signed into
law.
Well, I think the President shares that goal. I share that goal, and
I think the American people share that goal. They want a solution that
will be signed into law, and I think that we finally have that
solution.
I want to thank the gentleman from Georgia (Mr. Norwood) and I want
to praise the President for reaching out to him and other Members in
trying to find a solution to 7 years of legislative gridlock.
The underlying bill that we have before us causes me great concern,
because I do believe it will raise costs for employers and their
employees who share in the cost of their health insurance. Secondly,
the underlying bill, in my view, will cause many employers to simply
drop their health care coverage for their employees. That is not what
the American people expect from their Congress.
One of the real strengths of the Norwood approach is that it is
balanced, is that it will bring patient protections, it will increase
access to courts, it will bring new remedies, but it will contain them
so that we do not drive up the cost of health care for American
employers and their employees. But I think the proposal that we have
before us is a hard-earned compromise, and when we compromise here, it
is the American people who win, and they are going to win when we pass
this bill later on tonight.
Mr. Chairman, I reserve the balance of my time.
Mr. STARK. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from

[[Page H5209]]

Massachusetts (Mr. Tierney) to set the record straight.
Mr. TIERNEY. Mr. Chairman, I thank the gentleman for yielding me this
time.
The only thing that has been compromised here with the Norwood
amendment is the rights of the American people as patients. In 6
months, the President has done to this bill what he was unable to do in
Texas: he has killed those rights of the American people.
I wish the gentlewoman from Connecticut had stayed longer, because
she would realize that in the second sentence of the applicable section
of the Norwood amendment, what appeared to be giving States rights is
taken away, in essence, what appears to be a preemption for the managed
care industry of all underlying State law related to health care
quality.
On economic damages, yes, you can get the money for the cost of your
operation back, but now this law is going to tell you what your arm is
worth, what your eyesight is worth, and the limit is quite low.
Lastly, we spent over 5 years trying to deal with an industry that we
do not trust, that has made bad decision after bad decision, that the
American people have recognized; and the way this amendment deals with
it is to say that when you are sick, when you are down and out, you do
not just have to prove that you are right by the preponderance of the
evidence, as anybody else would with any other type of claim, but you
also have to overcome a presumption that is a rebuttable presumption.
This is the HMO protection act. This is something done in the dark of
night. I wish the gentleman from Georgia and others had had a chance to
get enough light to read its provisions, because if they did, they
would know that the only thing the President has done here is what he
could not do in Texas: kill patients' bills of rights, kill protection
for patients.
We can do better and we should do better. Let us hope the Senate, in
conference, can at least get us back on track.
Mr. BOEHNER. Mr. Chairman, I yield 2 minutes to the gentleman from
North Carolina (Mr. Ballenger), the former chairman of the Subcommittee
on Workforce Protection of the Committee on Education and Workforce.
Mr. BALLENGER. Mr. Chairman, I thank the gentleman for yielding time.
As most of my colleagues know, I have continually criticized the
Norwood-Dingell-Ganske bill because of the liability language which
threatens the employer-based system of health care. The gentleman from
Georgia (Mr. Norwood) continually promised me that my company back home
in North Carolina would not be sued because of his legislation. I did
not believe him. I had 250 insured employees to worry about who might
lose their insurance if the trial lawyers got their way.
Well, with the adoption of the Norwood compromise amendment crafted
with President Bush, I am now confident that employers will be
protected when voluntarily providing health insurance, just as the
gentleman from Georgia told me they would. The Norwood amendment
excludes employers from being held liable for selecting a health plan,
choosing which benefits are available under the plan or advocating on
behalf of an employee for coverage.
This amendment also adds the ability for employers to choose a
designated decision-maker who will have the sole liability for benefit
determinations. These are all essential to protect the employer-based
system of health care, protect them from trial lawyers.
Mr. Chairman, in an ideal world, Congress should be considering
legislation to tackle the problem of 45 million uninsured Americans.
Unfortunately, we are not there yet. But we can make a good start by
not only voting for the Norwood compromise amendment, but also the
Fletcher amendment to increase access to health care. Through medical
savings accounts and associated health plans, we will finally begin
attacking the looming problem of the uninsured.
By voting for both the Norwood compromise amendment and the Fletcher
access amendment, we protect both employees and employers under the
successful employer-based system in place today and start to provide
health care for millions more.
Mr. Chairman, I strongly urge my colleagues to vote for these
amendments and with their adoption, the final passage of the Bipartisan
Patient Protection Act. Protect us all from the trial lawyers.
Mr. STARK. Mr. Chairman, I yield myself 3 minutes.
Mr. Chairman, this is, as many speakers have said before, a sad day
for those of us who are neither lawyers or physicians, but from time to
time become patients in the medical delivery system. Because what my
Republican colleagues have done under the leadership of the President
of the United States and the Republican Speaker of the House is just
sold out the insurance companies and created a system for the very
richest people in the United States.
One might say, there they go again, harming the average working
person and bailing out the rich insurance companies, the rich
pharmaceutical companies, the rich managed care companies, and making
it easier for them to make a profit by denying us care. There is no
other way that a managed care company makes a profit, except to
withhold care, pay less for it, give us less quality, or harm us.
I am sorry that the gentleman from Georgia (Mr. Norwood) sold out for
a brief display of the Rose Garden. I am sorry that many of my
colleagues would like to make this an issue of trial lawyers.
I would suggest to my colleagues that the American public, when they
are faced with a pharmaceutical company or Aetna Life Insurance
Company, are going to trust the trial lawyer a whole lot more. And when
the doctor cuts off the wrong leg or when care is denied, that doctor
is not going to do anything to bring back a loved one, that doctor is
not going to redo the procedure. That doctor is going to run and hide.
And the only way we will get the doctors to do the right thing is to
take them to court occasionally and make them live up to their
professional creed, which we are not seeing much of here in the House
today.

{time} 1645

I hope that we will continue to support the Ganske-Dingell
legislation which is a compromise. It comes close to the Senate
bipartisan agreement which again is a compromise. These two bills, when
fit together, will do a lot to provide those of us who use managed care
with a reasonable certainty that we will be treated fairly, our medical
decisions will be decided by people with medical experience and
qualifications and not by clerks who will deny care to make a bonus or
a profit for their company.
I think we will find that the cost of medical care will not go up as
it has not in States which have these programs. The quality of medical
care will improve; and who knows, we may find that we may expand
coverage to those 40 million people that the Republicans have chosen to
ignore.
Mr. Chairman, I reserve the balance of my time.
Mr. BOEHNER. Mr. Chairman, I yield 3 minutes to the gentleman from
Kentucky (Mr. Fletcher), who spent months and months developing this
issue.
Mr. FLETCHER. Mr. Chairman, I certainly appreciate the work that has
been done by the gentleman from Ohio (Mr. Boehner), the chairman of the
Committee on Education and the Workforce; and as he has excelled in
education, now he has certainly excelled in this issue of protecting
patients.
Yesterday was a very fine day for the patients across America. After
months and months of negotiating, the gentleman from Georgia (Mr.
Norwood) agreed that it was time to strike a very good compromise,
something that was focused on patients. I certainly appreciate the work
of everyone that has been doing a great deal regarding this issue over
the last 6, 8 years.
But one thing I think we must realize is that we need to have a
patients' protection bill that will be signed by the President, one,
that makes sure that we stress the quality of health care; two, that we
protect access to health care and consider the uninsured; and, three,
we hold HMOs accountable. We do that with the Norwood amendment.

[[Page H5210]]

It is surprising the respect that the gentleman from Georgia (Mr.
Norwood) has across this Nation. According to the majority leader in
the Senate, he is the most respected voice on patient protection across
this Nation. Now because of political reasons, the other side would
change their tune because they are more concerned about politics than
they are the health of patients.
We have 43 million uninsured in this country, 10 million more than a
decade ago. Nearly 40 percent of uninsured adults skipped a recommended
medical test or treatment, and 20 percent said they did not get the
needed care for a serious problem in the last year.
The uninsured are more likely to be hospitalized for avoidable
conditions such as pheumonia and uncontrolled diabetes, and are three
times more likely to die in the hospital than an insured patient. That
is a striking, a very striking statistic from the Journal of the
American Medical Association. It is beyond me how the other side, who
has always talked about the most vulnerable in our society, low income
and minorities, how they could show such a flagrant disregard for the
uninsured, willing to drive up the costs with the frivolous lawsuits to
favor the personal injury lawyers over the patients.
It is striking to me how they can ignore this particular fact and the
impact of having more uninsured in this Nation will have on the health
of Americans. We need to come together, lay aside politics and make
sure we cover the uninsured.
That is the reason why I am glad we provide some access programs in
the amendment through association health plans to allow small
businesses to come together to be able to reduce the cost of premiums
from 10 to 30 percent and allow some medical savings accounts.
Again, I appreciate the work that is been done on this by a number of
individuals. I certainly want to thank the President for his passion of
making sure we get patient protection. I want to encourage everyone to
support the Norwood amendment to the Ganske-Dingell bill.
Mr. STARK. Mr. Chairman, I yield 30 seconds to the distinguished
gentleman from Iowa, Mr. Ganske.
Mr. GANSKE. Mr. Chairman, I thank the gentleman from California (Mr.
Stark), and I thank the gentleman from Kentucky (Mr. Fletcher).
The underlying Ganske-Dingell bill does have access provisions that I
think are bipartisan, for instance, 100 percent deductibility for the
self-insured and other small business provisions to help increase
access. There will be an amendment on the floor for that that will get
debate on further access provisions, and I think that debate will be a
fruitful debate.
Mr. STARK. Mr. Chairman, I yield 3 minutes to the gentleman from
Maryland (Mr. Cardin).
Mr. CARDIN. Mr. Chairman, first I would like all the Members to join
me in congratulating the gentleman from California (Mr. Stark) for
becoming a father with twins born to Deborah. We know that August will
be a very busy month for him.
Mr. Chairman, I want to respond very briefly to the points of the
gentleman from Kentucky (Mr. Fletcher). Most of the protections in the
Patients' Bill of Rights, many of our States have passed laws that
provide that to state-regulated plans. There is no evidence that
employers have dropped coverage. The enactment of good medical policy
will not reduce the number of people insured in this Nation.
Mr. Chairman, let me point out, many people have said that the Bush-
Norwood agreement is a compromise.
It is not a compromise; it is a complete victory for those who oppose
a Patients' Bill of Rights. We will take a look at some votes later
today, and I think that will be borne out by the people who will be
supporting the amendments and those who will be opposing them. This
really is a victory for people who want to see us do nothing.
Let me just give one example. Mr. Chairman, I have been working many
years with colleagues on the other side of the aisle for access to
emergency care protection so that people who go into the emergency
room, who have emergency symptoms, find out later that their bills will
in fact be paid. We have, in many cases, people going to the emergency
room with chest pains, only to find out that they did not have a heart
attack, but they have a heart attack later on when their HMOs refuse to
pay the bill.
We provide protection in this legislation to deal with that, in the
underlying bill. But when we look at the amendment that the gentleman
from Georgia (Mr. Norwood) will be offering, we give with one hand and
take away with the other. We say we give protection, but we offer no
enforcement, so the HMOs can continue to deny reimbursement without any
fear of any repercussion from their actions. That is not providing
patient protection. That is not doing what we should be doing here in
this body.
It is even worse than that, Mr. Chairman, because there are certain
protections that have been afforded by our States. Forty-one States
have passed an external review. That is where people can go to their
insurance company, to their HMO, and have a review done by an
independent body. Forty-one States have now enacted an external review
that is now providing help to those plans that are regulated under
State law. So what does the Norwood amendment do? It preempts our 41
States.
My colleagues on the other side of the aisle talk about federalism
and protecting the rights of States. The Norwood amendment will preempt
the State laws in those areas, and take away protection that the States
at least have had the courage to provide to its citizens that are
regulated under State plans.
That is not what we should be doing. A Patients' Bill of Rights
protects patients. The Norwood amendment will take it away. Vote down
the Norwood amendment.
Mr. BOEHNER. Mr. Chairman, I am pleased to yield 1 minute to the
gentleman from California (Mr. Hunter).
Mr. HUNTER. Mr. Chairman, I thank the gentleman for yielding time to
me.
Mr. Chairman, I had a personal experience with my chief of staff who
had what was diagnosed as incurable cancer, had a gatekeeper problem,
and I became one of the first cosponsors of the gentleman from Georgia
(Mr. Norwood) when he initiated his initial legislation.
We talked about the Norwood amendment today. We went over the fact
that one is going to have accountability, and yet, they are not going
to have so much exposure that small businesses will be denied coverage.
The key element in this entire debate has been balance. This approach
is well-balanced. It is going to enable small businesses to have
coverage. It is going to have accountability. It is going to move us
forward. My old friend and I had a good discussion this morning, the
gentleman who was most concerned about this who had incurable cancer.
He looked at this thing and he says, this is what we need. Support the
Norwood amendment.
Mr. STARK. Mr. Chairman, I am happy to yield 2\1/2\ minutes to the
distinguished gentleman from Wisconsin (Mr. Kleczka).
Mr. KLECZKA. Mr. Chairman, it is amazing to sit here and listen to
the debate, how a person can go in less than 24 hours from an SOB to a
PAL, and there is such glowing praise for one of the Members of this
body. Wow, where was that praise last year? Where was it 5 years ago
when he introduced the Patients' Bill of Rights? What a turnaround.
I know the White House operatives have been looking for somebody to
bring forth a poison pill to this bill. The insurance companies, the
HMOs, do not like it. The Republicans do not like it; the President
does not like it. So what we do in this legislation is sell out the
patients.
The operatives in the White House came here and were looking for
someone to do the poison pill. They looked at the gentleman from
Michigan (Mr. Dingell) and did not get too far there; they looked at
the gentleman from Iowa (Mr. Ganske) and did not get too far there;
then there is a new and sort of popular TV show which I think sums up
what happened. My friends, it is called The Weakest Link. They found
the weakest link.
So, in a hurried fashion, we are presented with that change, which
gives insurance companies privileged status; status that doctors do not
have, hospitals do not have, but HMOs, health insurance companies, will
have under this bill. I think that is sad.

[[Page H5211]]

Now the opponents of the real Patients' Bill of Rights bill say
premiums are going to go up 4 percent. Hundreds of thousands of people
are going to lose their health insurance. What is that based on? That
is based on a real Patients' Bill of Rights passing, the HMOs not
changing their bad practice of denying care to sick people, and all of
them being sued. That is what it is based on.
However, if a real bill would pass, we know they would change their
behavior. No one wants to be sued. But what happens under this bill?
They do not have to change their behavior. They can deny us care,
ending up in injury, possibly death for the patient, and under the
special protections, the preemptions of State laws throughout the
country, they are not going to get hit.
I ask my colleagues to reject Norwood, or in other words, good-bye.
Mr. BOEHNER. Mr. Chairman, I yield myself 1 minute.
Mr. Chairman, I say to my colleagues, I am confused. We have been
through 6 years of legislative gridlock on this issue. They all know
it. It has been not exactly a partisan divide, but almost.
Finally, the President of the United States reaches out on a
bipartisan effort over the last 6 months, does not get many takers on
the other side of the aisle, but finally over the last couple of weeks
he and the gentleman from Georgia (Mr. Norwood) come to an agreement to
break this legislative logjam and to move this issue down the road.
It is beginning to sound to me like it is ``my way or the highway.''
Members all know compromise is the art of legislating. I think what we
have before us is a bill that only is different in one respect, and
that is just how much liability, how much right to sue, and how many
damages we can impose on people. That is the only difference in this
bill.
The American people want access to health care, not access to the
courtroom.
Mr. STARK. Mr. Chairman, I am happy to yield 3 minutes to the
gentlewoman from Florida (Mrs. Thurman), who, unlike previous speakers,
has read the bill.
Mrs. THURMAN. Mr. Chairman, I thank the gentleman for yielding time
to me.
I would say to my colleague who talks about gridlock, that is wrong.
This House, that Senate, passed a bill, Senate to conference, and would
not by the majority put on conference committee members who voted for
the bill that the House voted for.

{time} 1700

So if my colleague wants to talk about gridlock, the gridlock has
been because the other side would not allow people to have the will of
the House, and they do it over and over and over again.
But let me make a point. When I come to this floor to vote today, my
mind is not going to be on the gentleman from Georgia (Mr. Norwood) or
the gentleman from Michigan (Mr. Dingell) or the gentleman from
Arkansas (Mr. Berry) or any of them. My mind is going to be on one
person.
This is an editorial that was written by the editor of our newspaper.
Roz is your typical over-achieving college kid. She is a hard worker
and extremely intelligent. As she graduated from college, she and her
whole life are in front of her. But several years ago Roz found a small
lump in her breast. Being a smart kid, she contacted her HMO and was
referred to a physician. When she went in for an exam she was told the
small lump was a torn ligament or muscle and it would just go away. The
HMO physician decided that no further expensive tests were needed. But
the lump did not go away. In fact, it grew larger.
After a second visit to her HMO-assigned physician, she was told
again that the lump in her breast was a muscle; no expensive tests were
needed. When Roz went home to her parents for a holiday break, they
sent her to a family physician who conducted the expensive test. It was
then determined that Roz had breast cancer. The cancer had been with
her so long that it had spread to her brain and her spinal cord. She
died at the age of 25.
I want a bill, whether the President signs it or not, that takes care
of Roz. She will be on my mind when I vote tonight.
Mr. BOEHNER. Mr. Chairman, how much time is remaining?
The CHAIRMAN. The gentleman from Ohio (Mr. Boehner) has 10 minutes
remaining and the gentleman from California (Mr. Stark) has 7 minutes
remaining.
Mr. STARK. Mr. Chairman, I yield 3\1/2\ minutes to the gentleman from
Texas (Mr. Doggett).
Mr. DOGGETT. Mr. Chairman, a patients' bill of rights should be about
helping patients: someone who has just received the bad news from her
doctor that she faces a life-threatening illness requiring extensive
and expensive medications, a parent, who has a child with a serious
disability, a family that has been shocked by an accidental injury to a
bread winner. With the patient already at a disadvantage, and then
further disadvantaged by an abusive insurance company, this Congress
has to decide today whether it wants to provide patient protections or
insurance loopholes.
The kind of bill that is being advanced by our Republican colleagues
is a little like the fine print of some worthless insurance policy that
promises much, but in the fine print limits coverage only to those
struck by lightning on a summer's midnight during leap year. That is
the kind of protection, riddled with countless loopholes for insurers,
that Republicans would afford.
In Texas, we stood and chose. We chose the patient and adopted a
model law that the rest of the Nation has looked to for our patients'
bill of rights. We adopted that law, it should be noted contrary to the
suggestion today, not because of, but in spite of then Governor George
W. Bush, who fought it every step of the way, who tried to undermine
it, as he has this bill, who vetoed the state legislation once before
it became law. He finally let it become law without his signature as he
worked hand-in-glove with the insurance companies in Texas in making
the very same arguments that are being advanced here today.
Our Texas law has worked well. Our newspaper in the capital city, the
Austin American-Statesman, editionalized that this law had ``changed
the health care climate in Texas.'' Yet there was a serious problem.
The courts interpreted an old Federal law called ERISA, designed
originally to protect employees with their pensions, as overriding or
preempting our state patient guaranties. This Federal law meant that
while some Texans can get state protection, millions get nothing.
Federal law wipes out what the State of Texas, over George Bush's
objection, adopted to protect our citizens. ERISA preempted that law.
Today, what do we find? We find George W. Bush, now as President,
perhaps using the same pen with which he vetoed the guarantees in
Texas, and he comes forward and says that preemption for some Texans is
not enough. With this Norwood amendment, preemption will apply to all
of those State guarantees for all, Texan's and folks in States with
such guarantees. These State patients' rights provisions will be wiped
out, and replaced with this new federal loophole law. Well, that is not
a patients' bill of rights, that is only protection for the insurance
industry.
Before I came to this Congress, I served as a judge on the highest
court in the State of Texas. I was called a ``Justice'' and expected to
do justice. And yet time after time I saw victims of insurance company
abuse come into our court and like other judges, my hands were tied.
They were tied by Federal interference in States' rights under ERISA.
Our laws, our guarantees, our consumer protections were preempted, and
no judge could do justice. Justice was not only blind, but rendered
helpless.
In this Congress, we are not helpless. We can reject the same
approach that Governor George W. Bush tried to impose on our State and
not let it be imposed on this country. We can stand up for patients and
reject loopholes for insurance companies.
Mr. BOEHNER. Mr. Chairman, I am pleased to yield 2 minutes to the
gentleman from the Great State of Ohio (Mr. Portman), my good friend
and colleague.
Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding me this
time and affording me this opportunity to talk a little about patient

[[Page H5212]]

rights, and I rise today in very strong support of giving patients more
protection and in support of patients' rights.
I would also like to thank the gentleman from Ohio (Mr. Boehner), the
gentleman from California (Mr. Thomas), the gentleman from Louisiana
(Mr. Tauzin), and particularly the gentleman from Kentucky (Mr.
Fletcher), and the gentleman from Georgia (Mr. Norwood) for all the
good work they have done on this issue, good people coming together in
a common cause to reach a result that will help all Americans.
Under the Norwood-Fletcher amendment that we are going to vote on a
little later today, this legislation that we are talking about now will
be improved, in my view. But this underlying legislation will continue
to provide a number of very important patient care improvements.
Patients will have better access to specialists. Patients will get
guaranteed coverage for appropriate medical care in emergency room
settings. Patients will be able to designate a pediatrician as their
child's primary care provider. Patients with serious illnesses will be
assured of continuous care from their existing physicians. All these
patients' rights and many more are going to be included in the
legislation, and again I commend the Members of this House who have
worked so hard to get to this point.
Perhaps most importantly though, Mr. Chairman, this legislation
provides these protections without risking the most important single
protection of all, and that is guaranteed health care coverage. I have
heard on the floor this afternoon a lot of concerns raised by opponents
to the Norwood-Fletcher amendment about what is not going to be
included in that amendment. I want to talk about that for a second.
I, too, want to talk about what the Norwood-Fletcher amendment will
not do. It will not allow unnecessary and frivolous lawsuits. It will
not risk dramatically increasing the cost of health care insurance and
thereby risking the number of people who can be insured and have
insured access to health care. And it will not take valuable dollars
out of the health care system and put them in the legal system. Yet it
provides all the protections we talked about and, most important, there
is no question that when HMOs and insurance companies wrongfully deny
care, they will be held accountable under this approach. I urge all my
colleagues to support it.
Mr. BOEHNER. Mr. Chairman, I am pleased to yield 3 minutes to the
gentleman from Texas (Mr. Sam Johnson), the chairman of the
Subcommittee on Employer-Employee Relations.
Mr. SAM JOHNSON of Texas. Mr. Chairman, I thank the chairman for
yielding me this time.
We have to work for our employees, those who are uninsured. I rise
today in support of a hard-fought agreement that would give patients
access to an emergency room, assure patients access to independent
external review, and hold health maintenance organizations accountable
for their actions. However, unlike Ganske-Dingell, the Norwood-Bush
compromise does all these things in a responsible way.
The Ganske-Dingell bill subjects employers to as many as 50 different
external review standards and treats some patients better than others,
depending on where they live. The Norwood compromise guarantees that
employers and employees are treated equally no matter where they live.
Unlike Ganske-Dingell, which would subject employers to frivolous
lawsuits, this bill would protect employers from Federal lawsuits in
all but the most extreme cases. Ganske-Dingell would also subject
employers to lawsuits in 50 different States. This bill does not allow
suits against employers to be filed in State court. Unlike the base
bill, our bill assumes that employers or their agents are using
ordinary care if the medical reviewer upholds their decision.
It is time to put patients first. It is time to pass a patients' bill
of rights that increases the number of Americans with health insurance.
By the end of this debate, I hope to have an amendment included that
would increase access to affordable health insurance to the 43 million
Americans who currently do not have health insurance through the use of
medical savings accounts or association health plans.
Mr. Chairman, we must support the Norwood amendment. It is good for
America.
Mr. BOEHNER. Mr. Chairman, I yield 2 minutes to the gentleman from
Arizona (Mr. Shadegg), who has spent many, many hours on this issue.
Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me this
time, and it has been a pleasure to work with him on this legislation.
He has been tireless in his efforts to pass good legislation.
These comments about a partisan divide and a deadlock are absolutely
accurate. We have struggled to get legislation passed here. And, sadly,
the extremes at each end have precluded us from doing so. The extremes
who want the plans to have no liability under any circumstance, and the
other extreme, which are the tort lawyers, who want to be able to sue
over anything, any time, anywhere and get everything.
The Norwood amendment pursues a goal that is absolutely fair, and it
is the goal we ought to pursue. Patients get the right care at the
earliest possible time. One of my colleagues on the other side said
what is wrong with the current system is that HMO bureaucrats make
health care decisions, and he is right. But the Norwood amendment,
unlike the Ganske-Dingell bill, moves that decision-making authority
over the quality of health care in America, what is the standard, what
care should people really get, away from those HMO bureaucrats. It
takes it away from the HMO bureaucrats and it gives it to a panel of at
least three medical doctors who are practicing physicians with
expertise in the field.
That is where the decision should be. We should get it away from HMO
bureaucrats, and we should give it to doctors so doctors can set the
standard of care in America. But here is what is wrong with the
underlying bill. They want to take it away from HMO bureaucrats, but
they do not want to give it to doctors. What they want to do, and what
their bill does, is give the ability to set the standard of care not to
a panel of independent doctors but rather to trial lawyers.
Under their bill an individual has to go through external review, but
it means absolutely nothing. It is a chimera. It is of no value.
Because whether someone wins or loses, they can go right ahead and sue,
which means it will get us nowhere. It becomes a battle of experts. It
does not advance health care in America. It does not empower doctors to
set the standard. It empowers plaintiffs' lawyers. And that is a
tragedy.
I urge my colleagues to defeat the underlying bill and support the
Norwood amendment.
Mr. STARK. Mr. Chairman, I yield 45 seconds to the gentleman from
Massachusetts (Mr. Delahunt).
Mr. DELAHUNT. Mr. Chairman, it is interesting to hear that it is
lawyers that are responsible for the rising cost of health care
premiums, but it is not lawyers who are responsible for awarding
damages. It is jurors.