Extension of Remarks
Introductory Statement of the Honorable Pete Stark


March 2, 2000

The American public is frustrated with the status quo on managed care. Poll after poll shows that the public strongly supports passage of a federal patients’ bill of rights. In fact, a recent Kaiser Family Foundation and Harvard School of Public Health survey finds that after more than two years of debate on patients’ rights, most Americans believe that problems with managed care have not gotten better and that the need for legislative action is more, or as urgent, as it was when this debate began.

With the voice of the American public firmly behind us, it is clear that the starting point for this important conference should be the House-passed Bipartisan Consensus Managed Care Reform Act. The House passed that bill last October by a stunning bipartisan margin of 275-151 – with 68 Republicans joining with us. The American public supports this legislation and it deserves to become law.

We worked with our Republican colleagues in the House who share a commitment to protecting patients in managed care plans across the country and the result is already a work of compromise. We agreed to changes from the original Dingell legislation that included: a limitation on liability so that if the plan follows the decision of the external appeals entity, then the patient has no right to punitive damages; deletion of a significant portion of the original legislation that required plans to turn over data to the federal government for quality purposes; and, changes in the external appeals structure and medical necessity definitions. All of these modifications were in order to make the bill a truly bipartisan product that could pass the House and be signed by the President. The House succeeded in our job.

That should be the starting point for this conference. Unlike the work of the House, the Senate legislation did not achieve bipartisan support, does not apply to everyone (it is limited to the 48 million Americans in self-insured plans), and it does not include a right for patients to sue their health plans when their medical decision-making causes harm.

Both the House and Senate bills also include a section dedicated to so-called "access" provisions. These include tax provisions to provide for the deductibility of health insurance premiums for people who pay more than 50% of their premiums, expansion of the failed MSA demonstration, tax deductibility for long-term care insurance, and the creation of new association health plans and so-called HealthMarts which would bypass state insurance regulation.

Providing access to health insurance for America’s 44 million uninsured citizens is a vitally important issue. Unfortunately, these provisions which total some $48 billion in taxpayer expenditures do virtually nothing to help decrease the number of uninsured. Instead, they provide new tax breaks for people who already have health insurance. And, according to new analysis by the Congressional Budget Office, the association health plans and HealthMarts would actually have the negative impact of causing some 20 million Americans to pay more for their health insurance, while only expanding coverage to some 330,000 people. Based on these facts, none of these provisions deserves the title "access."

Again, expanding health insurance coverage is one of my highest priorities. But, it would be wrong to hold this long-sought and much-needed patients’ bill of rights hostage over provisions that fail to effectively address the problem of the uninsured.

It is far too soon to tell what this conference committee will be willing or able to achieve. I recall numerous pronouncements of dates by which we would be done with the Patients’ Bill of Rights over the past several years. None of those have come true and I am not sure this one will either. But, I am ready and willing to get to work to with my colleagues to create a strong, federal managed care reform bill that applies to all health plans and holds health plans accountable for their actions. Let’s get to work.

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