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Here is little Jimmy today. I talked to his mom about 6 weeks ago. Jimmy

[Page: H5453]  GPO's PDF

   Mr. Speaker, under Federal law if one's little baby had this happen to them and their insurance was from their employer who had a self-insured plan and their plan had made that decision, that negligent decision which had resulted in this disaster, under Federal law that plan would be liable for nothing other than the cost of the amputations.

   Is that fair? Is that the way it is if one buys insurance as an individual from a plan that is covered by State regulation? No. So, Mr. Speaker, I would say to my colleagues, my colleagues in the other body and my colleagues in this body, when we get a chance to vote on whether health plans ought to be liable for decisions that they make that result in this type of negligence, a judge reviewed this case. A judge looked at the case. He said that the margins of safety by this HMO were, quote, ``razor thin.'' I would add to that, about as razor thin as the scalpels that had to remove little Jimmy's hands and feet.

   Mr. Speaker, I say to my friends on both sides of the aisle and in the other body, when we get a chance to vote on whether a health plan should be responsible for their actions that result in this type of injury, think, especially my fellow Republicans, think about how we always say as Republicans, hey, people should be responsible for their actions. Do not we say that? If somebody is able-bodied and they can work, they ought to be responsible for providing for their family? Do not we say that if somebody kills somebody or is a rapist that they ought to be responsible for their criminal behavior?

   How can we then say that an HMO which makes this type of decision that results in this type of injury should not also be responsible? There is no other entity, no other business, no other individual in this country that has that type of legal protection. It is wrong. It should be fixed.

   The State of Texas fixed this 2 years ago. They made their health plans liable. Now, of course this is being challenged because of the ERISA law. But since that time there has not been an explosion of lawsuits. There has only been one. I will read about it in a few minutes. But why has there not been? Because health plans suddenly realized that they cannot cut corners like they did with this little boy or they are going to be liable. They are going to be responsible.

[Time: 22:30]

   Did it significantly increase premiums in Texas? No. Premiums in Texas have not gone up any higher than they have anywhere else in the country. Did it mean that managed care would die out in Texas? No. Several years ago, there were 30 HMOs in Texas. Today, there are 51. That law is working. It did not result in a huge number of lawsuits, and it has not resulted in a big increase in premiums like all the HMOs would have us believe.

   Let me read today an editorial from USA Today. The title of this is, ``Why should law protect HMOs that injure patients ?''

   Last July, Joseph Plocica's health plan discharged him from a hospital, against the advice of his psychiatrist, who said the Fort Worth resident had suicidal depression requiring continued help, according to a lawsuit. That night, Plocica proved his doctor right and his health plan wrong. He drank a half-gallon of antifreeze and died 8 days later.

   As terrible as this story is, at least Plocica's bereaved family has more rights than most. A sweeping 1997 Texas law let them sue Plocica's health plan for malpractice.

   That's a right denied to the roughly 120 million other Americans who receive their health care through work. This week, the federal law that protects those health plans from lawsuits is the focus of a contentious Senate debate over patients' rights .

   The central question: Should HMOs, which often make life and death decisions about treatments, be legally accountable when their decisions go tragically wrong?

   Like Mr. Plocica who drank antifreeze or little Jimmy here who lost his hands and feet.

   ``Right now'', the USA Today editorial continues,

   the answer is no, although that is a luxury no doctor, and no other business, enjoy.

   The provision might have made sense when it was passed by Congress in 1974 as part of a law designed to protect workers' pensions. Most employees were covered by old-style fee-for-service insurance plans and payment disputes took place after health care had been delivered. So a law limiting recovery to the cost of care did not hurt anybody. But today, more than 80 percent of workers are in managed care plans that actively direct what treatments parents received.

   Unfortunately, despite efforts in Texas and a few other states to find ways around this law, the gaping liability loophole is not likely to be closed nationwide any time soon

   unless Congress acts.

   Insurance and business groups have mounted an aggressive fight against a version of the Patients' Bill of Rights that allows patients to sue. They say opening up HMOs to lawsuits will result in a flood of litigation and kill cost control by doing little too improve quality care.

   But in Texas, where these same groups made all the same arguments, the reality is far from different.

   No flood of lawsuits. Only a handful of cases have been filed against HMO plans in Texas since the challenge to the law was overturned last fall. This is due, in part, to another feature of that 1997 law, which requires swift independent review of disputes.

   Rates have not shot up. In the two years since the law was passed, HMO premiums in the state are almost exactly where they stood in 1995. Cost increases in Dallas and Houston were below the national average last year.

   Quality may be improving. News accounts from Texas suggests that HMOs, now accountable for their decisions, are more careful making

   those decisions.

   Doctors report health plans are less likely to drag their feet, for instance, and less likely to deny treatments doctors believe are needed.

   There's no reason to believe a national law would produce any different results,

   continues this editorial.

   Studies by the Congressional Budget Office and the nonprofit Kaiser Family Foundation find HMO liability would produce negligible premium hikes. Only industry-sponsored studies find otherwise.

   Lawmakers would do well to look at the facts before leaving this critical patient right on the cutting room floor.

   Mr. Speaker, I do not think we should hesitate about having HMOs be responsible, despite the fact that the HMO industry has spent more than $100,000 per Congressman lobbying against a strong Patients' Bill of Rights . Surveys show that, despite all that advertising, that money spent on advertising by the insurance and HMO industry for the last 2 years, there has been no significant change in public opinion about the quality of HMO care.

   Despite tens of millions of dollars of advertising, a recent Kaiser survey shows no change in public opinion: 77 percent favor access to specialists, 83 percent favor independent review, 76 percent favor emergency room coverage, 70 percent favor the right to sue one's HMO. Other surveys show that 85 percent of the public think Congress should fix these HMO abuses.

   If these concerns are not addressed, I think the public will see examples like this, and they will ultimately reject the market model as it now exists. However, if we can enact true managed care reform such as that embodied by my own Managed Care Reform Act of 1999 or the Dingell or the Norwood bills, then consumer rejection of a market model will be less likely.

   Common sense, responsible proposals to regulate managed care plans are not a rejection of the market model of health care. In fact, they are just as likely to have the opposite effect. They will preserve the market model by saving it from its own most irresponsible and destructive tendencies.

   Mr. Speaker, let us pass real HMO reform. Let us learn from States like Texas. After all, is it not Republicans who often say that the States are the laboratories of democracy? Yes, let us have some insurance tax incentives. But let us be very careful about repeating some mistakes that have been made with ERISA in the past that led to fraud in regards to association health plans.

   Finally, the Speaker of the House told me before the July 4th recess that it was his intent to have HMO reform legislation on the floor by the middle of July. Well, Mr. Speaker, here we are. According to my watch, it is now the middle of July, and we have no date yet even for a full committee mark-up

[Page: H5454]  GPO's PDF

   I think there are even majority votes in both the Committee on Education and the Workforce and the Committee on Commerce for strong medical necessity and enforcement measures. Maybe that is the reason why the committee chairmen are not moving ahead. Maybe that is why the leadership of this House is not telling them to get their act in order, get this to the floor.

   Well, the Senate is debating HMO reform this week. So let us see what happens there.

   I think today the Washington Post called it about right when it referenced the GOP Senate bill . It said, ``The Republican bill professes to provide many of the same protections, but the fine print often belies its claims. Among much else, it turns out to apply only to

   some plans and to only about one-fourth as many people as the Democratic bill would cover.''

   The Post then talked about the GOP criticisms of the Democratic bill , ``Critics say that the Democratic bill , by weakening the cost-containment industry, would drive up costs.'' The Post continues, ``Our contrary sense is that, in the long run, it would strengthen cost containment by requiring that it be done in a balanced way'', exactly the sentiments that I expressed a few minutes ago.

   Today the Washington Post closed that editorial by saying, ``The risks of increased costs tend to be exaggerated in debate. The managed care industry says that, by and large, it already does most of the modest amount this bill would require of it. If so, the added cost can hardly be as great as the critics contend.''

   Mr. Speaker, when we are talking about the cost for a strong Patients' Bill of Rights , we are talking about something in the range of $36 per year for a family of four. Is that not worth it to prevent an HMO tragedy like happened to this little boy?

   Mr. Speaker, please keep your promise. By next week, we should have debated HMO reform in full committee, and we should be headed to the floor. Is that going to be the situation? Or is it the Speaker's intention to try to limit debate on this important issue by putting it right up against August recess, when Members have planned vacations with their families, in order to limit debate.

   Well, Mr. Speaker, if that is so, it will be seen for what it really is, a cynical abuse of scheduling because the leadership of this House really does not want a full debate on protecting patients . Mr. Speaker, I hope that is not the case. The victims of managed care and their families are watching.

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