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Mr. FRIST. Mr. President, I rise to voice my support for the bill we are introducing today and to urge my colleagues to pass a strong Patients' Bill of Rights this year. Our Patients' Bill of Rights is a good bill that will improve the quality of health care fo r patients in this country.

[Page: S921]  GPO's PDF

   We have the benefit of starting off in a new Congress. The partisan rhetoric of elections is behind us. Today, we are here to convey our genuine interest to pass managed ca re re form th is year as well as to provide the necessary building blocks to improve health care qu ality.

   Not much attention was given in last year's debate to the many areas of agreement between the Republican and Democratic proposals. It is my hope that we can work together this year in a deliberative, thoughtful manner to pass bipartisan legislation. For example, there is bipartisan support to enact strong patient protection standards including coverage for emergency screening exams and services; allowing continuity of care so that patients may keep their physician, even if he or she is dropped from the plan, during a terminal illness, institutional care or pregnancy; and to prohibit plans from including gag clauses in their contracts. There is also strong consensus that we must require health plans to provide comparative information about their plans and to hold plans accountable for their decisions by allowing patients to appeal coverage denials to an independent medical expert, including expedited reviews, and receive a timely response.

   In addition, I am pleased that many provisions that are in the Senate Republican bill also have received bipartisan support. Our bill last year included the ``Women's Health Research and Prevention Amendments,'' which I also introduced as S. 1722, that passed the Senate unanimously at the end of last year. These programs provide a broad spectrum of activities to improve the quality of women's health; including research, prevention, treatment, education and data collection.

   We must remember that the central focus of this debate--the genesis for the entire debate--is to embark on a national discussion of how we can truly improve real quality of care fo r patients. Our bill this year will again contain two measures which have broad bipartisan support and will greatly improve the quality of health care in this country.

   Title III of our bill prohibits genetic discrimination against individuals in health insurance. Prohibiting genetic discrimination translates into a patient's right to quality care. G enuine quality care me ans that patients and practitioners have the very best information available to them when they make health care de cisions. Patients should not be afraid to benefit from new genetic technologies, or share personal information that has immense potential to improve care an d save lives. This is not a political or partisan issue. Our 49 Republican cosponsors last year, several of our Democratic colleagues, and President Clinton all support enacting legislation to prohibit genetic discrimination.

   Title IV of our bill refocuses the Agency for Health Care Po licy and Research to support our federal efforts to improve health care qu ality through a vigorous research agenda. I also introduced this proposal as a stand alone bill (S. 2208) last year which had broad bipartisan support. Our goal is to enhance the agency to become the driving force of our federal efforts to support the science necessary to provide patients with information about the quality of care th ey receive and to provide physicians with research data to improve health care ou tcomes for their patients.

   There is no question Congress will need to revisit some issues in the managed ca re de bate. However, we will work deliberatively and in a bipartisan manner through our committee work this year to pass comprehensive legislation because we all share the ultimate goal of improving health care qu ality for patients.

    Mr. JEFFORDS. Mr. President, I want to begin by commending Senator NICKLES and all of the members who participated in putting the legislation together. I think it is solid legislation that will result in a greatly improved health care sy stem for Americans, and I am proud to be a co-sponsor of the ``Patients' Bill of Rights Plus.''

   As Chairman of the Committee on Health, Education, Labor, and Pensions, with its jurisdiction of private health insurance and public health programs, I anticipate that the Committee will have an active health care ag enda during the 106th Congress. In fact, on January 20th, the Committee held a hearing on health plan information requirements and internal and external appeals rights. And, this hearing builds on the foundation of fourteen related hearings that my Committee held during the 105th Congress.

   People need to know what their plan will cover and how they will get their health care. T he ``Patients' Bill of Rights Plus'' requires full information disclosure by an employer about the health plans he or she offers to employees. Patients also need to know how adverse decisions by the plan can be appealed, both internally and externally, to an independent medical reviewer.

   The limited set of standards under the Employee Retirement and Income Security Act (ERISA) may have worked well for the simple payment of health insurance claims under the fee-for-service system in 1974. Today, however, our system is much more complex, and there are many types of decisions being made--from routine reimbursements to pre-authorizations for hospital stays. And it is in the context of these changes, particularly the evolution of managed ca re, t hat ERISA needs to be amended in order to give participants and beneficiaries the right to appeal adverse coverage or medical necessity decisions to an independent medical expert.

   The provision of our bill giving consumers a new right of an external grievance and appeals process is one of which I am particularly proud, since it is the cornerstone of S. 1712, the Health Care QU EST Act, which I introduced with Senator LIEBERMAN during the last Congress. Under the ``Patients' Bill of Rights Plus,'' enrollees will get timely decisions about what will be covered. Furthermore, if an individual disagrees with the plan's decision, that individual may appeal the decision to an independent, external reviewer. The reviewer's decision will be binding on the health plan. However, the patient maintains his or her current rights to go to court.

   As the Health and Education Committee works on health care qu ality legislation, I will keep in mind three goals. First, to give families the protections they want and need. Second, to ensure that medical decisions are made by physicians in consultation with their patients. And, finally, to keep the cost of this legislation low so that it displaces no one from getting health care co verage.

   Our goal is to give Americans the protections they want and need in a package that they can afford and that we can enact. This is why I hope the ``Patients' Bill of Rights Plus'' we have introduced today will be enacted and signed into law by the President.

    Mr. CRAIG. Mr. President, today, Senate Republicans are responding to America's number one health care co ncern: the high cost of health insurance and medical care. B y granting all Americans access to tax-free medical savings accounts; by allowing self-employed Americans to deduct 100 percent of the cost of their health insurance premiums; and by allowing workers with flexible savings accounts to keep some of the money in those accounts, our ``Patients' Bill of Rights--Plus'' will tear down the barriers that government has put in the way of affordable health coverage and care. < p>   Our proposal stands in stark contrast to those offered by others in Congress. With millions of Americans unable to afford insurance because of the unfairness of the federal tax code, some members of Congress want to force consumers to buy government-prescribed benefits--including many that are giveaways to special interests--even if it causes millions more to lose their health coverage.

   While other so-called ``patients' rights'' bills contain nothing but expensive mandates, hidden taxes and costly lawsuits, our bill will deliver quality health insurance to millions of Americans. Our bill will make a down payment on serious health care re form th at puts patients first--not doctors, not lawyers, not insurance companies, and certainly not government bureaucrats.

   Rather than support a patients' bill of rights minus access, I urge my colleagues to take a step forward by making health insurance accessible instead of taking a step backward by making it more expensive.

    Mr. BURNS. Mr. President, I am pleased to support and co-sponsor patient protection legislation. There is noting more important than protecting the patient-doctor relationship and guaranteeing our citizens the right to choose their own doctor. It is important to make sure patients have the information they need to make decisions about their health care an d make sure doctors, not accountants or lawyers, decide which medical services are needed.

   Under Senator NICKLES' Patients' Bill of Rights Act, no health plan will be beyond the scope of federal or state patient safeguards. The bill will expand access to doctors, incuding guaranteed access to obstetrical and gynecological care an d pediatric care, a nd require managed ca re pl ans to offer patients the option to receive care ou tside a plan's network of doctors.

   In addition, health plans would have to provide patients with information on covered services, cost-sharing requirements, payment restrictions for services from out-of-network providers, rules for out-of-area coverage, preauthorization requirements and procedures, and rules for grievence and appeals filings. Health plans would be required to have both an internal appeal and external third-party review if coverage for any service is denied. Plans would also be required to safeguard patients' medical information or face civil penalties.

   The Patients' Bill of Rights Act will also make it easier for many Americans to afford health care. O ver 3 million self-employed individuals and their families will benefit from increasing the tax deductibility of health insurance to 100 percent, the same deduction most companies take for their employees. This bill also gives every American the right to have medical savings accounts (MSAs) and puts MSAs on an equal tax treatment footing with standard health care in surance. These flexible savings plans allow you to save money for health expenses tax-free as long as you have a high-deductible health insurance plan. MSAs are currently only available for employees in companies with 50 or fewer employees.

   In this era of managed ca re, p atients need a Bill of Rights to make sure they get quality health care an d not a plan that will lead to higher costs and greater numbers of uninsured. I am happy to co-sponsor this important legislation.

    Mr. DOMENICI. Mr. President, I rise today in support of the recently introduced Republican Patients' Bill of Rights.

   I would like to begin by making an observation about the impact of any potential changes to the managed ca re sy stem.

   I would submit that whether a decision relating to healthcare is made by business or the government, the results will always have consequences on the those actually utilizing the system. Let me put that another way, we must always proceed with what the impact of any changes will mean to families and beneficiaries.

   Thus, when decisions are made, they must be thought out and done so in a responsible manner. And I believe the Republican Patients' Bill of Rights does just that by: holding HMO's accountable, increasing access, improving quality and, expanding choice.

   At the same time we must work to ensure that: costs are not unnecessarily increased, more Americans are not forced into the ranks of the uninsured and, additional layers of bureaucracy are not placed between patients and their doctors.

   Let me take just a moment to talk about the state of health care in New Mexico.

   Health care is close to a $5 billion a year industry in New Mexico. Almost 3,000 physicians practice in the state and overall the industry employs close to 52,000 New Mexicans. Over 600,000 New Mexicans are enrolled in managed ca re pl ans.

   With this in mind, I would like to make several points about New Mexico as a whole, that are relevant to any debate relating to managed ca re: 7 8% of New Mexico businesses have 10 or fewer employees and 96% of all businesses have 50 or fewer employees. New Mexico ranks 40th in the nation in terms of the number of people uninsured, a full 25% of the population.

   The preceding merely emphasizes a point that we must take into consideration and that is the potential impact upon a state and its people.

   I think everyone would agree that the managed care syste m is not perfect and we have all heard one or another of those so called HMO horror stories. As a result, there is now a debate going on here and around the country about the need for HMO/Managed Care refor m.

   I also want to take a moment to point out that New Mexico is already at the forefront of HMO/Managed Care Refor m.

   New Mexico has already implemented many of the so called ``patient protections'' like: no gag clauses; a prudent layperson standard for emergency care; dire ct access to an OB/GYN; choice of providers; access to prescription drugs; confidentiality of medical records and; a grievance and appeals procedure.

   I think it is important to stop and make a point that I believe is extremely important in light of the large number of small employers and high rate of uninsured not only in New Mexico, but the rest of the country. For every 1% increase in premium costs, 400,000 individuals will lose their health insurance coverage.

   That is an extremely sobering thought when one realizes that small employers often have the most difficult time providing insurance for their employees because of the already high cost.

   The Republican bill simply addresses Americans' concerns that their rights be assured in health care covera ge, in addition to increasing access to care, impro ving quality of care, and e xpanding choice.

   However, there is one thing the Bill will not do, create a new right to go into the courts and sue managed care c ompan ies for unlimited damages. I believe that we on this side of the aisle have adopted a sense about health care and it says: lawyers and lawsuits do not deliver health care. Rathe r, lawyers and lawsuits generally make health care cost m ore.

   I also think that it is very important to note that under the Employee Retirement Income Security Act (ERISA) a participant or beneficiary can already sue a managed care c ompan y. Let me repeat that, the right to sue a HMO is already available.

   Now why would we want to create even more lawsuits, when for years we have been attempting to enact tort reform.

& nbsp;  I know many New Mexicans share in the fears expressed by many Americans about the availability and quality of their health care. That is why I support the Republican Patients' Bill of Rights because it will ensure that patients receive: more affordable care and mo re choices; greater access to more and better information about health plans, benefits and the doctors that provide their care; and t he advantages of a system that holds health plans accountable for medical decisions through a strong internal and external appeals process.

   The Bill reforms the Agency for Health Care Policy and Research, renaming it the Agency for Healthcare Quality Research (AHQR). It will make annual reports on the state of quality and cost of America's health care, suppo rt primary care resear ch in underserved rural and urban areas, provide technology assessment, and coordinate federal quality improvement efforts.

   Furthermore, the Bill includes a provision that will prohibit insurance plans from using predictive genetic information to deny coverage or to set premium rates.

   Finally, the Bill would provide relief to those New Mexicans and Americans who are self-employed by allowing them to deduct 100% of their health insurance costs. More than 25 million people live in families headed by a self-employed individual (5.1 million of whom are currently uninsured).

   In closing, I believe that the key to improving our healthcare system and to improving our HMO/Managed Care Sy stem is to work together.

   As I have said, we must find a solution that would most benefit not only New Mexicans, but everyone across our country. However, at the same time we must remember that our decisions cannot affect these same people in an adverse manner.


[Page: S923]  GPO's PDF

   S. 301. A bill to amend title 39, United States Code, relating to mailability, false representations, civil penalties, and for other purposes; to the Committee on Governmental Affairs.


    Mr. CAMPBELL. Mr. President, today I introduce the Honesty in Sweepstakes Act of 1999. This bill addresses one of the most troubling and persistent consumer abuse issues we face today: highly deceptive, and all too often financially damaging, sweepstakes and other mass mail promotions.

   Our nation's seniors and other vulnerable consumers are clearly being taken advantage of, and in some cases seriously financially harmed, by intentionally misleading sweepstakes promotions. Thousands of nationwide victims are being deliberately misled into believing that they have just won or are likely to win a sweepstakes when in fact they have neither won nor are in fact likely to win such a prize.

   Each year American consumers also receive hundreds of millions of cashier's check look-alikes that deceptively masquerade as real cashier's checks while actually being worthless. These ploys unfairly prey upon some people's hopes and dreams.

   Over the years sweepstakes have become increasingly sophisticated and deceptive. While these promotional tactics may be technically legal they are designed to skirt the intentions and outer limits of the law. These deceptive tactics run counter to core American values of honesty and forthrightness. There is abundant evidence, including the deceptive sweepstakes and other promotions each of us receives in our mailboxes on a regular basis, that current laws aimed at stopping these deceptive promotions simply are not working. Something needs to be done.

   This bill addresses these deceptive sweepstakes and cashier's checks look-alikes by requiring up-front, clear and easy to read Honesty in Sweepstakes disclosures that will help protect consumers by counterbalancing false promises and deception. While honest and straight-forward sweepstakes promoters have nothing to fear from this bill, those promotions that revert to false and deceptive tactics will feel the heat.

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