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[Page: H5617] GPO's PDF---
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 542 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 542
Resolved, That at any time after the adoption of this resolution the Speaker may, pursuant to clause 2(b) of rule XVIII, declare the House resolved into the Committee of the Whole on the state of the Union for consideration of the bill (H.R. 1304) to ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of health care professionals and health plans and health insurance issuers in the same manner as such laws apply to collective bargaining by labor organizations under the National Labor Relations Act . The first reading of the bill shall be dispensed with. All points of order against consideration of the bill are waived. General debate shall be confined to the bill and shall not exceed one hour equally divided and controlled by the chairman and ranking minority member of the Committee on the Judiciary. After general debate the bill shall be considered for amendment under the five-minute rule. It shall be in order to consider as an original bill for the purpose of amendment under the five-minute rule the amendment in the nature of a substitute recommended by the Committee on the Judiciary now printed in the bill. The committee amendment in the nature of a substitute shall be considered as read. All points of order against the committee amendment in the nature of a substitute are waived. No amendment to the committee amendment in the nature of a substitute shall be in order except those printed in the report of the Committee on Rules accompanying this resolution. Each amendment may be offered only in the order printed in the report, may be offered only by a Member designated in the report, shall be considered as read, shall be debatable for the time specified in the report equally divided and controlled by the proponent and an opponent, shall not be subject to amendment, and shall not be subject to a demand for division of the question in the House or in the Committee of the Whole. All points of order against the amendments printed in the report are waived. The Chairman of the Committee of the Whole may: (1) postpone until a time during further consideration in the Committee of the Whole a request for a recorded vote on any amendment; and (2) reduce to five minutes the minimum time for electronic voting on any postponed question that follows another electronic vote without intervening business, provided that the minimum time for electronic voting on the first in any series of questions shall be 15 minutes. At the conclusion of consideration of the bill for amendment the Committee shall rise and report the bill to the House with such amendments as may have been adopted. Any Member may demand a separate vote in the House on any amendment adopted in the Committee of the Whole to the bill or to the committee amendment in the nature of a substitute. The previous question shall be considered as ordered on the bill and amendments thereto to final passage without intervening motion except one motion to recommit with or without instructions.
The SPEAKER pro tempore. The gentleman from Florida (Mr. GOSS) is recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Ohio (Mr. HALL), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.
Mr. Speaker, this is a fair and appropriately structured rule for debate on this matter. We have made six amendments in order on a bipartisan basis. These amendments cover a full range of topics concerned with the underlying bill.
The Committee on Rules has clearly erred on the side of inclusion to ensure a full, yet I believe efficient debate on this very important subject, which has caught the attention of Members.
We are here today because doctors have become disillusioned with some aspects of our modern healthcare delivery system. They rightly assert that some HMOs are interfering too much in the doctor -patient relationship undermining their ability to effectively do their job. Their complaints are understandable, and they do need to be addressed.
H.R. 1304 seeks to level the playing field between insurers and doctors. While HMOs should not be able to dictate to physicians because of their size, it is equally wrong for doctors to
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Those are the things we need to avoid, so we have to get it right. We have to find the correct balance, and this rule fairly provides for meaningful debate on how to proceed.
H.R. 1304 is a simple, straightforward bill. It proposes to give doctors and other health care professionals a limited exemption from antitrust laws when bargaining with health plans conferring on them the same rights afforded to unions operated under the National Labor Relations Act .
But based on testimony from some colleagues, there may be a hitch, unlike traditional unions, these doctor cartels, as they are called, would exist without any real regulatory oversight.
[Time: 21:00]
Doctors could refuse to negotiate in good faith and even engage in selective boycotts. Obviously, this is a problem that needs a remedy. We all know that Congress does have a role in curtailing HMO abuse. I am very proud to be one of many House Members and Senators who have been serving on the conference, working on a bipartisan basis, to finalize the details of the Patient's Bill of Rights. But while we still have some work to do on it, it is no secret that we are pretty well agreed to the need for an independent, binding review process where doctors' decisions will be evaluated by other physicians. In other words, meaningful and appropriate oversight.
We also understand that HMOs should be held accountable when they interfere in the doctor -patient relationship and harm occurs. But as encouraged as I am by this, I have reservations about H.R. 1304. It appears to be a necessary, simple solution to a tough problem, but as a wide range of experts have stated from the Congressional Budget Office to the Federal Trade Commission, the costs could outweigh any potential benefits. In fact, the CBO's projection put the cost at well over $3 billion over 10 years, not an insignificant amount of money, even around here; and that is worrisome to me.
I am hopeful that my colleagues will support this rule so that we can get on with deliberation of these and other issues and weigh the potential costs and benefits. That is, after all, why we are here and what a deliberative body does. America's doctors and patients do deserve relief from bad HMOs. Indeed, Congress is addressing HMO reform in a tough and serious manner; I am a firsthand witness to that. The gentleman from California (Mr. CAMPBELL) and the gentleman from Michigan (Mr. CONYERS) and some others urge that H.R. 1304 is the right direction we should pursue as part of congressional consideration. As our colleagues, they deserve respect for bringing this forward, and I urge a yes vote on this fair rule and look forward to a fair exchange on the underlying bill after everybody has the chance to hear all sides. However, we do not get that chance if we do not approve this rule.
Mr. HALL of Ohio. Mr. Speaker, I yield myself such time as I may consume, and I thank the gentleman from Florida for yielding me this time.
This is a restricted rule. It will allow for the consideration of H.R. 1304, which is the Quality Health Care Coalition Act . As my colleague from Florida has explained, this rule provides for 1 hour of general debate. It will be equally divided and controlled by the chairman and ranking minority member of the Committee on the Judiciary. The rule makes in order only six amendments. No other amendment may be offered.
This bill provides limited antitrust exemptions for doctors who negotiate contracts with health plans and insurance companies. Other workers enjoy a similar exemption under collective bargaining laws.
In recent years, health maintenance organizations and insurance companies, not doctors, have dictated the terms of health care for most Americans. Antitrust laws have prevented doctors from organizing to counterbalance the influence of the health care managers. Many people believe that this legislation is needed now more than ever because growth and consolidations among the HMOs and the insurance companies have only increased the bargaining power of the health care industry against the doctors. Obviously, the purpose of the bill is to swing the balance of power back in favor of the doctors.
The House sometimes uses restrictive rules like this, but it should only do it in sparing ways. However, as with some bills reported from the Committee on the Judiciary, it can be appropriate in the case to limit amendments. The few amendments that may be offered will give opponents of the current bill an opportunity to further debate and perfect it.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I am happy to yield 3 minutes to the distinguished gentleman from California (Mr. CAMPBELL), the author on this side.
Mr. CAMPBELL. Mr. Speaker, I thank the gentleman from Florida for all of his kindness and hard work in this field.
I wish to say that the rule is critical. The rule is critical. There will be no other means to address H.R. 1304. To those who have sponsored this bill, and I have a list of all of them, please, if they think that they might vote against the rule but have a chance to vote for the bill again, they are wrong. It is not going to come back. So this is the issue, this is the moment, this is the time to vote in favor of patients if we believe that they are not being adequately taken care of under today's medical system, because there is not a balance between the doctors and the HMOs.
The focus of the controversy is on the amendment by the gentleman from Oklahoma (Mr. COBURN). I understand that there is concern that his amendment was made in order, but the second degree amendment of the gentleman from Pennsylvania (Mr. GREENWOOD) was not.
Let me address this directly. I have a 100 percent pro-choice voting record. I am second to none in my support of a woman's right to choose. My record stands for that. The Coburn amendment says, ``Nothing in this section shall apply to negotiations specifically relating to requiring a health plan to cover abortion or abortion services.''
Whereas I would not have singled out abortion, I would not have treated this in any manner different than any other medical procedure, I emphasize to my colleagues that the Coburn amendment is a null set. There is no evidence of any health care plan, any HMO, requiring doctors to perform abortion or abortion services. I draw to the attention of all of the cosponsors of this bill that the amendment by the gentleman from Oklahoma (Mr. COBURN) uses the word ``requiring,'' not ``permitting.''
This amendment, in other words, is, in my judgment, an effort to introduce the topic of abortion into an area where it has no place. It is not a substantive amendment. Mr. Speaker, let me repeat, it deals with a case that has not been shown to exist--where an HMO requires a doctor to perform an abortion.
In conclusion, the gentleman from Florida (Mr. GOSS) noted two things with which I would like to take respectful disagreement. First of all, the concern he expressed for a boycott was addressed by an amendment by the gentleman from New York (Mr. NADLER), accepted in the Committee on the Judiciary, so that a boycott is not possible under this bill. Secondly, the cost estimate that the vice chairman of the Committee on Rules gave was for 10 years, but we adopted a 3-year sunset for the bill, so the cost is substantially less, actually, it's less than one third of the cost that the gentleman from Florida estimated.
With that, I conclude with one last request. For those who care about this bill, for those who care about the 3 1/2 years those of us have put into it, this is the moment. Do not let the rule keep us from the merits of this bill. It is not a perfect rule. I did not wish everything to go into it that has, but we will have no other chance.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. DOOLEY).
Mr. DOOLEY of California. Mr. Speaker, I rise in opposition to the rule on H.R. 1304.
I rise in opposition primarily because I think it is irresponsible for us to exempt this legislation from the budget
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Mr. Speaker, the original bill was scored by CBO as costing in excess of $11 billion. Even with the modifications that were added in the Committee on the Judiciary, it is still estimated to have significant cost in reduced Federal tax revenues of almost $11 billion if this was made permanent for the 10-year period. Obviously, it would be less if it only survives for the 3-year sunset period.
But it also is projected to have costs not only to the government in terms of increased cost to Medicare, Medicaid, and the Federal employee health benefit plans, but it is also estimated to cost consumers, as we will see an increase in health care premiums as a result of this, which are estimated to be on average of almost 2 percent by the third year of the enactment of this bill.
If we are going to maintain consistency with the budget rules that are to guide the legislation in this House, we should not exempt this legislation. We should not exempt legislation that is going to have budgetary impacts in the billions of dollars. I think anyone that prides themselves on being a fiscal conservative should not support this rule; they should send this bill back to the Committee on Rules where we will have the opportunity to bring this bill up when we can give adequate consideration to the fiscal and the revenue impacts they will have to the Federal Government and to the taxpayers of America.
Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Oklahoma (Mr. COBURN).
Mr. COBURN. Mr. Speaker, I want to, first of all, say that as a practicing physician I am extremely frustrated with the position physicians are placed in in this country in not being able to make decisions to care for their patients. I think the problem that the gentleman from California (Mr. CAMPBELL) is trying to address with this bill is a real problem, but I think this is the wrong fix. I do want to take exception to what he said about the position as to certain organizations wanting to require people to have to perform abortion services or to offer them. In his own State, in the California legislature this year, by a very narrow margin, a bill that would have forced Catholic hospitals in his own State was offered and barely defeated. It is the position of the California Medical Association that, in fact, that be the policy in California. That position was offered in the House of Delegates at the AMA this year.
So to claim that this is not an intent is not true; it is an intent in the long run to limit the conscious objection of health care providers and the hospitals to not provide abortion services.
I am leaving this House at the end of this session, and I will be in practice; and I will tell my colleagues that if the Campbell bill becomes law, I will utilize it vigorously. But it will not be, in the long term, the best thing for medicine. Because the prices would rise exorbitantly; and after that has happened, then the focus of the health care problems that we have in the country then will be on the doctors, and we are not the ones to blame. But through our frustration, through the lack of fees to keep pace, through our inability to care for our patients, we are bound to do the wrong thing.
So I adamantly oppose the Campbell bill. I was originally a cosponsor of this bill, and my first thought was, I thought this was a good idea. Thinking through of what I want the profession of medicine to be 10 years from now, I think this is a terrible bill. I think the rule is fair.
Mr. HALL of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. BENTSEN).
(Mr. BENTSEN asked and was given permission to revise and extend his remarks.)
Mr. BENTSEN. Mr. Speaker, I want to talk about the rule. I am not going to talk about the underlying bill, except what the rule provides for in the underlying bill.
It is interesting what a difference a day makes. We have a rule before us today that waives all points of order against the bill pursuant to the budget resolution, because the underlying bill would exceed the discretionary spending caps in the fiscal year 2001 budget resolution. In addition, it would violate the pay-go rules per the fiscal year 2001 budget resolution.
Now, why is that so significant in this context? It is significant because yesterday, Democrats were told and, in fact, a number of Republicans as it turned out, were told that we could not offer a broad-based, voluntary, universal prescription drug program under Medicare because the fiscal year 2001 budget resolution did not provide for it. But today, barely 24 hours later, as I and others predicted, the Republican leadership has decided that the paper that the budget resolution is written on is not worth very much.
So, we have before us a rule that shows the true hypocrisy of the Republican leadership when it comes to the question of providing true prescription, affordable prescription drug coverage for America's senior citizens. That is what this rule tells us today. We can debate the underlying bill later; but the sad fact of it is, there was a sham put upon the American people yesterday, 39 million senior citizens, under some phoney rule about what could be considered in the House and, today, we have thrown that out the window with a rule that waives points of order regarding the budget resolution. I think that is a real shame, and I would imagine that our friends will have something to answer about come this fall.
Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from North Carolina (Mr. BALLENGER).
Mr. BALLENGER. Mr. Speaker, I thank the gentleman for yielding me this time.
First, I would like to say antitrust exemption will not improve health care quality at all. Proponents of this bill say that it will level the playing field between doctors and health plans. But what happens to the consumer when the providers get together and collectively negotiate with insurers?
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