Rob Andrews

Mr. ANDREWS

Mr. ANDREWS. Mr. Speaker, generations of American school children will read and study about September 11, 2001. In their history, they will see that Americans across our land are manifesting the spirit of their chosen God in millions of acts of compassion and mercy. In their history, they will hear of the heroic efforts of firefighters, EMTs and EMS personnel, police officers and medical personnel. They will read this history, but, in the next few days, we will write that history. Let that history show that we came together, we found the organizations that were responsible for the acts of terror against our people and our country yesterday, and we found any nations who participated or permitted that terror, and we acted swiftly and destroyed those organizations and destroyed the war-making capability of those nations. Let that history show that this was the day when America said it was no longer any good in the world to play both sides of the fence when it comes to terrorism; that it was the day we said to the so-called moderate states around the world that they cannot have it both ways when it comes to terrorism. They cannot condemn terrorism with their words, but support terrorism with their prosperity, their currency and their diplomacy. Let us join together and write a history that says to those countries who are ambiguous about their support for us, that there will be no more aid, there will be no more trade, and there will be no more arms from the American people. Mr. Speaker, let us unify tonight, so that when our descendants read this history, they read this history in an America that is more strong, more free, and more safe than the one we are privileged and blessed to live in tonight.

Mr. ANDREWS

Mr. ANDREWS. Mr. Chairman, I yield myself 15 seconds. I believe the gentleman from Arizona said affirmative defenses are not spelled out in the Federal cause of action. That is right. Of course, that means it is up to the judiciary to invent them as we go along. We do not know whether there will be affirmative defenses or not, what they will mean, because it is not included in here. Because when you draft a cause of action overnight, you cannot think of those things. Mr. Chairman, I yield 1 minute to the gentleman from Massachusetts (Mr. Markey).

Mr. ANDREWS. Mr. Chairman, I demand a recorded vote.

Mr. ANDREWS. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, this amendment is very much in keeping in theme with the message today from the majority, which is illusions. The Norwood amendment creates the illusion of holding HMOs accountable for their misconduct, and we will discuss that in greater detail in the next amendment. This amendment creates the illusion of covering more of the uninsured Americans with health insurance. It is a remarkable miss of the target that we should be aiming at. We hear a lot about the 43 million uninsured Americans. It is curious, first of all, that we never hear much from the majority party about the 43 million uninsured Americans in April when we are doing the budget resolution. It only seems to come up when the patients' bill of rights comes up and they need a justification for their position. First of all, AHPs. The theory behind AHPs is that employers are going to enjoy a reduction in their premiums; and, therefore, more employers are going to buy health insurance and more individuals are going to be covered. That just does not square with the objective analyses that have been done of the AHP concept. One of them was done by the Congressional Budget Office, whose researchers concluded that AHPs would not reduce overall health insurance costs. The CBO found that four in five workers would see their health insurance costs increase under this amendment, under AHP legislation, because of disruption in health insurance markets. So the illusion that premiums would go down is not the fact. The second problem with AHPs is that it really is a race for the bottom. It preempts and therefore repeals the consumer protection legislation adopted by States all across the country, legislation that requires a minimum length of stay after a C-section for a woman who has given birth, legislation that requires a minimum length of stay after a radical mastectomy. All of these consumer protections are repealed when the AHPs go in. Maybe there is some argument that prices would go down, that if you eliminate quality standards and fiduciary standard, you could make it very cheap, but it would not be worth the money that people pay. So the argument that more people are going to be insured by AHPs just does not square with the facts. It does not square with the study by Rand researchers Steve Long and Susan Marque, who found that existing AHPs have not reduced insurance costs for participants. The next idea that is going to get more people insured is individual health savings accounts. This is remarkable. The theory behind this is that a person making $21,000 or $22,000 a year who works full-time and has no health insurance is going to put all of this extra income that she has into one of these medical savings accounts at the end of the week, and that all of this extra income that she generates is going to pile up and provide her with the health benefit that her employer is either unable or unwilling to afford. I would be curious as to how anyone in the majority could explain to us where this additional income is going to come from? I would invite the majority, I would yield to anyone over there, to tell me what present data tells us about who is participating in MSAs now, what the medium income of the participant is, how many people are participating in MSAs, whether they are in the bottom 30 percent of the wage earners in the country, since most of the uninsured working people in this country are in the bottom 30 percent of wage earners. So this is a remarkable idea. We are giving low-income, full-time working people the right to put away money that they do not have. We perhaps should also introduce an amendment giving them the right to purchase a Rolls Royce, or a condominium at an expensive resort. It is about as useful to them, because they do not have the money to put away.

Mr. ANDREWS. I yield to the gentleman from Kentucky.

Mr. ANDREWS. Mr. Chairman, reclaiming my time, because it was necessary to build a majority coalition to pass the bill, which we would have done had the leadership brought it to the floor when it was originally promised. Mr. Chairman, the problem with this amendment is it suffers the illusion, the continuing illusion, that we are going to cover more people. You want to cover more people? Put more money in the S-chip program. Repeal just a little piece of the tax cut that passed a couple of months ago and put more money into the program that has enrolled millions of children, and could enroll their parents, if we extended that. That is the way to enroll more people in health insurance. You want to enroll more people in health insurance? Let seniors 55 and over buy into Medicare at their own expense. You want to cover more people by health insurance? Expand Medicaid reimbursement to the States. That is the way to do it; not this fraud, not this illusion that is before us today. Mr. Chairman, I reserve the balance of my time.

Mr. ANDREWS. Mr. Chairman, will the gentleman yield?

Mr. ANDREWS. Mr. Chairman, I wonder if the gentleman could tell us the source of the quote he just read?

Mr. ANDREWS. Mr. Chairman, I yield 1 minute to the gentleman from New Jersey (Mr. Pallone), who represents a State that just enacted a very strong patient protection law that will be repealed by this amendment.

Mr. ANDREWS. Mr. Chairman, I yield 2 minutes to the gentleman from California (Mr. Waxman), who is a champion of consumer groups across the Nation that strongly oppose the Norwood amendment. (Mr. WAXMAN asked and was given permission to revise and extend his remarks.)

Mr. ANDREWS. Mr. Chairman, it is my privilege to yield 2 minutes to the gentleman from Iowa (Mr. Ganske), the principal voice for patients around America.

Mr. ANDREWS. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the record shows that this amendment will not substantially increase coverage. The association health plans will not substantially reduce premiums; therefore, more employers will not be enticed to buy in. MSAs are not going to work for low- and modest- income people who do not have money to put into the MSAs. This is an illusion, much like the Norwood amendment that we are going to debate next. I urge the defeat of the amendment. Mr. Chairman, I yield back the balance of my time.

Mr. ANDREWS. Mr. Chairman, reclaiming my time, I look forward to that. Mr. Chairman, I reserve the balance of my time.

Mr. ANDREWS. Mr. Chairman, will the gentleman from California (Mr. Thomas) do it by raising other revenues by $3 billion, by raising taxes?

Mr. ANDREWS. I yield to the gentleman from California.

Mr. ANDREWS. Mr. Chairman, reclaiming my time, I wonder where the other $3 billion might come from, the other $3 billion.

Mr. ANDREWS. Mr. Chairman, I yield myself such time as I may consume. Under the budget rules of the House of Representatives, when someone brings a bill to the floor that would reduce revenue flow of the Treasury, they normally have to show where it is going to be paid for. This amendment was given an exception to that, so it is not subject to a point of order. I wonder if anyone on the majority side could tell us where the $5 billion over the next 10 years is going to come from to pay for this bill. Mr. Chairman, I yield to anyone on the majority side to tell us where the $5 billion is going to come from.

Mr. ANDREWS. Mr. Chairman, I yield myself the balance of my time. (Mr. ANDREWS asked and was given permission to revise and extend his remarks.)

Mr. ANDREWS. Mr. Chairman, I yield 2\1/2\ minutes to the gentleman from Michigan (Mr. Dingell), a giant in this institution, the dean of the House of Representatives and our great friend. (Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Mr. ANDREWS

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 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. 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.

Mr. ANDREWS. Mr. Chairman, I yield 1 minute to the gentleman from New York (Mr. Engel).

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. 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. 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. ANDREWS

Mr. ANDREWS. Mr. Speaker, I thank my friend from New York for yielding time. Mr. Speaker, the House is about to embark on a travesty of procedure if it adopts this rule. The last speaker said that we wanted to hurry up and get the Ganske-Dingell bill to the floor, and he is correct. The Ganske-Dingell bill was filed in February. February. For the last 4 or 5 months we have all had a chance to read it, question it, understand it. The principal alternative to the patients' bill of rights that is going to be offered by the gentleman from Georgia (Mr. Norwood) this afternoon, the copy I read indicates it was printed at 7:18 a.m. today for the first time. We were in the Committee on Rules last night, or this morning, excuse me, after midnight, nearly at 12:30 in the morning, I know it went on long after that, I commend the Rules members for their diligence, and they had not started writing the bill yet. So an immaculate conception occurred sometime during the night last night. Sometime between 1 a.m. and 8 a.m., we gave birth to a product here that purports to do in 6 hours what lawyers and scholars and judges have taken 300 years to accomplish, and, that is, to write a complete set of rules about proximate cause, affirmative defenses, contributory negligence, rules of evidence, rules of discovery, all the things that come into the process of adjudicating a legal dispute. This is a travesty. Most of the Members who will consider this bill today will not know what is in it. We have a few hours to try to find out. Once this process goes forward, the American people will have a few weeks and a few months to find out. And when they do, they will recognize the deception that is about to be perpetrated upon the House this afternoon. Oppose this rule. Support the Ganske-Dingell bill.