Jeff Bingaman

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I send a second-degree amendment to the desk and ask for its immediate consideration.

Mr. BINGAMAN. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. BINGAMAN

Mr. BINGAMAN. We will put it on the right paper and go with it.

Mr. BINGAMAN. Mr. President, it is ready. We have it written up in amendment form. We just got it on a sheet of paper. We can easily do that and take another minute or two.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise to express my support for the legislation being introduced today. I am proud to be a co-sponsor of the Specialty Crop Insurance Act of 1999 with my colleagues, Senators Graham, Mack, Boxer and Feinstein. The outcome of this legislative effort will have a profound effect on the economic health and well-being of specialty crop producers in my state of New Mexico, as well as for farmers across the country. Today's crop insurance program does not provide sufficient risk management protection to many specialty crop producers, leaving the growers vulnerable to risk. Specialty crops in New Mexico include chiles, pecans, lettuce, and pistachios. In fact, Dona Ana County ranks as the number one pecan-producing county in the nation according to a recent USDA census. And we produce 50% of the chiles used in the United States. However, at present, viable crop insurance policies which offer valid risk management protection are available for only a limited number of specialty crops. Many policies which are available fall short of reflecting the needs of producers. This means that the great majority of specialty crops farmers in this nation are without appropriate, adequate and affordable risk management protection. This legislation addresses the needs of those farmers who produce our fruits and vegetables, nuts, and greenhouse and nursery plants for affordable crop insurance policies.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise to express my support for the legislation being introduced today. I am proud to be a co-sponsor of the Specialty Crop Insurance Act of 1999 with my colleagues, Senators Graham, Mack, Boxer and Feinstein. The outcome of this legislative effort will have a profound effect on the economic health and well-being of specialty crop producers in my state of New Mexico, as well as for farmers across the country. Today's crop insurance program does not provide sufficient risk management protection to many specialty crop producers, leaving the growers vulnerable to risk. Specialty crops in New Mexico include chiles, pecans, lettuce, and pistachios. In fact, Dona Ana County ranks as the number one pecan-producing county in the nation according to a recent USDA census. And we produce 50% of the chiles used in the United States. However, at present, viable crop insurance policies which offer valid risk management protection are available for only a limited number of specialty crops. Many policies which are available fall short of reflecting the needs of producers. This means that the great majority of specialty crops farmers in this nation are without appropriate, adequate and affordable risk management protection. This legislation addresses the needs of those farmers who produce our fruits and vegetables, nuts, and greenhouse and nursery plants for affordable crop insurance policies.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise today in support of the Trade Adjustment Assistance Reauthorization Act, a bill that has been reported from the Finance Committee and was filed on July 16th. I believe this bill is critical for American workers, companies and their communities. The bill as written would extend authorization for trade adjustment assistance for two years, and would allow workers and companies that are negatively impacted by international trade to receive the assistance currently allowed by law. If we do not pass this legislation, trade adjustment assistance will expire this October, and workers and companies that are presently receiving benefits will be completely cut off from government support. In specific terms, this means over 340,000 workers across the country, and several thousand workers in my state of New Mexico, will be without support needed to maintain their lives and re-train for the future. These are real people and real lives we are talking about, and we simply can't let this happen. We must act now to ensure the programs continue. Let me briefly explain what this legislation is about. In 1962, when the Trade Expansion Act was under consideration, the Kennedy Administration came up with a very straightforward proposition concerning international trade and American workers and companies: if and when Americans lose their jobs as a result of trade agreements entered into by the U.S. government, then the U.S. government should assist these Americans in finding new employment. If you lose a job because of U.S. trade policy, you should have some help from the federal government in re-training to get a job. I find this a reasonable and fair proposition. It suggests that the U.S. government supports a open trading system, but recognizes that it is responsible to repair the negative impacts this policy has on its citizens. It suggests that the U.S. government believes that an open trading system provides long-term advantages for the United States and its people, but that the short-terms costs must be addressed if the policy is to continue and the United States is to remain competitive. It suggests that there is a collective interest that must be pursued, but that individual interests must be protected for the greater good. This commitment to American workers and companies has continued over the years, and should not be ended now. The reason for continuity is obvious: globalization is only moving at a faster pace, with the potential for ever more significant impacts on our country. In my opinion, the process of globalization is inevitable. It is not going to stop. Therefore, the question for us in this chamber is not whether we can stop it, but how we can manage it to benefit the national interest of the United States. The picture we see of globalization is that of a double-edged sword, with some individuals and companies gaining and others losing. The gains are clear-cut. Exports now generate over one-third of all economic growth in the United States. Export jobs pay ten to fifteen percent more than the average wage. Depending upon who you listen to, it has generated anywhere from two to eleven million jobs over the last ten years. For those who dislike globalization, I say look in your kitchen, your living room, your driveway, your office, and see the products that are there as a result of a more open and interdependent trading system. Without expanded trade brought on as a result of globalization we will end up fighting over an ever-decreasing domestic economic pie. But in spite of these obvious benefits we cannot ignore the problems involved with globalization. Every day we hear disturbing stories about what this has meant for people across the country. In my state we have seen over the last year a large number of lay-offs and closings in small rural towns that cannot afford to have this happen. The closing of three plants in Roswell, Las Cruces, and Albuquerque meant 1,600 people lost their jobs. Next came lay-offs in the copper mines in my home town of Silver City. These people cannot simply go across the street and look for new work. They are people who have been dedicated to their companies and have played by the rules over the years. What they deserve when they lose their job is an opportunity to get income support and re-training to rebuild their lives. What they deserve is a program that creates skills that are needed, that moves them into new jobs faster, that provides opportunities for the future, that keeps families and communities intact. TAA offers the potential for this outcome. Although in need of revision in several key areas--and I am focusing on these areas at this time--it has over the years consistently helped individuals and companies in communities across the United States deal with the transitions that are an inevitable part of a changing international economic system. It helps people that can work and want to work to continue to work in productive jobs that contribute to the economic welfare of our country. We have made this promise to workers in every administration, both Democrat and Republican, and we should continue to do so. Although TAA is not without its flaws, it remains the only program that allows workers and companies to adjust and remain competitive. Without it, in my opinion we are saying unequivocally that we don't care what happens to you, that we bear no responsibility for the position that you are in, that you are on your own. Senators Roth, Moynihan, and others think otherwise, and I agree wholeheartedly with them. I believe that this commitment to individuals and companies and communities must be kept. I urge all my colleagues to support the passage of this bill when it comes to a vote on the floor.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, over the past few days, my Democratic colleagues and I presented a number of arguments which clearly laid out the need for managed health care reform. The ability to hold insurance companies accountable for their decisions is a critical element in ensuring the overall quality of patient protections. While we will continue to present our case in a variety of ways, I would like to take this opportunity to relate a story that was shared with me just a few weeks ago about a young girl from Albuquerque, New Mexico. Anna, 6 years old at the time, was a very active and energetic young girl and excited about entering first grade that year. One evening, Anna went with her parents and her brothers and sisters to a softball game. She and other children went off to play in an area near the softball field. Suddenly, some of the children came running towards the adults, screaming for help. Anna had caught her foot in a gate. Her foot was bleeding profusely and she was in agonizing pain. She was immediately rushed to the local emergency room. After Anna was examined by her doctor and after a conversation with her family's HMO, it was determined that Anna would not be admitted to the hospital that night. Anna's family reluctantly took her home that night where she was in pain throughout the evening. Her family was forced to watch their small, frail daughter lay in bed in agony. The next morning, her mother was worried because Anna's foot was purple, swollen, and cold. Anna was in tremendous pain and had a fever. Her parents did not hesitate any longer and Anna was rushed back to the emergency room. This time she was admitted immediately and treated on an emergency basis, but it was too late and her family's worst fears were realized. Anna had a raging infection that had already destroyed half of her foot which had to be amputated. Anna had two surgeries and spent 6 weeks in the hospital. She will live with this deformity forever. Unbelievably, her family's HMO has delayed paying for the 6 weeks she was in the hospital to have her foot amputated and grated at a cost of $23,000.00. Anna's family paid for the protection of health insurance. What they received in return was a possible delay of critical medical service which has left Anna disfigured and has ruined her family's credit. To the amazement of anyone who hears this story, under current law, Anna's HMO will not be held accountable for their decisions. Under the Democratic plan, Anna and her family would have legal recourse like any other American has in this country when they are wronged by a business. The Democratic plan simply states that if a patient is injured or killed as a result of an insurance company's decision, the insurance company can be held liable under state law. Let me be clear. This will not open the flood gates to more litigation and raise the cost of health insurance. It doe not override states' rights. It simply says that whatever rights a given state chooses to grant shall not be blocked by federal legislation. Without adoption of the Democratic plan, stories like Anna's will continue to be told. I understand Anna is quite a young girl and she will go on. But she and her family will struggle with this nightmare. The Democratic plan is not about lawyers--it is about people like Anna and protecting their rights. Anna, her family and millions like them in this country are waiting for us to do just that.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I thank the manager of the bill. Let me add one other thing. We need to ask, who are the 48 million people who are covered under the Republican plan and under this amendment they have offered on nondiscrimination against providers? They are people who work for large employers primarily who are self- insured. The employers have their own insurance programs. Unfortunately, in my State, there are very few of those large employers. You have to have over 100 employees, essentially, before it makes any sense to be self-insured. In New Mexico, people work for small employers, by and large. Even those who work for larger employers generally are not working for self- insured employers. Essentially, the folks I am representing in the Senate are not going to be covered by the amendment as it is offered. I think this is a serious defect. There is one other thing I want to say in relation to Senator Dodd's point. The American Cancer Society does not support an amendment or provision that does not apply to all insured individuals, that requires a commission to determine routine patient costs, and delays access to clinical trials until the year 2001. The American Cancer Society maintains that all patients with a serious and life-threatening illness should have assured access and reimbursement for clinical trials. Mr. President, I yield the floor. Mr. JEFFORDS addressed the Chair.

Mr. BINGAMAN. I thank the Senator. In relation to Medicare managed care plans, and in relation to Medicaid, it has worked extremely well in those cases. As far as I know, there has been no objection raised to it. So I believe what has worked there makes good sense in this area as well. I believe it is very important we have this provision included in the bill we finally pass. One other example. In my State, certified registered nurse anesthetists are the sole anesthesia providers for 65 percent of our rural hospitals. If our rural hospitals are going to continue to function, as they must, then we need to be sure the nonphysician providers who are able to provide services in these smaller communities are able to do so and be compensated through these health maintenance organizations. I think this is an important provision. I hope very much Senators support it and we can get this adopted as part of a bill we finally pass. I yield the floor.

Mr. BINGAMAN. I thank the Senator for that question. It is an extremely good point. This is the nondiscrimination requirement that was put into the Balanced Budget Act in addition to Medicare.

Mr. BINGAMAN. I am glad to yield.

Mr. BINGAMAN. Mr. President, I thank the Senator. I strongly support the effort my friend from Oregon is making to ensure that there is a provision in this bill that is finally passed prohibiting these gag provisions. I think that is very important. I want to speak about a different aspect of this larger amendment. This is a provision that Senator Harkin has taken the lead on, that I am cosponsoring with him. It deals with the problem of discrimination against nonphysician providers of health care services. What am I talking about when I talk about ``discrimination against nonphysician providers of health care services''? I am talking about the people whom everyone, on occasion, wind up going to for high- quality professional health care. I am talking about nurse anesthetists, about speech and language pathologists, nurse practitioners, physical therapists, nurse mid-wives, occupational therapists, psychologists, optometrists, and opticians. These are health professionals who are licensed to provide particular medical services. All we are providing in Senator Harkin's amendment, which I cosponsor, is that a health maintenance organization cannot arbitrarily prevent a whole category of health care providers from providing that health care they are licensed and qualified to provide. This is an extremely important issue for a State such as New Mexico where we have a great many rural and underserved areas. That is where the impact is the greatest because we have too few physicians in my State. The reality is that if a person is limited in obtaining their health care from a physician, in many cases in many parts of our State they either have a choice of driving a great distance or going outside their health plan and paying out of their pocket for something that ought to be covered by the premium they are already paying. It is a serious issue that needs to be addressed. In my State, the estimate is that we are losing 30 physicians. I believe it was 30 physicians in 1 month, according to the estimate. So we have a shortage of physicians. We are losing many of the ones that we have. We need to be sure people have access to the nonphysician health care providers who are very qualified to provide some of these services. Let me show a chart on one of the specialties I am talking about. This is on anesthesia providers. As I indicated before, nurse anesthetists are covered as one of the groups of health care providers. In our State, if you want anesthesia services, if you have to have anesthesia provided to you, your ability to get that strictly from a physician occurs in only one small area of our State. That is the area in blue. In all of the rest of our State, you are forced to rely upon someone other than a physician to provide that service. All we are saying is, in the case of anesthesia services, a health maintenance organization should have to allow those services to be provided by another qualified person other than a physician, where that person is available. This is a simple matter of fairness to patients in rural areas. It is something that does not involve significant costs. In fact, the estimate of the Congressional Budget Office is less than half a percent change in cost over a 10-year period. The reality is that many of these nonphysician health care providers provide these services at a much lower cost than the physician does. So, in fact, it is not a question of increasing the cost. In many cases, it is a question of decreasing the cost. We offered this amendment in committee when this bill was considered in the Health and Education Committee. I offered this exact language. Senator Harkin did. Several of our Republican colleagues at that time expressed their support--not with their votes but with their statements--for providing this type of guarantee. So it is nothing radical. This is a simple fairness issue, and it is one that makes all the sense in the world as far as the economics of health care is concerned. If we are really concerned about getting adequate health care to the rural underserved areas of our country, such as I represent in New Mexico, such as Senator Harkin represents in his State, it is essential we have this amendment as part of what we pass out of Senate.

Mr. BINGAMAN

Mr. BINGAMAN. I thank the Chair, and I thank the Senator from Massachusetts for yielding this time. Mr. President, this is a very important amendment. This is the amendment that I believe is the most significant for many Americans in this entire debate. This is the amendment that relates to the question of whether they are going to have access to speciality care as part of their arrangement with their health maintenance organization. Often, if speciality care is denied or if access to speciality care is delayed for a substantial period of time, it can involve a real health risk and even death for a patient. This is not an insignificant matter. This is a very important matter which is essential we deal with if we are going to put in place some protections for patients in this legislation. The amendment that Senator Kennedy has sent to the desk on my behalf establishes, first of all, a general right to speciality care if it is medically necessary. If a plan cannot provide such care within its own network, then it must allow the patient who needs that care to go outside the network at no extra cost to the patient. This is in sharp contrast to the amendment we were talking about before which the Senator from Maine sent to the desk. In that case, there was no restriction on the HMO in its ability to charge additional amounts to the patient if they went outside the plan. We provide that no additional charges can be imposed. This is a procedure which is in place in many of our managed health care plans, but unfortunately not in all. What we would do is say that this is a basic right that people in this country are entitled to if they have health care through health maintenance organizations. The second thing this amendment does is it allows people who have a chronic or a serious ongoing illness that requires specialty care to receive that care either through a standing referral to a specialist or by designating a specialist as their primary care provider. This is very important. This is an important protection for disabled people, for individuals with serious chronic illnesses, such as diabetes. In my comments a few minutes ago, I referred to the fact that a person with diabetes clearly needs access to a specialist on an ongoing basis. They receive most of their care from a specialist who understands their condition, and that specialist is in the best position to coordinate their care. The plan which the Republican Members offered a few minutes ago does not guarantee access to that specialty care without additional cost. It does not guarantee access to that specialty care for all patients. And it does not guarantee access to that specialty care on an ongoing basis with that specialist being designated as a standing referral or as a primary care provider. So there is a very great difference between what we are offering in this second-degree amendment and what was earlier discussed. This amendment I think is absolutely crucial for people who suffer from these ongoing chronic diseases. This is an issue which we heard very dramatically described earlier this morning in a press conference that occurred outside the Capitol. We had a woman attend who talked about the problems--she is a nurse herself, so she knows a great deal about providing medical care to individuals--and she talked about the problems she and her husband had in gaining access to specialty care for their young child, their 4- year-old son Matthew. What she said I think rings true to a lot of Americans. Let me just go briefly through her story. She talked about Matthew having a significant speech delay that had been directly linked to his repeated ear infections. She said for the first 2 years of his life Matthew suffered 14 ear infections. In most cases this is a normal childhood illness that is treatable by antibiotics, but in the case of Matthew it was not a normal childhood illness. The doctor who treated Matthew repeatedly used antibiotics instead of granting the request, which the parents made, for a referral to an ear, nose, and throat specialist. As a nurse, this mother, Beth Gross, knew the risks of the chronic condition. She grew frustrated at how a simple surgical procedure called an ear tube placement could have immediately corrected this problem, and eventually her frustration grew to a level where she made the decision to change her primary care physician. She called the insurance company at that point. She said when she explained the dilemma she was in, she was outraged by the response she received from the insurance company. This is a quotation from her statement. She said: We could not get a referral for Matthew because it was their policy [the policy of the insurance company] to impose monetary sanctions on the physician for giving a referral for something that he is able to treat. It was the view of the insurance company that he was able to treat this. They were going to impose monetary sanctions on him if there was a referral made. On that basis, they would not allow the referral. So she had to fight for another year to get the referral that Matthew needed. By that time, Matthew was 18 months old and was still not speaking. Although she had changed doctors, she could not change insurance companies. When they finally did see the specialist they needed, the specialist immediately knew the right procedure and performed it to correct the problem. So Matthew finally did receive this ear tube surgery that he desperately needed. After that, his hearing cleared up; the problem was solved. Unfortunately, though, if Matthew had only been treated earlier he would have been able to avoid the speech problem he now has as a 4- year-old. She said in her statement: Now our family must work to correct his speech problem. Our insurance company has changed since then, but it has been another fight with another HMO to cover speech therapy. They denied coverage for that service until the National Patient Advocate Foundation stepped in and won that battle for Matthew. We have a serious problem in gaining access to specialty care in the case of many of these HMOs. The amendment we have prepared has the support of a tremendous number of groups: The National Alliance for the Mentally Ill, the Patients Access Coalition, the Religious Action Center of Reform Judaism, the Coalition of Cancer Organizations, the Oncology Nursing Society, the American Thoracic Society, and on and on. So there is a very long list of organizations that believe very strongly we need to have this protection built into the law. I believe very strongly in that. When I travel through New Mexico and talk to people about their health care problems, of all the issues that I am told about, probably this issue of gaining access to specialty care is the most significant. People are very concerned that if a circumstance befalls them or their child or their parent, they will be denied access to specialty care unless we do something to ensure that that access is there. The amendment we are offering will provide that access. It will ensure that access is there. It is a basic right that we ought to ensure. Let me mention one other thing because I think this is a point that was made several times this morning. We spend billions and billions of dollars in this country, and we vote for those dollars right here on this Senate floor, to support the very best medical research in the world. At the National Institutes of Health, I think their budget this year is somewhere in excess of $13 billion. We do have the specialists that the rest of the world envies. People come here from all over the world to gain access to these specialists.

Mr. BINGAMAN. Mr. President, I appreciate the chance to speak about the pending amendment, particularly about the specialty care provision of the pending amendment. I read it recently, but I think there are some serious concerns that need to be addressed. The Senator from North Carolina has raised them. I know others have as well. As I understand the amendment now, there is no provision in it to restrict an HMO from charging additional for a patient if they need to go outside the plan to get specialty care. One of the things we have tried to do in the amendment we drafted on specialty care is to ensure not only that a person has the right to specialty care but that they cannot be charged whatever the HMO determines in additional charges they want to tack on in order to get that access. I think this is important. Clearly, if a person has signed on to a health care plan, they expect to be able to access the care they need without incurring additional costs, particularly when there is no restriction in this legislation or this pending amendment, that I am aware of, which would in any way restrict the amount of the additional cost that might be added. That is a very real concern which I think we have to bear in mind. Another concern is, the amendment we intend to offer on specialty care tries to specify that if a person has a chronic illness that requires the care of a specialist, that specialist could be designated as the primary care provider. For example, someone who is diabetic and who needs to see a specialist, an endocrinologist--which I believe is the specialty that is focused on dealing with the problems of diabetics--a person could have that endocrinologist designated as their primary care physician so they could go directly to that person and not have to go through a primary care provider in each case. As I read this amendment, it says nothing in this section shall be construed to prohibit a plan from requiring the authorization of a case manager--that is, the person working for the insurance company--or the primary care provider each time you go to see a specialist. I think that is another defect in the bill, as I understand it. Now, I could be corrected on any of this if the author of the amendment can point to other language that I am not aware of. The third point I want to make is the same question the Senator from North Carolina raised. He referred to it as ``gaping hole No. 3.'' That is the question about what do you do when the health maintenance organization says no, we will not allow you to access a specialist. That is a real-life circumstance that many people face. In the amendment we intend to offer, we provide if you are denied access to a specialist, you can get an independent reviewer to review that decision on a very timely basis and then abide by that decision. There is nothing in the pending amendment I can see that would provide for any such appeal if the HMO turns down a patient's request for specialty care. We had a very good opportunity earlier today to hear from a mother of a 4-year-old boy about the problems she encountered in trying to get access to specialty care for him. That circumstance is one that many people face. She was delayed and delayed and delayed by the health maintenance organization constantly saying they would not allow her to see anyone but her primary care physician for the various ear infections her 4-year-old son was having because they believed those should be treatable by that primary care physician. After more than 2 years of being delayed, she finally did get access to a specialist. The specialist did a surgical operation which corrected the problem. Unfortunately, because this situation existed at this time in her son's life, her son now has a speech impairment and is having to go through therapy for that. Again, she is encountering problems getting access to that speech therapy for her son through the HMO. I don't believe the specialty care provision in this amendment that is pending solves the problem for most Americans. I yield the floor.

Mr. BINGAMAN. I very much hope that all Members of the Senate will support this amendment. I yield to the Senator from Nevada the remainder of my time and yield the floor.

Mr. BINGAMAN. Unless we put some of these protections in the law, we are denying our own citizens, in many cases, access to the specialists their tax dollars have paid to train in the specialty care their tax dollars have gone to develop. So we need to put these protections into place. The great research and the great health care that is developed at NIH needs to get to the patient, and that is what this amendment will try to do.

Mr. BINGAMAN. As I understand the bill you are referring to, you say it provides this access. There is no requirement that access to the specialist be provided at the regular amount that is being paid. Whatever the HMO determines the additional cost should be to go to the outside specialist would be charged, is that correct? That is my understanding. I have read the bill fairly carefully, and that is a major difference between the amendment I have offered and the amendment that you are referring to.

Mr. BINGAMAN. Will the Senator yield for a question?

Mr. BINGAMAN. Mr. President, I referred in my earlier comments to a circumstance that was described to us this morning. Beth Gross talked about her 4-year-old named Matthew and the difficulties the family had in obtaining access to specialty care. I have been given a copy of a statement she made describing that in more detail. I ask unanimous consent that that statement be printed in the Record.

Mr. BINGAMAN. Mr. President, may I ask for time to ask for unanimous consent?

Mr. BINGAMAN. Mr. President, the amendment that myself, Senator Harkin, and many of my colleagues are offering today guarantees American families the right to access medical specialists. Our amendment is fair. It is what working families pay for each month, and very simply put; this amendment can literally save lives. Let me briefly outline the fundamental components of this amendment. First, our amendment says that if you pay for health insurance, you are guaranteed the right to see a specialist if medically appropriate. Second, if a plan cannot provide such care within its network, it must allow the patient to go outside the network to an institution or individual competent to provide the care, at no cost to the patient beyond what would be required if the patient were treated in network. Third, this amendment allows people with chronic or serious ongoing illnesses that require continued specialty care to receive that care either through a standing referral to a specialist or by designating the specialist as their special care coordinator. The current requirement that patients must go back to a primary care doctor whenever they need to see a specialist or when additional care is ordered is at best an inconvenience, and at worst, a real detriment to timely, appropriate medical services. This is especially critical for the disabled and for people with chronic disorders and serious or complex medical conditions. Our Republican colleagues have said that they cover access to specialists in their bill. In fact, their bill does not guarantee access to specialists. Under their bill, patients could actually be charged more for out-of-network specialty care--even if the plan is at fault for not having access to appropriate specialists within the plan. Our amendment will have a profound effect on the lives of American children and the families who care for them. For example, our amendment would allow a child with leukemia to go directly to a pediatric oncologist instead of being hauled from doctor to doctor. A sick child should not have to go through such an additional ordeal. This makes perfect sense to me and the American people overwhelmingly agree. People who are fighting to stay healthy should not have to battle their HMO as well. This amendment has other common sense effects. The access provisions in this amendment, when combined with a right to a meaningful and speedy independent appeal, will help minimize the need for litigation by helping ensure patients get the benefits they need from appropriately qualified providers in a timely fashion. The guaranteed right to have access to a specialist should not be a controversial issue. This is a simple matter of allowing working Americans to get what they pay for--the best medical health care available. Mr. President, I believe this amendment is fair. The current system wasn't fair for Henry, a 40-year-old man from Albuquerque, New Mexico who had what the doctors refer to as ``lymphocytic lymphoma'' a form of cancer. Henry was not responding to conventional therapy and quickly required a specialized procedure. This was not an experimental procedure and he would most certainly die without it. His doctor immediately applied for the referral. Since there were no facilities for such a procedure in Henry's managed care network, his doctor requested a referral to a specialist out of network, a right he would have guaranteed under our amendment. Even knowing exactly what kind of speciality procedure was necessary, where that specialist was, and that time was critical, the managed care company held multiple meetings which dragged on for more than a year. Under our amendment speciality care is guaranteed to be available and accessible because we recognize the importance of providing timely, appropriate medical services. A final meeting was held between Henry's doctors and the managed care company personnel. During that meeting, the managed care company required that Henry's doctor explicitly relate descriptions of what would happen to Henry without the referral for the necessary procedure. Henry's doctor writes: I had to sit in front of this patient and his wife and explain in graphic detail just exactly how he would die, how that would be, and how little hope there actually was that anything else would occur. Henry's doctor continues, ``Henry had been pretty strong until that time, but this broke him and after that point he lost any spirit to fight.'' After one year of requests and delays, the managed care company did, in fact, approve the referral, but by that time Henry's condition had deteriorated and it was too late. Henry died. In a final, sad epilogue to this story, the managed care plan is on record as having approved the referral to the specialist for the procedure. We are fortunate to live in a country that has seen so many medical advances. We all have family or friends who have benefited from the knowledge and expertise of specialists. Blocking access to these health care professionals is wrong and it is well past time to address this issue. Mr. President, I ask unanimous consent to have printed in the Record letters in support of the amendment from the American Academy of Pediatrics, the Children's Defense Fund, the American Academy of Physical Medicine and Rehabilitation, the National Breast Cancer Coalition, Consortium for Citizens with Disabilities, the National Association of People with AIDS, the Oncology Nursing Society, and the National Multiple Sclerosis Society.

Mr. BINGAMAN

Mr. BINGAMAN. Madam President, I rise to discuss managed care reform, an extremely important issue which we are finally getting to a debate this week. We have an opportunity this week to substantially improve the quality of life for 161 million Americans, including 900,000 New Mexicans, many of whom have contacted me through letters and phone calls and faxes, telling about their desire for some reform of the managed care system. Our goal this week seems to me very clear. The American people--and I believe every family who spends their hard-earned dollars on health insurance--need to receive nothing less than the finest of medical care available. We are trying to ensure that through this legislation. That is the task we have set, to guarantee the people of this country critical patient protections. It is clear the reasons are valid, why we should do this. First, survey after survey reports the American people are demanding the passage of patient protections such as those contained in the Democratic bill that I supported, which Senator Kennedy offered in the committee. In my State, there are 350,000 New Mexicans who will not have critical patient protections if the bill we pass at the end of this week leaves medical decisions up to non-medical insurance personnel. There are 200 patient groups and health care provider organizations, physicians, workers' unions, and employee groups, that stand behind the need for these patient protections. There are 30 million Americans who have had trouble seeing a specialist, women and children with special needs who either had critical care delayed or, worse, had that care denied. I heard my colleague from Wyoming just now say providing this access to specialized care will dramatically increase premiums. The statistics are clear. The Congressional Budget Office did an analysis and determined that the increase in premium costs would be, at the most, 4.8 percent over a 10-year period. Providing this specialized care or access to specialists would be a one-tenth-of-1-percent increase in cost, less than $2 per patient per month for the entire array of patient protections about which we are talking. This is a very modest amount which Americans are willing to pay. Americans who live in rural areas, such as my State and the Senator from Wyoming was talking about his State, have to travel an hour or more to get to a doctor when there is an appropriate health care provider just down the road. We are trying to ensure those other appropriate health care providers also be made available to those patients. Even if you put aside all of these particular reasons for passing the bill, clearly the main reason we should pass it is that it is the fair thing to do. There was a very good editorial in this morning's Washington Post which I believe all Members should read. Let me refer to it for a moment. It talks about the managed care debate coming up in the Senate this week. It says: The objective is, or ought to be, to legitimize the containment of these costs by giving the public a greater guarantee that the process will be fair. Republicans resist the increased regulation this would entail. In the past they have tried to deflect the bill; now they offer weak legislation that is mainly a shell. My colleague from North Dakota said the Republican proposal is an empty vessel. The Washington Post says it is ``mainly a shell.'' It goes on to say: The stronger Democratic bill is itself fairly modest. Much of it is ordinary consumer protection. Patients would have to be fully informed about the costs and limits of coverage, including any arrangements a plan might have with physicians or other providers that might give them an economic incentive to cut costs. No gag orders could be imposed on physicians to keep them from disclosing the range of possible treatment, without regard to cost. A plan would be required to have enough doctors to meet the likely needs of the enrollees. Patients could not be unfairly denied access to emergency care or specialists. . . . It goes on: The Republican bill professes to provide many of the same protections, but the fine print often belies the claim. Madam President, the debate is going to be very constructive this week. The distinctions between the Democratic bill, which contains real protections, and the Republican bill, which the Washington Post refers to as ``mainly a shell,'' will be made clear to the American people. I hope very much we will step up to the challenge and pass something that contains some substantive protections for the people of my State. We will have other opportunities to debate specific amendments in the future. I see the Democratic leader is ready to speak. I yield the floor, and I appreciate the chance to speak.

Mr. BINGAMAN. Madam President, I ask unanimous consent that Robert Mendoza, a fellow on my staff, and Matt Maddox on my staff be granted the privilege of the floor during the pendency of this bill, and also that same privilege be granted to Ellen Gadbois and Arlan Fuller, fellows from Senator Kennedy's office.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise to talk about a bill that I have sent to the desk. It relates to a very serious problem faced by a large number of Navajo people in my State. The issue is referred to as ``fractionated lands.'' Around the turn of the century, the Federal Government attempted to force Indian people to assimilate by breaking up traditional tribal lands and allotting parcels of the land to individual tribal members. In New Mexico, this policy created what is known as the ``checkerboard,'' because alternating tracts of land are now owned by individual Navajos, the state, the federal government, or private landowners. A Navajo allotment was generally 160 acres. Under the allotment system, the Navajo owner was granted an undivided interest in the entire parcel. The heirs of the original owner also inherit an undivided interest, geometrically compounding--or fractionating--the number of owners of the original 160 acres. This allotment policy, coupled with other federal laws governing Indian land ownership, land management, and probate, have not served the Navajo people well during this century. I am introducing legislation today to help address this problem. Mr. President, I'd like to take a few minutes to illustrate why the legislation I am proposing is needed. If a Navajo was allotted a 160- acre parcel and had four heirs, the heirs did not inherit 40 acres each when the original owner died. Rather, each heir inherited a 25 percent undivided interest in the full 160-acre allotment. Going forward, when the current four owners died, assuming again four heirs each, sixteen heirs inherited a 6.25 percent undivided interest in the allotment. The next generation would result in 64 heirs each with a 1.5625 percent undivided interest. And so forth. What makes this situation so unique is that each heir inherits an undivided interest in the allotment. Over time, individual owners may inherit tiny fractions in many different allotments around the reservation. In my state, there are about 4,000 individual allotments covering nearly 700,000 acres. At this point, these 4,000 Navajo allotments have a total of 40,000 listed owners, and the number grows every day. It doesn't take a Ph.D. in math to figure out what's wrong with this policy. Mr. President, in April I held a town meeting with Navajo allottees in Nageezi, New Mexico, a small chapter house in the Northeast section of the Navajo Reservation. The allottees talked about the serious problems that fractionated ownership has caused. Over 100 members of the Navajo Nation came from as far away as Aneth, Utah, to speak at the meeting. As you know, the Navajo Nation extends into three states, New Mexico, Arizona and Utah, and there are allottees living in all three states. Record keeping of individual land ownership has become a nightmare. In many cases, owners can no longer be located. Also, ownership can be clouded when an owner dies without a legal will--a common situation in Indian Country. Some individuals do not even realize they own one or more of these allotments. Often, individuals are surprised to find out that they are an heir to an allotment on another reservation. Mr. President, we all recognize there are serious problems with BIA's management of its trust responsibilities for allotted lands in New Mexico. The management problems were brought out very clearly at a joint Senate hearing in March. The hearing also revealed the extent to which the government's allotment policy contributed to BIA's current trust management problems. On the Navajo reservation, a three-year pilot project is underway in Farmington, New Mexico, to try to unravel some of the management problems with allotted Navajo lands. This project, called the Farmington Indian Minerals Office, or FIMO, is trying to cut through the red tape created by three different Bureaus in the Department of Interior, BIA, BLM, and MMS, which share responsibility for management of allotted lands. The FIMO has worked hard to assist Navajo allottees determine who their fellow allottees are and what land each allottee owns. I support the efforts of FIMO. If this legislation is passed, FIMO could accomplish even more on behalf of the Navajo allottees in the three states. Mr. President, over the years, Congress has tried to deal with the problem of fractionated lands, and has failed every time. The long history of trust management problems is not going to be corrected quickly. Developing and implementing a comprehensive solution is going to take time. The Indian Land Working Group is one of the leaders in this area and has submitted a proposal for Congress to consider. I applaud the efforts of Senators Campbell and Inouye and the members of the Indian Affairs Committee for taking on this difficult issue. Some of the proposals include improved record keeping, probate and estate planning programs, and new processes for consolidating fractionated lands. I look forward to working with the Committee to craft a comprehensive solution. While the larger issue of fractionated ownership is being considered by the Senate, I believe it is appropriate to consider a stop-gap measure to help stimulate near-term economic development on fractionated Navajo lands. There is an abundance of oil and gas beneath the Navajo allotments, yet the allottees are unable to benefit from this wealth because of federal laws that make it very difficult for Indian allottees to lease their land. To illustrate, during the last 12 years, $7 million in leasing bonuses has been paid to the state and federal government for leases in the checkerboard region of New Mexico, while only $27,000 has been paid to owners of Navajo allotments. The problem lies in the 1909 Mineral Leasing Act. The Act requires all persons who have an undivided interest in any particular parcel to consent to its lease. In the case of Navajo allottees, 100 percent of the allottees must consent to a lease of their land. Because of the fractionated land problem, obtaining 100 percent consent is often impossible because many owners cannot be located. Consequently, the Navajo allottees are precluded from the beneficial use of their land. The bill I am introducing today will facilitate the leasing of Navajo allotted land for oil and gas development. In the case of non-Indians, most states already allow mineral leases with less than 100 percent consent of the owners as long as all persons who own an interest receive the benefits from the lease. My bill simply extends similar benefits to Navajo allottees. The bill would authorize the Secretary of the Interior to approve an oil or gas lease connected to Navajo allotted land when less than 100 percent of the owners consent to such a lease. A similar bill was passed in the 105th Congress to facilitate mineral leasing of allotted lands on the Ft. Berthold Reservation in North Dakota. My bill proposes a graded system for lease approval. In situations where there are 10 or fewer owners of an allotment, 100 percent of the owners must consent to a lease. However, where there exists 11 to 50 owners of an allotment, only 80 percent of the owners need consent. And, with more than 50 owners, 60 percent consent would be required. This graded system was suggested by the Navajo allottees. Mr. President, unemployment on the Navajo Reservation now exceeds 50 percent. The opportunities for economic development on this land are few. It is not appropriate for the federal government to continue to deprive the legal owners of Navajo allotted lands the option to develop their land as they choose. This bill is a small step toward correcting the mistakes of the past and a bigger step towards providing economic prosperity for future generations of Navajo allottees. The bill has the support of the Navajo Nation and the Shii Shi Keyah, the principal Navajo Allottees' Association. Mr. President, I ask unanimous consent that a resolution from the Shii Shi Keyah Association and a letter from the Navajo Nation be printed in the Record.