Gene Green

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, on June 17, with the support of every Democratic Member of the Commerce Health and Environment Subcommittee, I introduced H.R. 2257, the Chemical Security Act of 1999. This bill represented a consensus among Subcommittee Democrats that I believe would have recognized and respected the Right-to-Know laws while shielding chemical facilities and their employees from potential terrorist attacks. However, after weeks of negotiations with our Republican colleagues, i believe the legislation before us today achieves the same goal and is worthy of all our support. Most importantly, the House-amended version of S. 880 would preserve the intent of the Clean Air Act Amendments of 1990 by requiring public meetings to inform citizens who would be impacted by off-site worst case scenarios at each covered facility. These meetings, which will take place during the moratorium on information disclosure, will provide every interested resident with the relevant information about the potential dangers in their community. It is our intent and hope that these meetings will not only include facility representatives, as required by the Act, but also local emergency planning responders who are most qualified to answer questions about safety and security as well as how to react to an accidental off-site chemical release. By bringing different community representatives together to discuss the off-site consequences of a worst case scenario, we maximize the probability that the damage caused by such an event will be minimized for the facility, its employees, and especially the surrounding community. It is also our intent that the Administration will develop regulations that recognizes every individual's fundamental right to the Off-Site Consequence Analysis (OCA) information affecting their community--including their home, office and children's school. I have not heard any justifiable reason, based on either policy or security, that would allow this information to be compiled by the government but prevent citizens from receiving the OCA data impacting their own community. The widespread public release of public information is being delayed to give the Administration some time to determine how, not if, this information can be distributed safely to the people impacted by worst-case scenarios. I am also supporting this legislation because it includes the appropriate and necessary site security studies to be completed by the Attorney General. If we agree that the legislation is necessary because of potential risks to site security, than we have a responsibility to aggressively investigate these concerns. With the results of this study, the Administration and Congress will have the necessary tools to base future decisions on site security on substantive and complete information. The results can also be used by the facilities to improve their internal safety procedures to minimize risk to the facility and its employees. Again, I want to express my appreciation to the Chairmen and Ranking Members of both the full Commerce Committee and Health and Environment Subcommittee for working so hard to develop this consensus bill in a truly bipartisan manner.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Chairman, I thank my good friend from Missouri for allowing me this time to speak on this legislation and talk about the need for the Martinez substitute. First of all, Mr. Speaker, one of the concerns I have is the reauthorization of the Elementary Secondary Education Act. The majority side has split it up into a number of pieces of legislation, and my concern is one of those pieces may fall out. We have to educate and think about the whole child and the whole system and not just one part of it. I am concerned that by having different parts, we will not be able to see the whole picture at one time. This decision may sound good, but we need to make sure that the Elementary Secondary Education Act is whole and not just parts. I heard my colleague from Hawaii talk about Federal education funding is only 6 or 7 percent of some school budgets, and that is true. But in urban districts, poor districts, with at-risk children, sometimes the Federal money is as much as 10 to 12 percent. So 6 to 7 percent is a dramatic part, and I have some districts that need the Federal education money just to provide the education they need for those children. H.R. 1995 needs to be amended by the Martinez substitute to continue our Nation's commitment to our at-risk children. We need to provide the assistance to the States and the local communities and local school districts where most of our education dollars originate. They do not originate here in Washington or even in Austin, Texas. They originate in the local districts. My wife is a public high school teacher in the Aldine district in Houston, and our two children went to public schools. In my experience both as a spouse and as a member of Congress, I hear it every weekend when I go home that class size is important. Whether it is kindergarten through 4th grade, like in Texas where we have 22-to-1, or through the 12th grade, we need to have smaller class sizes. Teachers cannot teach if they are simply managing that classroom. They may be able to manage 35 children, but they cannot teach. Teachers have to impart knowledge, and that is what the Martinez amendment would do, and continue our efforts on that. So I encourage people to support the Martinez complete substitute.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, during the July 4th celebrations, I had the opportunity to experience the quality health care that is offered in my own hometown of Houston, and it made me come back realizing how important a real, meaningful managed care reform bill is and what is going on in the United States Senate. The American people have been clear to us that they want meaningful managed care reform. It is estimated that 122 million Americans do not have simple patient protections. This is not about politics, Democrat versus Republican, it is about what patients need and the providing of quality health care. We need to eliminate gag laws. Patients need to talk to their doctor about their injuries. We need to have access to specialists and particularly make those doctors the one to define a medical necessity. We need to have an external-internal appeals process. We need to cover emergency room care instead of making someone have to decide they have to go past the closest emergency room to one on their list. They ought to get the health care they need immediately. We should also have accountability. If the doctor making the decision is accountable and he is under law, so should the person making that decision in place of that doctor. This is not about employees suing employers. It is not about higher costs for health care. In fact, our own Congressional Budget Office and our own experience in the State of Texas shows there was little or no cost at all in providing these protections. Let us not lose this opportunity to help our constituents.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, I rise today to pay special tribute to President Lyndon B. Johnson. President Johnson was born on August 27, 1908, in central Texas, not far from Johnson City, which his family had helped settle. He knew poverty firsthand, which helped him learn compassion for the poverty of others. In 1960, Johnson was elected as John F. Kennedy's Vice President. On November 22, 1963, when Kennedy was assassinated, Johnson was sworn in as President. On May 22, 1964, in a speech at the University of Michigan President Lyndon B. Johnson spoke of a ``Great Society.'' He said, ``The Great Society rests on abundance and liberty for all. It demands an end to poverty and racial injustice, to which we are totally committed in our time. But that is just the beginning.'' President Johnson's vision included aid to education, attack on disease, Medicare, urban renewal, beautification, conservation, development of depressed regions, a wide-scale fight against poverty, control and prevention of crime and delinquency, and the removal of obstacles to the right to vote. On July 6, 1999, the Houston Chronicle printed a column by Marianne Means, a Washington, D.C.-based columnist for the Hearst Newspapers, which details why President Johnson will be considered as one of our nation's greatest Presidents. Mr. Speaker, I would like to conclude by including Ms. Means' column in my remarks. Don't Forget LBJ--His Legacy Highly Visible (By Marianne Means) For 30 years, President Lyndon B. Johnson has been ignored by Democratic politicians afraid of being tagged as liberal lackeys for the much-mocked Great Society or the bloody Vietnam War that brought down his presidency. His name is seldom mentioned in his own party. Only a few brave souls defend him against conservatives who have campaigned for decades against the ambitious federal social programs he created and the cultural tumult of the 1960s that took place during his administration. President Clinton has been particularly craven. Although he often cites his admiration for President Kennedy, who produced very little legislation, Clinton never speaks of Johnson, who compiled a monumental domestic record. It was to remind us of Johnson's impact on our lives and put a tidy historical end to the 1990s that scholars and former Johnson administration officials gathered recently at the Lyndon B. Johnson Library in Austin to look back across the generation gap at a period of almost unimaginable change. This nation would be a far worse place had Lyndon Johnson not occupied the White House. He demanded that elderly patients get government help for health care through Medicare and Medicaid, blacks be granted the right to vote and enjoy equal access to public places, students be given financial aid for education, consumers be protected from fraud, poverty be assaulted with an array of education and employment initiatives and discrimination attacked with affirmative- action concepts. This remarkable domestic revolution was overwhelmed by public outrage at Johnson for escalating a distant war in which more than 50,000 U.S. soldiers died. As a young student, Clinton himself dodged the draft to avoid being sent to Vietnam. Resentment of the war still fuels Clinton's chilly attitude toward Johnson even though Clinton has fought to perpetuate and expand most of LBJ's social programs. But finally that war is fading into history. It was nearly a quarter century ago that we fled Saigon in defeat. Now diplomatic and trade ties are being restored and even battle- scarred veterans are returning there on sentimental visits. If the war itself can recede, so can public anger at LBJ. He didn't live long enough to crusade for his own political rehabilitation, as Richard Nixon did. But time may do the task for him. And despite decades of conservative scorn, the Great Society and the War on Poverty still exist, sometimes under different labels. At the LBJ Library symposium, Joseph Califano Jr., a former Johnson White House assistant and Jimmy Carter's secretary of health, education and welfare, summed up LBJ's domestic record. And what a stunning record it is. He shoved through a reluctant Congress all sorts of radical ideas to help ordinary people. For the first time, the federal government subsidized scholarships, grants and work-study programs to expand education opportunities for students from families with limited resources. Since 1965, the federal government has provided more than $120 billion for elementary and secondary schools and billions for college loans. Today, nearly 60 percent of full-time undergraduate students receive federal financial aid. When LBJ took office, only 41 percent of Americans had completed high school; only 8 percent held college degrees. Last year, more than 81 percent had finished high school and 24 percent had completed college. Medicare and Medicaid provided millions of elderly Americans with health insurance for the first time. Since 1965, 79 million senior citizens have benefited from Medicare. Since 1966, more than 200 million poor Americans have been helped financially by Medicaid. The food stamp program launched in 1967 helps to feed more than 20 million people in more than 8 million households. The school breakfast program begun the same year has provided a daily breakfast to nearly 100 million schoolchildren. Johnson's civil rights act ended the officially segregated society that belied the American promise of freedom. No longer did blacks have to drink from separate water fountains and eat in separate restaurants. No longer were they automatically denied equal opportunities for jobs and education. Johnson was proudest of the Voting Rights Act, which outlawed all the sneaky practices that kept blacks from the ballot box. In 1964, there were only 300 black elected officials in the country; by 1998, there were more than 9,000. In 1965 there were five blacks in the House; today there are 39. Although conservatives charge that LBJ's Great Society was a failure, Great Society projects like Head Start, the Job Corps, Community Health Centers, Foster Grandparents, Upward Bound and Indian and migrant worker programs helped reduce the number of Americans living in poverty. When LBJ took office, 22.2 percent of Americans lived below the poverty level. Today 13.3 percent are below that level, still too many but a trend in the right direction.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, on July 1, 1999, I missed fifteen votes because of scheduled back surgery in Houston. Had I been present, I would have voted: Rollcall No. 262: Aye. Rollcall No. 263: Aye. Rollcall No. 264: No. Rollcall No. 265: Aye. Rollcall No. 266: Aye. Rollcall No. 267: Aye. Rollcall No. 268: No. Rollcall No. 269: No. Rollcall No. 270: No. Rollcall No. 271: Aye. Rollcall No. 272: Aye. Rollcall No. 273: Aye. Rollcall No. 274: Aye. Rollcall No. 275: Aye. Rollcall No. 276: Aye.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, I am proud this morning to talk about one of those programs that the President announced yesterday that we need to do, and we should have done it many years ago. Studies have shown across this country in congressional districts prescription drugs on the average cost twice as much for senior citizens as they do for other most favored customers. It affects people like in my district 85-year-old constituent who relies on Social Security as her primary source of income and she has medical conditions that require her to spend $260 a month on prescription medication. She has already sold her car, sold her furniture to pay for these prescription drugs; and yet she cannot continue to afford it for $3,000 a year. The President yesterday announced a program that will not help as much as maybe I would like to, but it goes further than what we have today. With the budget as good as it is, maybe we ought to pay something back to those senior citizens who have built this country into what it is and not make them spend $3,000 a year of their Social Security money for prescription medication. In her case, it would actually almost cut her prescription cost in half, the President's program would do. And so, that is what we need to do. Sure, I would like to have tax cuts. But let us take care of those folks who have built this country and made it what it is today.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, earlier, in a 5-minute special order, I talked about a constituent of mine that pays $260 a month for her prescription medication. That comes out to a little over $3,000 a year, $260 a month. Basically, under the President's plan, and again we will all see how this applies to our own constituents but now she pays a little over $3,000 a year. Under the President's plan, she would pay $25 a month so that would be times 12. She would pay 200-and-something dollars. Let me see. I have to go back to my math but probably around $300 a year. And then she would get half of that so she would be paying $1,500 if her medication costs stay the same, $3,000. She would pay half under the President's plan and then the other half would be paid for by Medicare part B. So she would actually come out saving money. Again, that is like I said, she still has to come up with her amount. She is paying this $260 a month now, and at $25 it just seems like it would save her money. It is not as far as I want but, like I said, it moves us down the field a little bit. Again, I do not have all the numbers. We serve on the Committee on Commerce, not the Committee on Appropriation and the Committee on the Budget. We identify the problems. Then we have to figure out how to do it. If we cannot completely solve them, let us at least go part of the way to do it. The President's plan goes $3,000 for the first few years, and then it goes up to $5,000 after that. I have constituents that have been to my townhall meetings literally for years and said that a husband or wife, oftentimes the wife has minimum benefits on Social Security because the wife worked traditionally at a lower wage job. Her whole check, every month, goes to their prescription medication. Their fear is that what happens when one of them passes away? Now, sure, their prescription medication may be cut in half, but they are losing that income, and they are also going to lose some of their Social Security. So they cannot afford for one of them to pass away because of the high cost of their prescriptions. It is just a shame in our country. I have seniors who have told me their blood pressure medicine that they have to take once a day, I really cannot afford it because it is really so expensive so I take it every other day. That should not be for that senior to have to do it or decide I am not going to have dinner tonight or I am not going to have breakfast or go to lunch because I need to take my medication. Those choices should not have to be made in a country as wealthy and as great as ours and who has a tradition, at least since the 1930s, of taking care of our seniors, first by a Social Security system that literally was the first welfare bill because people paid into Social Security so when they are retired they get something back on it, and then in 1965 with the Medicare bill and now in 1999 to expand it to include prescription medication. The other thing the President talked about in his Medicare proposal was to correct some of the inequities in the Balanced Budget Act of 1997 where a lot of our hospitals and even our home health care providers, the cuts were so dramatic that they are not being able to provide some of the services. I know I get letters in my office from senior citizens but also hospitals. So by dedicating 15 percent of the budget surplus over and above the Social Security amount that we will need for Medicare, it shows that that will help us and not only with prescription medications. So I congratulate the President. Again, I hope that we will have the chance on the floor of the House to debate prescription medication provisions for our senior citizens. Again, it may not go as far as I want to, but again let us show some progress in the legislative side. Instead of just saying no, we are not recognizing the problem, let us show we recognize the problem and do the best we can with the resources we have to do it. Again, I thank the gentleman for taking this time tonight and also letting us talk a little bit about prescription medication because that is important to all of our constituents. Whether they live in Houston or Texas or New Jersey or California or whether they are Democrat or Republican, it is important for us to address that.

Mr. GREEN of Texas. Madam Speaker, I thank my friend from New Jersey for one, requesting this special hour this evening, but also for the announcement yesterday that you are going to continue to serve with us in the House, we hope, and not make that jump over to the other Senate side, and because of your leadership both in our health task force but also on this issue. I think we can use that experience here on this side of the aisle. The air is so rarified over in the Senate anyway, you have to have oxygen over there. But, Madam Speaker, for months all we have heard is that we cannot pass a Patients' Bill of Rights because it will increase the cost and open employers to unfair lawsuits, both of which will supposedly force employers to drop insurance coverage from their employees. Essentially they are trying to kill meaningful managed care reform with half truths and scare tactics. The insurance industry, managed care organizations, HMOs and oftentimes even some of the big businesses have repeatedly tried to scare the American people by saying the bill would dramatically raise premiums and force employers to drop health insurance for their employees. Obviously, that is not the furthest thing I would ever want to do and I know every Member of the House would not want to do that. Some of these special interest groups even suggest that the increase could go as high as a 40 percent increase in premiums, and once they are done spreading that inaccurate number, maybe we really ought to talk about what the bill may cost and even use some real life experience, what has happened in the State of Texas. But even on the Federal level our nonpartisan Congressional Budget Office after thoroughly analyzing each section of the Patients' Bill of Rights determined that the bill would cost beneficiaries only $2 a month; that is right, the cost of a happy meal at McDonalds. Patients and managed care could have what they really need as fairness and protection in accountability and for $2 a month. But the news is even better than they want to hear because in my home State of Texas, which passed a Patients Protections in 1997, the State of Texas Patient Bill of Rights included external appeals and accountability and liability sections, and you know the only premium increase that can be attributed is to the higher cost for prescription medication. There have been increases, but it has been the standard increase whether it is in Dallas or Houston, it has been in San Francisco or Denver or in Washington or New York, anywhere else in the country. There has been no noticeable increase in premiums in the State of Texas since 1997 because of the managed care reform bills. So even the Congressional Budget Office at $2 a month may be over exaggerating, but again maybe we can afford a happy meal to make sure we get the health care we need. In fact, in the State of Texas in the outside appeals 50 percent of those appeals are being found in the patients benefit; so in other words, 50 percent of the time if an HMO tells you that is not covered or we are not covering it, they are wrong, and that is what happened in the State of Texas. So again, for $2 a month or even less I would be more than happy to have an outside appeals process that is really an appeals process. Plus, there has been no mass exodus in the State of Texas for employers that drop health insurance in Texas. What Texas residents do have now is health care protections that they need and they deserve. Provisions included in the Patients' Bill of Rights in the State of Texas should be extended to all Americans and, most importantly, to the 8 million Texans who have insurance policies that come under federal law. Again, we have many policies in our country that come under State law or Federal law, and no matter if all 50 States pass their own patient protections or the Patients' Bill of Rights, we still have to pass it on the Federal level because of the Federal law and ERISA. These include eliminating gag clauses so that the physicians will be able to communicate freely with their patients. That should not cost a dime except letting the doctors talk to their patients. Open access to specialists for women, children in the chronically ills of patients who will not need to have a referral every time they see a physician. They have to go back to their primary care doctor, and we understand this. A woman, for example, may pick a primary care doctor that is not her OB/ GYN, and she should not have to go back to that primary care doctor every time she needs to go to her obstetrician. Same way a person who may be diagnosed with cancer. They should not have to go back to that primary care doctor every time they need a cancer treatment. They should be able to go to their oncologist that is on their list. External and binding appeals process that guarantees patients timely review of questionable decisions. Again, in the State of Texas 50 percent of the time the appeals have been found for the patient, and 50 percent for the insurance company, and that is great; 50 percent of the time they are wrong, and before this law passed in Texas, 100 percent of the time they were wrong. It is just that we have found out that half the time they were right. Coverage for emergency care so families will not be required to stop at a pay phone to get pre-authorization because they could go to the nearest emergency care unit that they have and medical necessity for those decisions. But also, and we heard it last week and we have heard testimony not only in our Committee on Commerce hearing we had, but also in our task force hearing we had last week: If you hold the medical decision maker accountable, if you hold that doctor or that provider accountable, then the person who is telling that doctor how to practice medicine ought to also be accountable, and in the State of Texas again; I hate to keep using Texas as an example, but that is where this has been tried and tested and proven. There have been no more than three lawsuits anybody knows of filed since 1997; one because the appeals process is working. Patients only want to have the health care that they pay for, and so if they get it and then plus if they are ruled against half the time, then they are probably not going to go hire them a lawyer because the facts are already out there, and they know what reason was made for not having the health care that they expected they should have. Instead they recognize the affordability and the value of the Patients' Bill of Rights. I am sorry to hear that our Republican leadership continues to push with sometimes half fixes and even loopholes. To be honest, I am not so sure I have been convinced that the leadership seriously wants to pass a managed care reform bill that truly protects patients with some of the things I have heard the last few weeks. Certainly their actions to date have not given us any reason that they will, but I do think they would have compassion to bring a bill up on the floor so we can debate it here on the floor just like we are doing tonight. If our ideas do not have the majority vote, then so be it. That is the democracy and the American system. But we need to have, the American families need to have, the protections, and we ought to debate it openly here on the floor of the House, and whether it takes, as my colleagues know, 1 hour or 10 hours we ought to have that time here for the most important health care bills that will come along maybe in our lifetime. Unfortunately that is not the case. Last year's floor consideration, as Members of the Committee on Commerce, we did not even have, were unable to consider the bill that came up here on the floor, was actually drafted in the Speaker's office, and we had one chance to mend it, one chance. And we all, we lacked five votes in coming up with a real strong Patients' Bill of Rights. Ours failed by 5 votes. What passed the House was not even seriously considered by the U.S. Senate because it actually weakened the law that had already been passed in a lot of our States. And so that is why tonight I am happy to be here with you again and in talking about how important a comprehensive Patients' Bill of Rights, and let us stop stonewalling, let us go ahead and get this bill out here on the floor. Sure, we can have all the committee hearings we want, but we really need to get a comprehensive bill here on the floor of the House. It is a fair bill, but it rules that we can debate our ideas, and that way we can vote out here in public for everyone. With that I would be glad the gentleman requested this time this evening, and again I know you wanted to talk about the President's plan today. And let me just say that a few minutes ago I spoke, and the President's plan may not go as far as I would like it to go, but it moves us down that road. In football terminology we may be on the one yard line now, he may move us to the 40 or 50. Of course, I would rather have a touchdown, but at least he moves us down the road on really prescription medication for our senior citizens. And so I am glad the President announced that today. Hopefully we will go from here and go forward with it.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, seniors are being forced to choose between buying food and their prescribed medications. The high cost of prescription drugs is particularly difficult for seniors, who use one-third of all prescriptions. Medicare does not cover prescription drugs. So, many seniors, 37 percent, do not have prescription drug coverage and must incur these expenditures out of their own pocket. Studies conducted by the Committee on Government Reform minority staff show that older Americans pay much higher costs than other groups. These studies show that in congressional districts across the Nation, seniors pay for prescription drugs, on average, nearly twice as much as the drug companies' favored customers, such as the Federal Government and large HMOs who have the economies of scale who can purchase it in large quantities. So seniors are paying double what the Federal Government may be paying through the VA or through some other program. This price differential is approximately five times greater than the average price differential for other consumer goods. So it is actually five times more than what the economies of scale and other consumer goods may cost for large purchasers. H.R. 664, the Prescription Drug Fairness for Seniors Act, allows pharmacies to purchase drugs for Medicare beneficiaries at the best price charged to the Federal Government through programs such as the VA or Medicaid. The legislation has been estimated to reduce prescription drug prices for seniors by more than 40 percent. That is not price controls, Mr. Speaker. H.R. 664 just ends discrimination and allows seniors to buy just like a large customer would do, seniors on Medicare, fee for service. Mr. Speaker, this is not a bunch of Democrats trying to play politics with this issue. What we are trying to do is bring up an issue that affects all Americans, because many seniors have no prescription drug benefits. It affects people in my district like Ms. Holec of Houston, Texas. Ms. Holec is 85-years-old and relies on Social Security as her primary source of income. She also has a medical condition that requires her to buy prescription drugs that cost $260 every month. Ms. Holec already has had to sell her car and some of her furniture to pay for her prescription drugs. What is she supposed to do when she runs out of things to sell and can no longer afford her medicine that costs her now $3,000 a year? What if she develops another condition or requires another prescription drug? The solution to the problem is the Medicare prescription benefit, one that recognizes today's health needs of senior citizens. Today the President announced his Medicare modernization proposal. I expect many people will talk about or speak out against this proposal, but before they do, think of my constituent and maybe another constituent, someone like Mrs. Holec, who is forced to spend a significant portion of her income on prescription medication or prescription drugs. The President's plan will establish a new voluntary Medicare part D prescription drug benefit that is both affordable and available to all beneficiaries in fee-for-service. The Medicare task force that was made up of House Members, Senators, and public members failed for primarily two reasons: One, it forced low-income seniors into managed care, and it did not include a prescription drug benefit. Mr. Speaker, seniors should not have to look to managed care for their health needs. They should be able to look to Medicare. Whether it is the Prescription Drug Fairness Act that I am a cosponsor of, or the proposal outlined by the President today, or maybe another proposal that some Members would come up with, we have the responsibility to provide for this critical benefit. Simply relying on managed care to meet this need is both unrealistic and unfair to beneficiaries. HMO coverage of prescription drugs varies widely between plans, and often has caps that do not fit the needs of the beneficiaries. Moreover, some beneficiaries do not have an HMO choice because they live in rural areas, Mr. Speaker. I hope my Republican colleagues are as committed to solving this problem as the President is and my Democratic colleagues. If so, maybe they can join us in support of either one of these proposal or develop a new proposal, just so we can make sure that seniors have prescription medication without having to literally put themselves into poverty to do so. However, to continue to do nothing it seems, like we do with so many issues important to hard-working Americans, is not the option. So I hope many Members will look at not only what the President proposed today, but also H.R. 664, to see if we cannot come up with a solution during this Congress, before the end of the year, to solve the problems of seniors who have to pay an inordinate amount, double in some cases what prescription medication would be for other Americans.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, yesterday we began signing a discharge petition to bring the HMO reform bill to the floor of the House, simply because of the refusal to bring up the Patients' Bill of Rights for debate on this floor. The American people have been very clear about their desire for meaningful HMO reform. It is estimated that 122 million Americans who have insurance do not have these same patient protections. In my home State of Texas, we passed health care legislation similar to the Patients' Bill of Rights, which has proven to be very successful. However, we still have 8 million insured people in Texas who fall under ERISA, which preempts Texas law, who do not have these basic patient protections. This is not about politics, it is about fairness, protection and accountability. The American people deserve a Patients' Bill of Rights that eliminates gag clauses, open access to specialists, external and timely appeals, coverage for emergency room care for families to go to the closest emergency room, and accountability for medical decisions. Mr. Speaker, the American people cannot afford any more delays. We need to support the Patients' Bill of Rights. Let us sign that discharge petition today.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, the biggest concern I have in comparing what we are trying to do here in Washington and what has been done in State of Texas and other States is that the States can pass laws that regulate insurance policies in their States. Now I have employers that are multi State, employers who are self insured, and they come under federal law. So the State of Texas, the State of New Jersey, the State of Maine, State of California can do all they want and pass a Patients' Bill of Rights, but it only affects in fact less than 40 percent, in some cases maybe even less than 20 percent of the insurance policies that are issued in their State. In the State of Texas we have over 8 million people who have insurance policies that are covered by ERISA. When you think we have about 11 million, a little over 11 million people covered, that is a little less than 80 percent of the people are not covered by the State protections that were passed not only in 1997, but even earlier over the last 4 or 5 years, and that is why we need to have a federal legislation. And today is a special day, I guess, because we, a few of us, because of a frustration of not being able to have a managed care bill to debate here on the floor of the House and to compare our ideas or my ideas and yours or my colleagues' on the Republican side; we do not have that opportunity, and so we had to, all of us, a number of us, sign a discharge petition today to actually take a bill away from the committee you and I serve on. We serve on the Committee on Commerce. I am proud to be on that Committee on Commerce, but we are literally not doing the people's business by not addressing managed care reform and Patient Bill of Rights. One of the concerns I had back during the Memorial Day recess, I spoke to some business owners in my district, and they said, well, we are concerned that this Patient Bill of Rights that you have will let our employees sue their employer, and I said that is the further these thing from the truth, and tonight I would like as much time as you have left to address some of those half truths and outright untruths that we have been hearing. One, there is nothing in this bill that will allow for an employee to sue an employer. All this does is that that employer buys an insurance policy, it is covered under Federal law, that that employer, that employee will have some rights under that insurance policy. Never would there ever be a suit against the employer because again employers can afford a Cadillac insurance plan, or they can afford the Chevy insurance plan, but as my colleagues know, some will pay for everything, some pay for only certain things, maybe higher deductibles and things like that. But that is not what is in this bill, so they are using scare tactics to say we are going to have employees suing employers. That is just not true. The other thing that they used is, is it going to raise the cost of health care? In fact, one publication I saw said it could increase insurance rates 40 percent, which is outrageous. Today I heard testimony; I think you did, too; that the State of Texas that did the managed care reforms that we are trying to do, there were hardly any increases at all. In fact, the increases in managed care rates were comparable to States that had no reforms that were passed. In fact, even my argument, I think, that some of those increases were already built in because the managed care companies were increasing rates 3 or 6 percent depending on the market, and they were doing that in other States that have not done it. So what we are trying to do and the other concern I have is that they say that it will increase rates. Well, it may increase rates, but maybe it will increase them because they are having to pay some of those claims because in the State of Texas one of the items that is important in a Patient Bill of Rights is an appeals process, a fair and accurate and fast appeals process. In the State of Texas, the number of appeals that have been appealed by the patient to an impartial body, 50 percent of those appeals have been found for the patient. So granted, it may increase rates because for 50 percent they are going to have to start paying for actual health care instead of denying it unfairly, and that is what we found in the State of Texas. And so maybe that will increase their rates. I hope not because I think their actuaries already have premiums based on what those experiences ought to be. So in the Texas experience, for less than the cost of a happy meal at McDonald's patients in managed care could really have some fairness and protection and accountability. In my home State, we have passed a lot of these patient protections, including the external appeals and the accountability and the liability. Physicians are always frustrated, health care providers saying wait a minute, if I do something wrong, my patient can sue me, but if I call an insurance company and they say no, you cannot do that, you have to do this and the patient is injured by that, that is not fair, because they cannot sue that insurance company because they are the one practicing medicine. So that is why accountability is so important. I would hope we would have the same experience as the State of Texas has, who has had that accountability and liability in law now for 2 years. Again, I have heard testimony today literally that there was only one or two cases filed, simply because if we have a fair appeals process, people will get what they need, and that is adequate health care. People do not want to sue insurance companies, they just want to have them pay for what they should be paying for in their health care. Again, one of the old truths that we have heard is that there will be a mass exodus in employers dropping insurance coverage. Again, in the State of Texas, we have had literally an increase in the number of people who are covered under managed care plans, even under the new rules we have. In fact, again today, under sworn testimony, we heard that Aetna Insurance said that the State of Texas, and I assume this was recently, said the State of Texas's insurance market is the filet mignon of insurance markets, and that is a quote from a hearing today that we both attended. I have to admit, if the State of Texas under our managed care reform is the filet mignon, all I am concerned about is the hamburger. Typically, most of our folks can afford decent hamburger. So there will be no mass exodus of employers dropping health care coverage just because we are giving insurance companies some rules to live by. Emergency care so that a person does not have to drive by the closest emergency room to get to the one that may be on their list, because frankly, we want to make sure they have the quickest and fastest emergency room care as possible. Anti-gag. A physician or health care provider should be able to talk to their patients. They ought to be able to say, this is what your insurance company will pay for, this is what they will not pay for. Again, we have employers who can pay for the Cadillac plan and the Cadillac plan may pay for everything, but the Chevrolet plan may not pay for everything, but that doctor ought to be able to talk to their patients. Open access to specialists for women and children, particularly chronically ill patients, so that every time they do not have to go back to their family practice person or their gatekeeper before they go to their oncologist, for example, if they are diagnosed with cancer. That should not have to be the case. Women ought to be able to use their OB-GYN as their primary care. Children ought to be able to go to a pediatrician without having to go back to a primary care doctor. Of course, I talked about the external and binding appeals process and how important it is, and how important it is to have the accountability linked to that, that the accountability is hardly ever used if one has a real effective appeals process. Those are the important things that managed care reform bill offers. I do not know, I heard we had 161 signatures, 167 now, so I would hope that we get to the 218. Of course, we are going to have to have it bipartisanly, and last session it was. We had some Republican Members who were supportive of the Dingell bill, and hopefully we will see them come together over the next few weeks so we can really see some national managed care reform, similar to what the States have been doing and doing so successfully. I hear all the time that we do not want to in Washington tell States what to do. Well, I do not want to do that. But we can use the States as a laboratory, as an example, and say, okay, it is working in Texas, has been for 2 years. There is not a lot of lawsuits, there is not an increase in premiums. Actually, people are winning half of those cases. I like to use the example that if I was a baseball player and had a 300 batting average, which is a 30 percent batting average, I would be making $8 million a year. But for my managed care provider, if they are only right half the time when they decide my health care, I want a better percentage than the flip of a coin. In Texas, that is our experience. We have seen that we have the flip of the coin. We want a better percentage. Managed care providers I hope will see that percentage where they are not overturned, because they are actually providing better care and they are providing for more adequate care to their customers, our doctors, patients, and our constituents. So that is why I think it is important. This year we need to have a real Patients' Bill of Rights. Last session we had one that was worse than a fig leaf, because it actually overturned laws that were passed by our State legislatures. So it would have hurt the State of Texas, the bill that passed this House last session by 5 votes. Thank goodness the Senate killed it. This year, hopefully we will have a real managed care and Patients' Bill of Rights. I thank the gentleman for his leadership as our health care task force person on the Democratic side. We are doing the Lord's work in trying to do this.

Mr. GREEN of Texas

Mr. GREEN of Texas. Madam Speaker, I thank my colleague, the gentleman from Florida, for yielding time to me and allowing me to speak on behalf of House Joint Resolution 33. I am a strong supporter of everyone's First Amendment rights to the freedom of speech and expression, and I feel a hallowed symbol like our flag deserves to be respected and protected as a national treasure. We do have limits. Court-made law restricts our freedom of speech, as limited by the example in lots of law school classes of not screaming fire in a crowded theater. That is court-made law that restricts my freedom of speech. What we are trying to do today with this amendment is by legislation to say there is something on the same level of yelling fire in a crowded theater unjustly. One of them is desecrating or burning the symbol of our country. Those who desecrate our flag undermine the powerful symbol that thousands of Americans have died trying to defend, as my colleague, the gentleman from Florida, just talked about. Our flag represents the principles our Nation was founded upon. I feel it should be afforded the maximum protection we can under legislative-made law, just like court-made law has protected people from being unjustly stomped by leaving a crowded theater when someone says, but wait a minute, I have a right to yell in a crowded theater. That is my freedom of speech. They do not have that, just like we need to protect our flag using the same idea, but this is legislative-made protections. For these reasons, I am proud to be a cosponsor of House Joint Resolution 33, and I urge my colleagues to join me in support of this important resolution.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, the gentleman from Colorado that said he would bury us as Democrats, I guess going on their experience, they buried managed care reform for 2 years, so they have that kind of experience. Let me talk this morning about some ads that are in the Washington publications that talk about how the Dingell bill will be more expensive. Well, let me give my colleagues the Texas experience. We have had managed care reform in Texas for 2 years and the reason it is going to be more expensive is that they are going to have to start paying claims. They have lost half of the appeals process, so I would much rather have better than a flip-of-the-coin odds if I am going to managed care for health care. Mr. Speaker, a 500 percentage may be great if one is a baseball player who will be making $10 million, but when one is deciding whether one is going to have adequate health care, I would rather have a better percentage than a flip of the coin. They are actually going to have to pay those claims. We need a real patients' bill of rights that has everything in it: accountability, access to specialists, a real appeals process, and no gag rules and medical necessity. That is why I do not think they are going to have the experience in burying this bill any more.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, yesterday, the Institute of Medicine released its report on silicone breast implant research. It evaluated past studies on the association between silicone implants and diseases as well as considering the frequency of complications including rupture, the need for additional surgeries, and problems with contraction. Perhaps the Institute of Medicine's most important directive was to recommend areas of future research concerning silicone breast implants. The IOM, the Institute of Medicine, report points to the undeniable need for additional scientific research on the long-term outcomes and local complications of silicone breast implants. In fact, the report states these complications occur frequently enough to be a cause for concern and to justify the conclusion that they are the primary safety issue with silicone breast implants. Although the rate of implant rupture and silicone leakage has not been definitively established, a recent analysis of implant failure conducted by the University of Florida found silicone breast implant rupture at a rate of 30 percent at 5 years, 50 percent at 10 years, and 70 percent at 17 years. However, in information sent to women considering implants, manufacturers currently are grossly underestimating the rupture rate at 1 percent. The Institute of Medicine, the IOM, also concluded that the information concerning the nature and relatively high frequency of local complications and reoperations is an essential element of adequate informed consent for women undergoing breast implantation. Therefore, the IOM recommends the development of national model of informed consent of women undergoing breast implantation to ensure women fully understand the risks associated with silicone implants. Women have the right to choose to get breast implants, but Congress has the responsibility to make sure that they are fully aware of the risks associated with these products. For these reasons, I, along with the gentlewoman from New Mexico (Mrs. Wilson) and nearly 45 cosponsors have introduced H.R. 1323, the Silicone Breast Implant Research and Information Act. This bill promotes independent research at NIH in order to ensure impartial, scientifically sound studies on silicone breast implants. To date, there have been no National Institutes of Health, NIH, clinical studies of mastectomy patients who have had implants. With the level of attention and controversy on this issue, supporters of H.R. 1323 believe leadership from NIH is critically important. Our legislation would also require the FDA to strengthen informed consent procedures in clinical trials and institute better follow-up mechanisms for consumer complaints. Because the FDA has never approved silicone breast implants for the market, it is crucial that women and their doctors have access to accurate information concerning the possible risks. Finally, the Institute of Medicine, the IOM, recommends additional research to determine safe levels of silicone in the human body. Everyone has some level of silicone in their body. However, there has never been any research to establish a safe level of silicone. How can scientists be expected to determine whether silicone is causing diseases if we do not know what is the safe level? Mr. Speaker, I urge my colleagues to look at H.R. 1323.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, today, my colleagues and I and the State of Texas lost a legend. Lt. Governor Bob Bullock passed away at the age of 69. Before coming to Congress, we served with Governor Bullock as members of the Texas State Senate. No Texan stood taller than Bob Bullock in his knowledge of Texas Government, his influence over the affairs of Texas and his deep commitment to our State. His love for our state was legendary. Each time he spoke of Texas, the feeling of his pride was very clear. He always said, ``I have no agenda but what's good for Texas. And I have no love, but Texas.'' Governor Bullock was born in Hillsboro, Texas on July 10, 1929. He was elected to the Texas House of Representatives in 1956 and was reelected in 1958. While still in the Texas Legislature, Governor Bullock enrolled in law school. He earned a law degree from Baylor University as well as a bachelor's degree from Texas Tech University. He was also a graduate of Hill College in his hometown. Governor Bullock also served as an assistant attorney general, heading up the first anti-trust and consumer protection division in that office. He won several historic cases including a multi-million dollar recovery from five large drug companies that conspired to fix prices. Bob Bullock held other positions in Texas State government, serving on the Texas Historical Commission, on the staff of former Governor Preston Smith, and as the Texas Secretary of State. In 1974, Bullock was elected Comptroller of Public Accounts. He would serve four terms as the state's chief tax collector. His tenure as Comptroller was marked by innovation and efficiency. He became the first elected state official to adopt an equal employment opportunity program. He was among the first elected officials to use computer technology in state government to cut costs and improve productivity. He developed a Taxpayer Bill of Rights to guarantee that Texas taxpayers were treated with fairness, courtesy and common sense. In 1990, Bob Bullock was elected Lieutenant Governor, a job considered the most powerful in the State of Texas. In this position, he presided over the Texas Senate, made committee appointments, sat on key government boards, and controlled the flow of legislation in the Senate. As the presiding officer of the Texas Senate, Governor Bullock overhauled the ethics laws in an effort to restore public confidence in state government. He created the Texas Performance Review to analyze spending at state agencies and recommend cost-saving alternatives. He pushed through a constitutional amendment requiring voter approval before a state personal income tax could be enacted and if the voters approved the tax, requiring the money be earmarked for education. Governor Bullock is survived by his wife, Jan; a son, Robert D. (Bobby) Bullock, Jr. of Austin; a daughter and her husband, Lindy and Phil Ward of Austin; a grandson, Grant Bullock Robinson of Austin; a stepdaughter and her husband, Kimberly and Jeff Ader of Houston; and a brother and his wife, Tom and Jane Bullock of Brenham. He is also survived by several nieces and nephews. Two sisters, Sara Read and Louisa Bond preceded him in death. We would like to offer our sincere condolences to Jan and the rest of his family. Governor Bullock's accomplishments were shaped by his desire to make Texas the best state in the union. Governor Bob Bullock always ended his speeches with, ``God bless Texas.'' Today, we would like to add, ``God bless Bob Bullock.''

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Chairman, I thank my colleague from Michigan for yielding me this time. I rise in support of the Dingell amendment that hopefully will bring some reasonableness to the debate on gun restrictions. I do not think any of us support criminals having access to guns and the Dingell amendment will not encourage this. It would make background checks more effective and still protect the second amendment to our Constitution. I would feel more comfortable about this debate tonight if the opponents of the Dingell amendment were not also reported in the press favoring national registration maybe like we have here in Washington, D.C., which is probably the most gun restricted jurisdiction in our country, yet I do not know if the criminals in D.C. are any more effective than they are anywhere else in our country. I know they get guns elsewhere. But are you saying we need to restrict every American from being able to own a firearm? Because that is what happens here. The waiting periods have stopped convicted felons from receiving guns. I know, that has worked. But are you telling me that that person who is refused because of that background check did not also go out and find a gun on the illegal market? Let us just make it reasonable for the millions of Americans who are not afraid of guns, who have them for protection, and also for sporting.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, I also rise in support of the motion to recommit. Having looked at the motion to recommit, my goal in trying to deal with the violence that is in our schools and in our country from our juveniles is not obviously necessarily more gun control. We will debate that this evening and tomorrow. But what this amendment would do, if we vote for the recommital, it will provide more cops on the street, it will provide school resource officers and guidance counselors and after-school care and block grants for prevention. My wife is a high school teacher in a very urban district in Houston. What we have seen today is teachers and counselors do not have the time to get to know those students. What we need is some additional assistance for our local schools and our States to be able to help. We need counselors who counsel and not just schedulers for classes. That is what this will do. That is why I think we need to deal with the prevention programs, and let us leave gun control to the next debate. That is why I think this provision is so important. Mr. Speaker, I ask for a yes vote on the motion to recommit so we can deal with prevention and get the tools that our teachers and our parents and our school administrators need.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Chairman, I thank my good friend, the gentleman from Virginia (Mr. Scott) for yielding me the time. Mr. Chairman, like the gentleman from Washington (Mr. Smith), I am on the other side on this amendment. I was honored to serve 20 years in the legislature in Texas and so I have some hesitation in requiring States to do something that we typically do not pay for but there are exceptions to this, and frankly we cannot accomplish this without a change in Federal law. If a person is released from one State and commits a crime in another State, then without a Federal law we have to have Federal action to be able to require that. I am proud to be a cosponsor of the Aimee's Law legislation by the gentleman from Arizona (Mr. Salmon), the gentleman from Washington (Mr. Smith) and the gentleman from Pennsylvania (Mr. Weldon), because of the problem with repeat offenders, dealing with murder, rape or child molestation. The only crimes that are more heinous than murder and rape are those same crimes committed against children. I believe that individuals who commit these violent or sexual crimes against children should spend the rest of their lives in prison. Lord knows, in Texas, we have had the biggest building boom in prison in many years, so we are trying to build a place for them. If, however, a State believes that such a criminal has been rehabilitated and decides to release this person back to society before the end of their term, then that State should be held responsible if that person commits the crime again in someone else's neighborhood, if it is in another State. Under the Salmon-Smith amendment, these States who have an early release of violent criminals would pay to incarcerate these criminals in the other State. This is the only fair and just approach. I urge my colleagues to support it simply because the repeat offenders are what we are trying to get to. We have seen some good numbers on our crime statistics, and the reason is because a lot of States are keeping people in prison longer because they are the repeat offenders, and this will make it even, hopefully, make those statistics even sound better.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, on Thursday, June 10, I missed 12 votes because I was unavoidably detained in my district. Had I been present, I would have voted ``no'' on rollcall 192, 193, 194, 195, 196, 197, 198, 199, 200 and 201, and ``aye'' on rollcall 202, and ``no'' on rollcall 203. Yesterday, on June 14, I was detained by weather when landing at Washington National Airport. I would have voted ``aye'' on rollcall 204.

Mr. GREEN of Texas

Mr. GREEN of Texas. If the gentleman will continue to yield, again, it is such a small cost, and the people are more than willing to pay it to get adequate health care.

Mr. GREEN of Texas. Mr. Speaker, I would like to thank my colleague from New Jersey, who is our Chair of the Democratic Health Care Task Force and also serves on the Committee on Commerce and the Health Subcommittee. The reason I asked to move to the Committee on Commerce two years ago was, one, because of the complaints and concerns about managed care, along with Medicare and lots of other issues, prescription medication for seniors and everyone. It is frustrating, because we now, after the experience of the last two years, we have a bill that has a huge number of cosponsors on it, bipartisan cosponsors working on it, and now to have to go to the discharge petition route that will be ripe next week for us to begin working on that. Again, it is only because we are having to do that, it is literally taking the bill away from the committee, because this year, here we are almost in the middle of June and have not had hearings on managed care reform. So we obviously know what the priorities of our colleagues on the other side, who are very honorable and I enjoy working with them, but they do not have the same priorities as we do. Again, managed care reform is one of the top Democratic agendas this year, so that is why we have had to go through the discharge petition to try to get on this floor a fair hearing on real managed care reform. I say that, and I want to make sure we use the word ``real'' in quotes, because our experience last year was that the managed care reform bill that was written in the Republican task force, or in the Speaker's office actually, turned back the clock, actually was worse than passing no bill at all. That is why when it passed this House, it died over in the Senate. The reason I say that is because in Texas, and my colleague from Dallas and I know that Texas passed a law in 1997 that would do what we are asking to do on a national level. All we are trying to do is learn from our State's experience and say okay, the states have done their job on insurance policies issued in the states; now we need to do our job on policies, insurance policies, issued nationally, that come under ERISA. Last year's experience, the bill that passed on this floor would have reversed the success in the State of Texas. That is why I have some concern about my colleagues on the Republican side saying, well, we are going to pass legislation now on a piecemeal basis, whether it is 5 issues or 9 issues or whatever they come up with, because I watched last year and they would have reversed the successes of our individual states, and that is why we need real managed care reform this year. Let me talk a little bit about the Texas plan. It has been in effect for 2 years now. We have seen no ground swell of lawsuits. In fact, there are very few. I knew the first one was filed by one of the insurance companies challenging it. There may have been one more filed. But we actually have a great experience in Texas on there not being any huge costs associated with these real reforms that have been used, a lot of times saying we don't want to build in costs. In Texas we have not had the costs. In fact, on the outside appeals process, it is one of the issues that actually 50 percent of the appeals have been found in favor of the patient, so that is a .500 batting average if you are a baseball fan. But let me tell you, if I was one of those 50 percent that had been denied some type of health insurance coverage for a procedure, I would be glad that I had that 50 percent percentage. Now, sure, 50 percent went against the patient and their request, but that shows how important it is to have the appeals process, which is just one of the issues. The no-gag clause is important again. That was part of the Texas bill. Medical necessity, the emergency room care, the accountability issue, there are so many things that have to be in a real managed care reform bill, and they have to be drafted correctly. They cannot be drafted to where, sure, we are going to give you the accountability or medical necessity, but they will leave a loophole that you can drive an 18 wheeler truck through. That is what happened last year. So I have to admit coming to this floor I do not doubt the sincerity of my colleagues, but I saw what happened last year, and it does not take too much to show us from Texas that maybe your intent is not as good as what it should be on real managed care reform. Again, an outside appeals process is not going to break the bank. The experience in Texas is very small cost. No gag rules, let a doctor or provider talk with their patients. Even if the insurance policy does not cover certain procedures, that doctor ought to be able to tell that patient that. Just like Medicare does not cover everything, that doctor ought to be able to tell that patient ``Medicare does not do this, I will do it, but you have to pay for it.'' Accountability, if the doctor is held accountable for a certain procedure, then whoever tells that doctor they cannot do that procedure should also be accountable. Again, medical necessity is so important for those of us who realize that we really want healthcare, and managed care is going to be with us. We just want to make it work. I think my colleague from Arkansas said, let us reform it. It is here, we are going to have to do the it. In closing, let me touch on one issue that came up during the break. I had an opportunity to speak to the National Association of Manufacturers group in my district. I have to admit there are not a lot of times over my legislative career that I spoke to the National Association of Manufacturers. But during the question and answer period, one of my business owners said he did not understand the managed care debate. He said he has insurance for his employees. He said, ``I am afraid. I don't want my employees to sue me.'' I said, ``Let me tell you, that is not my intent as a cosponsor of this bill and a signatory on the discharge petition. Our intent is not to have employees suing employers. Our intent is to just make sure that employees have that ability to go to that person who makes that decision.'' Maybe it is in Hartford or Des Moines or wherever it is, or Dallas, Texas, but they ought to be able to go against that person who is making that decision. Employers do not make that decision. I was a manager of a business and had the job of finding insurance coverage for our company. I spent a lot of my time as a manager listening to my employees complain about the insurance coverage, so I would contact the insurance company and say, ``This is not what you told me when we bought this 3-year policy.'' Some employers can afford a Cadillac plan. Maybe they have a union contract and they bargained for their benefits. Some employers can only afford a Chevrolet. That is not the issue. We do not mandate. Whatever the employer can afford, we want to make sure that employee receives that care and what the employer is paying for. So there is no intent on that. Hopefully the National Association of Manufacturers will realize that we do not want their members to be sued. We want their members to get their money's worth out of what they are paying for insurance coverage today and in administering their plan. Hopefully they will realize that and we will see some support, because employers want to do the right thing by their employees. Hopefully their trade association here in Washington will do the same thing, and let them know that that is not our intent as Democratic members to have that happen. Again, I thank the gentleman. I am glad to see our other colleagues from other committees, the Committee on Education and the Workforce, where I served for 2 terms, because we have joint jurisdiction on this bill. Hopefully we will see some hearings, real hearings and a markup before we get our 218. But if not, we will work hard to get our 218 signatures to have that discharge petition.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, I rise today to pay tribute to Walter R. Stovall, who passed away on May 31, 1999. I ask all of my colleagues in Congress to join me in paying tribute to an outstanding individual. Walter Stovall was born on May 28, 1910, and was married for 64 years to Inez Kessler Stovall. He is preceeded in death by his son, Walter Stovall, Jr. and is survived by a sister, Viona Kirby of Normangee, numerous nieces, nephews and devoted friends. Walter will be missed by many people. In 1942, he enlisted in the U.S. Navy as one of the 1,000 Houston volunteers who replaced the crew of the sunken U.S.S. Houston. After his distinguished career in the U.S. Navy, Walter went to work for the FMC Corporation. He retired after 42 years of committed service. As a dedicated Christian layman, Walter Stovall participated actively in the life of Memorial Baptist Church. He was a member of this church for 51 years, serving as its treasurer for 39 years. His devotion and morals are an inspiration to us all. Walter was also an energetic and vital member of the Aldine community, where he served on the Board of Trustees of the Aldine Independent School District for 22 years. He was also active in the Boys Scouts of America and the Aldine Civic Club. For years, the Aldine community benefited from the wisdom and dedication of Walter Stovall. I am certain that the strength of the community would not be what it is without Mr. Stovall's years of service, and I am confident that his legacy will continue for years to come. We will miss him, but we feel fortunate for having known him.

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, I rise today to honor the achievement of Rebecca Krepick. On May 29, 1999, Rebecca graduated from Klein High School. I ask my colleagues in the House of Representatives join me in congratulating her and her family. Although this achievement deserves recognition in and of itself, Rebecca accomplished much more. When she was in second grade, the Anthony Robinson Foundation offered 600 students a $20,000 scholarship if they maintained a B+ average, participated in community service, and were a model student for 10 years. On the day of graduation, less than thirty of these students completed the program. Rebecca's achievement should be recognized and commended. Rebecca and her fellow scholarship recipients are examples of what is right with public education. They should be held up as role models for other students everywhere to emulate. Rebecca plans to use the scholarship at the University of Houston, one of the finest universities in our nation. Rebecca's parents, Mr. and Mrs. George Barbosa, family, friends and community are very proud of her. We wish her well in her future education pursuits. Mr. Speaker, I ask that all Members join me in congratulating Rebecca Krepick for her outstanding achievement

Mr. GREEN of Texas

Mr. GREEN of Texas. Mr. Speaker, this weekend, in a solemn ceremony at Glendale Cemetery, families will gather to honor those who gave their lives so that future generations of Americans might live in freedom. America bows its head in thanks to our fallen heroes. With flags at half-mast, with flowers on a grave, and with quiet prayers, we take time to remember their achievements and renew our commitment to their ideals. Across our country, Americans will be holding similar ceremonies in remembrance of those who have died under the colors of our Nation. We will remember the brave men and women whose sacrifices paved the way for us to live in a country like America. We will remember the families of our fallen heroes, and we will grieve for their losses. We will remember the men and women who are now serving in our Armed Forces. Throughout our history, we have been blessed by the courage and commitment of Americans who were willing to pay the ultimate price. From Lexington and Concord to Iwo Jima and the Persian Gulf, on fields of battle across our nation and around the world, our men and women in uniform have risked--and lost--their lives to protect America's interests, to advance the ideals of democracy, and to defend the liberty we hold so dear. For more than 200 years, the United States has remained the land of the free and the home of the brave. The NATO military operations in the former Yugoslavia have reaffirmed that international peace and security depend on our Nation's vigilance. Even in the post-Cold War era, we must be wary, for the world still remains a dangerous place. This spirit of selfless sacrifice is an unbroken thread woven through our history. Wherever they came from, whenever they served, our fallen heroes knew they were fighting to preserve our freedom. On Memorial Day we remember them, and we acknowledge that we stand as a great, proud, and free Nation because of their devotion.

Mr. GREEN of Texas

Mr. GREEN of Texas. I would like to thank my colleague again for this special order like my other friends, and neighbors even, because to talk about managed care reform is so important, and also in light of the filing of the rule for a discharge petition, which is a major step in the legislative process. I am proud to serve on the Committee on Commerce. It took me a couple of terms to get there. I would like for the Committee on Commerce, both Democrats and Republicans, to be able to deal with this bill. The last session we were not. The bill was actually drafted by a health care task force of the Republican majority and written in the Speaker's office. It was placed here on the floor that we could not amend except we had one shot at it. We came close, lost by six votes, it went to Senate and died which it should have because it actually was a step backward in reform. I am glad you mentioned Texas, New Jersey and other States have passed managed care reform that affect the policies that are issued under State regulation. But in Texas, I think the percentage is about 60 percent of the insurance policies are interstate and national in scope, so they come under ERISA. A little history. ERISA, I understand, was never intended to cover health insurance, it was really a pension protection effort. But be that as it may, that is why we have to deal with it in Congress to learn from what our States have done and to say, ``Okay, let's see what we can do to help the States in doing it.'' The State of Texas now has had the law for 2 years. I know there is some concern about the additional cost, for example, that these protections would provide, emergency, without having to drive by an emergency room, to go to the closest emergency room, outside appeals process, accountability and eliminate the gag rules. In Texas it is very cheap. In fact there was only one lawsuit filed, and that was actually by an insurance company challenging the law that was passed. Now, maybe there have been other ones recently, but it is not this avalanche of lawsuits, suing, whether it be employers or insurance companies or anything else. And so it has worked in a State the size of Texas, a large State, very diverse population, both ethnically and racially but also with a lot of rural areas and also some very urban areas. In fact, my district in Houston, Houston and Harris County, is the fourth largest city in the country. So you can tell that it is a very urban area and it is providing some relief, but again only for about 40 percent of our folks. So we need to pass real managed care reform. And we need to deal with it in the committee process, not like we did last session. And the discharge petition that I hope would be available by the middle of June, and both Democrats and Republicans hopefully will sign that petition to have us a hearing on it and to have the bill here so we can debate, so we can benefit those folks. The reason I was late tonight, I take advantage of the hour difference in Texas and try to return phone calls. A young lady called my office and was having trouble with her HMO. She was asking us to intervene. We have done that. We have sent letters to lots of individual HMOs. Frankly they are responsive to the Members of Congress oftentimes, but we each represent approximately 600,000 people, and how many of those folks call their Member of Congress to have that intervention? We need to structuralize it where people can do it. The outside appeals process, timely appeals, not something that will stretch out, because again health care delayed is health care denied. If, for example, you have cancer, then you want the quickest decision by the health care provider that you can. That is why it is important. I am looking forward to being able to work on the bill, whether it be through our committee or on the floor of the House and send to the Senate real managed care reform. We cannot eliminate managed care, and I do not think I want to. What I want to do is give the managed care companies some guidelines to live by, just like all of us have in our businesses, or in our offices and individual lives. We just need to give them some parameters and say, ``This is the street you have to drive on. You can't deviate. You can't deny someone access to some of the cutting-edge technology that's being developed around the country for health care.'' We just want to give them that guideline and go their merry way and make their money but also provide the health care. Let me tell the gentleman a story. My wife and I are fortunate, our daughter just completed her first year of medical school. Last August, she had just started, and I had the opportunity to speak to the Harris County Medical Society and talk about a number of issues. During the question and answer session, the President of the Harris County Medical Society, the first question is, when I explained that I am a lawyer, and normally legislators and Democrats do not speak to medical societies in Texas. He congratulated me on my daughter who had been in medical school all of 2 weeks. And so I joked. I said, ``She's not ready for brain surgery yet.'' The President of the medical society said, ``You know, your daughter after 2 weeks of medical school has more knowledge than who I call to get permission to treat my patients.'' That is atrocious in this great country. That is, that it is affecting your and my constituents and all the people in our country. Sure, we want the most reasonable cost health care and I think we can get it. We are doing it in Texas, at least for the policies that come under State law. But we also want to make sure we have some criteria there so our constituents will be able to know the rights they have. Let me just touch lastly on accountability. At that same discussion, the physician said, they are accountable for what they do. That if they make a mistake, they can go to the courthouse. And in Texas we have lots of different ways. You do not necessarily go to the courthouse. You can go to other alternative means, instead of filing lawsuits, to have some type of resolution of the dispute. But accountability is so important, because if that physician calls someone who has less than a 2-week training in medical school, that decision that that person makes, that doctor has to live with. That doctor has to say, ``Well, I can't do that.'' Or hopefully they would say that. But that accountability needs to go with the decision- making process. If that physician cannot say, ``This is what I recommend for my patient who I see here, I've seen the tests, and I'm just calling you and you're saying no, we can't do that.'' We have lots of cases in our office, and I think all Members of Congress do, where, for example, someone under managed care may have a prescription benefit but their doctor prescribed a certain prescription, but the HMO says, ``No, we won't do that, we'll give you something else.'' I supported as a State legislator generic drugs if they are the same component, but oftentimes we are seeing the managed care reform not agree to the latest prescription medication that has the most success rate that a lot of our National Institutes of Health dollars go into research, and they are prescribing something or saying, no, we will only pay for something that maybe is 5 or 10-year-old technology. Again, that is not what people pay for. They want the latest because again the most success rate. And it ought to be in the long run cheaper for insurance companies to be able to pay up front instead of having someone go into the hospital and have huge hospital bills because maybe they did not provide the most successful prescription medication. There are a lot of things in managed care reform, antigag rules, and I know some managed care companies are changing their process and they are changing it because of the market system. That is great. I encourage them to do it. But city councils, State legislators and Members of Congress, we do not pass the laws for the people who do right, we do not pass the laws for the companies who treat their customers right. We have to pass the laws for the people who treat their customers wrong. That is why we have to pass this and put it in statute and say even though XYZ company may allow doctors to freely discuss with their patients potential medical services, or they may have an outside appeals process, a timely outside appeals process, but we still need to address those people who are not receiving that care. I can tell you just from the calls and the letters we get in our own office, without doing any scientific surveys, we get a lot of calls from people, partly because I talk about it a lot not only here but in the district. But people need some type of reform. Mr. Speaker, I hope this Congress will do it timely. When the gentleman mentioned a while ago that he heard our committee may conduct hearings all summer, that is great. I mean I would like to have hearings in our committee, but we got to go to mark up what we learn from our committee. We have to make the legislative process work, the committee process work. We will put our amendments up and see if they work, and maybe they are not good, and we can sit down with the Members of the other side. But that is what this democracy and this legislative process is about, and last session it was terminated, it was wrong, and we saw what happened. We delayed, and there was no bill passed. It did not even receive a hearing in the Senate because it actually was a step backward in changing State laws like in Texas. So I would hope this session, maybe with the discharge rule being filed tomorrow, we will see that we are going down that road, but maybe we can actually see maybe hearings in June when we come back after celebrating Memorial Day, and with a short time we can, a lot of us have worked on this issue. So, sure, I would like to have some hearings, but maybe we could have a markup before the end of July or June or mid July, something like that, so we could set it on a time frame where we would vote maybe before the August recess on this floor of the House for a real managed care reform, and when we vote on the House floor, let us not just come out with a bill and say, ``Take it or leave it.'' As my colleagues know, let us have the legislative process work within reason and so we can come up with different ideas on how it works and the success. So again I thank the gentleman for taking the time tonight and my colleagues here, and particularly glad we had the first hour.