Tom Harkin

Mr. HARKIN

Mr. HARKIN. Mr. President, the Missouri River is a tremendous resource for the Midwest. It is used for recreation and for transportation. It supplies water for drinking, for irrigation, to cool power plants, and it can, at times provide far too much water resulting in flooding, hurting many farmers and sometimes communities as a whole. It is also the home for a wide variety of wildlife, providing excellent hunting and fishing opportunities. It has many beautiful views to be enjoyed by all. And it is the habitat for a number of species that, unfortunately, appear to be in very serious difficulty, endangered. I believe we have a responsibility to protect endangered and threatened species, and I take that responsibility very seriously. And, I take the needs of my constituents to minimize flooding, to maximize the benefits of barge traffic and to use the areas along the river for good hunting and fishing very seriously as well. The Corps of Engineers which manages the large dams on the river is charged with a number of legislative purposes such as navigation, flood control, recreation and environmental remediation and enhancement. And, many of those responsibilities are in regular conflict. Doing more to promote one priority can and regularly does hurt another priority. Few Members are happy with the Corps in this balancing effort. I understand lots of Corps officials are not happy with the Corps either at times. Under the Endangered Species Act, passed in the early 1970s just before I became a member of Congress, we said that saving endangered species was a top priority. And, I strongly support that goal. It is often a difficult task. We so often know so little and, at times, can be so very wrong. But we should work in a determined manner to help species that are endangered. In this case, the Fish and Wildlife Service has issued a biological opinion of what they think is the best course of action. Is it the best path to take? Under the law, there is a process that the Corps is supposed to follow in making the determination of what they will do to move forward towards saving the endangered species. It is a long process. But, as the language already in the bill notes, under its timetable, the Corps is more than a year away from coming to a final ``record of decision'' and then more months away from that decision's implementation. I believe that the Corps needs to very carefully consider the input it gets during that time. Many, including the state governments, learned professors, organizations representing many sides, have a great deal of resources and expertise. I feel that the comment period is not supposed to be for show, or to allow people to vent. I believe that it should be an opportunity for people to not only forcefully note their interest, but for those with the capability to propose creative solutions, solutions that can both do more to help the endangered species and more to maintain the historic priorities of the Corps. Do I know what that solution is? No. Is there such a solution? I don't know. I did propose increasing funding in this measure to increase sandbars of benefit to birds and towards slow moving water which I am told will help the endangered fish. And, the committee placed a portion of that funding in the bill. But, I am certainly not sure that it will be effective. A Senator is constantly listening to experts who may or may not be correct. I believe the Corps is responsible for truly sifting through all of the ideas and taking the best and melding them, to do what it can to find the best path. Some say the Fish and Wildlife Service has already spoken--period. This is only correct to a point. Yes, they have spoken, but that does not mean that they can't learn about new options and become aware of more information that can, with an open mind, lead to different alternatives. Last year, I opposed Senator Bond's amendment because it simply precluded under all circumstances one type of action from being used that might help endangered species. I understand his strong concerns about a spring rise that his proposal of last year was designed to prevent under all circumstances. I certainly have considerable doubts about the logic of the Fish and Wildlife Service's proposed spring rise. But, frankly, I believe that the best path is not to legislatively say: No, this option shall be excluded. The best path is for knowledgeable parties to propose better alternatives to be considered on their merits. Frankly, I also was told that last year's amendment would have quickly resulted in a strong lawsuit, with a likely judgement that the restrictions on the Corps to implement a spring rise would violate the Endangered Species Act. My fear was that a Federal judge, instead of the Corps would have replaced the Corp of Engineers. Today's amendment is a balanced one. Under the already existing language of the bill, clearly, the process is not going to come to a final judgement in the coming year. The amendment adds to that reality, saying to the Corps: look at the need of the endangered species, look at the many purposes of the river. Listen to those who come to testify and to provide meritorious input. And, put together some options. Ideally, the Corps will do just that. And, a year from now, hopefully, something will be presented that provides for the protection of the endangered species and the many benefits that are derived from its flowing waters. Mr. President, I am pleased that I was able to help develop this language which has genuine balance.

Mr. HARKIN

Mr. HARKIN. Mr. President, I would like to announce that the Committee on Agriculture, Nutrition, and Forestry will meet on July 17, 2001, in SR-328A at 9 a.m. The purpose of this hearing will be to discuss the next Federal farm bill. Committee on Agriculture, Nutrition, and Forestry

Mr. HARKIN. Mr. President, I would like to announce that the Committee on Agriculture, Nutrition, and Forestry will meet on July 19, 2001, in SR-328A at 9 a.m. The purpose of this hearing will be to discuss the nutrition title of the next Federal farm bill. Committee on Indian Affairs

Mr. HARKIN

Mr. HARKIN. I thank the Senator. Ohio Water Projects

Mr. HARKIN. Madam President, fuel cells, a family of technologies that produce energy electochemically, without combustion, are being developed for a exciting variety of applications. Some of these applications were not contemplated in 1992 when Congress authorized the Office of Transportation Technologies to support development in a variety of product areas. To its credit, the department has attempted to keep pace and to provide the most meaningful support possible to the research, development and demonstration of fuel cells. My purpose today is to clarify the Senate's interest in two applications, auxiliary power units for motor vehicles and portable power. Auxiliary power units promise a substantial improvement in energy efficiency of vehicles of all types and may reach commercial readiness before complete fuel cell engine systems for vehicles. APU's might also encourage the development of fuel infrastructure and encourage consumer acceptance, readying the marketplace for fuel cell vehicles. Successful development of fuel cell portable power units will also accelerate consumer understanding and market acceptance. The manufacture of portable power units would yield important experience in manufacturing technology and the increased production volumes would have a direct benefit in reducing the cost of fuel cell engines and systems for vehicles. Is it the understanding of the distinguished chairman that these applications fall within the jurisdiction of the Office of Transportation Technology?

Mr. HARKIN

Mr. HARKIN. Yes. That is correct. In addition, subsequent to our full committee action, we received Congressional Budget Office scoring that has allowed inclusion of language postponing the rescission until the Secretary of Labor reallots the excess unexpended balances to the States. Our goal with respect to the Dislocated Worker Program has always been to try to ensure that no state finds itself without the resources to meet its obligations. We believe that is accomplished through the ``hold harmless'' provisions.

Mr. HARKIN. Again, my good friend is absolutely correct. Many of us predicted during the debate on the tax cut that we would be facing precisely these impossible choices. It is upon us and it will only get worse.

Mr. HARKIN. I will be delighted.

Mr. HARKIN. Yes. My friend is absolutely correct.

Mr. HARKIN. Yes, my good friend is correct. We are now having to make some very, very difficult choices--really impossible choices--because the pot of resources we are working with is too small. And you have correctly stated both what the committee has done as well as the committee's strong support for the job training program for dislocated workers under the Workforce Investment Act. Our intent is to carefully monitor the need for dislocated worker assistance to ensure that this commitment is met and to take that need into account as we take up funding for fiscal year 2002.

Mr. HARKIN. Yes.

Mr. HARKIN

Mr. HARKIN. Mr. President, I would like to announce that the Committee on Agriculture, Nutrition, and Forestry will meet on July 12, 2001, in SR-328A at 8:30 a.m. The purpose of this hearing will be to consider nominations for positions with the United States Department of Agriculture, and to discuss the next Federal farm bill.

Mr. HARKIN

Mr. HARKIN. Mr. President, for too long, American families have been left in the waiting room while HMOs refuse to provide the health care services that families need and deserve. The results have often been tragic. Now we are on the verge of a big victory for the American people-- passing a meaningful Patient's Bill of Rights. S. 1052 represents the culmination of five long years of bi-partisan work to ensure that patients in managed care get the medical services they need, deserve, and have paid for. We have debated this issue for years, negotiated differences of opinion to find common ground, and worked across party lines to develop the best bill possible. S. 1052 truly represents the best of all our collective ideas and most importantly, meets the needs of the American people. Let me say that again. This bill--the McCain-Edwards-Kennedy bill-- meets the needs of the American people. And when you cut through the rhetoric and political posturing, that is what this debate is all about-- guaranteeing the American people basic and fundamental health care rights. One of the cornerstones of a meaningful Patients' Bill of Rights is access to a swift internal review and a fair and independent external appeals process. Without a strong review system in place--where real medical experts make the decisions and not the HMO accountants--all the other protections would be compromised. Our amendment would strengthen the review system to ensure the integrity of the appeals process and protect patients by requiring that the appropriate health care professional makes the medical decision. It ensures that health care professionals who can best assess the medical necessity, appropriateness, and standard of care, make determinations regarding coverage of a denied service. As currently drafted, S. 1052 only requires that physicians participate in the review process. While the bill does not prohibit non-physician providers from participating in a review at a physicians discretion, it does not guarantee their involvement in relevant medical reviews. I think we all agree that the intent of the appeals process is to put medical decisions in the hands of the best and most appropriate health care providers. In many cases, this will undoubtably be a physician. However, when the treatment denied is prescribed by a non-physician provider, it is critical that the case be reviewed by a provider with similar training and expertise. For example, when a 59-year-old man fell in his home, he experienced increased swelling, decreased balance, decreased range of motion. decreased strength and increased pain in his right ankle and knee. A physical therapy treatment plan would have included specific exercises to increase strength, range of motion, and balance--enabling the patient to better perform activities of daily living and to prevent further deterioration of his health. A reviewer who was not a licensed physical therapist, and did not have the expertise, background, or experience as a physical therapist, denied physical therapy coverage. Without physical therapy intervention, the patient was severely limited in activity and spent significant time in bed. The time in bed resulted in further deterioration of the original problems and the development of wounds from the prolonged static position in bed. A physical therapist reviewer would have recognized the importance of patient mobility while in bed to prevent bedsores and interventions to improve the patient's function with his right ankle and knee to enable him to independently walk. Utilizing health care professionals with appropriate expertise and experience in the delivery of a service that has been denied by a health plan guarantees beneficiaries the best possible review of their appeal. My amendment is supported by a wide range of health care professionals, including: The American Association of Nurse Anesthetists, The American Chiropractic Association, The American College of Nurse Midwives, The American College of Nurse Practitioners, The American Occupational Therapy Association, The American Optometric Association, The American Pharmaceutical Association, The American Physical Therapy Association, The American Podiatric Medical Association, The American Society for Clinical Laboratory Science, The American Speech-Language-Hearing Association, The National Association of Orthopaedic Nurses, The National Association of Pediatric Nurse Practitioners, The National Association of Social Workers, and The Center for Patient Advocacy. I do not believe that non-physician providers were deliberately excluded from the review process. In fact, just the opposite is true--I believe it was the intent of the bill's authors to develop the best possible review process. However, unless my amendment is adopted, I worry that we will fall short of our shared goal of giving patient's access to the best and most appropriate health care services in every instance.

Mr. HARKIN

Mr. HARKIN. Mr. President, I, along with 15 of my colleagues are introducing a bill today that addresses an issue we haven't talked enough about in the Senate in recent years--but it's a critically important issue that we cannot continue to ignore. I'm talking about workers' rights--specifically the erosion of a worker's fundamental right to strike, to protect that right. Today, we are introducing the Workplace Fairness Act. This may sound familiar to many of my colleagues here in the Senate. It was a bill my good friend and former colleague Senator Howard Metzenbaum from Ohio introduced in the 102nd and 103rd congress. The Workplace Fairness Act would amend the National Labor Relations Act and the Railway Labor Act by prohibiting employers from hiring permanent replacement workers during a strike. It would also make it an unfair labor practice for an employer to refuse to allow a striking worker who has made an unconditional offer to return to go back to work. Why do we need this legislation? Because right now, a right to strike is a right to be permanently replaced--to lose your job. Every cut-rate, cutthroat employer knows they can break a union if they are willing to play hardball and ruin the lives of the people who have made their company what it is. In my own state of Iowa--Titan Tire Company out of Des Moines, is trying to drive out the union workers with permanent replacements--the union has been on strike for three years now. Over the past two decades, workers' right to strike has too often been undermined by the destructive practice of hiring permanent replacement workers. Since the 1980s, permanent replacements have been used again and again to break unions and to shift the balance between workers and management. Titan Tire just outside is just one of many examples. On May 1, 1998, the 650 members of the United Steelworkers of America, Local 164, who work in Des Moines Titan Tire plant, were forced into an Unfair Labor Practice Strike. During the contract negotiations preceding this strike, Titan International Inc. President and CEO, Morry Taylor, attempted to eliminate pension and medical benefits and illegally move jobs and equipment out of the plant. He also forced employees to work excessive mandatory overtime, sometimes working people as many as 26 days in a row without a day off. Well, the membership decided that Titan's final offer was impossible to accept, and they voted to strike. Two months later, in July, 1998, Titan began hiring permanent replacement workers. During the past three years, approximately 500 permanent replacement workers have been hired at the Des Moines plant. And little or no progress has been made toward reaching a fair settlement. In fact on April 30, 2000, the day before the second anniversary of the Titan strike, Morrie Taylor predicted that the strike would never be settled. Workers deserve better than this. Workers aren't disposable assets that can be thrown away when labor disputes arise. When we considered this legislation in 1994, the Senate labor and Human Resources Committee heard poignant testimony about the emotional and financial hardships caused by hiring permanent replacement workers. We heard about workers losing their homes; going without health insurance because of the high costs of COBRA coverage; feeling useless when they were permanently replaced after years of loyal service. The right to strike--which we all know is a last resort since no worker takes the financial risk of a strike lightly--is fundamental to preserving workers' rights to bargain for better wages and better working conditions. Without the right to strike, workers forgo their fair share of bargaining power. Permanent striker replacement not only affects the workers who were replaced. It affects other workers in competing companies. When one employer in an industry breaks a union, hires permanent replacements, and cuts salaries and benefits, it affects all the other companies in the industry. Now they either have to find a way to compete with the low-wages and shoddy benefits of a cut-rate, cut-throat business--or they have to follow suit. Also, workers faced with being replaced are forced to make a choice. They can either stay with the union and fight for their jobs, or they can cross the picket line to avoid losing the jobs they've held for ten or twenty or thirty years. Is this a free choice, as some of our colleagues would suggest? Or is this blackmail that takes away the rights and the dignity of the workers of this country? What does it mean to tell workers, ``you have the right to strike''--when we allow them to be summarily fired for exercising that right? In reality, there is no legal right to strike today. And because there is no legal right to strike, there is no legal right to bargain collectively. And since there is no legal right to bargain collectively, there is no level playing field between workers and management. In other words, Management gets to say that you must bargain on their terms--or find some other place to work. If you're permanently replaced, that means you're out of work; you lose all your pension rights; you lose your seniority; you lose your job forever. How did this happen? We've got to go back to the 1930's for the answer. In response to widespread worker abuses--and union busting--Congress passed the National Labor Relations Act--the Wagner Act--in 1935 and it was signed into law by President Roosevelt. The Wagner Act guarantees workers the right to organize and bargain collectively and strike if necessary. It makes it illegal for companies to interfere with these rights. In fact, it specifies the right to strike and states: `Nothing in this act--except as specifically provided herein--shall be construed so as to interfere with or impede or diminish in any way the right to strike.' In 1938, the Supreme Court dealt the Wagner Act a mortal blow in the case National Labor Relations Board (NLRB) versus Mackay Radio and Telegraph Co. In that case, the Court said that Mackay Radio could hire permanent replacement workers for those engaged in an economic strike. There are two types of strikes: economic and unfair labor practices. Employers must rehire employees in unfair labor practice strikes. The NLRB determines if the strike is economic or based on unfair labor practices. Unions cannot know in advance whether NLRB will rule that their employer has engaged in unfair labor practices. So any employee participating in a strike runs a risk of permanently losing his or her job. What's interesting is that following the Court's ruling, companies did not take advantage of this loophole until the 1980s. Before then, they recognized that doing that would upset this level playing field. For almost 40 years, management rarely hired permanent replacements. That began to change in the 1980s. Since then, hiring permanent replacements has become a routine practice to break unions and shift the balance between workers and management. Again, the Workplace Fairness Act would restore the fundamental principle of fair labor-management relations--the right of workers to strike without having to fear losing their jobs. Permanent striker replacement keeps us from moving forward as a nation into an era of high-wage, high-skilled, highly productive jobs in the global marketplace. Without the right to strike, workers' rights will continue to erode. The result will be fewer incentives and less motivation to produce good work, and companies will also suffer with less quality in their products. Obviously, this legislation won't be adopted this year. But we are introducing it today to signal my intent on raising it and other fundamental labor law reforms in the next session of Congress. It's time for us to level the playing field for hard-working Americans. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Madam President, I rise today to congratulate the people and Republic of Slovenia on their tenth anniversary of independence. It is a privilege to join my Republican colleague, Senator George Voinovich, as an original cosponsor of the legislation he introduced today to pay tribute to the remarkable transformation of Slovenia into a free, democratic state during the past decade. Since the fall of the Soviet Union and the break-up of the former Yugoslavia, no country in either Southern or Eastern Europe has made greater and faster progress in embracing human rights, the rule of law, open markets, and democratic governance. At the same time, Slovenia has demonstrated both the readiness and the capacity to become a regional leader in pursuit of peace and stability that has long suffered from ethnic divisiveness, turmoil, and bloodshed. Let me cite just one example. Slovenia took the initiative a few years ago to establish the International Trust Fund for De-Mining, ITF, which has become the leading organization to rid the Balkans of landmines and to rehabilitate the victims of these deadly weapons. In so doing, it is the Slovenians who deserve the credit for securing contributions from the U.S. and eighteen other Nations as well as many private donors to meet this urgent humanitarian challenge. I am hopeful that this Congress will authorize and appropriate a second U.S. contribution to help sustain the outstanding work of the ITF this year and beyond. Slovenia has also become an active member of various international organizations, including the United Nations, the World Trade Organization, the Council of Europe, and the Organization for Security and Cooperation in Europe. Therefore, it is not surprising that President Bush and Russian President Putin held their first summit meeting earlier this month in Ljubljana, the capital of Slovenia. I salute the remarkable courage of the Slovenian people in achieving their quest for free and democratic government as well as their entrepreneurial drive in building a vibrant, growing national economy in such a short span of time. Accordingly, the U.S. and our NATO allies should move forthwith to extend a formal invitation for Slovenia to become a full-fledged NATO member within the next 12-18 months.

Mr. HARKIN

Mr. HARKIN. Mr. President, I would like to announce that the Committee on Agriculture, Nutrition, and Forestry will meet on June 28, 2001, in SD-106 at 9 a.m. The purpose of this hearing will be to discuss the next Federal farm bill. committee on energy and natural resources

Mr. HARKIN

Mr. HARKIN. First, I thank my friend from North Carolina for his kind words and for visiting my State. I invite him back soon and often. I thank the Senator from North Carolina for his great leadership on this issue, and I am delighted to be a soldier in his army to fight this battle and make sure our patients get decent care.

Mr. HARKIN. I thank our leader for pointing that out. I, too, congratulate my friend and dear colleague from Georgia for being a good friend of mine and for being a great Senator. A patient should have the right to appeal an HMO's decision to deny or delay care to an independent entity and to receive a binding and timely decision and, finally, the right to hold HMOs accountable when their decisions to deny or delay care lead to injury or death. It was my friend from North Carolina, Senator Edwards, who said earlier that there are only two groups in the United States that can't be sued--diplomats and HMOs. It is time to end the HMO diplomatic immunity in this country and to allow them to be held accountable. I know there is a lot of talk about the right to sue. Let's face it: Most of the situations will be resolved through the strong and binding appeals process that is in the bill. But the HMOs should not have special immunity when they harm patients. The reality is that unless HMOs are held accountable when they make inappropriate medical decisions that harm a patient, there is no guarantee that they will change their ways and stop putting profits before patients. As this debate unfolds, I know that I and others will be coming to the floor to point out the tremendous profit margins some of these managed care industries have. When you think about it, that is hundreds of billions of dollars a year being sucked out of medical care that people need in this country and given to their shareholders or sometimes to a very small group who happen to own the HMO or the managed care system. I don't mind HMOs making profits--that is fine--but they should not be able to make these unconscionably high profits by disallowing appropriate care for patients. That is what I mean. The HMOs cannot continue to put profits ahead of patients.

Mr. HARKIN. I am delighted to yield.

Mr. HARKIN. Mr. President, I first say a big thank you to Senator Kennedy for his many years of leadership on this issue, and also thank Senator Edwards for his leadership and sponsorship of this bill, along with Senator McCain. This is not a new issue in this Chamber. Senator Kennedy led the battle on this, starting about 5 years ago, if I am not mistaken. We passed it last year, as you know. The House passed a good bill, but the Senate passed a rather bad bill. We went to conference, and we could not get anything out of conference. We used to meet periodically over here in a room, in Senator Nickles' room, to try to hammer things out, but it became clear that the more we met, the less that was going to get done. So now we have a chance, this year, to catch up on all that and to pass this meaningful legislation. I believe we are on the verge of a big victory for the American people. They have been waiting too long for this in the waiting rooms-- about 5 years--where mothers, fathers, and children have been forced to spend countless hours negotiating the massive bureaucracy of their managed care plans, desperately trying to get the health care services they need and deserve. Unfortunately, it is clear that the opponents of a Patients' Bill of Rights are not giving up their fight. They may succeed in convincing a few to delay it for a few more days, but they are not going to be successful in stopping the Senate from passing the protections that patients should have had years ago. Right now, as I understand, we have an objection from the Republican side to proceed to the bill, an objection from the Republican side to not even take the bill up. That is unfortunate, but I think it indicates that we have to be resolute in our determination to answer the call of our patients all over America. We do not have to look too hard to see that there are too many people being denied appropriate care. We have all heard the horror stories of individuals unable to see their doctor in a timely manner, of patients unable to access the specialists they need. We just heard a number of stories from the Senator from North Dakota and the Senator from New York. I am certain we will hear many more as we are here in this Chamber during this debate. These are all individuals who have been denied the treatment their doctor has recommended or their health specialist has recommended because the HMO simply doesn't want to pay the bill. I hope we will all remember, as we hear all these stories coming out, that those are the ones we know about. That is just the tip of the iceberg. Think about the many more Americans who have been denied the care but in their desperation they went elsewhere. Maybe they paid for it out of their pocket; they moved on with their lives. The stories we hear are the tip of the iceberg. There are many more about which we don't know. These are real stories and these are real people. These are real hurts they have. It is very simple: Your HMO either fulfills its promises to pay for medically necessary services or it doesn't. We have heard enough to know that in too many cases it doesn't. As I said, I didn't have to look very far to find such situations in my own State of Iowa. Let me relate the story of Eric from Cedar Falls who has had health insurance through his employer. Eric is 28 years old with a wife and two children. He suffered cardiac arrest while helping out at a wrestling clinic. He was rushed to the hospital where he was fortunately resuscitated. But tragically, while in cardiac arrest, Eric's brain was deprived of sufficient oxygen. He fell into a coma and was placed on life support. The neurosurgeon on call recommended that Eric's parents get him into rehabilitation. It was then that the problems began. Although Eric's policy covered rehabilitation, his insurance company refused to cover his care at a facility that specialized in patients with brain injury. Well, thankfully, Eric's parents were able to find another rehabilitation facility in Iowa. Eric began to improve. His heart pump was removed, his respirator was removed, and his lungs are now working fine. But even with this progress, Eric's family received a call from his insurance company saying they would no longer cover the cost of his rehabilitation because he was not progressing fast enough. Eric's mother wrote to me and said: This is when we found out we had absolutely no recourse. They can deny any treatment and even cause death, and they are not responsible. In the coming weeks in this Chamber, we have a critical choice before us. We can choose for Eric and his family. We can choose between real or illusionary protections. We can choose between ensuring health care for millions of Americans or perpetuating the burgeoning profit margins of the managed care industry. I have been working on this issue with my colleagues for over 5 years. Last year I was a conferee trying to work out this bill with the House. It came to naught. We have debated this issue for years. We have negotiated differences of opinion to find common ground. We have worked across party lines to develop the best bill possible. I am delighted to say that amendments I offered during the past debates, such as access to specialists and provider nondiscrimination, have been incorporated into the underlying bill. S. 1052 truly represents the best of all of our collective ideas and, most importantly, meets the needs of the American people. Our bill establishes a minimum level of patient protections by which managed care plans must abide. States can, and it is my hope that they will, provide even greater protections, as necessary for individuals in HMOs in their States. As a starting point, we need to pass a strong and substantive Patient Protection Act. S. 1052, our Patients' Bill of Rights Act, delivers on what Americans want and what they need: Real protection against abuse; direct access to needed specialists, especially pediatrics specialists and OB/GYNs for women; the right for patients to see a doctor not on their HMO list, if the list does not include a provider qualified to treat their illness; access to the closest emergency room; the right for patients with ongoing serious or chronic conditions such as cancer or arthritis or heart disease to see their medical specialist without asking for permission from their HMO or primary care doctor every time they need to see their specialist; the right for patients to continue to see their doctor through a course of treatment or a pregnancy, even if the HMO drops their doctor from its list or their employer changes HMOs. This is so important. Right now, so many people in managed care plans are seeing a doctor for a course of treatment. It could be a difficult pregnancy. The mother-to-be has every confidence in this specialist. Then her employer changes HMOs and this doctor is not on their approved list, not on their list for HMOs. Many HMOs will just drop that. What this bill says is: If you started on a course of treatment, you can continue to see the doctor of your choice through that course of treatment even if the HMO has changed or if they have dropped the doctor from their list. This bill has the right for patients to get the prescription drug their doctor says they need, not an inferior substitute that the HMO chooses because it is cheaper. Congratulating Senator Cleland

Mr. HARKIN. I thank my friend from Massachusetts for postulating this question because it is really important. Before I answer it, I again thank the Senator for his 5 years of leadership. The Senator from Massachusetts was the leader on this issue when it started 5 years ago. He was our leader last year, and he is our leader again this year trying to bring to the American people commonsense decency. As the Senator said, there is nothing in the bill that would not meet the test of good old common sense. Yes, I want to know if those on the other side who oppose this are going to offer an amendment that says, no; if a woman is seeing an OB/ GYN, if she is having a difficult pregnancy--this may be a specialist in whatever the difficulty might be. But then the woman's employer changes HMOs and drops the doctor. Right now they can refuse to pay that specialist. She would have to go to someone else and start over. Doesn't it make common sense that she should at least be able to see that specialist through the end of her pregnancy, the birth, and have that same specialist see her? That is common sense. I question out loud, will someone on the other side offer an amendment to disallow that? Fine, if they want to do that, if that is their opinion. I want to see how many people vote against something such as that. That is just common sense. Or a person with a disability who has to see a specialist on a continuing basis, I cannot tell the Senator--he knows this as well as I do; he has been very supportive.

Mr. HARKIN. I yield to the Senator.

Mr. HARKIN. Mr. President, I was at a town hall meeting in Iowa, where I first heard this comment made by a gentleman who I think really brought it all home. He said to me: I don't want my doctor doing my taxes, and I don't want my accountant deciding my health care needs. To me, that sort of brought it all home and pointed out what we are trying to do: let the doctors and health care professionals make the decisions, and not the accountants, on what kind of health care we need. As I said earlier, the stories we hear about the lack of medical care from people in HMOs in Iowa--again, this is the tip of the iceberg. We are going to hear a lot of stories. These are real people with real injuries and real hurt. We have to keep in mind that these are just the ones we know about. How many more that we don't know about are out there? I retold a story here about Eric, a 28-year-old man who was working and had a wife with two kids. He was helping out at a wrestling clinic and he had cardiac arrest. They rushed him in and he was resuscitated. His brain had been denied sufficient oxygen, so he needed special rehabilitation. The neurosurgeon recommended to his family to get him into rehabilitation. His insurance policy covered rehabilitation, but his insurance company refused to cover his care at a rehabilitation facility that specialized in brain-injured rehabilitation. So his family took him to another place in Iowa. He began his rehabilitation. The good news is that he had progressed very well. The heart pump was removed, the respirator was removed, and his lungs are now working fine. But just at this point, the HMO calls his family and says they will no longer cover the cost of his rehabilitation because he is not making enough progress fast enough. I would never have known about this except that his mother wrote me a letter and said: This is when we found out we had absolutely no recourse. They can deny any treatment and even cause death and they are not responsible. I hear stories such as this all over my State. That is why we need to move ahead aggressively and why we have to keep in mind, when this debate occurs and we hear all these amendments being proposed, that we are talking about real people, real consequences, and real hurt that is happening to these families. The need is clear. This bill is not about doctors, nurses, or politicians; it is about patients, about our friends and our families when they get sick and they need to have the peace of mind that the health care they need and deserve--and that they have already paid for--will be available in a timely manner. We have a chance to pass real and responsible legislation. The time is now. The American people have been in the waiting room for far too long. It is time to pass a meaningful Patients' Bill of Rights. Let's not delay any longer. We will have the debate. Let's have the amendments that are pertinent. Let's get it done once and for all.

Mr. HARKIN. Sure.

Mr. HARKIN

Mr. HARKIN. Mr. President, I ask unanimous consent that floor privileges be granted to my health policy fellow, Kris Hagglund, for the duration of the debate on the Patients' Bill of Rights.