Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. The Senator is correct.

Mr. KENNEDY. The Senator is correct.

Mr. KENNEDY. The Senator is correct.

Mr. KENNEDY. The Senator is quite correct. It is the difference between substance and process. You can have the greatest substance in the world, but if you control the process, you can limit it and restrict it in such a way to preclude people from being protected. That is exactly what is happening here.

Mr. KENNEDY. Even the underlying substance of the Republican proposal we believe has fallen short in the areas mentioned by the Senator from New York. We are going to try, during the latter part of the afternoon, tonight, and tomorrow, to continue to address those inadequacies, and hopefully we will have some support.

Mr. KENNEDY. The Senator is quite correct. On the other side of the room--I am glad to see our two colleagues. We are missing some of our other colleagues for this debate on a matter of such great importance. I rarely see, and I ask my other colleagues how many times have they seen, legislation written that effectively excludes 72 or 73 percent of all Americans but meets American's needs? Yet we effectively exclude 72 or 73% of Americans who need these protections. This, I think, makes the proposal fraudulent in its representation to the American people.

Mr. KENNEDY. I finally yield to the Senator.

Mr. KENNEDY. The Senator is correct.

Mr. KENNEDY. I think the Senator is correct in his statement. It is basically because the industry is putting its profits ahead of the protection of the patients. We had reaffirmation yesterday, in an indirect way, with the publication of an article in the medical journal JAMA, that says the for-profit HMOs provide a good deal less service for the coverage of individuals than those which are not-for-profit. It is, I think, a kind of intuitive, self-evident factor that this is taking place. I would be glad to yield time.

Mr. KENNEDY. I am advised by my friend and colleague, 2\1/2\ minutes.

Mr. KENNEDY. Mr. President, how much time remains for each side?

Mr. KENNEDY. I yield 2 minutes to the Senator from Illinois.

Mr. KENNEDY. Mr. President, I yield myself 3 minutes off the bill.

Mr. KENNEDY. I have listened with a good deal of interest to our colleagues on the other side complaining. They want it both ways. On the one hand, they are supporting covering 48 million Americans and leaving out 113 million Americans--so they are covering some Americans--but they are not covering all Americans. Then they are troubled, evidently, because they are covering some Americans. Many of our colleagues on the other side, as we have just heard, do not think there ought to be any kind of protection for the American citizens, that we ought to just leave this up to the States. My response is, the law of the jungle may be good in the jungle, but we do not accept that in the United States, when people are being exploited by the private sector. In this case, the insurance industry refuses to provide the protections for women and children in our country. The insurance industry refused to provide protections for workers in our country. That is basically the fact of it. We hear repeatedly, mistakenly, that the States have provided protections. I will include in the Record the Families USA analysis of the various States. An examination of state legislation in 13 areas of basic managed care consumer protections finds that no state has all 13 on the books. . . . I ask unanimous consent to have that analysis printed in the Record.

Mr. KENNEDY. Mr. President, may we be in order. The Senate is not in order. The Senator is entitled to be heard. We have had a good debate over the course of the day. Members have been attentive. We would like to make sure that the good Senator has the attention of the membership.

Mr. KENNEDY. Vermont has 10 out of the 13, but no State has all 13. These are basic and fundamental standards that can be built upon. If Texas wants to do more, so be it. If Pennsylvania wants to do more, so be it. But these are the most basic and fundamental protections. That is what this legislation is all about. These are basic kinds of protections which, in most instances, have been included in the protections of the Federal employees, who include every Member of this body. I have been so interested in listening to this debate about how we do not want the Federal Government having anything to do with health care. The Federal employment insurance has 11 million members. Every Member of this body has an opportunity to go in there and check a little box and say: We don't want the Federal employment protections. We don't want that. We want the private sector. Yet very few Members of this body have done that. Eleven million Federal employees have these protections. It is so nice to hear: Well, we're glad to have protections for our children. We refuse to provide them for other people's children. You don't hear anyone suggesting we are going to give up our Federal employees' health care. We should not say, when we provide this kind of protection for our children that we are going to provide the protection for other people's children. That is the heart of this issue. I yield myself another minute off the bill. I have included in the Record an analysis of which States provide these 13 basic protections and which States do not. They are rather basic and fundamental protections. They are protections concerning emergency care, OB/GYN care, access to clinical trials, access to specialists, ensuring adequate accountability, and eliminating the financial incentives that lead to denying people quality health care. For all those who say they do not want these protections, I do not know what their States are like. I do not know the last time they talked to their insurance commissioners. I doubt if there is anyone in this body--1 more minute--anyone in this body who could call their insurance commissioner this afternoon and not hear scores of complaints. That is what is happening, maybe not in the Senate, but all across this Nation. This amendment will make an important difference in terms of protection. I reserve the remainder of my time. Mr. NICKLES addressed the Chair.

Mr. KENNEDY. Could the Senator yield, on my time, on that issue?

Mr. KENNEDY. We couldn't see a specialist like Dr. Frist under the Republican bill. I am glad to use him if I need him. I thank the Senator.

Mr. KENNEDY. I yield myself 1 minute. Mr. President, what about the bureaucrats in the insurance industry who are denying coverage for children in these emergency rooms? What about the bureaucrats who are denying women the right to be able to be in the clinical trials? What about those? This isn't HCFA. The Senator from Oklahoma knows this. When the General Accounting Office recommended they get additional resources for HCFA, they led the fight against giving them resources to enforce the Kassebaum-Kennedy legislation. Go back and look at the Record, I say to the Senator. You know that. I am not interested in going back and forth on this issue. But I daresay the bureaucrats in the insurance industry are the ones about whom people are most concerned. Americans know what the insurance industry is doing. They are looking at the bottom line. I think maybe HCFA has its problems--maybe they made some mistakes--but, by and large, they are dedicated men and women who are committed to public service who are trying to do a decent job. It is easy to beat up on employees, Government employees, but for my money, they do a great job.

Mr. KENNEDY. I am a good friend of the Senator from Texas. I will tell you, Mr. President, the Senator is as wrong in his explanation about the debate here on the floor of the Senate and as wrong about President Clinton's bill on health care as he was about President Clinton's proposal about economic recovery in 1993 when he predicted the end of the free market system, that inflation was going up through the roof, with unemployment lines around the Capitol of the United States. He predicted that deficits were going to grow and it was going to be the end of the American free enterprise system. He was wrong then, and he is wrong tonight. Mr. President, I yield the last minute to the Senator from South Dakota,

Mr. KENNEDY. Mr. President, I yield myself 1 minute on the bill.

Mr. KENNEDY. I yield to the Senator from West Virginia. Privilege of the Floor

Mr. KENNEDY. Mr. President, I yield 4 minutes to my colleague, the Senator from Massachusetts.

Mr. KENNEDY. Of course.

Mr. KENNEDY. Mr. President, I yield myself such time as I might use. We are coming into the final moments before we will vote on this amendment. I will take at least these final moments to point out where we are. Primarily, what we are talking about are the protections that have been included in our Patients' Bill of Rights. No matter how many times our Republican friends say they are shocked, shocked to discover the deficiencies in their amendments and promise to do better, their new product is just the same old, tired, flawed proposal in fancy dress. The problem is a simple one: Insurance companies don't want real protections, so Republicans won't produce them. We have two different proposals on emergency care, two different proposals on OB/GYN care, and another proposal in terms of specialty care this evening--all changes, alterations, in terms of their original proposal. No matter how many times they alter or change, they still do not meet the basic standard and test of providing that the medical professions make the judgment of what is in the interest of that patient, not the insurance company. Access to the needed specialty care is one of the most critical ingredients in quality health care. Timely access to a qualified specialist can often determine whether a patient lives or dies. For those living with chronic illnesses or with a physical or mental disability, access to specialty care can improve the quality of life, prevent deterioration, or cure or ameliorate the disease. Nowhere is the contrast between the Republican plan and our proposal clearer than on the issue of access to needed specialty care. Our amendment, offered by Senators Bingaman, Harkin, Reed, and others, guarantees it. The Republican plan is a sham proposal that carries the label of access to specialty care but does nothing meaningful to help patients. Our amendment has key protections that guarantee appropriate specialty care. Health plans are required to provide care by a qualified specialist or center of excellence when needed. If sufficient expertise does not exist inside the HMO network, it must allow patients to go to a specialist or a center of excellence outside the network, without any additional financial burden beyond what would be involved in seeing a network specialist. For chronic or ongoing conditions, HMOs must allow standing referrals to a specialist or, where appropriate, allow the specialist to be a care coordinator--in effect, the primary care gatekeeper for treatment related to the condition. These provisions are especially critical for anyone suffering from a chronic disease or disability and for disabled children with their complex needs. If there is a disagreement between a plan and a physician or patient about the need for specialty care or out-of- network care, the dispute will be resolved by a speedy independent review. It is guaranteed. It is written into the law. The Republican plan includes none of these critical guarantees, not a single one. More than two-thirds of all patients are excluded even from the minimal protections it does provide. Access to qualified specialists is essential to quality care, particularly for those who need care the most: those with a disabling or life-threatening illness. If our proposal is adopted, every family can be confident that if serious illness strikes, their health plan will not deny them the care that is essential for recovery--no ifs, ands, or buts; the guarantee is there. Once again, the issue is clear: Will the Senate protect the patients or will it protect the insurance industry profits? That is what is before the Senate in this amendment. That was basically the protections that were included in our legislation. This amendment will guarantee that any measure that comes out of this body will have those protections, and that is why this amendment is so important to be accepted. I reserve the remainder of my time.