Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Just 30 seconds of the time to point out, in response to the comments of the Senator from Oklahoma, the insurance industry has just spent $2 million in opposition to our program, which basically includes the provisions so eloquently commented on by the Senators from California and North Carolina. Zero has been spent by the insurance companies in opposition, to my best understanding, to the Republican proposal. If it looks like a duck and quacks like a duck, it is a duck. This is the insurance company's proposal, the HMO proposal. They are the ones that will gain if this amendment of the Republicans is accepted. There is no question about that. It is the disabled, the cancer groups, and the children who will gain if our proposal prevails. I yield back the remainder of the time.

Mr. KENNEDY. Mr. President, I reserve the right to object. Unless I am entitled to speak, I will object, Mr. President. Mr. CHAFEE addressed the Chair.

Mr. KENNEDY. Reserving the right to object, and I will not object, just in response to the Senator's earlier statement, I wonder why the insurance companies are spending more than $2 million opposing our program. Mr. NICKLES addressed the Chair.

Mr. KENNEDY. I reserve my time.

Mr. KENNEDY. Mr. President, much of this debate may seem technical, but the definition of medical necessity and a fair and independent appeals process are at the heart of any serious effort to end insurance company abuse. Our plan has it; their program does not. That is why Consumers Union--the outfit that publishes Consumer Reports--calls the Republican program ``woefully inadequate'' and ``far from independent.'' No one supports their program but the insurance companies and the HMOs, the very organizations that profit from the abuses of the status quo. Their program is opposed by the American Cancer Society, and virtually every cancer organization in the country. It is opposed by the American Heart Association. It is opposed by the disability community. It is opposed by the women's community, and the people who represent children. These are the patient groups that have the most to lose from low quality and the most to gain from high quality. And they lose under the Republican program. This amendment will determine whether Senators stand with the patients or with the HMOs. We yield back the remainder of our time and are prepared to vote. Mr. NICKLES addressed the Chair.

Mr. KENNEDY. I yield the Senator 30 seconds.

Mr. KENNEDY. Does the Senator still have time left?

Mr. KENNEDY. I yield 1 minute to the Senator for a question.

Mr. KENNEDY. I yield the Senator 1 minute.

Mr. KENNEDY. I yield the Senator 2 minutes.

Mr. KENNEDY. I yield 1 minute to the Senator from California and then 1 minute to the Senator from North Carolina.

Mr. KENNEDY. But the Senator is entitled, the Senator from North Carolina, to inquire of the Senator from California, is he not?

Mr. KENNEDY. Parliamentary inquiry. Can the Senator be inquired of by a Member of the Senate and answer a question?

Mr. KENNEDY. Regular order. Senators are permitted to inquire and ask questions. That is the regular order, Mr. President. I insist on the regular order, not the interruption of the Senator from North Carolina. Whose time is this on, Mr. President?

Mr. KENNEDY. Mr. President, I yield 10 minutes to the Senator from Rhode Island.

Mr. KENNEDY. Mr. President, I yield 8 minutes to the Senator from North Carolina.

Mr. KENNEDY. I yield 5 minutes to the Senator from New York.

Mr. KENNEDY. It does not say that. To the contrary, does the Senator not agree that we have example after example where HMOs have used definition based on lowest cost?

Mr. KENNEDY. I want to ask the Senator from California a question. Where in the earlier response does it say they will use the best practices?

Mr. KENNEDY. Mr. President, this amendment goes to the heart of the issue. I urge our colleagues to pay attention to the exchange we are going to have on the floor of the Senate. Let us look, first, at what is in the Democratic bill. In the Democratic bill, ``medical necessity,'' as defined on page 86, is ``medically necessary or appropriate.'' That is the standard definition medicine has used for 200 years. It is the standard recommended by none other than the Health Insurance Association of America itself, on page 269: Medical necessity. Term used by insurers to describe medical treatment that is appropriate and rendered in accordance with generally accepted standards of medical practice. Our legislation does what the Health Insurance Association of America recommended. This is the standard that has been used for 200 years. This is the standard that is supported by the medical profession. The Republican plan knocks that standard out. It knocks it out. What do they put in as a substitute? As a substitute, on page 148, they say ``medical necessity'' used in making coverage determinations is determined ``by each plan.'' ``By each plan.'' The plan can define medical necessity any way it wants. In their appeals procedure we find that medical necessity issues can be appealed, but medical necessity is defined by the HMO. That sounds complicated. What does it mean in real terms? Let me read you a few examples of how HMOs have defined medical necessity. Here is a company--I will not give its name--and their definition. The company: . . . will have the sole discretion to determine whether care is medically necessary. The fact that care has been recommended, provided, prescribed or approved by a physician or other provider will not establish the care is medically necessary. In other words, medical necessity is whatever the HMO says. Whatever the HMO says. Here is an example of Aetna U.S. Health Care, the provision in their Texas contract: The least costly of alternative supplies. . . . Here is another HMO: The shortest, least expensive, or least intensive level. . . . They throw out the medical necessity standard used for 200 years and say, medical necessity will be whatever the HMO wants it to be. That is the heart of this issue. What do we find when the HMO uses their own medical necessity definition? Who makes the judgment? It is an insurance company bureaucrat. That is what this amendment is all about. Finally, when you see the appeals procedures which will be addressed by my other colleagues, all you have to do is look at the Consumers Union and many other consumer groups. The consumer groups believe their appeals procedure does not provide adequate protections. The American Bar Association believes basic consumer protections are not met. The American Arbitration Association makes the same judgment. This is a status quo amendment. If you want to do nothing about the pain and injury being experienced by children, women, and family members in our country, go ahead and support this program. It is an industry protection amendment. It will protect the profits of the industry; it puts the profits of the industry ahead of protecting patients. I yield 5 minutes to the Senator from California.

Mr. KENNEDY. Mr. President, I yield myself 5 minutes.

Mr. KENNEDY. Mr. President, the more we debate, the more confused our good colleagues on the other side, quite frankly, become. The underlying amendment dealing with the OB/GYN is the amendment that was offered in committee and that is no surprise. The other provision the Senator from Oklahoma talks about is funding the self-insurance tax deduction introduced by the Senator from Oklahoma without paying for it. This would subject the bill to a point of order if it was carried all the way through. He did not pay for it. It is a red herring. Time and time again we have put in the General Accounting Office document which states that the protections in this bill will enhance the number of people insured, not reduce the number. Does the Senator from Pennsylvania actually believe we are endangering breast cancer tests for women, reducing Pap tests, reducing examinations for breast cancer and yet the breast cancer coalition supports our proposal? Is he suggesting any logic to his position? Mr. President, I yield back the remainder of the time and look forward to the vote.

Mr. KENNEDY. I yield myself 2 minutes on the bill.

Mr. KENNEDY. No, I don't know. I don't know, because you talk about self-insured plans, and there are only 48 million Americans in those plans. You don't cover the 110 million Americans who have other health insurance plans. Does the Senator know a single State that provides specialized care for children if they have a critical need for specialty care--one State in the country? We provide that kind of protection. Does the Senator know a single State that has that kind of protection?

Mr. KENNEDY. Will the Senator yield on that issue?