Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, in just 3 days, this House will adjourn without having brought to the floor the Patients' Bill of Rights, the Democrats' legislation for comprehensive HMO reform. I bemoan the fact that that is the case. I think that this legislation and the need to address the issue of HMO reform is really the preeminent issue that needs to be addressed in this House, in this Congress, in this session of Congress. I have to say that the Republican leadership since the beginning of the year has made many promises with regard to the Patients' Bill of Rights and the whole issue of HMO reform. First, the Speaker said that we would follow the normal committee process and an HMO reform bill would have hearings in the relevant committees and have a markup in committee and come to the floor in the normal way, but that has not happened. Then, as Members know, in the other body basically the Democrats forced the issue, forced the other body to bring up HMO reform. Unfortunately, the bill that was finally passed was not real reform, was ineffective, was a sham, but the impetus, if you will, that at least some sort of HMO reform would be brought up in the Senate caused the Speaker and the Republican leadership just a few weeks ago after the Senate took action and had a hearing and had a markup on the floor, basically forced the Speaker to say that a bill would come to the floor, an HMO reform bill would come to the floor in the House of Representatives sometime before the August recess. Well, Mr. Speaker, the August recess begins probably this Friday and Democrats have basically been pushing to achieve action here on the floor for the Patients' Bill of Rights, our Democratic HMO reform. We actually had Members come to the floor over here in the well and sign a discharge petition that would force the Republican leadership to bring up our Patients' Bill of Rights. One hundred eighty-three Members signed that discharge petition. But now ultimately to no avail. The Speaker, the Republican Speaker, just announced that no action will be taken on the bill before the August recess. I ask why? The answer, I think, is very simple. That is, because the Republican leadership here in the House as well as in the Senate is a captive of the insurance industry. The insurance industry does not want a true HMO reform, a true comprehensive bill to come to the floor of the House because, unlike the other body, they realize that if it does, it will pass. Some of my colleagues, a handful of my colleagues on the other side who are health care professionals, doctors, dentists, have made the point that they will vote for a strong HMO reform bill, something akin to the Democrats' Patients' Bill of Rights. When they made that statement and basically indicated to the Republican leadership that they would join with the Democrats in passing a bill, well, all of a sudden this week we find that the Speaker and the Republican leadership say, ``No, no, we're not going to bring a bill to the floor. We can wait until the fall. We'll have further discussions. No action will be taken now.'' I just want to commend the Republicans on the other side of the aisle, those few, all of whom, I think, who have been most outspoken are health care professionals, doctors, because they have stood up and said that we need a strong HMO reform bill and they refuse to say that the action taken by the other body meets that need. In fact, it does not meet that need. Mr. Speaker, if I could, I hope that during the August break and when we come back in September that we will see a bipartisan coalition of the Democrats, all of whom support the Patients' Bill of Rights, and enough Republicans on the other side that will come together in a bipartisan way to demand action on something like the Patients' Bill of Rights so we can have true comprehensive HMO reform come to the floor when we return in September. Mr. Speaker, if the House leadership is not willing to bring it up, I think we will simply have to get every Democrat to sign the discharge petition and join with some of the Republicans who are willing to sign it to force the issue to make sure that the Patients' Bill of Rights or some strong comprehensive reform like it comes to the floor. As my colleagues know, Mr. Speaker, I just wanted to point out that increasingly we are seeing every comprehensive report, every study that is being done around the country about what the American people want, what the health professionals want, what people see basically as common sense reform with regard to HMOs, that we need some kind of action taken. There were two reports that came out just in the last week that I wanted to mention tonight. One of them was basically a report, if you will, where various doctors and health care professionals were interviewed. It was a survey that found nearly nine in 10 doctors and more than one in four consumers are having trouble receiving the medical care and services they need within the context of HMOs managed care, and as a result between one-third and two-thirds of the doctors said the service denial resulted in adverse health consequences for the patient. The types of problems that we are seeing that myself and others have documented on the floor about people who have had abusive situations with managed care and with HMOs, this is becoming commonplace, and both consumers, patients as well as doctors, are decrying the situation, and I say to my colleagues and, I guess, to the American people as well, why is it that the Republican leadership will not allow us to take action when the majority of us in a bipartisan way would like to see comprehensive HMO reform? And it always comes back to the same thing, and that is the money spent by the insurance industry against this type of comprehensive HMO reform. The second survey that came out in the last week or so basically said that last year 1.4 to $2 billion was paid to lobbyists to influence politicians and policy, a 13 percent increase from 1997; and for the second year in a row the insurance industry topped the list in lobbying costs, nearly $203 million last year alone. The Republicans basically on the leadership or amongst the Republican leadership are bowing to the insurance industry which is spending millions of dollars once again trying to defeat true HMO reform. Mr. Speaker, I just wanted to, if I could, make reference to a New York Times editorial that was in the New York Times on July 16 of this year, and it just kind of sums up what is happening out there and why we cannot see action on the House floor, and I quote. It says: ``There is no mystery here. Campaign money is dictating medical policy in the Senate. The political system and especially the Republican party is awash in money from the health care industry. As President Clinton said yesterday, and this was back on July 16, GOP senators could not support the Patients' Bill of Rights because the health insurers will not let them do so. That is the bottom line, Mr. Speaker.'' Mr. Speaker, if I could just use a couple minutes of my time to talk about some of the comparisons between the Patients' Bill of Rights, the bill that the Democrats and some of the Republicans want to bring to the floor, versus the bill that passed the Senate and the one that would have been considered, I believe, on the floor pursuant to the Republican leadership if they thought that they could get the votes to pass it. There is a real contrast, if you will, between that Republican Senate bill and the Democratic Patients' Bill of Rights, and let me just go through a few highlights of it, if I could this evening. The Republican bill, and I refer to the Senate bill, leaves more than 100 million Americans uncovered because most substantive protections in the bill apply only to individuals enrolled in private, employer-based, self-funded insurance plans, and self-funded coverage is typically offered only by large companies. Only 48 million people are enrolled in such plans, and of those 48 million only a small number, at most 10 percent, are in HMOs. So the Senate Republican bill really does not help effectively anyone, does not provide patient protections really to almost anyone. What the Democrats insist on in the Patients' Bill of Rights and the Republicans that support us have said is that all, all 161 million privately insured Americans have to be covered by the bill, by the patient protections. Let me just give my colleagues some of the other examples that I think are important. In the Democratic bill we have talked about the prudent lay-person standard in the situation where you go to an emergency room. This is so important. So many people come up to me and say, if I have under my HMO, if I want to go to the local emergency room, I cannot. I have to go to one maybe 20 miles away, 30 miles away, 50 miles away, and when a person is in extremis or has a problem and has to go to an emergency room, they do not want to have to travel 20 or 30 miles away when the emergency room for the local hospital is maybe only within a mile distance from where they are. Well, under the Democratic bill, what we say is that an individual who has symptoms that meet a prudent lay person, what the average person would think is the need to go to the emergency room under given certain circumstances, that that standard should allow them to go to the local emergency room, the closest one, without pre-authorization, and the insurance plan must cover the visit. The plan may not impose additional charges for use of non-network facilities. It is unclear in the Republican Senate bill whether that kind of standard would apply. There really is not any prudent lay person standard, if you will, in the Republican bill. Most important in the Democratic bill is that we provide for adequate specialty care. It provides the right in our Patients' Bill of Rights to specialty care if specialty care is medically indicated. It ensures no extra charge for use of non-network specialists if the HMO has no specialist in the network that is appropriate to treat the condition. I just wanted to mention a couple other things that I think that are really crucial in terms of the differences between the Democratic bill and what the Republicans passed in the Senate, and one of those most important distinctions is on the issue of medical necessity. The issue of medical necessity is basically whether or not a particular type of care, operation, equipment, length of stay in the hospital will be provided in a given circumstance if you get sick, and basically the Republican Senate bill allows HMOs to define what is medically necessary. No matter how narrow or unfair to patients, the HMO's definition is their definition controls in any coverage situation including decisions by an independent third-party reviewer. The Democratic bill by contrast codifies a traditional definition of medically necessary or appropriate means of service or benefit consistent with generally accepted principles of professional medical practice. In other words, what we are saying in the Patients' Bill of Rights is that the doctor and the patient have to decide based on standards that are used for most physicians in a given circumstance. It is an independent standard, if you will, not defined by the HMO. Most important also, the distinction on the issue of external appeals. The Republican Senate bill allows the HMO to choose and pay the appeal entity that decides the case. It also allows the HMO or insured to define medical necessity, tying the hands of the independent review entity and forcing them to defer to the HMO's definition. It does not provide, the Republican bill, an appeal when most rights under the bill are denied. For example, when emergency care is denied or access to a specialist is denied, no appeal is allowed. The Democratic Patients' Bill of Rights by contrast ensures the State or Federal agency controls the process for choosing the independent appeal entity, not the insurer. It ensures a de novo review, a fresh look at the facts. It ensures the reviewer's decision is based on a statutory definition of medical necessity, not the insurer's plan's definition, and the review of best available medical evidence, and all denials of care are appealable. Finally, the most important distinction between the Democratic Patients' Bill of Rights and the Republican Senate bill is the ability to hold HMOs accountable. Under the Republican bill, it maintains existing Federal law that basically preempts state remedies, and the only remedy under ERISA, which is the federally covered plans, is recovery of the cost of the denied benefit. For example, if a patient is denied a mammogram and dies of breast cancer as a result, the only remedy under the Republican bill available to the family is the recovery of the costs of the mammogram, not the damages that result, including the death of the patient. Under the Democratic bill, by contrast, the ERISA presumption of State remedies, the ability to go to State court, only exists when the actions of an HMO have killed--well, essentially what we are saying is that that ERISA preemption is repealed, and you can go to State court and you can seek damages and you can recover for the damage that the HMO has inflicted, just like you would in any normal tort action. Mr. Speaker, I think that there are crucial differences here, and I think that ultimately what it comes down to is money. It is a very sad day, but what we are seeing is the insurers increasingly spending a lot of money on TV trying to get the word out that somehow what we are trying to do with the Patients' Bill of Rights is not going to work, that it is going to cost more money, that it is not going to achieve the desired result. The fact of the matter is that the American people are crying out for comprehensive HMO reform. They want to see something like the Patients' Bill of Rights passed. Again, I want to commend some of my Republican colleagues, particularly the physicians on the other side of the aisle who are saying, you know, we are practicing doctors. We see what happens. We know there are abuses, and we want strong HMO reform passed, something like the Democratic bill, and we will work together with the Democrats to achieve a bipartisan proposal. If I could just conclude tonight, I always like to talk when I come to the floor about local people in my part of New Jersey who have had problems with HMOs, because that is really what it is all about. We are talking a little bit in the abstract here about what needs to be done, but the bottom line is it is our own constituents coming to us and saying we need HMO reform, we need something done because of what is happening to them. If I could just conclude tonight with a letter that was in the Asbury Park press, which is the largest circulation daily in my district in Monmouth County, New Jersey, and this was in the Asbury Park Press, a letter to the editor on Thursday, July 15, from Jack Moriarty of Dover Township. I am going to read part of it because I think it is so telling. He says, Each time I must deal with my health maintenance organization on any matter other than the routine and the basic, problems continue. This is a system designed and managed to restrict our access to medical care and to place roadblock after roadblock in our way as we attempt to circumvent that design feature. On July 6th I sustained an eye injury while swimming when a thumb with sharpened fingernail found its way into my eye. I stopped the bleeding, applied ice and went to bed. This morning there was blood on the pillowcase, the pain had intensified, and my vision was blurred. I reasoned this required an objective medical evaluation to ensure there was no permanent damage. Thus began my hassle for the day. What followed was more than a dozen telephone calls to various medical professionals and administrators to get permission to go to the doctor and secure the required referral for them to be paid. I knew what had to be done, but what is the justification for wasting my time and causing me anxiety and aggravation? As a professional, if I am not working, I am not being paid. Consequently, the very real financial loss I endure by sitting in a waiting room makes me choose the medical visit option only as a last resort. That day I wasted additional time and resources playing phone tag all around the State trying to get some paperwork- pushing clerk to give me permission to do what I knew to be right. And, by the way, we pay for this, which is what truly amazes me. What should we do? I suggest we all write to our State and Federal elected officials demanding that they return the right of self-determination in health matters to us by passing the Patients' Bill of Rights and similar state statutes. It is no wonder the doctors are unionizing. Perhaps the patients should too. He was talking about an eye injury, but we just know that with the case of eye injury or so many other serious problems that people face the same reality. All I am really saying tonight, Mr. Speaker, because this may be the last opportunity we get to talk about this before the August break, is let us bring up the Patients' Bill of Rights. Let us bring up HMO reform. Let those Democrats and those Republicans, and I see my colleague is going to come after me, the gentleman from Iowa (Mr. Ganske), let us put together a bill I think that is very close to the Patients' Bill of Rights that really provides comprehensive HMO reform. This is what the public wants, this is what we keep hearing every day from our constituents, and I know that I am going to use the time during this August break to go out and explain to the public why we need to bring this up on the floor of the House when we come back in September. I am confident when I see people like my colleague, the gentleman from Iowa (Mr. Ganske) and others on the Republican side that are demanding that we take action, that when we come back in September, either through the means of a discharge petition or because the Republican leadership finally sees they have to do something, that we will see comprehensive HMO reform. But I am not going to rest, and I know the gentleman from Iowa (Mr. Ganske) and a lot of us are not going to rest until that happens.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I just find it so sad to listen to my colleagues in support of this Burton amendment spread inaccurate information about India which has tried so hard to deal effectively with human rights problems within the country. The true human rights problem in Kashmir is that of a violent separatist movement supported by outsiders, supported by Pakistan, carried out by the followers of bin Laden and other extremist terrorist leaders destroying the homes and lives of thousands of peace-loving Hindus and Muslims. In Kashmir, and Kashmir is part of India, the Indian security forces are trying to maintain order and protect all the citizens of Kashmir, Muslims and Hindu alike, just like we would do in any State of the United States. I heard mention of Punjab. In Punjab, there is a Sikh government elected by the Sikhs themselves which has been in place for over 2\1/2\ years. Mr. Chairman, I heard mention of Dalits. The President of India is a Dalit, an untouchable. The President of India. The Indian Constitution specifically provides that the caste system is outlawed and not recognized in that state. We have a national human rights commission in India that has been lauded by the State Department and other international agencies for going after human rights violations, bringing people to justice, jailing people who committed those kinds of violations. The gentleman from Indiana (Mr. Burton) talked about a loan to Iraq. The loan to Iraq, from what we understand, we have talked to the embassy, is nothing more than basically for humanitarian purposes. It is just totally inaccurate information that we are getting on the other side.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Florida, Mr. Bilirakis, and my colleague from New York, Mrs. Maloney for organizing this Special Order. This year the anniversary of the illegal Turkish invasion of Cyprus is, tragically, of particular significance. It is being called the ``Black Anniversary'' because 25 years--a quarter of a century--have now passed since the Turks invaded Cyprus on July 20, 1974. So while it is important to remember this date every year, this year's remembrance has added meaning. The Turkish invasion and occupation of Cyprus is tragic for so many reasons. Innocent lives were lost. Families and friends were torn apart, and have been kept apart by an occupation force of 35,000. The human suffering that has been caused by the Turkish invasion can never be reversed, and we must always remember on this day that a great many Cypriots lost their lives for no good reason. None of us here tonight can say anything that can reverse the brutality that took place. We can only honor the memory of those whose lives were prematurely cut short by Turkish aggression. In addition to the human suffering, the Cyprus problem is tragic because the history of attempts to resolve the situation is one of missed opportunities for peace. Since the invasion, hundreds of attempts to solve this problem have been made, yet to date, the island is divided and remains one of the most militarized places on the face of the earth. Recent statements from the Turkish side, moreover, indicate their obstinance is only getting worse. Following the leading role it played in bringing NATO's war with Serbia to an end, the Group of 8 major industrialized nations, the G8, agreed to press for a new round of United Nations negotiations on the Cyprus issue. The Secretary General of the U.N., Kofi Annan, endorsed the G8's plan and subsequently announced he was prepared to invite the Greek and Turkish Cypriots to hold comprehensive peace negotiations. The Turkish Cypriot President Rauf Denktash quickly dismissed the U.N.'s proposal for a new round of peace talks as ``nonsense''. The justification the Turkish leader provided for rejecting a new round of peace negotiations is absolute garbage. Denktash said he would not attend any negotiations at which the democratically elected president of Cyprus, Glafcos Clerides, represented the Cypriot government. According to Denktash and his patrons in Ankara, the Cypriot government does not have any official jurisdiction or authority over the portion of the island that has been illegally occupied by Turkish troops for almost 25 years. Adding to this absurdity, Denktash and Turkey claimed talks based on the bizonal, bi-communal framework that had been earlier accepted by the Turkish side and endorsed repeatedly by the international community were useless because they have to date failed to acknowledge the existence of two separate governments on the island. In other words, the Turkish side is now claiming talks are useless unless Cyprus and the entire international community accept terms that have for years been rejected as absurd. Glafcos Clerides is recognized internationally as the President of Cyprus. Turkey is alone in its recognition of the so-called Turkish Republic of Northern Cyprus. No other country in the world recognizes the portion of Cyprus that the Turks have illegally occupied as an independent state. The Turkish suggestion that future peace negotiations must be between leaders of independent nations was made by Denktash for the sole purpose of killing the proposed round of negotiations before it has a chance to succeed. The international community has reaffirmed its position on the Cyprus issue twice in the last seven months. In December of last year, the U.N. Security Council passed a number of resolutions on the Cyprus situation, including Resolution 1217, which reiterates all previous resolutions on the Cyprus problem. Those resolutions state that any solution to the Cyprus problem must be based on a State of Cyprus with a single sovereignty and international personality and a single citizenship, in a bi-communal and bi-zonal federation, with its independence and territorial integrity safeguarded. That position was again reaffirmed in United Nations Security Council Resolution 1250, which was passed just about a month ago on June 29. So on the one hand, we have the international community taking steps to reaffirm its commitment to a peaceful and just settlement to the Cyprus problem, and on the other, the Turks are only hardening their position and thumbing their nose at whatever the international community suggests. And as I said this is truly tragic; this most recent refusal promises to be another chapter in a historical record that clearly documents a systematic campaign by the Turkish side to undermine proposals for peace no matter where they come from. Last year, for example, the Cypriot government again offered to demilitarize the island after it decided to cancel the deployment of a defensive air-to-surface missile system. The Turks rejected the offer. In a separate gesture, the Cypriot government invited the Turkish- Cypriot community to participate in the Cyprus-EU negotiating team. That offer was also rejected. When the United States made an attempt last year to restart talks, the Turkish side undermined them before they had a chance to begin. In that instance, they insisted on two irrational preconditions to negotiations, prompting Ambassador Richard Holbrooke, who was leading the United States effort, to publicly rebuke the Turkish side for not being seriously interested in resolving the problem. And just last month, as I mentioned earlier, the Turkish side dismissed the U.N. invitation to start a new round of comprehensive talks later this year as nonsense. For 25 years now, the Cypriot people have had to endure this unconscionable behavior from the Turkish side. It is long, long past time to bring this nightmare to an end. In my view, the United States needs to stop looking the other way and do more to bring the Turkish side to the negotiating table. Twenty-five years of Turkish intransigence is more than enough evidence to prove that the strategies we have employed to bring Turkey to the table have been, and still are, totally ineffective. The United States is the most powerful nation in the world. The full weight of that power should be employed to move the peace process forward. I have said many times before on this floor that we can achieve that goal by focusing American efforts to move the peace process forward on the Turkish military, which has real and substantial influence on decisionmaking in the Turkish government. The United States government must convey to Ankara in forceful and unequivocal terms that there will be direct consequences in United States-Turkish relations if Ankara does not prevail upon the Turks to come to the negotiating table in good faith. I urge all of my colleagues to join me in communicating this message to the Turks, and to the key decision-makers in the United States Government, on this historic day. On the Black Anniversary of the Turkish invasion of Cyprus, the Cypriot people deserve to know that the United States has the utmost respect for their suffering and struggle, and will do whatever it takes to help them secure their freedom and independence.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to thank the gentleman for yielding me this time. I also want to reiterate my opposition to the rule for the reasons that were articulated both by the gentleman from Ohio (Mr. Hall) and by the gentlewoman from California (Ms. Pelosi). I do want to point to some underlying provisions in the legislation that I support. I want to cite several key areas where the legislation has continued U.S. support for Armenia's economic development, while helping to jump- start the peace process in Nagorno Karabagh. In this time of fiscal restraint, I am encouraged that the fiscal year 2000 legislation at least ensures that the same percentage of aid will be made available to the Republic of Armenia as was available in fiscal year 1999. It is important for us to maintain our support for and partnership with Armenia as this country continues to make major strides towards democracy, most recently evidenced by the May 30 parliamentary elections, as well as market reforms and increasing integration with the West. U.S. assistance also serves to offset the difficulties imposed on Armenia's people as a result of blockades maintained by Azerbaijan and Turkey, as well as helping regions of the country to rebuild from the devastating 1988 earthquake. The legislation also seeks to ensure the delivery of humanitarian assistance to Nagorno Karabagh. In the fiscal year 1998 bill, Congress took the historic step of providing, for the first time, U.S. humanitarian assistance to Nagorno Karabagh. Unfortunately, the administration has not delivered much of this assistance and the legislation today includes language reiterating the obligation of $20 million in U.S. aid to Nagorno Karabagh. Mr. Speaker, the Foreign Operations Appropriations bill contains language addressing the need for a negotiated settlement to the Nagorno Karabagh conflict. Noting that the important position of special negotiator for Nagorno Karabagh is currently vacant, the committee urged the Secretary of State ``to move forthwith to appoint a permanent special negotiator to facilitate direct negotiations and any other contacts that will bring peace to the long suffering people of the south Caucasus.'' I would point out, Mr. Speaker, that one of the most positive developments of late has been the increased and direct contacts between the leaders of Armenia and Azerbaijan. The President of the two countries recently met previously in Geneva, and the surprise announcement that came out of the meeting was a tentative agreement to have Nagorno Karabagh to participate directly in the next session of face-to-face talks. So at this critical juncture we must get a permanent special negotiator in place without delay, and I applaud the members of this subcommittee for including this provision in the bill. Finally, Mr. Speaker, I want to address one or more amendments that may be offered under this rule by the gentleman from Indiana (Mr. Burton) seeking, in various ways, to limit development assistance to India. I would urge my colleagues to oppose these ill-advised amendments if they come up. Following the imposition of Glenn amendment sanctions against India last year, the USAID program has been restructured in conformance with the law to provide only humanitarian assistance to India. If this amendment were adopted, programs to limit the spread of HIV/AIDS would have to be cut as well as basic health services to mothers and children. Thus, without achieving any positive policy goals, the amendment would only serve to punish some of India's most vulnerable people who are currently benefiting from American humanitarian assistance. Mr. Speaker, this House has consistently rejected similar Burton amendments over the past few years. Indeed, 2 years ago a similar amendment only gained the support of 82 Members of the House, while 342 voted against it; and last year, no amendment was offered. Both Houses of Congress have been moving on a bipartisan basis to lift the Glenn amendment sanctions on India and Pakistan, and an amendment like the one proposed by the gentleman from Indiana would be way out of step with the progress being made towards greater cooperation and confidence-building between the United States and India.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, the foreign operations appropriations bill, which this House is expected to begin debating later this week, contains an important provision that is extremely timely and deserves our support. Language in the foreign ops legislation addresses the need for a negotiated settlement to the Nagorno Karabagh conflict; noting that the important position of special negotiator for Nagorno Karabagh and NIS, the Newly Independent States of the former Soviet Union, regional conflicts is currently vacant. The Committee on Appropriations urged the Secretary of State to move forthwith to appoint a permanent special negotiator to facilitate direct negotiations and any other contacts that will bring peace to the long suffering people of the South Caucasus. Madam Speaker, Nagorno Karabagh is an historically Armenian populated region that declared its independence as the Soviet Union was breaking up. The neighboring Republic of Azerbaijan, which claims Nagorno Karabagh as part of its own territory, went to war to prevent Karabagh, known to the Armenian people as Artsakh, from achieving its independence. The people of Karabagh prevailed in battle and Azerbaijan agreed to a cease-fire in 1994 but, Madam Speaker, a permanent negotiated settlement acceptable to all sides has been elusive. The U.S. has played a leading role in the effort to resolve this conflict, as a co-chair of the Minsk Group, under the auspices of the Organization for Security and Cooperation in Europe. The U.S. has had three of our diplomats serve in the post of special negotiator to try to resolve this conflict. Madam Speaker, the position of special negotiator recently became vacant with the departure of Donald Keyser, a career diplomat who moved on to another post in the State Department. Mr. Keyser, our third special negotiator, played a major role in shaping a new plan to settle the conflict, known as the Common State proposal. Despite their substantial reservations, both Armenia and Nagorno Karabagh agreed to the Common State proposal as a basis for negotiations. Unfortunately, Azerbaijan flatly rejected this proposal. Mr. Keyser worked very hard to move this process forward, so his departure leaves a major void. At this critical juncture, we must get another permanent special negotiator in place without delay, preferably either a very senior diplomat or perhaps another American recognized for leadership in public policy and public life, someone who can command the respect necessary to win the confidence of all parties to the conflict. To echo and amplify the language in the foreign ops bill, I will be circulating amongst our colleagues here a letter to President Clinton and Secretary Albright urging that they move to appoint a special negotiator immediately. Madam Speaker, two weeks ago Armenia's ambassador to the United States, Ambassador Rouben Shugarian, came to Capitol Hill to brief Members of Congress and our staff about the Nagorno Karabagh peace process, and one of the most positive developments of late has been the increase in direct contacts between the presidents of Armenia and Azerbaijan. The presidents of the two countries recently met privately in Geneva. The surprise announcement that came out of the meeting was a tentative agreement to have Nagorno Karabagh participate directly in the next session of face-to-face talks. While it may be too soon to talk of a breakthrough, Armenian President Kocharian stated that he believes Azerbaijan's President Heydar Aliyev is serious about achieving a solution to the Karabagh conflict. Ambassador Shugarian spoke at our recent meeting with cautious optimism about other avenues for direct talks, and it is important for this process to continue and indeed to be accelerated as much as possible. That is why today I want to stress that the presence of a permanent U.S. special negotiator to facilitate direct negotiations and other contacts is extremely important at this time. I urge the administration to act quickly to appoint a new and permanent special negotiator.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, although the world welcomes the apparent withdrawal this month of Pakistani forces from India's side of the line of control in Kashmir, we are continually reminded of the dangerous situation that still exists in that mountainous region. Last Wednesday's New York Times reported that 20 Hindus were killed in 3 incidents before dawn last Tuesday in what the newspaper suggested could be a stepped-up campaign of hit-and-run tactics by Muslim insurgents in remote areas of the Indian state of Jammu and Kashmir. I am sad to have to report that these kinds of attacks are nothing new, Mr. Speaker. The worst of these attacks in the village of Lihota left 15 dead. Last week's violence was the fourth mass killing in Kashmir in just 3 weeks. Mr. Speaker, this spring, when Islamic militants had been infiltrating India's territory with the support of, and active collaboration with, Pakistan, the world took notice. The fact that India and Pakistan are both nuclear powers stirred up fears of a wider war. When it became apparent even to Pakistan's ruler that their gambit in Kashmir was both a military and a propaganda disaster, the Pakistani Government reverted to its traditional ploy by trying to internationalize the conflict by bringing in the United States as a mediator, an effort that our administration has wisely resisted. However, Mr. Speaker, the prospect of an India-Pakistan war obscures the ongoing violence that has destroyed the life of this entire region. While people of all faiths have suffered, the Hindu community of Kashmir has been particularly severe. The Pandits have suffered as individuals, singled out for violence, and as a community, forced to leave their ancestral homes and way of life, turned into refugees in their own country. Mr. Speaker, in light of the ongoing unique suffering of the Kashmiri Pandits, I am urging the Indian government to recognize the Kashmir Pandit community as a minority under Indian law to provide additional benefits and protection. While Hindus are the majority religion in India as whole, they are a minority, and indeed, a persecuted minority in Jammu and Kashmir. Mr. Speaker, it is my understanding that the chairman of the National Minority Commission has proposed that Hindu minorities in various Indian states be officially classified as minorities. The chairman's recommendation is pending before the government. Although such a designation would usually require an amendment to be passed by the parliament, the Lok Sabha, the lower House of the Indian Parliament, there may be occasions where the commission can unilaterally act. While the details of such an action are obviously an internal matter for India's government, I soon will be circulating a letter to India's Prime Minister Vajpayee, which I hope my colleagues in Congress will join me in signing, urging that the appropriate steps be taken to provide the Pandits with the minority designation. Mr. Speaker, the militants, with Pakistan's backing, have transformed a peaceful, secular state in India, one which happens to have a predominantly Muslim population, into a killing field. The militants make no secret of their desire to drive the Pandits out of Kashmir and do not think twice about killing as many of them as possible. And under such a severe, violent threat to their very existence, I believe that the designation of minority status is an urgent priority and respectfully urge the Indian Government to make this designation. While I understand the enormity of the challenge, I urge Prime Minister Vajpayee and his government to create an environment in which the Pandit community can return to their homeland in the Kashmir Valley in the future. I also urge that the government of India raise the ongoing genocide of the Kashmiri Pandit community in bilateral talks with Pakistan. I have the highest regard for Prime Minister Vajpayee, both personally and in his capacity as the elected leader of the world's largest democracy. I know he also grieves over the victimization of the Kashmiri Pandit community, and I hope to work closely with the Indian Government with the support of the Kashmiri-American community in resolving this humanitarian crisis.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I urge my colleagues to oppose H.R. 1074 and support the Hoeffel-Kucinich amendment. H.R. 1074 would impose unduly burdensome analytical requirements and contain excessive provisions for consulting with State and local governments. The bill would waste huge sums of hard-earned consumers' income. The financial burden that would result would take scarce funds away from critical environmental protection and public health programs. H.R. 1074 fails to include the costs and benefits of corporate welfare. One cannot determine the complete costs and benefits of regulations without also taking into account taxpayer-funded subsidies to the regulated corporations. The administration opposes H.R. 1074, as do over 300 public interest organizations ranging from the AFL-CIO to the National Environmental Trust, United Auto Workers, U.S. Pirg, and the New Jersey environmental lobby in my home State. I can't remember the last time such a large and diverse range of interests united on an issue--imagine--the auto industry representatives and the environmentalists standing side by side! The League of Conservation also is likely to score the vote on final passage as well as on the Hoeffel-Kucinich amendment. I urge my colleagues to join me in supporting Hoeffel-Kucinich and opposing final passage.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, this is nothing more than a slap in the face to India. The bottom line is, when did anyone decide that the votes in the general assembly, which many people in this body consider almost irrelevant, are a basis for deciding whether or not a country is a friend or a foe of the United States? I do not need to mention this again, but the gentleman's amendment refers to recorded votes. If we count all votes in the general assembly, India votes with the U.S. 84 percent of the time. If we count important votes by the State Department, India is with us 75 percent of the time. This is just a way to configure largely irrelevant votes in the general assembly to try to say that India is bad. Well, my friends, India and the United States have a lot in common. We have a lot of business interests and trade interests in India; and India, in fact, in the last few weeks if we look at what has happened in Kashmir, India was attacked, Pakistan was the aggressor, and the United States and the President clearly pointed out that Pakistan should withdraw and that India showed restraint and cooperated with the United States in that conflict. This is not the time to send a vote that refers to these irrelevant votes in the general assembly. Oppose the Goodling amendment. Mr. Chairman, I believe this amendment is unnecessary and potentially destructive to U.S. interests internationally. According to the amendment, the sole method for determining how pro- or anti-U.S. a country is would be how the country votes in the United Nations General Assembly. This is a largely irrelevant way of determining who our friends and foes are. Under the Goodling Amendment, all of our other diplomatic, political, strategic or economic interests would be sacrificed to the mostly symbolic indicator of General Assembly votes-- often on issues of peripheral importance. In practical terms, this amendment would serve as a symbolic slap at India, the world's largest democracy, a country that is moving forward with historic free-market reforms that offer tremendous opportunities for American trade and investment. At a time when Congress is working on a bipartisan basis to lift the unilateral sanctions imposed on India last year, enactment of this provision would set back much of the progress we have been making. It would be seen as a purely punitive action, creating an atmosphere of distrust that would make it much more difficult for us to achieve vitally important goals. Mr. Chairman, the vast majority of Resolutions adopted by the General Assembly are adopted by consensus. When you count those votes, India votes with the U.S. 84 percent of the time. If you look at the votes identified as ``important'' by our State Department, including the consensus votes, India is with us 75 percent of the time. India also cooperates with the U.S. in a wide range of other U.N. activities, ranging from health issues to cultural and scientific matters. India has sent significant troop contingents to various peace- keeping missions around the world, serving as a partner to further our mutual interests. But the U.N. is only a small part of the story of how the United States and India work in partnership and friendship in ways that help the people of both of our countries. Passage of this amendment would create a poisonous atmosphere that would set back these other efforts. Most of the other countries that would be affected by this amendment are already barred from receiving U.S. assistance under various sanctions, many of which have been on the books for decades. Thus, realistically, we're talking about cutting $130,000 in IMET funding to one country, India, a democracy that shares many of our values and interests and works with us in countless positive ways. Mr. Chairman, India and the United States have a great stake in working for improved relations. We should focus on the significant issues that unite us, and not the minor disagreements. I urge my colleagues to defeat the Goodling Amendment.

Mr. PALLONE. Madam Chairman, I also would like to support the Gilman- Markey amendment. I know that both sides on this issue are trying to prevent nuclear proliferation by North Korea. But whatever efforts are taking place I do not believe are working. We have all been concerned in the last few weeks about the conflict in Kashmir, because India and Pakistan both have nuclear weapons. India developed its nuclear weapons indigenously, but not so with Pakistan that continues to get help from North Korea, China, and other countries exporting nuclear weapons and equipment. On June 25 of this year, a North Korean vessel, the M.V. Kuwolsan, docked at Kandia port, which is an India port in the state of Gujarat. During the examination of the cargo on board, it was found to contain 148 boxes, declared as machines and water-refining equipment. Subsequent examination of these boxes established that equipment was, in fact, for production of tactical surface-to-surface missiles with a range in excess of 300 kilometers. It included special materials and equipment, components for guidance systems, blue prints, drawings, and instruction manuals for production of such missiles. Subsequently, in what seems to establish North Korea's active role in Pakistan's missile program, Kuwolsan, the owner of the Korean ship that was impounded, admitted that the Malta-bound missile parts- manufacturing machinery were to be delivered at the Karachi port in Pakistan. So we know that North Korea's continued support for the Pakistani nuclear program missile and missile development program continues at this time. Whatever efforts we are making are not working. North Korea continues to be a rogue state. There is no reason why the U.S. Government should allow their nuclear proliferation to continue. I urge support for the Gilman-Markey amendment. I yield back the balance.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I rise in strong support of the Andrews amendment, part of the en bloc, and thank my colleague from New Jersey for offering it. In February of this year, I introduced a bill, H. Con. Res. 36, that is very similar to my colleague's amendment. Like the amendment, it expresses the Sense of the Congress that the islets of Imia in the Aegean Sea are sovereign Greek territory under international law. As those who are familiar with this issue know, for some three and a half years now Turkey has stood firm in its totally groundless claim that it has sovereignty over the Greek islets of Imia. On December 25, 1995 a Turkish bulk carrier ran ashore on the islets of Imia, one of two uninhabited islets which are part of the Dodecanese islands group in the Aegean Sea. This incident nearly escalated into armed conflict between NATO allies Turkey and Greece due to Turkey's belligerent claim that the islets, which are sovereign Greek territory, belonged to Turkey. Hostilities were avoided after the Greek government refused to attack a detachment of Turkish commandos who had been dispatched to the islets and President Clinton personally intervened to help defuse the crisis. Despite Turkey's continued insistence that the islets are Turkish territories, the historical record on this issue is clear. As this amendment, as well as my bill details, the Dodecanese islands group was ceded by Turkey to Italy in the Lausanne Treaty of 1923. The boundaries delineating the exact sovereignty between Turkey and the islands group were finalized in a December 1932 protocol between Turkey and Italy. That protocol, which was annexed to the Convention Between Italy and Turkey for the Delimitation of Anatolia and the Island of Castellorizio, placed the islets of Imia under the sovereignty of Italy. In the 1947 Paris Treaty of Peace with Italy, Italy ceded the Dodecanese islands groups to Greece. The legal status of the Dodecanese islands group remained unchallenged by Turkey until its bulk carrier ran aground in late 1995 and Ankara began making its unfounded claims in 1996. That same year, the European Parliament approved a resolution reaffirming the historical record. The 1996 resolution stated that the water boundaries established in the Treaty of Lausanne of 1923 and the 1932 protocol to the convention between Italy and Turkey, are the borders between Greece and Turkey. Despite all of these readily available and irrefutable facts, Turkey continues to promote instability in the region by ignoring the historical record with its claim of sovereignty over the islets of Imia. Mr. Chairman, Turkey's unfounded claim should not go unnoticed by Congress. The United States Congress should follow the precedent of the European Parliament and reaffirm the historical record in a show of support for territory that is unquestionably sovereign to Greece and for the rule of international law in general. The United States should also pressure Turkey to resolve this issue, and all other outstanding territorial disputes with Greece--the most notable of which is the nearly 25 year old invasion of Cyprus--in a peaceful fashion. To that end, in addition to reaffirming Greece's sovereignty over the islets of Imia, both my bill and the Andrews amendment include language urging Turkey to agree to bring the dispute in the Aegean over Imia to the International Court of Justice at the Hague for a resolution. I encourage all Members to join myself and Mr. Andrews in formally putting the United States on record in support of Greek sovereignty and in opposition to Turkey's seemingly endless campaign to subvert international law and destabilize the entire Mediterranean region. I urge support of the en bloc amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is my great pleasure to rise today to honor a man who has spent the last 43 years of his life representing the interests of working men and women in Central New Jersey. Robert A. Munyan, today, retires as President and Business Manager of International Brotherhood of Electrical Workers Local Union 1289. For the last several decades, Robert Munyan has spent a majority of his time improving the quality of life for thousands of workers in the State of New Jersey. Throughout his career in organized labor, Mr. Munyan has held numerous positions for Local 1289, culminating with his election as President and Business Manager in 1980. Mr. Munyan has played an essential role in IBEW contract negotiations, helping shape the New Jersey Master Energy Plan, and protecting workers' rights in the New Jersey State Energy Deregulation Bill. He continues to be a constant supporter of organized labor and works to ensure that all workers have a voice. With Robert Munyan's retirement, IBEW Local 1289 is losing a worker, a family man, and a leader. I want to offer Mr. Munyan my congratulations and thanks for his outstanding career of service. It is with men like Robert Munyan that our nation's labor movement is such a huge success. He will be sorely missed.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I wanted to spend just a short amount of time this evening talking about the optimism that many of us are seeing as a result of the meeting that took place in Geneva last week between President Kocharian of Armenia and President Aliyez of Azerbaijan. I am sure that many people know, particularly those of us who have been involved with the Armenia Caucus for many years, that we are very hopeful that, as a result of this meeting and some other activities that have taken place over the last few months, that we could see a resolution of the conflict in Nagorno Karabagh, which has been basically a bone of contention, if you will, between the two countries for some time. I think many people know that Nagorno Karabagh is an independent republic that is Armenian speaking, ethnically Armenian, that fought a war, if you will, about 10 years ago that at the time when the Soviet Union broke up, and even though it has been independent and has been a state for all practical purposes, for about 10 years it is not recognized by the United States and there is a continued conflict, albeit mostly peaceful conflict, between Armenia and Azerbaijan over the future of Nagorno Karabagh. It would certainly behoove anyone who is concerned about peace in the Caucasus region to see if these two countries could come to an agreement over the future of Nagorno Karabagh that, of course, involves the people of Nagorno Karabagh, as well. The Presidents of Armenia and Azerbaijan met last week in Geneva for talks that seek a political settlement of the Nagorno Karabagh conflict. President Robert Kocharian of Armenia went to Geneva directly from Warsaw, where he had been for other business, and while there he told the news conference that he was optimistic about the meeting with President Aliyev. He said that there had been serious progress since active talks have begun with President Aliyev, most recently in April during the NATO summit conference when both leaders were here in Washington. I must say also and give praise to U.S. Secretary of State Madeleine Albright, who had written to both presidents after those Washington talks urging further direct discussions between the two presidents. The latest proposal of the OSCE Minsk Group, and the Minsk Group has been set forth by the United States and other countries to try to come to a settlement of the Nagorno Karabagh conflict, basically last fall the Minsk Group put forth a proposal called the ``common state proposal,'' which essentially sets up a sort of confederation, if you will, between Nagorno Karabagh and Azerbaijan where the two countries would be part of a confederation or common state with equal status. We know that Azerbaijan very quickly after that announcement last fall by the Minsk Group rejected the common state proposal. But there have been strong indications recently that if it was not for the actual label ``common state'' that Baku and Azerbaijan essentially might be willing to accept the idea of what the common state proposal is all about. In other words, they may not like the term ``common state,'' but if another term like ``confederation'' or ``free association'' or something like that was used that they might be willing to go along with it. I must say, Mr. Speaker, that what I am hoping and I think the atmosphere is ripe for it is that after this meeting of the two presidents that it might be possible to engage in some kind of direct negotiations between the three parties, between Armenia, Azerbaijan, and Nagorno Karabagh, which is something that I and most members of the Armenia Caucus have been talking about for some time, that we can see the three sides, if you will, get together perhaps at some point nearby and simply start negotiations using the common state proposal or something like it and ultimately come up with a peaceful settlement. I wanted to praise our own House of Representatives and particularly the House Committee on Foreign Operations Appropriations because in the bill that they reported out of the subcommittee last week and I think will be considered by the full committee on appropriations tomorrow that bill incorporated several constructive initiatives to help jump start the Karabagh peace initiative. If I could just give some examples, in the report language for the Foreign Ops bill, it specifically says that the primary national interest of the United States in the Southern Caucasus is peace, and it recommends continued support for the people of Armenia and Azerbaijan, and says that the extent and timing of United States assistance should depend on whether or not the parties move towards a peaceful settlement. I want to commend our own Foreign Operations appropriations subcommittee for what it did and that this leads in the long run to a peaceful settlement of the conflict.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Ohio for yielding me time on the rule for the American Embassy Security Act. Mr. Speaker, I wanted to address my concerns briefly with regard to U.S.- India relations and how this legislation would affect that vitally important relationship between the world's two largest democracies. The rule makes in order a manager's amendment introduced by the gentleman from New York (Mr. Gilman), the chairman of the Committee on International Relations. This manager's amendment contains an important provision regarding the sanctions that were imposed last year on India and Pakistan following the nuclear tests conducted by the two South Asian nations. It would extend for another year the waiver authority provided for under the Omnibus Appropriations Act for fiscal year 1999, giving the President the authority to waive the unilateral U.S. sanctions that were proposed pursuant to the Glenn amendment of the Arms Export Control Act. I wanted to stress, however, I believe we should be going further than the 1-year extension provided for in this legislation. Recently, the Senate approved an amendment to the fiscal year 2000 Defense Appropriations bill that would suspend for 5 years the sanctions against India and Pakistan as opposed to continuing to waive the sanctions for only 1 year. When we discussed the legislation of the gentleman from New York (Mr. Gilman), the Security Assistance Act, in the House about a month ago, the chairman indicated his support for lifting the sanctions on a longer-term basis, and I look forward to working with him on that effort. But, Mr. Speaker, the rule also makes in order an amendment offered by the gentleman from Pennsylvania (Mr. Goodling) that would prohibit foreign military assistance to countries which fail to support the U.S. at least 25 percent of the time in the U.N. General Assembly. I hope the House will defeat this amendment. According to the Goodling amendment, the sole method for determining how pro- or anti-U.S. a country is would be how the country votes in the U.N. General Assembly. This is largely an irrelevant way of determining who our friends and foes are, in my opinion. Under the Goodling amendment, all of our other diplomatic political strategic or economic interests would be sacrificed to the mostly symbolic indicator of General Assembly votes, often on issues of peripheral importance. In practical terms, the Goodling amendment would serve as a symbolic slap at India at a time when Congress is working on a bipartisan basis to lift the unilateral sanctions imposed on India last year, as evidenced by the manager's amendment; and enactment of the Goodling amendment would set back much of the progress we are trying to make. It would be seen as purely a punitive action, creating an atmosphere of distrust that would make it much more difficult to achieve vitally important goals. Mr. Speaker, the vast majority of resolutions adopted by the General Assembly are adopted by consensus. When we count those votes, India votes with the U.S. 84 percent of the time. If we look at the votes identified as important by our State Department, including the consensus votes, India is with us 75 percent of the time. And India also cooperates with the U.S. on a wide range of other U.N. activities, ranging from health issues to cultural and scientific matters. India has sent significant troop contingents to various peacekeeping missions around the world. But the U.N. is only a small part of the story of how the U.S. and India work in partnership. Passage of the Goodling amendment would create a poisonous atmosphere that would set back these other efforts. Mr. Speaker, if I could just say, in conclusion, most of the other countries that would be affected by this amendment are already barred from receiving U.S. assistance under various sanctions; and thus, realistically, the Goodling amendment would cut $130,000 in IMET funding to one country, India, a democracy that shares many of our values. When we get to debate and votes on the bill, I hope we will approve provisions to build on the significant issues that unite America and India and not magnify our minor disagreements.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise today to pay tribute to one of the world's great religious leaders, who recently passed away. On June 29th, Armenia's Catholicos, Karekin I, died at the age of 66. The Catholicos is essentially equivalent to the ``pope'' of the Armenian Apostolic Church. Armenia's President Robert Kocharyan declared three days of official mourning, from July 6th through the 8th. Funeral services for the Catholicos were held on July 8th in the Cathedral of Echmiadzin. The principal celebrant of the four-hour funeral rite was Aram, I, Catholicos of Cilicia, the sister Catholicosate of the Armenian Apostolic Church. Thousands of Armenians were joined by religious leaders from around the world, including the Armenian Church Patriarchs of Jerusalem and Constantinople (Istanbul). Also participating in the funeral mass were the heads of a number of national Orthodox Churches, and Cardinal Edward Cassidy, who represented Pope John Paul II. Messages of condolence on the passing of Karekin I have been sent to the religious and national leaders of Armenia from around the world. President Clinton stated, ``His Holiness was widely respected for his deep scholarship, deep sense of principle and his sincere devotion to the broadcast possible ecumenical dialogue.'' President Kocharian noted that Karekin I had the fortunate distinction to be one of the few Supreme Patriarchs to serve as Catholicos of All Armenians in an independent Armenia. Last week, an Ecclesiastical Council, composed of the 49 bishops and archbishops, elected Archbishop Nerses Pozapalian as Locum Tenens to run the affairs of the Catholicosate until a new Catholicos is elected. Archbishop Pozapalian, who is 62 years old, was born in Turkey but educated in Armenia. Although the traditions of the church dictate that an election should take place after a six-month wait, a change in the rules has been proposed to permit an election before the year 2000 so that the Armenian Apostolic Church could fully participate in the Jerusalem commemorations of the second millennium of Christ's birth. Mr. Speaker, Karekin was born in Syria in 1932, baptized as Neshan Sarkissian. He was educated at Oxford in England, and held top church positions in New York, Lebanon and Iran. He was a unique individual in the way he combined a deep reverence for one of the world's oldest religious traditions with a very modern word view. He fluently spoke Armenian, English, French, and Arabic. He was equally at home in meetings with the leaders of other religions, and with leaders of foreign governments and international institutions like the World Bank. In 1991, Armenia--the first nation to embrace Christianity as its national religion achieved its independence from the officially atheist Soviet Union. Four years later, Karekin was elected as the 131st leader of the Armenian Church, after the death of Vazgen I, who had served for 40 years. At that point, he took up residence in the Armenian town of Echmiadzin, the seat of the Armenian Church. Mr. Speaker, I consider myself fortunate to have had the opportunity to meet Karekin, both here in the United States, and also at Echmiadzin. He was a man of deep faith and spirituality. But he also addressed very worldly concerns, such as calling for a peaceful solution to the Nargorno Karabagh conflict and securing Armenia's place in a free and prosperous world. In what promised to be a major breakthrough in relations between different branches of Christianity, Pope John Paul II had been scheduled to visit Armenia. Unfortunately, the serious illness of the Catholicos, as well as the Pope's recent health concerns, caused that visit to be put off. As a Roman Catholic with deep concern for the Armenian people, I hope that a meeting between the leaders of these two great churches will eventually take place. Mr. Speaker, the Armenian Apostolic Church--which will celebrate its 1,700th anniversary in the year 2001--is one of the so-called Ancient Churches of the East which split away from Byzantine Christianity before the Great Schism of 1054, which divided the Eastern and Western Churches. Christianity was brought to Armenia by the apostles Jude and Bartholomew. King Trdat III proclaimed Armenia a Christian country in AD 301, 36 years before Emperor Constantine I, the first Christian ruler of the Roman Empire, was baptized. During the many years that Armenia lived under often hostile foreign domination, the Armenian Apostolic Church was the focus of the national aspirations and identity for the Armenian people. To this day, the Armenian Church is a major focal point for all Armenians, those living in Armenia and Nagorno Karabagh, and the millions of others in the Armenian Diaspora, including more than one million Armenian-Americans. Mr. Speaker, on this occasion, I join with the Armenian people in mourning the passing of Karekin I, a great man who leaves a towering legacy.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, recent events in India's state of Jammu and Kashmir, where radical Islamic militants have infiltrated into India's territory with the support of, and apparently active collaboration with, Pakistan, have drawn international attention to this mountainous region. Now that Pakistan has apparently agreed to withdraw its fighters who have crossed onto India's side of the Line of Control, I hope that the attention of the U.S. and the world community will finally focus on the long-ignored plight of the Kashmiri Pandits. The Pandits, who are the Hindu community of Kashmir, have an ancient and a proud culture. Their roots in the Kashmir Valley run deep. The Pandits have been amongst the most afflicted victims of the Pakistani- supported campaign of terrorism in Jammu and Kashmir. Virtually the entire population of 300,000 Kashmiri Pandits have been forced to leave their ancestral homes and property. Threatened with violence and intimidation, they have been turned into refugees in their own country. Mr. Speaker, in June, the Pandits received somewhat of a mixed message from the National Human Rights Commission of India. In a positive step, the Commission did accept jurisdiction over the issue of human rights in Kashmir which was a matter of some question because of the special status that the state of Jammu and Kashmir enjoys under India's federal system. But the Commission also announced that it would not term the violence against the Pandits as genocide as has been requested by leaders of the Pandit community as well as myself and other Members of Congress. The National Human Rights Commission also rejected the request to define the Pandits as an Internally Displaced People. The Commission did acknowledge that the Pandits had been victims of killings and ethnic cleansings as part of the militants' campaign to get Kashmir to secede from India. The National Human Rights Commission has recently set up a committee to address the Pandits' concerns, which includes representatives from the Commission, the Jammu and Kashmir State Government, and one representative from the Pandit community. But, Mr. Speaker, the committee has not yet met. I am asking my colleagues to join me in signing a letter to the National Human Rights Commission asking that the decisions on genocide and internally displaced persons be reconsidered and that the new committee begin regular meetings. I have often cited India's Human Rights Commission as a model for other Asian nations and developing nations the world over to emulate. It is an example of India's commitment to democracy and the rule of law. I am sure the commission will give serious consideration to these requests by myself and other Members of Congress. Mr. Speaker, I have been calling along with some of my colleagues in this House for increased world attention to the plight of the Kashmiri Pandits. As I have gotten to know the Kashmiri-American community and have heard about the situation facing the Pandits, I have become increasingly outraged not only at the terrible abuses that they have suffered but at the seeming indifference of the world community. Mr. Speaker, India's government must work to provide conditions for the safe return of the Pandit community to the Kashmir Valley. I also urge that our State Department continue to hold Pakistan accountable for provoking the current fighting in Kashmir by its support for the militants who have infiltrated India's territory. Even before the current fighting, there has been a disturbing pattern of massacres of civilians carried out by the militants operating in Kashmir. While it is predominantly Hindus who have been the victims of these attacks, we have also seen attacks against Muslim residents of Jammu and Kashmir who have dared to assist the legitimate state authorities in putting a halt to the violence. Finally, Mr. Speaker, this is the true face of the insurgency in Kashmir. The militants have transformed a peaceful, secular state in India, one which happens to have a predominantly Muslim population, into a killing field as part of the goal of turning the state into an area under strict Islamic rule. From the standpoint of international stability, this would be a disaster. From the human standpoint, the militants' campaign has already been a disaster as the displaced Kashmiri Pandit community demonstrates. It is wrong to continue to ignore their plight. We must address their concerns and hopefully the Human Rights Commission will do so and reconsider some of the decisions that it has already made.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this week the Subcommittee on Foreign Operations of the House Committee on Appropriations is expected to mark up the fiscal year 2000 bill regarding foreign assistance and other programs vital to maintain and enhance American leadership throughout the world. This legislation is extremely important for the Republics of Armenia and Nagorno Karabagh as they emerge from the ashes of the former Soviet Union to establish democracy, market economies, and increased integration with the West. Thus, in my capacity as co-chair of the Congressional Caucus on Armenian Issues, I am asking my colleagues on both sides of the aisle to join with me this week in urging the members of the Subcommittee on Foreign Operations to express our concerns on several key issues regarding Armenia, Nagorno Karabagh, and U.S. policy in the Caucasus region. This Subcommittee has many friends of Armenia, and I look forward to their support on these important issues. First, Mr. Speaker, we will be urging that the Subcommittee earmark assistance for the Republic of Armenia at the highest level possible. The legislation that has been adopted by the other body, the Senate, last month earmarks $90 million for Armenia, with a sub-earmark of $15 million for the earthquake zone. We hope that the House subcommittee will consider providing a similar figure. It is important for the United States to maintain our support and partnership with Armenia as this country continues to make major strides toward democracy, most recently evidenced by the May 30 parliamentary elections. U.S. assistance also serves to offset the difficulties imposed on Armenia's people as a result of the hostile blockades maintained by their neighbors to the east, Azerbaijan, and to the west, Turkey. I would also like to see the subcommittee continue humanitarian aid for Nagorno Karabagh, an historically Armenian-populated region that has proclaimed its independence and exercises democratic self- government but whose territory is still claimed by the neighboring country of Azerbaijan. The subcommittee took an historic step in the fiscal year 1998 bill by providing for the first time humanitarian assistance to Nagorno Karabagh. Unfortunately, much of that American assistance has not yet been obligated. I hope that the subcommittee, in the fiscal year 2000 bill, will make efforts to ensure that this assistance be fully obligated for the people of Nagorno Karabagh by directing the Agency for International Development to expedite delivery of this assistance. Mr. Speaker, another key priority is to maintain Section 907 of the Freedom Support Act, which restricts certain direct government-to- government assistance to Azerbaijan until that country lifts its blockades of Armenia and Nagorno Karabagh. Last year, the full House voted to strip a provision from the fiscal year 1999 bill that would have repealed Section 907, and last month the other body defeated a provision to waive Section 907. Clearly, there is a bipartisan consensus in both Houses that the conditions for lifting Section 907 have not been met. Another way in which the Foreign Ops bill can make a big difference is by encouraging progress on the Nagorno Karabagh Peace Process. The U.S. has been one of the countries taking the lead in the peace process, as a co-chair of the Minsk Group under the auspices of the Organization for Security and Cooperation in Europe. Late last year, the U.S. and our negotiating partners put forward a compromise peace plan, known as the ``Common State'' proposal, as a basis for moving the negotiations forward. Despite some serious reservations, the elected governments of Armenia and Nagorno Karabagh have accepted this proposal in a spirit of good faith to get the negotiations moving forward, while Azerbaijan summarily rejected it. I hope the subcommittee would include language urging the administration to stay the course on the compromise peace proposal and to use all appropriate diplomatic means to persuade Azerbaijan to support it. To further promote the peace process, we would ask that the subcommittee consider language calling on the State Department to work with the parties to the conflict to initiate confidence-building measures. These measures should be geared both towards a reaching of a negotiated settlement, such as strengthening the current cease-fire, as well as for establishing a framework for better integration following a negotiated settlement, such as transportation routes and other infrastructure, trade, and increased people-to-people contacts. Mr. Speaker, I recognize that the members of this subcommittee are grappling with many competing demands in a complicated world with limited budgets. The fiscal year 2000 Foreign Ops Appropriations bill provides us with a chance to shape U.S. foreign policy for a new century and a new millennium. Armenia is a nation that measures its history in millennia, yet the Republics of Armenia and Nagorno Karabagh are very young democracies that embrace many of the same values that Americans cherish. I hope that the legislation that the Subcommittee on Foreign Operations adopts this week will make a priority of supporting both Armenia and Nagorno Karabagh.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, the references that I will continue with are from the article, not from the other body. This is, as I said, an opinion that was by Bob Herbert in his column in The New York Times on Thursday in which he said, ``A few days ago I spoke by phone with Steve Grissom,'' a constituent or someone basically from North Carolina who has had health problems. And he said, ``A few days ago I spoke by phone with Steve Grissom of Cary, North Carolina. He is 50 years old and suffers from leukemia and AIDS, which he contracted through a blood transfusion. Mr. Grissom is locked in a harrowing dispute with his insurance providers over payment for medical equipment and a continuing supply of oxygen that could determine whether he lives or dies. ``Said Mr. Grissom: I've been a Republican all my life. I don't think I've ever missed a vote. Now is the first time in my life that I've considered changing my party affiliation because I see a real lack of compassion in the Republican Party. They're hearing from the HMOs and they're hearing from the lobbyists with their fat checkbooks, and they're not hearing from people like me who are in desperate need of this kind of consumer protection.'' Mr. Speaker, I think it really says it all. As we said before when we had the two Congresswomen on the floor, the bottom line is that all that the Democrats are proposing are common sense patient protections within the context of HMOs. The only reason that we are getting opposition from the Republicans is essentially because of the fact that the insurance companies do not want this legislation brought to the floor, do not want a debate, and do not want a vote on it. I would like to, if I could, just take a few minutes to point to the differences substantively between the Democratic bill and the Republican bill. There are really a few key points in the Democratic bill that I would just summarize right now and why the Democratic Patients' Bill of Rights would make a real difference for American families. First, it holds managed care plans responsible for denial of care with real, reliable and enforceable appeals and remedies. This is the enforcement that we talked about before that involves an independent review of any denial of treatment outside of the confines of the HMO and includes also, ultimately, the right to sue the HMO for damages. Second, it guarantees patients the right to see a specialist when they need to do so. It is so crucial today. So much medical care is provided through specialists. If one does not have access to a specialist within the network of one's HMO, one should be able to go outside the network to get a specialist who can cover the concern or deal with the medical concern that one has. Third, it guarantees that vulnerable patients can stay with their own doctor even if their own doctor is no longer in their health care plan. Fourth, it bans financial incentives to reward physicians for prescribing less care. Fifth, it returns health care decisions to health care professionals and their patients, which again we discussed earlier this evening. Now, if I could just elaborate on a few of these points. When we talk about providing patients with access to care, which is so important, there are really a number of things in the Democratic bill that relate to access. Some of them we discussed a little bit earlier this evening. One is access to emergency room care. The Democrats' Patients' Bill of Rights allows patients to go to any emergency room during a medical emergency without having to call a health plan first for permission. Emergency room physicians can stabilize patients and begin to plan for post-stabilization care without fear that health plans will later deny coverage. Another access point, access to needed specialists. The Democrats' Patients' Bill of Rights ensures that patients who suffer from a chronic condition or disease that requires care by a specialist will have access to a qualified specialist. If the HMO network does not include specialists qualified to treat a condition such as a pediatric cardiologist to treat a child's heart defect, it would have to allow the patient to see a qualified doctor outside its own network at no extra cost. The Patients' Bill of Rights also allows patients with serious ongoing conditions to choose a specialist to coordinate care or to see their doctor without having to ask their HMO for permission before every visit. Another access, very important obviously for women, access to an OB/ GYN. The Democrats' Patients' Bill of Rights allows a woman to have direct access to OB/GYN care without having to get a referral from her HMO. Women would also have the option to designate their OB/GYN as their primary care physician. Also on the issue of access, my colleague from California mentioned earlier that Democratic Patients' Bill of Rights makes needed prescription drugs available to patients. Currently, many HMOs refuse to pay for prescription drugs that are not on their preapproved list of medications. As a result, patients may not get the most effective medication needed to treat their condition. The Democrats' Patients' Bill of Rights ensures that patients with drug coverage would be able to obtain needed medications even if they are not on their HMOs approved list. Now, the other issue that was mentioned by the gentlewoman from the Virgin Islands (Mrs. Christensen), who is a physician who has practiced, is the idea of freeing doctors to practice medicine. This is what so many of my constituents complain about, that accountants should not make medical decisions. Yet, some managed care organizations interfere with doctors' medical decisions and restrict open communication between patients and doctors. The Democrats' Patients' Bill of Rights protects the doctor/patient relationship and frees doctors to practice medicine. Most important, it prohibits insurers from gagging doctors. Patients have a right to learn from their doctor all of their treatment options, not just the cheapest. The Democrats' bill prevents HMOs from interfering with doctors' communications with patients. Doctors cannot be penalized for referring patients to specialists or discussing costly medical procedures. The Patients' Bill of Rights provides that doctors and patients, rather than insurance company bureaucrats, are once again allowed to make medical decisions. Now, how do we do that? Well, under our bill, HMOs are prevented from inappropriately interfering with doctors' judgments and cannot mandate drive-through procedures or set arbitrary limits on hospital lengths of stay. In addition, doctors and nurses who advocate on behalf of the patients will be protected from retaliation by HMOs. Also important in this whole idea of allowing doctors to freely practice medicine is to limit improper financial incentives. Some managed care organizations use improper financial incentives to pressure doctors to deny care to their patients. The Democrats' Patients' Bill of Rights limits insurance companies' ability to use financial incentives to get doctors to deny care. HMOs and insurers also would have to disclose to all patients information about any incentives that they use. Now, I just want to talk about one more aspect of the Democratic bill, and then I want to talk briefly about the Republican bill that is being put up in opposition to it. This is with regard to enforcement and the whole idea of bringing the appeal when one has been denied treatment. When health plans deny needed care, patients and doctors reserve the right to appeal the decision and to receive a timely response. To protect patients and give them a meaningful right to appeal, the Democrats Patients' Bill of Rights establishes a sound, independent and timely external appeals process. What we do with our bill is to ensure that patients who are denied care by an insurance company can appeal the decision to an independent reviewer with medical and legal expertise and receive a timely decision that is binding on the HMO. Finally, I would like to talk a little bit about why it is necessary to have the ability to sue. I think a lot of people do not realize that they can sue the HMO if they have been denied treatment or if they have suffered damages because they did not get proper treatment. But today, even if an HMO has been involved directly in dictating, denying, or delaying care for a patient, it can use a loophole in the statute called ERISA, the Employment Retirement Income Security Act of 1974. The HMO can use ERISA to avoid any responsibility for the consequences of its actions. ERISA was designed to protect employees from losing pension benefits due to fraud, mismanagement, and employer bankruptcies during the 1960s. But it has had the effect of leaving patients harmed by their HMO's decisions to deny or delay care with no effective remedy. Now, what the Democrats do in our Patients' Bill of Rights is to close this loophole and ensure that, like any other industry, HMOs can be held accountable for their actions. Since HMOs have the financial incentive to deny care to patients, they should bear responsibility if such denials cause harm. Employers, under our bill, are shielded from liability unless they make the decision to deny care. But the HMO is not. The HMO can be sued because they are in fact making the decision. Now I just wanted to, if I could, briefly talk about these sham piecemeal bills that the Republican leadership has brought up in the last few weeks after we started to get a number of signatures to our discharge petition and it seemed as though at some point in the near future we were likely to get enough signatures to bring the Patients' Bill of Rights to the floor. So the Republican leadership has rolled out eight piecemeal bills which they call HMO reform but are really not. Let me just point out some of the things that are left out in this Republican approach. First of all, the bills only cover people who obtain health insurance through their employer. They fail to extend patient protections to the millions of people that purchase health insurance individually. Obviously, the patient protections that we are talking about should apply to all health plans, not just plans that are provided by the employer. Also, the Republican bills pretend to secure patients' rights, but they contain no way to enforce those rights other than the weak penalties currently available through ERISA. So the outside independent review, the ability to sue is not there. The piecemeal bills are inconsistent and incomplete. For example, one of them is supposed to protect against so-called gag clauses where the physician is told that he cannot speak out about a particular procedure that is not covered. But it does not. But the bill the Republicans have put forward to try to deal with these gag clauses does not prohibit plans from retaliating against doctors who discuss the plans' financial incentives. Well, the reality then is essentially the doctors are still gagged and cannot speak their mind. There are so many other examples. Let me give one other example in an effort to try to address the Democrats' initiative with regard to OB/ GYN care. The Republican bill purports to guarantee women direct access to routine OB/GYN care, but it would allow a plan to require a woman to obtain such services from a generalist. So these are the kinds of games that we are seeing with this piecemeal approach that the Republicans have put forward. They pretend that they are dealing with some of the patient protections, but in fact they do not. Mr. Speaker, what I would really like to point out is that, on the one hand, I am pleased to see that the other body is taking up the issue of HMO reform, but I think that it is crucial, first of all, that we in the House bring up the issue and allow for a debate on the Patients' Bill of Rights. But even more so, it is necessary for us to bring up a bill, a strong comprehensive approach like the Democrats' Patients' Bill of Rights, allow it to be brought to the floor, vote on it, go to conference with the Senate, and have a strong piece of legislation like the Patients' Bill of Rights go to the President. President Clinton has repeatedly said that he would sign the Patients' Bill of Rights if it comes to his desk. I notice that, during the break, actually over this past weekend, he again used an opportunity I think when he was out on the West coast in Los Angeles to criticize the GOP, the Republican leadership, for trying to avert a vote on true HMO reform. We are not going to rest, those of us in our party, and I know some of the Republicans as well who care about this issue are not going to rest until we have a comprehensive bill passed by both houses and on the President's desk. This is what the American people demand. This is what they deserve. It only makes sense to do so if we are really going to provide protections for patients throughout the country.

Mr. PALLONE. I appreciate what the gentlewoman said. It is just very true. One of the biggest problems that people have is that when they have been denied certain types of treatment, they are in bad shape, they are seeking an operation, they are not feeling well by definition, or otherwise they would not need the treatment. It is at that very time when they have to go through all these hurdles that currently exist, most of which do not lead to anything anyway, because under the current law, the HMO can define what is medically necessary. Then they can have an internal process to review what they have defined as medically necessary. So we never really have somebody independent, outside, that can review the decision and take an appeal. I want to thank the gentlewoman again. Mr. Speaker, the gentlewoman from the Virgin Islands is herself a physician, and I know she has been part of our Health Care Task Force for a few years now, and has spoken out frequently on the issue of the Patients' Bill of Rights. The gentlewoman deals from firsthand information. Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. Christensen.)

Mr. PALLONE. Well, basically, being from a legal background, I always think about the legal aspects of this. But the way I see it, essentially what the Patients' Bill of Rights does in the emergency room situation is to essentially put the burden on the HMO in that circumstance rather than on the patient. In other words, right now if the patient gets chest pains and feels they may be having a heart attack and they go to the emergency room, the HMO can find every excuse, assuming they did not have a heart attack and they survived, the HMO can say that they should have had prior authorization. We would have known that chest pain does not necessarily mean a heart attack. What we say in our bill is say it is the ``reasonable person'' formula. If the average person would think, if they have chest pains, that they have to go to the emergency room, that is good enough. They do not have to prove after they had the heart attack to justify getting the emergency room care paid for, which of course makes sense. The other thing, and the gentlewoman would know this better than I, the other aspect of our bill is that in order to, as we said since we want to leave it to the doctor and the patient to decide what is medically necessary, we use the standard practice in that particular specialty. So that the reference that the HMO has to make to, for example, a certain kind of cardiac care or pediatric care is to the standards for that pediatric college or cardiac college. I do not know the terms. The standard is that set by that specialty, medical specialty, rather than just by the insurance company; and that is a big difference as well. Mr. Speaker, what I was trying to do tonight, and I appreciate the input from the two gentlewomen, the two Congresswoman who so far participated in this debate, was to draw a distinction between the Democrats' Patients' Bill of Rights and some of the proposals that the Republican leadership has put forward. I tried to point out that, on the one hand, the Republican leadership here in the House has consistently refused to bring up HMO reform, not only the Democrats' Patients' Bill of Rights but any kind of legislation, over the last 6 months in essentially a stalling, delay tactic because of the support that the leadership receives from the HMOs and from the insurance industry. But now that the time has come when it is very difficult for the Republican leadership to continue to delay because we have a sufficient number of signatures on this discharge petition, that we are getting close to the point where we could actually bring the bill up, they are now turning to a different device to bring up legislation that they pretend is some kind of HMO reform but really is not and does not pass the test to really provide comprehensive patient protections to the average American. Mr. Speaker, I want to make reference in that regard to an op-ed article by Bob Herbert in The New York Times that appeared just prior to the break on Thursday, July 1. To the extent it talks about the action in the other body, I will not get into that because we are not supposed to talk about what happened in the Senate. But the op-ed does make the point that the Republicans really do not want to bring up HMO reform, true HMO reform like the Democrats' Patients' Bill of Rights, and that they will do whatever they can to try to avoid the issue and prevent a bill from passing here in the House of Representatives, even though the American people have repeatedly spoken out and say that they want HMO reform and they want the type of comprehensive approach that the Democrats have put forward in the Patients' Bill of Rights. I just wanted to make reference to certain sections of this op-ed which I think is very significant, and it refers to the GOP right wing, The Restless Radicals, and it talks about the fight. And it says that the fight over HMO reform was not over the merits of the legislation but over the Republican Majority's refusal to even allow debate on a series of Democratic proposals aimed at curbing abuses by insurance companies and HMOs. I will just quote certain sections here. ``There is strong support among the public and among health care professionals for the Democratic proposals, known as the Patients' Bill of Rights. The Republicans have offered much weaker legislation and have not been anxious to permit a public airing of the differences. ``Virtually all leading patient and medical groups have supported the Democratic proposal'' in the Senate, ``Senator [Tom] Daschle's proposal,'' says Senator Edward Kennedy. ``These groups do not care whether Democrats or Republicans are on a piece of legislation. They just want a strong bill. And virtually every single leading----''

Mr. PALLONE. Mr. Speaker, I will give an example. Of course, the insurance companies always say that they do not make the decisions and it is really up to the physician. But, as the gentlewoman knows, that is not the case. I remember when my son was born, he is about 4 years old now, and we were at Columbia Hospital for Women here in Washington; and at that time my wife delivered him through C-section. I was told that, generally, the standard in the industry before HMOs came along was to allow the woman to stay in the hospital approximately 4 days. We had a standard BlueCross, and this actually was applying not just to HMOs but in general, but basically what had happened is that a lot of the HMOs have moved to allowing just 1 day for natural delivery and then 2 days for C-section. The physician that we had said that he really wanted my wife to stay in the hospital at least another day, for the third day, but he said that he could not authorize it because the insurance company would not allow it. I asked the question at the time, I said, ``I do not understand. Aren't you the one that makes the decision?'' And he said, ``In theory I am, but if I allow too many people stay the extra day then they will penalize me or I may not be able to be part of the network or whatever.'' And so, even though they may say that that it is up to the doctor, the reality is that the physicians are under these kind of financial or other licensure penalties, not licensure but to be able to stay in the network to not allow it. So, effectively, they control the process and they make the decisions and that is what we need to change.

Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for what she said and for being a leader on all of the issues of health care reform but particularly on the issue of the Patients' Bill of Rights and managed care reform. The gentlewoman mentioned some of the piecemeal approaches that we are hearing from the Republican leadership, and I just wanted to remind my colleagues and maybe we could just spend a few minutes explaining why we are here tonight. Essentially, the problem that we face as Democrats is that the Republican Majority in the House has been unwilling to bring up the Patients' Bill of Rights. And since we do not control the procedure either in committee or on the floor of the House, we are forced essentially just to speak out and explain why it is unfair that the Patients' Bill of Rights has not been brought up here in the House of Representatives. Obviously, what we have tried to do from the beginning of this year is to have a hearing on the bill in committee, which has not been allowed, and then to mark it up and bring it to the floor. When none of that was possible for the last 6 months, we then tried the discharge petition process, where we come down to the floor and sign a petition the way our constituents petition us and basically the way the rules provide that if a majority of us sign a petition, that the bill comes to the floor, the Patients' Bill of Rights would come to the floor without going to committee. That is, of course, difficult, too, because we have to get a majority, and I believe because of the delegate status of the gentlewoman from the Virgin Islands, she is not even allowed to sign the petition. Or maybe she can sign it, but it does not mean anything that she signs it, which I think is also unfortunate and should be changed. But now that we have gotten a significant number of Members to sign the petition, I know we had over 180 before the July 4th break, we are starting to see the Republican leadership get a little restless and come up with other ideas about how to avoid a debate on this issue. One of the things they did was to bring up a series of piecemeal bills that took little pieces of the patient protections that we have in the Patients' Bill of Rights and basically brought them up in committee and tried to get them out of committee. Fortunately, there were a few, I think two or three, Republicans who did not want to go along with that because, as the gentlewoman said, they wanted a comprehensive approach like the Patients' Bill of Rights, so that has gotten bogged down. Mr. Speaker, I am not sure what the latest tactics are to deal with that piecemeal approach. We do have some Republicans that are joining us in the effort and feel that this really should be a bipartisan issue, but unfortunately it has not been because the Republican leadership continues to not allow the Patients' Bill of Rights to be brought up. Mr. Speaker, I just wanted, if I could, to again say that the problem with these piecemeal bills is essentially what I talked about before with the gentlewoman from California (Ms. Lee) which is the two key points: The fact that doctors and patients should make decisions about what kind of treatment or care they get and not the insurance company is absent in those piecemeal bills. And, of course, there is no real enforcement. There is no real opportunity to go outside the HMO to make an appeal. There is no opportunity to sue in a court of law if someone is seriously damaged. So I think it is important that we keep raising this issue and even though we do have the other body now bringing up the issue of HMO reform, it is not at all clear whether or not we are going to really see action on the Patients' Bill of Rights. So we will have to wait and see what develops in that regard.

Mr. PALLONE. Mr. Speaker, this evening I have some of my colleagues, and I want to thank the previous speaker, my colleague from Kansas (Mr. Moore), for talking about the Patients' Bill of Rights and the need for managed care reform. The reason that we are here tonight to talk about the Patients' Bill of Rights and managed care reform primarily is because the Senate began debate today on the Patients' Bill of Rights, and I wanted to point out, Mr. Speaker, that while it is true that the debate has begun today in the other body, and we are certainly appreciative of that, it was only because Democrats over the last few weeks before the July 4 break insisted almost to the point of filibustering and saying that they would not continue the appropriations process in the Senate if there was not an opportunity to bring up the Patients' Bill of Rights and deal with the issue of HMO reform. Announcement By The Speaker Pro Tempore

Mr. PALLONE. Mr. Speaker, what I wanted to point out this evening, though, is that even though it is true that the HMO reform debate has begun, that we still have a problem in the sense that the Republican leadership is unwilling to support or, I think, ultimately even have considered particularly here in the House of Representatives the Patients' Bill of Rights, and I just wanted to start out this evening, if I could, by pointing out a few things that occurred and that were in the newspaper the last week or so on this issue, and then I want to yield to the two Congresswomen that are here tonight to join me. One of the things that was in today's paper, in the New York Times, was an article by Robert Pear which is entitled, Managed Care Lobbyist Is Ready For The Debate; and essentially what this article says is that the HMO industry has commenced because of what is happening in the other body, that the HMO industry has commenced a huge lobbying effort not only by hiring lobbyists and paying them a lot of money to try to put an end to the Patients' Bill of Rights and not allow true HMO reform to pass, but also by spending millions of dollars on TV and in advertisements to try to kill any kind of HMO reform. And just to give my colleagues an example of this, this is in today's New York Times. It says, it says specifically here, that the association and its business allies, and this is the HMO industry, have flooded the air waves and newspapers with advertisements opposing legislation to regulate HMOs through an umbrella group known as the Health Benefits Coalition. They spent $2 million on advertising last year and have already spent more than that this year with a new burst of advertising planned for this week while the other body debates this issue. The advertisements attack the main democratic bill by name, and of course it goes on to explain that HMOs are mostly profit making. The other thing that particularly galled me was that when they talked about the lobbying effort here in the Congress, it says that what they are trying to essentially say is that it is not necessary to have new laws to regulate HMOs because the HMOs are being told now that they should voluntarily adopt a code of conduct that will provide for patients' protections. I thought that was interesting given the fact that just in the last week since we had the July 4 break, we have seen articles in the same newspaper, in the New York Times, talking about the long delays by HMOs that were cited in a New York report. This came out in New York. It was put out by Mark Green, the city's public advocate, and it talks about how patients' rights are being ignored. Again, if it is not necessary to pass HMO reform, why is it that we have a report showing that it is needed and in fact that patient protections are being ignored? Also the previous Friday in the New York Times was an article that said that HMOs will raise Medicare premiums or trim benefits. So not only do we have the HMOs essentially saying that they are not going to provide the patient protections on a voluntary basis, but also they are talking about raising premiums, trimming benefits for their patients who are part of their plan. So I would maintain, and we are going to talk about this for a long time tonight and other days, that in fact we do need legislation. We do need the Patient's Bill of Rights. I am pleased with the fact that the other body has at least started the debate on this issue. Mr. Speaker, I have two Members who are here tonight and who are joining me. I yield to the gentlewoman from California (Ms. Lee), who I know has been an advocate for the Patients' Bill of Rights and for HMO reform ever since she started here in the U.S. Congress.

Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman, and I think that in many ways that really is the key. What we are talking about with the Patients' Bill of Rights are commonsense patient protections that, frankly, when we mention them to our constituents, they are surprised that they are not already the law, or they are not already required. I will give the example with the gag rule that says that if a particular procedure is not covered by the HMO in the insurance policy, the doctor cannot mention it to us, cannot mention that procedure or treatment. When I tell that to my constituents, they are shocked to think that a doctor can be told by the insurance company that they cannot mention a procedure just because it is not covered, the so- called gag rule. We are just looking for commonsense protections here, but the reality is that there is so much money being spent to counteract our efforts to try to legislate and come up with HMO reform. That is really what we are up against. So many of these HMOs are for profit, and basically the profit is the bottom line for them. We have seen so many examples, and we had a couple before a hearing we had about 6 months ago where, because the HMO was seeking to be purchased by a larger group, they were actually changing the policy of what was covered for certain kinds of procedures in order to save costs, because they knew that a few months down the line they wanted to be purchased, and they wanted to show that their profits were good, and they needed to change the policy on what they would cover as a result of it. So I think the gentlewoman is right on point when she points out that it is profits over patients in many cases.

Mr. PALLONE. I appreciate that, Mr. Speaker. One of the two issues that I point out constantly that really show the distinction between what the Democrats have proposed in the Patients' Bill of Rights as opposed to the legislation that the Republicans have put forward, one is this whole issue of who is going to make the decision of what type of medical procedure we have, what type of operation, how long we stay in the hospital. The problem right now is that the insurance companies make those decisions. What we are saying with the Patients' Bill of Rights, with the Democratic bill, is that that decision should be made by the doctor and patient. The other thing, of course, is the enforcement. We say that there should be external independent review, separate and apart from the HMO, and if that fails we should be able to go to court and sue the HMO if they do not provide the proper care. Of course, the Republican bill does not get into that kind of enforcement. So I think one of the things we need to do is draw those distinctions, if you will, between the Democrats' bill, the Patients' Bill of Rights, and some of the other things that are being proposed that really do not get to the problem in a comprehensive way.