Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, tonight I want to talk about Social Security reform. I am going to be joined by the gentleman from Washington (Mr. Smith), who is here also to talk about the same issue. We may be joined by other Democrats this evening. This is an extremely important and controversial issue and it deserves more attention than the majority, the Republicans, have been willing to give it in the 105th Congress. I am increasingly concerned about the neglect of Social Security for a number of reasons. For one, Mr. Speaker, there is a lot of disinformation about the Social Security program and its connection to the budget surplus flying around these days and I intend to spend some time talking about that tonight. While I am concerned about it, I think we can get the truth out there through education. What concerns me far more is the willingness by Republicans to dip into the surplus before we have strengthened the Social Security trust fund. We hear that on Thursday, this Thursday, the Committee on Ways and Means is going to be reporting out a bill by the gentleman from Texas (Mr. Archer), the chairman of the committee, that will basically be providing some kind of tax cuts, if you will. The alleged basis for this is because we have a large surplus and will continue to have a large surplus over the next few years and therefore we can afford to have this tax cut. But what in reality is happening, Mr. Speaker, is that we are taking the money from essentially an unreal surplus, or money that could and should be devoted to make sure that the Social Security trust fund is sound. In order to explain why what the Republicans want to do is a bad idea for Social Security, I first need to explain the connection between the surplus and the Social Security trust fund. Mr. Speaker, the Social Security trust fund is funded through payroll taxes and the overwhelming majority of the money collected from payroll taxes goes into a fund called the Old Age Survivors and Disability Trust Fund. The fund also generates money through interest and other methods, including that from taxes on Social Security benefits themselves. But this fund in turn holds all money that is not used to pay benefits and administer the program itself. Federal law, from what I can tell going back to Franklin Roosevelt when Social Security was started, the Federal law requires that this remaining money, or the surplus or extra money, if you will, in the Social Security trust be invested in U.S. treasury securities. So what this all means is that there is currently a surplus in the Social Security trust fund but the Federal Government uses this surplus to fund other portions of the Federal budget. In fact, if it were not for the surplus in the Social Security trust fund, there would be no budget surplus at all. This is what so many Democrats are saying now, that the true budget surplus is not a surplus at all. It is simply the money that has been borrowed, if you will, from Social Security and that has to be paid back with interest. Let me just give you an example. The budget numbers for the current fiscal year basically bear this assertion out. According to the Congressional Budget Office, the Social Security trust fund will take in a $101 billion surplus in fiscal year 1998. But the CBO also projects that the total budget surplus for this fiscal year will be $8 billion. So if you take away the $101 billion going into the Social Security trust fund, the Federal budget would actually be in deficit for the year to the tune of $93 billion. To say it succinctly, Mr. Speaker, were it not for a surplus in the Social Security trust fund, the total Federal budget surplus that everyone talks about here in Congress would not exist. Because that money in effect belongs to Social Security, Congress should not be talking about using a budget surplus for anything else but Social Security at this time. Until such time as this Federal budget can be in surplus without touching the Social Security trust fund surplus, Congress should not spend one penny on anything else. Now, what we are hearing is that the Republicans want to do and they want to use that money for tax cuts before we preserve Social Security for the long term. That is simply not right. It basically is pulling the wool over the eyes, if you will, of the American people. It is very important for me to add that Democrats do not just want to stop using the Social Security trust fund to fund the rest of the Federal budget, we want to ensure that the Social Security trust fund is strengthened for the long term. So we want to make sure that when the baby boomers, the generation that we call the baby boomers, are over 65 and are eligible for Social Security that there is enough money in the Social Security trust fund, or in the program to pay out those benefits. We believe this can be done fairly easily if the Congress remains committed to this goal as well. Right now the Social Security trust fund is currently projected to take in more than it pays out until about the year 2029. The depletion of the trust fund's solvency is expected to begin around 2012 when the baby boom generation starts to retire. By 2019 it will still be taking in more than it pays out, but by 2029 the annual revenue coming into the trust fund will begin to experience a shortfall. So if nothing is done to correct it, in 2029 the Federal Government will only be able to meet about 75 percent of the benefits it currently pays out to Social Security recipients. I want to emphasize again that this shortfall, Mr. Speaker, I think a lot of people are under the impression that the trust fund would be depleted at this time, and that is not the case. It would be a shortfall, but we have time to correct it. Over the long term, the system would be in balance but we still could fix it. What we basically are saying is that even though it may not be a while before we face a real crisis in Social Security, that whatever surplus we generate now as a result of general revenues should be used and held, if you will, to pay back what is owed to Social Security, what has been borrowed, if you will, from the trust fund. I guess basically what we are saying, Mr. Speaker, is that when this Ways and Means bill comes out on Wednesday and when it is reported out, we need to put in some language, if you will, it will be a Democratic substitute, that essentially says that none of these tax provisions click in until the time when there is enough money coming in from the so-called surplus to pay back what is owed to Social Security. That is why I think it is very important right now that we not rush into a situation where we give these tax cuts knowing full well that we still owe a lot of this money back to the Social Security trust fund. I know it gets a little complicated and I am not trying to succeed in doing that, but I think when I had my town meetings during the August break and I had a few senior town meetings and also others where senior citizens came, they all understood that Social Security, the trust fund in essence was being borrowed by the Federal Government to pay other expenses and that a lot of money was owed back, and they clearly understood that there was not a real surplus that could be spent on tax programs or other budget priorities. We all like to spend money, we all like to give tax breaks if we can because we know that there is a need out there for a lot of things by the American people, but the most important thing, I think, is to shore up the Social Security trust fund so that people at least know that when they are paying into it and they expect that when they retire that they are going to have the Social Security benefits, that it will be available to them. We could go into this a lot more tonight and I know we will be going into it a lot more over the next few days. I would like to yield now to my colleague from Washington who basically started this debate on the floor this morning and I thought gave an excellent explanation about why we should not move ahead with what the Republican leadership wants to do.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to thank the chairman of the subcommittee and, as the gentlewoman from Maryland (Mrs. Morella) mentioned, the other members of the Committee on Resources for pushing this bill so we could bring it to the floor this day and get it passed and sent over to the Senate. As my colleagues know, the sponsor of the bill, the gentleman from Florida (Mr. McCollum) co-chairs the India Caucus with me, and this is a bipartisan effort. We have over a hundred Members in our India Caucus, and this is one of the bills that we have been trying to push on a bipartisan basis throughout most of this year. We are very pleased that it is coming to the floor today. There is a companion bill offered by Senator Moynihan, who is a former U.S. Ambassador to India, that is being sponsored in the Senate, again on a bipartisan basis, so if we can get it over to the Senate, we will undoubtedly get it signed by the President before the end of this year. As was mentioned last month, India celebrated actually the 51st anniversary of her independence, and of course the individual most closely identified with the historic and successful effort by the people of India to secure the independence from British colonialism and establish a democracy was Mahatma Gandhi. Gandhi's contributions to the causes of democracy, freedom, and human rights are felt to this day not only in India but throughout the world, including here in the United States. And that is why I think it is particularly important that we have a memorial or a monument to him here in Washington, D.C., which of course is our capital and the place where we celebrate democracy and the freedoms that we enjoy as the leader of the free world. I just wanted to say very briefly, Mr. Speaker, when I was in India a couple times, I had the opportunity to go to the Gandhi ashram in Ahmadabad and also to a place where Gandhi spent a number of years in Bombay, and I was incredibly impressed with the way he organized this movement in India. There is really nothing quite like it in terms of the way he took an intellectual idea and was able to expand it to the masses of the people in India and have success in throwing off the yoke of colonialism. From a practical standpoint, though, I wanted to say that this memorial will be entirely not only an appropriate addition to this city, but it will not cost the Federal Government anything. The legislation specifies that American taxpayers will not have to bear the cost of construction and maintenance. The Embassy of India will bear all costs. The National Capital Memorial Commission and the National Park Service will both have very active consultative roles, ensuring that it will add to the beauty of our capital and blend in well with the surrounding area. The location of the tract of land where the memorial will be erected is close to the Embassy of India. It has been selected because the location would be in keeping with the Commemorative Works Act for location of commemorative works as subjects of lasting historical significance to the American people, and I wanted to point out that the proposed monument was approved last June by the National Capital Memorial Commission. So, Mr. Speaker, this city is a city of great monuments and memorials, and we are just very happy on behalf of the India Caucus to have this addition added to those commemorative monuments.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I join my colleagues today in supporting the passage of H.R. 3445, the Oceans Act. As the world celebrates the International Year of the Ocean, we have an excellent opportunity to initiate a major review of ocean policies in this Nation and to take actions to improve our understanding of ocean systems and the ocean environment as a whole. As a coastal member and co-chair of the Coastal Caucus, I've always been supportive of protecting our oceans and coasts and realize the tremendous benefits they offer all Americans. Our oceans provide us with jobs, food, recreational as well as education opportunities, medicine, and transportation. Each year an estimated 180 million Americans visit the coast and nearly one third of our nation's Gross National Product is produced in coastal areas. Our oceans also play an important role in determining climate. But all is not well with our oceans. Today, more than half of all 265 million Americans live within 50 miles of our shores. This has put tremendous pressure on our estuaries, coastal zone, and near and offshore areas. In 1996, nearly 2,200 health advisories were issued against the consumption of contaminated fish. In 1997, over 4,000 beach closings or warnings were issued due to pollution. Harmful algal blooms, like red tides and pfiesteria, have been responsible for over $1 billion in economic damages over the last decade. A 1997 National Marine Fisheries Service report to Congress stated that of the federally managed species for which sufficient data was available, 31% are ``overfished.'' The list goes on and on. H.R. 3445 attempts to rectify some of these problems by establishing a Commission on Ocean Policy. This Commission, which is similar to the original Stratton Commission of the late 1960's, will report to Congress and the President policy recommendations for how to do better with respect to our oceans, ultimately resulting in a coordinated National Ocean Policy. While I support H.R. 3445, I am deeply disappointed that the bill before us today is much weaker than what was passed unanimously by the Fisheries Conservation, Wildlife and Oceans subcommittee. Nevertheless, I applaud the efforts of Mr. Farr Mr. Saxton, and others for working so hard to bring this bill to the floor today. In closing, Mr. Speaker, I urge all Members to vote in favor of this legislation so that we can go to conference and have it signed into law before the end of the session. Cast a vote for the oceans! Vote yes on the Oceans Act!

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I move that the House do now adjourn.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, let me say this evening that I will be talking about HMO reform and the need to address that issue before this House adjourns in about four weeks, or at least is tentatively scheduled to adjourn after the first week in October. I am concerned that over the next four weeks that time will not be spent on the issues that the American people want addressed in this Congress, health care reform, HMO reform, education concerns, Social Security, environmental issues. There are so many issues that need to be addressed, and I am only going to talk about one of them tonight but I wanted to mention that the Democrats as a party are united behind a strong and a bold agenda which addresses the real challenges that face working families. I am very concerned that the Republican leadership is not going to address these issues. We need to strike out and say that these issues need to be addressed before we adjourn. The one that I would like to talk about tonight and that I think really is the most important because this is the one that I hear the most about from my constituents is HMO or managed care reform. Too many of my constituents at town hall meetings or at my district offices tell me about the horror stories, and there are many, where they have been denied necessary care because their HMO, their insurance company, has refused to pay for it. The President and the Democrats have put forward a bill, we call it the Patients' Bill of Rights, that is a real, not a fig leaf political bill designed to cover the health insurance industry. We need patient protection legislation that returns medical care to doctors and patients instead of leaving those decisions to health insurance company bureaucrats. Let me just mention a few key elements of this Democrat real patient protection act, or HMO reform. It includes guaranteed access to needed health care specialists, access to emergency room services, continuity of care protections, access to timely internal and external appeals process if you have been denied care by your HMO or by your insurance company; limits on financial incentives to doctors. We know that too often now the HMOs give the doctors financial incentives, bonuses, if you will, if they do not spend a lot of money or require a lot of services for their patients. Also assuring doctors and patients that they can openly discuss treatment options. Many people do not know that many HMOs now put their physicians within their HMO network under a gag rule that they cannot talk about legitimate medical options, operations or other procedures if the HMO will not cover it because they do not want the patients to know that those procedures exist because they are not going to pay for them. We should not allow those kind of gag rules. They should be prohibited. The Democrats' Patients' Bill of Rights would prohibit those kinds of gag rules. Also, the Democratic bill, the Patients' Bill of Rights, assures that women have direct access to an OB-GYN; and there is also an enforcement mechanism that ensures recourse for patients who were maimed or die because of health plan actions. So not only do we allow you to go through a procedure, an appeal externally before a board, before you have to go to court where the insurance company cannot influence that appeal, but also we allow you to go to court and sue for damages if you have suffered severe damages as a result of the denial of care. I just want to talk a little bit more if I can about the positive aspects of the Democrats' Patients' Bill of Rights and why we need to get this legislation, or something like it, passed before we adjourn this Congress in another four weeks. Greater choice of doctors. A lot of my constituents point out that they feel there should be some sort of option that you can go outside the HMO network if you want to, even if you have to pay a little extra. What the Democratic Patients' Bill of Rights says is it requires that individuals enrolled in HMOs be offered a greater choice of doctors under what is called point of service. Employers must provide employees with the option of choosing a doctor outside the company health plan. What that means is that when your employer offers you a health plan, he can give you the choice of an HMO but he also has to give you the option of having the HMO and letting you go outside the HMO network for a little extra if you decide to do so. You get that option when you first sign up for your health insurance. Most important, in the Patients' Bill of Rights, the Democratic bill, medical decisions are made by doctors and patients based on medical necessity, not by insurance company bureaucrats. The bill ensures that treatment decisions, in other words, what you need, what is medically necessary for your care, those treatment decisions such as how long a patient should stay in the hospital after surgery, what type of procedures are appropriate, that these decisions are made by the doctor in consultation with the patients. They are not made by the insurance company. Again, we have an example of that which we did last year, or in the previous Congress with regard to pregnant women, that the length of stay provision for pregnant women, when they go to have the child, that they are guaranteed that they can at least stay in the hospital 48 hours for a normal delivery or four days for a C- section. That is exactly the type of guarantee that we will be including in this Democratic bill when we say that the doctor and the patient decide what is medically necessary rather than the insurance company. Access to specialists. I want to spend a little more time on that because it is so important to so many of my constituents. Our bill allows patients to see an outside specialist at no additional cost whenever the specialist in their plan cannot meet their needs. So if there is a specialist in the HMO network who can take care of you, fine, but if there is not because they do not have that particular specialization, then they have to allow you to go outside the network to see another doctor. The bill also lets women select obstetricians and gynecologists, as I have said, as their primary care provider. Enforcing patient protections. I think everybody knows, most Americans realize that if you have a right or you have a protection, it does not do you much good unless you can enforce it. What our bill does is it holds managed care plans accountable when their decisions to withhold or limit care injure patients. Unfortunately in court cases around the country, HMOs have not been held accountable. Currently patients may not have the right to sue their HMO in court if they are in certain circumstances. The Democrats' Patients' Bill of Rights removes the exemption under current Federal law that prevents HMOs from being sued in certain circumstances. It also establishes an independent system for processing complaints and appealing adverse decisions with expedited procedures for life-threatening situations. What this means is that if you have been denied a particular operation, not only do you get an external review board which is not influenced by the insurance company that you can go to to appeal the insurance company's decision and it would be enforceable, but also if it is life-threatening, that has to be done very quickly. Otherwise it is not very useful to you. What this guarantees is that decisions on care are based on medical appropriateness or necessity, if you will, not cost, because obviously what the HMOs do in many cases is make their decisions based on cost. What I wanted to talk about a little more tonight, I have given you some idea I think about what the Democrats are trying to do with our Patients' Bill of Rights but I also have to point out tonight that the Republican alternative which passed the House in August before the August recess not only does not provide the types of guarantees that I am talking about but actually takes us back. It creates an even worse situation, even less guarantees in my opinion for the American people. The House hastily, and I say hastily because this Republican bill was just brought to the floor without any committee action or without any hearings, just brought to the floor right before the August recess and passed and the Democrats' Patients' Bill of Rights, of course, was defeated only by five votes, so we still have a chance to resurrect it. What the Republican leadership was trying to do when they brought their own version, if you will, of HMO reform to the floor in August was to get something passed so that they could go back to the voters at their August town hall meetings or their other venues and say, ``Oh, we've accomplished something.'' But their plan, I assure you, was a sham. It is essentially a managed care bill that is better for managed care organizations, and they are not going to be able to or should not be able to pawn it off as a good piece of legislation. The bottom line is that the Republican leadership is not willing to pass a real managed care reform bill because it does not want to offend the insurance industry. Let me say, Mr. Speaker, that based on what my constituents voiced to me during the various town hall meetings I have had in the last few weeks is that the Republican plan was essentially a bust. They repeatedly told me that when it comes to managed care that they want three things above everything else. They want medical decisions to be made by doctors and their patients, they want direct access to specialists, and they want HMOs to be held accountable for the decisions they make. And my constituents were emphatic in their belief that none of the protections under consideration in this Republican bill are worth a dime because they cannot be enforced, and there is basically one of the best ways to enforce patient protections is to have the right to sue, which of course is not expanded under the Republican bill. Let me point out why I think that this Republican HMO bill makes current law worse and essentially why all the things that they mention would be corrected, if you will, by the democratic bill. The first of the three aspects I mentioned is, and perhaps the best indicator of just how bad the Republican managed care bill really is, and this is with regard to the necessity of medical treatment or the appropriateness of medical treatment because this really lies at the very heart of the managed care debate. The Republican managed care bill addresses this question of medical necessity by essentially locking the status quo into place. It does so by allowing HMOs to define what is medically necessary. Under the Republican bill, if your doctor's recommendation does not match your HMO's definition of medical necessity, you are out of luck. So, as you can see, if you have to have a particular operation or you want to stay a certain length of time in the hospital and the HMO decides through its own definition that that operation is not medically necessary, it does not matter what your doctor tells you, because the final word is that they have defined it as not medically necessary. So, if you allow the insurance company to define what is medically necessary which is what the Republican bill does, then the whole idea of shifting the decision back to the doctor and the patient and away from the insurance company as to whether or not you have a particular type of care coming to you is essentially lose. Now, of course I mentioned before that our democratic bill, the Patient Bill of Rights, corrects this problem and lets the medical professional, the doctor, decide what is medically necessary. The Republicans are trying to pull the same kind of scam, if you will, with access to specialists. The GOP bill would allow women to go directly to the OB/GYN, but it would not give women the right to designate the OB/ GYNs as their primary caregivers. And of course the democratic Patients Bill of Rights would do that. So basically also the Republican bill would also allow children to go directly to pediatricians so they give that right but not without strings because under the Republican bill your child may be guaranteed access to a pediatrician, but if your child gets cancer and needs speciality care, there is absolutely no guarantee that he or she will have access to, for example, a pediatric oncologist, a specialist within the pediatric field. So under the Patients Bill of Rights however that child will get that guarantee, so again what we are saying is if the OB/GYN is not the primary care provider, then that person is not going to be the person that gives you a referral to another specialist. And again, if you are allowed to see a pediatrician, that pediatrician does not have the right to send you to a specialist for your child in a particular area that he or she may need the specialist. Then essentially you again are limited in the choices that you have for a physician or your access to specialty care. Let me give you another example, if you will, with a cardiologist. If you have a heart problem and you need to see the cardiologist, the Republicans would have you jump through hoops to try to get there, and you could still fail. The democratic bill directly opens the cardiologist's door. So if you have asthma, you can see the asthma specialist and down the line. In other words again, you may through the Republican bill be able to see a cardiologist, but if you need a speciality care or reference for a particular type of cardiologist, you would not have that access, and the same with asthma and other kinds of sub specialities. What I found at the town meetings that I had is that person after person basically stood up and communicated the belief that patient protections are meaningless without a means of enforcement, and so I would like to talk a little bit about the enforcement issue now as well when you have been denied care. The only way to enforce protection, a lot of my constituents said, is to give the right to sue when their HMO denies them care and their health suffers as a result. And I know some people say, oh, you cannot give patients the right to sue when the HMOs deny them care because that is just going to result in more lawsuits. Well, I was not getting that from my constituents at the town hall meetings. They were not worried about the fact that there would be too many loses. They were worried about the fact that if they were denied care, they could not sue for rights under the law, and that is the way it should be. People should be able to go to court if they have been damaged as a result of denial of care. What we do, what the law is right now, unfortunately, is that if you are in a HMO or a managed care organization that comes under Federal protection, what we call ERISA because the employer is self insured, then you are denied the right to sue for damages, and we would correct that and eliminate that loophole and say that all HMOs or managed care companies can be sued regardless of whether you are under ERISA and under Federal protection. And I also mention this external appeals process, too, as another means of enforcement where right now under the current law and also under the Republican bill a number of people would only be able to appeal the HMO's decision with regard to denial of care through an internal review process which basically still gives the HMO the right to decide what care should or should not be provided. The democratic bill insists on external appeals for all purposes, and those external appeals are basically judgment calls made by people appointed who are not under the sway of the insurance company. Now I have to say, Mr. Speaker, that my biggest concern right now is that even though we have passed this, what I consider bad Republican bill in the House, that the Senate may not take up any legislation tall, and I am really saying tonight that the most important thing is that the other body at least move on HMO reform, certainly not on the Republican bill, but at least take up the issue so there is some fair debate and some opportunity to hear from the senators on both sides of the aisle what their constituents are telling them. Before I conclude tonight I would like to do two things. First of all I would like to give some examples, real life examples that have been brought to my attention, of people that have been denied care or suffered from some of the problems that I pointed out this evening that would be corrected by the Democrats Patients Bill of Rights, and then I would like to go over a few sections of a letter that the President wrote to Trent Lott, the majority leader in the Senate, asking that we move on this debate because I think that is the most important thing, that we move on this debate in the 4 weeks that we have left before this Congress is scheduled to adjourn. Let me give my colleagues some examples though, and I may have used some of these before on the floor, but I want to use them again tonight. Some of them, I think, are totally new because I think they best illustrate why we need the Patients Bill of rights. This example is from a newspaper dated January 21, 1996, and it talks about a 27-year-old man from central California who was given a heart transplant and was discharged from the hospital after only 4 days because his HMO would not pay for additional hospitalization, nor would the HMO pay for the bandages needed to treat the man's infected surgical wound. The patient died. Well, again I use the example with the drive-through deliveries. We did pass in the first effort to deal with these problems, we did pass in the last couple of years legislation that eliminated drive-through deliveries so that, if a woman is pregnant, she goes to a hospital, have the baby, she is guaranteed at least 48 hours for a normal delivery, and 2 days for normal delivery, 4 days for a C-section because many of the HMOs were forcing women out of the hospital within 24 hours. Now this case that I just mentioned with the heart transplant, under the Patients Bill of Rights the decision about whether or not the patient would be able to stay a few extra days in the hospital would be decided by the physician in consultation with the patient and the HMO would not be allowed to deny those extra few days that the physician thought was necessary. Another example; this is from the same year from Long Island. Well, this is from the Long Island News Day I should say, but it is about a mother in Atlanta who called her HMO at 3:30 a.m. to report that her 6- month-old boy had a fever of 104 and was panting and limp. The hotline nurse told the woman to take her child to the HMO's network hospital 42 miles away, bipassing several closer hospitals. By the time the baby reached the hospital he was in cardiac arrest and had already suffered severe damages to his limbs from an acute and often failed disease. Both his hands and legs had to be amputated. Now that may have been the example that my colleague, the gentleman from Iowa (Mr. Ganske), gave last week when we were talking about the same issue on the floor. Again I had not talked much about emergency care tonight, but what the Patients Bill of Rights does, what the democratic bill does, and I call it a democratic bill, but the Patients Bill of Rights has Republican supporters, too. Mr. Ganske from Iowa is, in fact, the chief sponsor of the bill. So it really truly is bipartisan, but the Republican leadership basically has opposed it. So even though there are some Republicans that support it, the leadership is opposed to it. And what our bill would do is it would say that the decision about going to an emergency room and going to the closest hospital as opposed to some hospital further away is based on the average citizen's analysis; you know, what we call a prudent lay person's analysis of what is an emergency. And so if you have the situation where your 6- month-old baby had this fever and was panting and limp, the average person would say, well I cannot wait to go to a hospital 42 miles away, I have got to go to the hospital next door or within a few minutes of my house, and therefore the HMO would have to pay because average citizen would understand that that is necessary, and you cannot wait to go to a hospital 42 miles away which is absurd. I think most people have no idea that their HMOs put these kind of restrictions in, but then they find out when it is too late. Let me give you another example. This is from the Minneapolis Star Tribune, March 23, 1996. A 15-year-old girl with a serious knee injury was taken by her parents to a PPO orthopedic surgeon. The surgeon said there were 2 kinds of surgery for such an injury, traditional scapel surgery and state-of-the-art laser surgery which is considered the most effective method. The insurer would not pay for the more expensive lasar surgery. A company claim supervisor was quoted as saying we are not obligated contractually to provide Cadillac treatment, but only a treatment. Well there again we go back to who is going to define what is medically necessary. Under the Republican bill that decision is made by the insurance company which is the way it is now under the current law. Under the democratic Patients Bill of Rights that decision is made by the doctor in consultation with the patient. So, if the doctor in this case said that the most effective method is the state-of-the-art laser surgery, that is what the insurance company would have to pay for. This kind of illustrates, this also illustrates, the gag rule example as well. Now fortunately in this case the HMO apparently did not have a requirement that the physician not tell the patient about the better method, but there are many circumstances where the HMO will actually say to the physician that he cannot mention the alternative, the better alternative, in this case the state-of-the-art laser surgery so that the patient would not even know that there is a better alternative, and that is another thing that we are eliminating with the Patients Bill of Rights. Let me mention a couple of other examples, and then I will conclude with this letter that President Clinton sent. This is in Oklahoma. It is from the Washington Post, March 12 of 1966, and this is the case in Oklahoma where a neurologist performed a cat scan on a patient suffering headaches revealing an abnormality in the brain. The doctor recommended a magnetic resonance arteriogram which required a one night stay in the hospital. The patient's HMO denied payment on the grounds the test was investigative. The doctor wrote the patient saying I still consider that a magnetic resonance arteriogram is medically necessary in your case. The HMO wrote to the doctor: I consider your letter to the member to be significantly inflammatory, the HMO's medical director wrote. You should be aware that a persistent pattern of pitting the HMO against its member may place your relationship with the HMO in jeopardy. So here, because the physician refused to abide by a gag rule and said that he was going to tell his patient what needed to be done even though the HMO would not cover it, now he is in trouble, and he is likely to be penalized or perhaps thrown out of the network because he told the truth. Well, what kind of a society do we live in where we advocate freedom of speech yet we would deny the physician to speak out and tell his patient what is best based on his own medical opinion? Well, once again that would be corrected by the democratic Patients Bill of Rights not only because the physician would be allowed to say what he had to without any repercussions from the HMO but also because the procedure that was recommended, they would have to pay for it. What a lot of the HMOs do, they get around paying for a particular type of surgery or operation or procedure by saying it is investigative, et cetera, speculatory, it is something that has not received enough attention. What we find is that oftentimes a procedure that really is needed by the patient is not reimbursed or not paid for on those grounds. Let me just give one final example, if I could. This is from the New York Post, September 19, 1995, and this is a 12-year-old girl who had to wait half a year for a back operation to correct a severe scoliosis. The HMO rejected the parents' bid to have a specialist perform the procedure, insisting instead on an in-network surgeon. After taking 6 months to determine that no one in its own network was capable, the HMO relented. Now, there again, that goes back to what I mentioned before. Under the Democratic Patients' Bill of Rights, if, within the network, there is not a specialist who can deal with the particular problem or the health care need that one has, then one is entitled to go outside the network and the HMO has to pay for the specialist in that circumstance, and that would clearly cover this case. I could go on and on and mention a lot more examples, and we certainly will over the next few weeks in an effort to make sure that this issue comes to the attention of the Senate and that we have action in the Congress as a whole, and we send a bill to the President before we adjourn in October. The President, in responding to a letter to Trent Lott, the majority leader in the Senate earlier, this month, and I think we entered this letter into the Record last week, so I am not going to go into all of the details; but he spells out the problems that he has with the Republican bill that is proposed in the Senate and has a lot of similarities, in a negative way, to the House Republican bill. But I do want to point out what the President is talking about in terms of the need to move the agenda. He says that, ``Since last November, I have called on the Congress to pass a strong, enforceable and bipartisan Patients' Bill of Rights. During this time, I signed an executive memorandum to ensure that the 85 million Americans in Federal health plans receive the patient protections they need, and I have indicated my support for bipartisan legislation that would extend these protections to all Americans. With precious few weeks remaining before the Congress adjourns, we must work together to respond to the Nation's call for us to improve the quality of health care Americans are receiving.'' Mr. Speaker, I want to point out that not only has President Clinton been talking about the need for the Patients' Bill of Rights for over a year, started very emphatically in the State of the Union address last January, but he has signed these executive orders that actually expand the types of patient protections that I talked about tonight to those within Federal health plans. Also, last year, the Congress passed and sent to the President, and he signed, the Balanced Budget Act, which also included a lot of these protections in Medicare and Medicaid programs. Not all of them, but a lot of them. So the President has done his part, really, to not only bring this issue to the attention of the Congress and the American people, but also through administrative methods to try to include it in any plan that comes under the aegis of the Federal Government. However, none of these things apply, or at least are required under Federal law, for anyone who has private health insurance. That is not fair. Clearly, if these things are good enough for the Federal Government, for Federal employees, for those who are in Medicare and Medicaid, it should apply to everyone equally, the same way. More needs to be done, of course, because a lot of the things are not covered even under the Federal plans because the President does not have the authority to expand all of the patient protections to those plans, so we need the patient protections that I mentioned tonight, not only to make it fair for those who have private plans, but also to cover all of the public plans as well. The last thing, the other thing that I wanted to point out that the President says in his letter to the majority leader in the Senate, he says, ``I remain fully committed to working with you, as well as the Democratic leadership, to pass a meaningful Patients' Bill of Rights before the Congress adjourns. We can make progress in this area if, and only if, we work together to provide needed health care protections to ensure Americans have much-needed confidence in the health care system. I urge you to make the Patients' Bill of Rights the first order of business for the Senate.'' The President has indicated, and all of the Democrats have indicated, that we want to work with the Republicans in a bipartisan way to get the Patients' Bill of Rights, or something like it, passed. So far we have not been getting that cooperation from the Republican leadership, even though we do get support from some Republican Members individually. So I would urge tonight, we only have less than 4 weeks left really, and I would urge my colleagues to put pressure on the Republican leadership, in the Senate primarily, and ultimately in both Houses of Congress, to get this managed care reform agenda moving. Let us have debate in the Senate, let us get something that both houses can agree on, and let us send it to the President before the October recess. We owe this to the American people, because so many people are suffering now when they are denied health care that they should have as Americans.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, tonight I want to talk about the prospects of passing a managed care reform bill in the time Congress has left before it adjourns for the year in October. Last evening, I mentioned how over the August break I had many town meetings and outreach programs throughout my district and continually the issue of managed care reform was the number one concern that my constituents had. I know, having talked to many of my colleagues since we returned this week, that many of them say the same thing; that this is the issue that the average American or that most Americans want this Congress to address before we adjourn in October. Although there is not much time left, I am hopeful that we can reach an agreement with our Republican colleagues and send the President a managed care reform bill that he can sign. Now, we know that the full House took up the issue of managed care reform before the August recess and the Republican leadership's bill narrowly passed and the bipartisan Patients' Bill of Rights, which I support, unfortunately was narrowly defeated. I want to stress again how important it is to pass the bipartisan Patients' Bill of Rights or at least something very much like it because of the valuable patient protections that are included therein, such as the return of medical decision-making to patients and health care professionals, not insurance company bureaucrats; access to specialists, including access to pediatrics specialists for children; coverage for emergency room care; the right to talk freely with doctors and nurses about every medical option; an appeals process and real legal accountability for insurance company decisions and, finally, an end to financial incentives for doctors and nurses to limit the care that they provide. If Congress is going to get a bill to the President that is like the Patients' Bill of Rights, then the Senate must act very swiftly. We passed the Republican leadership bill, which I think was a bad bill, in the House but now it is up to the Senate to pass a strong bill so that we can go to conference and get something to the President's desk that both Houses agree on. The House Republican bill, I would point out, is considerably different from the Senate Republican bill, for one thing, but more importantly both Republican bills fail to address a number of provisions that the President and congressional Democrats believe must be part of any managed care reform legislation. Just as an example, both the House and Senate Republican bills let HMOs, not health professionals, define medical necessity. They both fail to guarantee access to specialists. They both fail to assure continuity of care and they both weaken the standards for emergency care which needs to be strengthened. Both Republican bills allow financial incentives to jeopardize patient care. They both fail to hold HMOs accountable when the decisions harm patients, and they both are loaded with poison pills. Issues such as medical malpractice reform, expanding medical savings accounts, expanding health insurance pools, whether or not we agree or disagree on these issues, they are just issues that are very controversial that are going to kill the legislation because they take away from the issue of managed care reform. I just wanted to say this evening, because I want to yield some time to my colleague, the gentleman from Ohio (Mr. Strickland), that the President has already said that he would veto the House bill if it was sent to him in its current form. In a letter which I have here, and I would like to introduce into the Record dated September 1, that the President sent to Senate Majority Leader Trent Lott, he reiterates that he would veto a bill that does not address the serious flaws that I have just mentioned in these Republican bills.

Mr. PALLONE. Mr. Speaker, we have very little time left, but I want to thank the gentleman from Ohio (Mr. Strickland) for giving us those two examples. All I can say again, and I am sure that the gentleman from Iowa (Mr. Ganske) will say the same, is that this is happening on a regular basis. These are not isolated instances. We are getting these kinds of problems on a daily basis in our districts, and that is why it is so important that we pass the Patients' Bill of Rights.

Mr. PALLONE. Mr. Speaker, can I just clarify again, is that because it is understood that the other 45 minutes of the hour will be dedicated to the gentleman from Iowa (Mr. Ganske)?

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is not my intention to use all the time this evening, but I did want to spend some time this evening to talk about managed care reform. Today, after having spent the last month in their districts, Members of the House returned from Congress' annual August recess. And the month of August always provides Members with an extended opportunity to hear what is on their constituents' minds. And I just wanted to assure my colleagues that the number one issue on people's minds, at least in my district, continues to be managed care reform. I think over the last 4 weeks I held about 20 town meetings or forums in various municipalities in my district, and it was the issue people were most concerned about before we left in August and it continues to be the one that I hear most about at town hall meetings and the open houses that I have had in my district offices. And I think it will be the major issue that people worry about in terms of legislative action in this Congress and that we need to address the issue before this Congress adjourns sometime in October. One of the things that a lot of people ask me is exactly what type of reform we have in mind. And I talk specifically about the Patients' Bill of Rights, which is the legislation that myself and other Democrats put forth before the House before the August break. The Patients' Bill of Rights, the Democratic Patients' Bill of Rights, basically provides a number of patient protections, if you will, for Americans that are in a managed care organization, or HMO. And just to give an example of some of the patient protections that we do provide in the Democratic bill, most important is the return of medical decision-making to patients and health care professionals, not insurance company bureaucrats. Most of the people who have attended my town meetings or come to my district office complain to me about the fact that a decision about what kind of procedure or operation they might have or whether they are able to stay in the hospital after a particular operation or particular care that they need that that decision is increasingly made by the insurance company and not by the doctor. The doctor may say to them, ``Well, I really think you should be staying in the hospital a few more days,'' or the doctor may recommend a particular medical procedure or operation and the insurance company decides that they will not pay for it because they do not deem that operation medically necessary. Well, it should not be the insurance company that makes that decision. It should be the physician in consultation with the patient. And that is what the Democrats are trying to do with our Patients' Bill of Rights, bring that decision about what is medically necessary back to the physician and the patient, to the health care professionals, not the insurance company bureaucrats. The other major patient protection that we provide in our Democratic bill relates to access to specialists, including access to pediatric specialists for children. Many people have complained to me that if they need a specialist, sometimes a specialist is not available within the managed care network or that they do not feel that the person that they are referred to within the managed care HMO network really has the expertise that is necessary with regard to the care that they need. And what we say in our Democratic bill is that they have to be guaranteed access to a specialist. If in fact these specialists within the HMO network are not adequate, for example, if the HMO decides that they can see a pediatrician but not a pediatrician that has a specific type of expertise, then they have the right under the Democratic bill to go outside the network and the insurance company would have to pay for that specialist that is necessary even though it is not a doctor that operates within the HMO. The other major issue that I hear constantly from constituents, probably even more so than any other, is coverage for emergency room care. Many insurance policies now that come under managed care, or HMOs, would say that in a given circumstance they might have to go to an emergency room, to a hospital, that is further away from where they are located, or if they do go to the emergency room, they may decide afterwards that it really was not an emergency, and therefore, they are not going to cover the care and they have to pay for it out of their own pocket. Well, what the Democratic bill says is that if the average person, it is a standard we call a ``prudent layperson'' standard, if the average person, the average citizen, would feel that at a particular time they need to go to an emergency room because they have a particular type of pain or they have suffered a particular kind of injury, then they have the ability to go to the closest emergency room and the insurance company has to pay the bill. It really is common sense. Most of these patient protections, Mr. Speaker, are nothing more than common-sense proposals that I think most Americans would feel that we already have. But we do not; we do not have these guarantees, and we need to make these patient protections, these guarantees, we need to make them the law of the land. The other issue that comes up and another patient protection in the Democratic bill is the right to talk freely with doctors and nurses about every medical option. What we have found is that many of the HMOs now will simply tell the doctor that they cannot talk to the patient about a particular medical option, say, a particular procedure or operation, if they do not cover it. It is called a ``gag rule.'' They basically implement a gag rule and limit what the doctor or the nurse can say. That is not right. We live in a country where we value freedom of speech, and certainly we would expect that our physician would be able to tell us freely whether we need a particular procedure and what kinds of procedures or care are available. The Democratic bill basically guarantees that there would be no gag rule and that the physician or the nurse would have the right to talk freely with the patient about medical options that might be necessary. Also, in our Democratic bill we have an appeals process and real legal accountability for insurance company decisions. Now, let me talk a little bit about that. What I find is a lot of people will come to my office or they will testify at some of the hearings that we have had in Congress, and they will say that if the insurance company or the HMO denied them care and said that they could not have a particular procedure or said that they had to leave the hospital, and they tried to appeal it, they either filed a grievance or they called up the insurance company and said they did not agree with their decision and would like to have it reviewed, that right now, for most people, that is not really an option because the review, if there is one, is done internally by the HMO, by the insurance company, and they simply review their own decision and decide that they are wrong and that is the way that it is going to be. Well, what we do in the Democratic bill is, we say that there will be an external review procedure, that it will not be the insurance company that they go to if they have a grievance or they want to appeal the denial of care. They get to go to an outside board that they do not appoint and they cannot influence that will decide whether or not that decision was accurate; and if it was not, they have the power to overturn the insurance company and guarantee that the care is provided or that the care is reimbursed for and paid for. In addition to that, for many people now, if they are in what we call an ERISA plan, which is a plan where their company that is helping pay for the insurance is self-insured and, therefore, it comes under the Federal Government's review, that they may not have a right to sue the HMO or the managed care organization for damages that are inflicted because they denied them care. They cannot go to court and recover for the damages that occurred because they were denied a particular type of care. Well, that is not right. People should be free, in my opinion, to be able to go to court and sue the HMO, sue the managed care organization, if they have been denied care and they suffered damages. And that is what we also say in the Democratic bill, that they will have that right. Again, we are not talking about anything that anyone should be surprised about. It only makes sense that if someone injures them that they should be able to go to court and recover for their injuries. And finally, there are a number of patient protections, but I wanted to talk about one more that I consider particularly important, and that is an end to financial incentives for doctors and nurses to limit the care that they can provide. What we find now is that many insurance companies, many HMOs, many managed care organizations basically, give a financial incentive to the doctor if they limit the care that is provided, so that, in a sense, they have an incentive because they are getting paid more, for example, if they do not do as much and if they can show over a period of time that they have not prescribed or recommended certain procedures that may be costly. Well, again, that is just the opposite of the type of incentive that we should have. People should feel free, if their doctor thinks that they need care, that the doctor will recommend that the care be provided and not have a financial incentive not to provide it. Again, our Democratic bill makes it clear that that type of financial incentive to limit care is not allowed and is essentially made illegal. Now, I wanted to talk about what happened here in the House before the break, before the August break. The House, of course, hastily considered a Republican managed care bill and the Democrat's Patients' Bill of Rights, which I have talked about this evening, was essentially defeated by about 5 votes, very narrowly, and I believe that the Republican leadership was anxious to get something passed so that the Republicans would have something to point to when voters raised the issue of managed care reform at town meetings and other opportunities back in our districts. So what I want to stress tonight is that the Republican alternative to this Democratic Patients' Bill of Rights that I talked about this evening really is not going to do the trick. It is not going to be effective in providing patients with adequate protections. I just wanted to spend a little time, if I could, talking about why this Republican plan that was passed in the House, and was basically passed and the Democratic plan was defeated, why this Republican plan will not work effectively to protect patients' rights and to reform HMOs and managed care. I do not do this in an effort to suggest that I am not open to alternatives that would come from the other side and come from the Republican leadership but I am concerned that if the Republican bill is the one that ultimately were to pass the Senate and go to the President's desk that it really would not do anything to improve the situation for health care for those in HMOs and, in fact, might make it a lot worse in terms of the kind of protections that people have. I talked a little bit about access to specialists under the Democratic proposal. The Republican bill does not ensure access to specialty care. For example, if a child with cancer needed to see a pediatric oncologist, there is no requirement that he or she would have access to that specialist. If the HMO said, okay, we will provide a pediatrician for children but we are not going to provide any specialists for children beyond the basic pediatrician, then you would not have the ability under the Republican plan to see a pediatric specialist or certainly to have the insurance company pay for it. Protection of doctor/patient relationship, I talked about how one of the most important things that people bring up to me is the need to have the decision about what is medically necessary and what care is provided, that that decision be made by the doctor and the patient and not by the insurance company. Well, under the Republican bill, basically the insurance companies decide what is medically necessary. The health plan can define medical necessity any way it wants and if there is a review of a decision to deny care, then the review only goes back to what the plan originally provided in terms of what is medically necessary. So, for example, if you want a particular type of operation and the HMO decides that they are not going to pay for it, well, they decide what is medically necessary, and if you go out and try to appeal that, the court or the appeal board would have to say, well, that decision about what is medically necessary is made by the insurance company. We cannot review it. So, again, this is a major flaw. If the decision about what is medically necessary is decided by the insurance company essentially the patient has effectively no protection. The other thing that I have not discussed tonight but I want to discuss, and I think is very important, is the whole idea of choice of doctors. Now, we know that the basic idea with an HMO or a managed care plan is that the plan is limited to a network of doctors that sign up and that you are allowed to choose from, but what we say in the Democratic plan is that we will do initially, when a patient decides what kind of health insurance to sign up for, that they must have the option of being able to sign up for an HMO that allows point of service; that allows them to go outside the plan and see another doctor even if it means they have to pay a little more. So that what we are saying is that you will have a choice in the beginning when you decide what kind of health insurance to buy, you will have a choice, other than a closed panel HMO. Right now, many employers only provide what we call a closed panel HMO. In other words, you can take the HMO and they have their network of doctors and if you do not want to see one of those doctors, that is it. Those are the only choices you have. What we are saying in the Democratic bill is that initially you should be able to decide to have the point of service option so that you can go outside the network at your own option if you want to pay a little more for a physician that is not a part of the network. Now, again, contrasting that Democratic proposal with the Republicans, what the Republicans put forward, they have a point of service option, if you will, but it is so full of loopholes as to make it essentially meaningless. There are exemptions for Health-Marts. There are exemptions if the employer does not want to contract with the plan to do it; exemptions if premiums increase 1 percent. Basically, they are saying if the cost of premiums go up or if the employer doesn't want to have an option where you can go outside the network, then you do not get this point of service option where you can choose your doctor. So essentially they have not provided for a point of service where you can choose your doctor. Again, talking to many of my constituents during the August break, this was a very important point, that they wanted to have that option if they wanted to go outside of the network and choose a doctor, even if it meant that they had to pay a little more. The other thing that I wanted to mention is, again, with regard to specialists, there are a few things that the Democratic bill does that the Republican bill does not do. First of all, we allow women to choose their obstetrician or the gynecologist as a primary care doctor. That is not allowed under the Republican plan. Again, this is important, because if your OBGYN is your primary care doctor then that person can make referrals to other specialists. If they are not, then you are dependent upon the general practitioner essentially to make those kinds of referrals. Let me also talk about emergency care again and how the bills differ, how the Republican and the Democratic plan differ. In the Democratic plan, we specifically say that severe pain is a basis for going to the emergency room. Like, for example, if you have severe chest pains and the average person would think well, that is a good enough reason to be able to go to the emergency room that is closest to me, well, the Republican bill does not include that so that essentially, again, it is up to the insurance company to decide whether or not there was justification for you to go to the emergency room. To me, that is very important. I do not want to have to second-guess, when I have severe chest pains, whether or not it is strong enough for me to have to go to the emergency room. I would think that the average person would think if they have severe chest pains that they go to the emergency room and they get care and it is going to be covered. That is the way it should be. Unfortunately, that is not the way it is under the plan that the Republican leadership brought forward here a few weeks ago before we had the August break. Now, I just wanted to talk about a few other things that the Republican bill does that I think ultimately cause the situation even to be worse in terms of patient protections and health care. The Democratic bill is pure in the sense that it seeks to address the issue of managed care reform and HMO reform directly without adding a lot of other things. When we talk about health care in the House of Representatives amongst our colleagues, Democratic and Republican, we know that there are a lot of issues that need to be addressed. For example, one of the biggest concerns I have is the fact that so many people are uninsured and have no insurance. The number keeps growing. Others want to address the issue of malpractice reform, because they think that physicians in many cases are too liable for malpractice and that we need to address that issue. Others feel that there needs to be ways to expand and experiment with other kinds of health insurance that many people do not have right now. Well, all that makes sense and certainly are things that we should look into, but what the Republican bill has done, and I think it is purposeful, is to throw a lot of these things that are unrelated to managed care reform into their legislation, which will make it very difficult for the legislation to move forward. Now, again, we only have about a month here from today until we are scheduled to adjourn. It is going to be very difficult in that month to get anything passed. So if you overlay legislation dealing with managed care reform with all these other concerns, you are pretty much guaranteeing that we are not going to address the issue. Well, what the Republican leadership has done is they put in their legislation medical malpractice reform. They have also said that if companies right now that are self-insured and come under the Federal law, under the ERISA, if a group of companies want to get together and start their own self-insurance pool, that they also will be exempt from State laws and come under Federal law and be under ERISA and also, therefore, there would not be the ability to sue. Well, throwing that in, throwing in, again, an expansion of self- insurance and bringing it under ERISA is another sort of poison pill that takes away from the real issue at hand, which is managed care reform. So we have the medical malpractice reform, we have the expansion of ERISA, and a third thing that we also have is expansion of medical savings accounts. Medical savings accounts were started on an experimental basis last year when we passed the Balanced Budget Act and it is a very controversial way of basically allowing people to take money, for example, in the case of Medicare, if you had a medical savings account under Medicare, if you decide to have a very high deductible and pay out-of-pocket for most of your every day health care expenses, then the Federal Government would give you money in a savings account from Medicare, from Medicare funds, rather than pay for your health insurance for most of the normal daily occurrences that might result in your need to have health care. So you basically get an account coming from the Federal Treasury for you to save money as opposed to getting your health insurance paid for. You have to pay out- of-pocket from that account. Well, it is an idea that some people think needs to be looked into and we do have it on an experimental basis, but what the Republicans have done in their bill is to allow this to be expanded to cover a lot more people in the context of the managed care reform that I have been talking about this evening. Well, once again, that is a poison pill. That is a controversial issue, along with the medical malpractice reform and the expansion of ERISA, that needs to be debated, needs to be discussed a lot more by the House of Representatives and by the Senate. If we throw that into managed care reform, we are basically going to kill managed care reform and not allow it to come to the floor and really be passed and considered in the month or so that we have left here before we adjourn. So what I am asking tonight, and I will be saying it many more times over the next month while we are in session, is that we put partisanship aside, we put all of these other issues aside that really do not relate to managed care reform, and we try to get to the heart of the matter. Americans from all walks of life, no matter how poor, no matter how rich, no matter how young, no matter how old, that I have talked to in my district and even from other parts of the country feel that this issue of HMO reform needs to be addressed and needs to be addressed now. We need to address it before we adjourn. We should get together and pass something, pass the Patients' Bill of Rights with the patient protections that I outlined or at least something very similar to it. I am just hopeful that on this first day when we are back, and, of course, there are a lot of other things on our mind here in Congress, that we pay attention to this and try to get HMO reform approved before we adjourn sometime in October.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise in strong support of the Thomas Alva Edison Sesquicentennial Commemorative Coin Act. Although it was last year that marked the sesquicentennial of Edison's birth, it is never too late to commemorate the vast creativity, scientific discovery, and technological achievement of this great American inventor and industrialist. Edison has impacted all of our lives with the invention of the photograph and over a thousand other patented devices, not to mention the prototype for the modern industrial research laboratory. As Members of Congress, Edison's very first patented invention may have been the most influential. Many of you may not know that the first patent that Edison ever received was for an electric vote recorder, which he invented in 1869 at the ripe old age of 22. I am proud to represent the town of Edison, New Jersey, home of Edison's Menlo Park lab where Edison spent the peak of his creative life--including the invention of the phonograph in 1877. The Edison Tower now commemorates the site of the Menlo Park lab, where Edison created some of the most revolutionary inventions in history. The tower also stands as a key symbol of local pride for the community and the people of Edison Township. Unfortunately, the Edison Tower has been forced to close due to structural deterioration. With the passage of the Thomas Alva Edison Sesquicentennial Commemorative Coin Act, the Edison Tower and six other Edison-related historic sites across the country would benefit from much needed funding. Proceeds from the sale of an Edison commemorative coin would be used in combination with state and local contributions to restore the Edison Tower and ensure that the adjacent Tower Museum remains open to the public. I would like to thank my colleague, Congressman Gillmor, for his leadership on this issue and for introducing this important legislation. And I urge all of my colleagues to vote to commemorate the unrivaled accomplishments of a great inventor and a great American, Thomas Alva Edison.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this morning I want to join with the people of India and the Indian American community as we conclude a year of celebrations in honor of the 50th year of Indian independence. The 51st anniversary of India's independence will actually occur on August 14th of this year, when Congress is in recess. So I wanted to take this opportunity today to mark this important occasion before my colleagues and the American people in this House. On August 14 of 1947, after years of determined and dignified struggle, the people of India finally gained their independence. That midnight hour, a vote by India's first Prime Minister, Nehru, in a stirring speech to the Parliament, marked the beginning of an inspiring effort by the people of India to establish a Republic devoted to the principles of democracy and secularism. In the 5 decades since then, despite the challenges of sustaining economic development while reconciling her many ethnic and religious and linguistic communities, India has stuck to the path of free and fair elections, a multiparty political system, and the orderly transfer of power from one government to a successor. Mr. Speaker, earlier this year, India once again demonstrated its continued commitment to democratic values through its parliamentary elections in which more than 300 million people voted. The 1998 elections were but the latest example of the vibrancy of the electoral process in the world's largest democracy. Mr. Speaker, while the programs and policies have changed over the years, successive Indian governments representing various parties and coalitions, have continued to build on the dream of India's first Prime Minister Nehru to move forward on the path of representative democracy and economic development. Mr. Speaker, there is a rich tradition of shared values between the United States and India. The United States and India both proclaimed their independence from the British colonial order. India derived key aspects of her Constitution, particularly the statement of fundamental rights, from our own Bill of Rights. The Indian independence movement has strong moral support from American intellectuals, political leaders and journalists. One of our greatest American heroes, Dr. Martin Luther King, in his struggle to make the promise of American democracy a reality for all of our citizens, Dr. King derived many of his ideas of nonviolent resistance to injustice from the teachings of the father of India's independence movement, Mahatma Gandhi. In our time, Mr. Speaker, we are seeing another exciting way in which our two societies are moving closer together, namely through the influx of immigrants from India who have made their homes in America. The Indian American community, now numbering more than 1 million, have become an important part of the ethnic mosaic in my home State of New Jersey and in communities throughout the United States. As they strive for a part of the American dream, Indian Americans continue to enrich our civic, political, business, professional and cultural life through their commitment to hard work, family values and communities. The Indian American community also serves as a human bridge between the world's two largest democracies. Another way in which India and America continue to grow closer is through economic ties. The historic market reforms begun in India at the beginning of this decade continue to move forward, offering unparalleled opportunities for trade, investment and joint partnerships, all of which include a human dimension of friendship and cooperation, in addition to the economic benefits for both societies. Mr. Speaker, it is my hope that this House will soon after the recess pass legislation I have sponsored with my colleague, the gentleman from Florida (Mr. McCollum), which would allow the Government of India to construct a statue of Gandhi here in Washington, D.C. The legislation, which has been reported out of committee and is ready for floor action, stipulates that American taxpayers would not have to bear any costs for constructing or maintaining the memorial, but merely provides the land for the Government of India to construct the monument. The location of the monument would be adjacent to the Indian Embassy on Washington's ``Embassy Row'' on Massachusetts Avenue. The National Capital Memorial Commission has already given its approval to this proposal. Washington, as we know, is a city of great monuments and memorials that help define who we as Americans are and what we as a Nation stand for, and I believe that the proposed Gandhi memorial would be a worthy addition to the landscape of our Nation's Capital. Mr. Speaker, just a few weeks ago, we Americans celebrated the Fourth of July. For nearly 1 billion people in India, one sixth of the human race, the 14th of August holds the same significance, and I am proud to extend my congratulations to the people of India as they embark on their second half-century of independence and democracy. Mr. Speaker, as we enter the August recess after today, the United States and India are preparing to meet and discuss peace and security in south Asia. We all know that our relations were somewhat dampened after the explosion of the nuclear bombs, the tests that occurred back in May of this year. Last week the Congressional Caucus on India and Indian Americans met with Assistant Secretary of State for South Asia, Rick Inderfurth. And Mr. Inderfurth has accompanied Deputy Secretary of State Strobe Talbot for talks in New Delhi. Mr. Inderfurth said that the meetings in India were positive and he believed that progress was being made in terms of improving relations. He categorized the bilateral meetings as successful ``quiet diplomacy.'' He told the India Caucus that the United States was not demanding, but helping India take the proper steps towards international consensus on nuclear nonproliferation. Later this month in Washington, Mr. Talbot will again meet with India's Prime Minister's representative, Mr. Jaswant Singh, to reconcile U.S. differences on the Comprehensive Test Ban Treaty. I am confident that progress will be made at this meeting. I am confident because earlier this week, India's Prime Minister Vajpayee told the Indian Parliament that India was close to signing the Comprehensive Test Ban Treaty. The Prime Minister felt that India was ready to sign, because India's national security is no longer compromised and it is not necessary to conduct further nuclear tests. Furthermore, he said that he wanted to improve bilateral relations with Pakistan and that he wanted to conduct ranging talks with Pakistan that incorporated long-term vision. Although a recent meeting between India and Pakistan's prime ministers did not lead to concrete and positive results, they may meet again in South Africa later this month, and I am hoping that they will meet and resolve some issues that have kept them apart and begin talks for peace in south Asia. Mr. Speaker, I was very pleased to learn that the U.N. Conference on Disarmament is close to beginning new talks on halting the production of nuclear bomb fissile material. India, a member of the conference, has agreed to take an active role in the talks; and ironically, India and Pakistan's nuclear tests have revived the talks after they stalled for 3 years. When we return from the August recess, I look forward to working with Members of this body in giving the President proper sanction waiver authority so that he may have more flexibility in imposing sanctions. Senator Brownback has amended the Senate agricultural appropriations bill so that the President would have a limited waiver authority. And this amendment is similar to the proposal put forward by the Senate Task Force on Sanctions. Although the House agricultural appropriations bill does not include a similar amendment, I hope that my colleagues will include the amendment in the conference report. I have introduced similar language to the Brownback amendment and the Senate task force proposal, and I urge my colleagues in the House to support the Brownback amendment and give the President proper waiver authority. When India conducted nuclear tests earlier this year, for a period of time there was no dialogue between our two countries, but now we are talking and determined to maintain peace in south Asia. To encourage such dialogue, President Clinton should continue with his plans to visit India, probably this November. It has been almost 20 years since a U.S. President has been to south Asia, and if the President is serious about peace and nuclear nonproliferation, he should go to India. Mr. Speaker, I have a large Indian American constituency in my district in New Jersey, and this community feels very strongly that U.S.-India relations need to prosper, regardless of the two countries' views towards nuclear tests. One leader in the community, Dr. Sunil Jaitly, recently noted that the gap between India and the United States is not large and that the differences can be resolved. Dr. Jaitly said, and I agree, that ``the U.S. and India need to express to each other clearly and open-heartedly'' so that ``we may eliminate any and all misunderstandings created by the May 1998 events.'' Mr. Speaker, finally, I want to say that it is important that we support the administration and India in their efforts to reconcile their differences in an effort to bring peace not only to south Asia, but throughout the world.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on Wednesday, August 19, at the Breakers in Spring Lake, NJ, Mr. Steve Hornik will be honored by his many friends at a testimonial dinner on the occasion of his retirement as President of the Monmouth-Ocean Counties Central Labor Council. Mr. Speaker, Steve Hornik has been President of the Monmouth-Ocean Council for more than 25 years. His has been a career in which he came up through the ranks, serving the labor movement at virtually every level. Through it all, he has put first and foremost the needs of working men and women, whose interests he has defended so staunchly for decades. Indeed, you could say that his enthusiasm and dedication for fighting for working people is in his blood. His father, Stephen, was a truck driver and is a retired member of the Teamsters Union. His mother, Frances, was a counter girl at Woolworth's, who walked picket lines to try to organize her co-workers, and later became a member of Local 56, the United Food and Commercial Workers Union (U.F.C.W.). Steve Hornik first became a charter union member when he was 14 years old while working at Yankee Stadium and the Polo Grounds as a vendor for Harry M. Stevens Concessions, where he helped to organize his fellow workers. He was later a member of the Teamsters Union Local 814, then the Mailers Union of the big six Newspaper Guild at the New York Times and John Sweeney's Local 32A, working nights while going to school. He later went to work at the Maxwell House Coffee Plant in Hoboken, NJ, where he became a member of Local 56, Amalgamated Meat Cutters and Butcher Workmen's Union of North America, which has since merged to become the U.F.C.W. Steve Hornik has been a member of Local 56 for 40 years, during which time he moved up the ranks from Alternate Department Steward and Department Steward of 250 members, then Chief Steward of the plant of 1,200 members, after which he was put on the Local 56 staff as Organizer, Business Representative, after moving on to the Officer's Staff as Press Secretary, First Vice President and Secretary Treasurer of the 16,000-member local for more than 20 years. He was a charter member and President of the Hunterdon- Warren Counties Central Labor Council for four years, after which he was elected President of the Monmouth-Ocean Counties Central Labor Council. Some of the other responsibilities Steve Hornik holds or has held, representing labor, include: Chairman of the Rutgers University Trade Union Consulting Council, the Monmouth County Workforce Investment Board, United Way of Tri-State Board of Governors, and a Commissioner on the Governor's Employment and Training Commission. He is also on the Advisory Boards of Brookdale College, Monmouth University and is a member of the State Board of Arbitration and Mediation. He was previously on the Executive Board of the New Jersey Central and State Lung Associations, a Member of New Jersey Chief Justice Robert N. Wilentz's Courts Committee on Efficiency, the Private Industry Council, the Congressional Award Council and the Manalapan Democratic Club. He has been a member of numerous State and County screening committees, and was a delegate to four of the last five Democratic Conventions. He remains a County Committee Member, a position he has held for the last 35 years. He has been and continues to be active with the Knight of Columbus. Steven Hornik is also a devoted family man. He and his wife Arline have four grown children and 10 grandchildren. Mr. Speaker, I could go on and on, talking about my good friend Steve Hornik, citing his many accomplishments on behalf of working people and his many contributions to our community. At the testimonial in his honor later this month, many of these great accomplishments will be recounted, happy memories recalled and funny stories told. We will miss his hard work, his energy and his honest dedication to fighting for the interests of working people. Mr. Speaker, labor unions have achieved many important victories over the years, fighting for safe working conditions, living wages, health care benefits and a dignified retirement. The battles fought and won by the labor movement have not only helped union members. America's broad- based economic growth, the expansion of the middle class, the existence of programs like Social Security and Medicare, and the realization of the American dream for tens of millions of families all owe a tremendous debt of gratitude to labor unions. These days, unions are under attack. But I believe public support is still strong. I know that the unions will continue to fight for such basic rights as universal health care coverage, increased pension security and fair trade agreements that protect American jobs. It's great leaders like Steve Hornik who have made, and continue to make, the union movement strong. I regret that Steve Hornik will no longer be at the helm of the Monmouth-Ocean Central Labor Council. But I know that we will continue to benefit from his contributions to the ongoing fight for social and economic justice for working people. Steve Hornik has contributed to that fight more than anybody I know. The example that he set will guide us all for years to come.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from Maryland (Mr. Gilchrest), the cosponsor of the amendment.

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from North Carolina (Mr. Jones).

Mr. PALLONE. Mr. Chairman, I yield myself 2 minutes. Mr. Chairman, polluted runoff into our bays, lakes, rivers and estuaries is the Nation's number one water pollution problem and affects over half of all Americans who live along the coast. It also impacts the 32 percent of the Nation's gross national product that is derived from coastal areas and resources. This amendment, which is cosponsored by the gentleman from Maryland (Mr. Gilchrest), increases funding for the coastal nonpoint pollution program and the Coastal Zone Management Act to meet the levels in the Administration's Clean Water Action Plan. Both of these programs provide invaluable financial assistance to the States to deal with the problems of coastal nonpoint pollution. More specifically, the Pallone- Gilchrest amendment provides an additional $4 million for coastal States to complete their coastal nonpoint source pollution control programs. Since 1995, only $1 million has been appropriated for this purpose. The amendment also adds $1 million in coastal zone management grants so that all eligible coastal States can receive maximum support from this program, including three newly eligible States, Minnesota, Ohio and Georgia. These grants are used for important projects such as waterfront revitalization, improving public access to beaches, and controlling coastal nonpoint source pollution, the country's leading cause of water quality problems. Finally, the amendment increases funding for coastal zone management enhancement grants by $3 million. This funding is particularly important to those States which have already reached the existing cap in coastal zone management funding. This is a modest amendment, Mr. Chairman, $8 million in all, but it is an amendment that will have an enormous impact for 30 coastal States and four territories. It is money that can easily be leveraged. The coastal zone management program has a proven $2 return for every Federal dollar invested. Mr. Chairman, clean water is not only important for our environment, it is important for our ports and tourism industry. I urge my colleagues to join the gentleman from Maryland and myself in casting a vote for clean water and adopting this important amendment. Mr. Chairman, I reserve the balance of my time.

Mr. PALLONE. Mr. Chairman, I offer an amendment.

Mr. PALLONE. Mr. Chairman I demand a recorded vote.

Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentlewoman from New York (Mrs. Lowey), a member of the Committee on Appropriations. (Mrs. LOWEY of New York asked and was given permission to revise and extend her remarks.)

Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentlewoman from California (Mrs. Capps). (Mrs. CAPPS asked and was given permission to revise and extend her remarks.)

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, last week, our community lost one of its brightest lights with the passing of Thomas V. Karaban of Atlantic Highlands, NJ. Mr. Karaban, who died on Saturday, August 1, 1998, at the age of 53, gave up a lucrative career on Wall Street to found a children's charity, the Rainbow Foundation. Since its founding in 1984, the Rainbow Foundation has provided 3,000 children in New Jersey with wheelchairs, Christmas presents, air fare to hospitals and other needs. While we mourn his loss, Mr. Karaban's life is a cause for great celebration. His legacy of trying to ease the sorrow of gravely ill children will endure for years to come. Mr. Speaker, the story of Tom Karaban is one of those inspirational, ``only in America'' success stories--but, in the case of Mr. Karaban, success is measured in terms of what he gave back and how he enriched others. A native of Brooklyn, NY, Mr. Karaban worked for Chase Manhattan Bank and Eastman Dillion Union Securities before becoming Deputy Fiscal Agent for Fannie Mae, the federal national mortgage association. In 1983, while serving as a senior partner at Chapdelaine Government Securities, he became seriously ill and took a one-year medical leave. It was during that year that he got involved in fundraising for a child from Colts Neck, NJ, who was seriously ill. As his son, Edward, recalled in The Asbury Park Press, ``He found his calling then.'' The following year, he started up the Rainbow Foundation, working out of an empty bedroom in his family's Middletown, NJ, home. The first donation to the Foundation was $200,000 from the Karaban family's savings account. Eventually, Mr. Karaban devoted himself full-time to the administration of the Rainbow Foundation, leaving behind his Wall Street career. Mr. Karaban was widely honored for his years of dedication and devoted service to children in need. In 1995, Governor Whitman honored him with the Madeline Worthy Williams Youth Advocacy Award, one of the annual Governor's Awards, which are the highest honor the state can bestow on an individual. He has also been honored by the Veterans of Foreign Wars, the Middletown Chamber of Commerce, the New Jersey National Association of Social Workers, and New Jersey Monthly Magazine, among others. He served on a variety of organizations, including the Governor's Task Force on Child Abuse and Neglect, to which he was appointed in 1990 by former Governor Thomas Kean, the Knights of Columbus, Vince Lombardi Council, Middletown, the Bishop McFaul Assembly, the Middletown Police Department Advisory Board and he was an honorary chairperson of Catholic Schools Week at St. Mary's Grammar School, New Monmouth. He was a member of St. Agnes Roman Catholic Church, where he was a lector and Eucharistic minister. Mr. Speaker, it was about two years ago that Mr. Karaban began treatment for cancer. Throughout this personal ordeal, Mr. Karaban retained his optimism and his deep religious faith never wavered. Indeed, as his family and his many, many friends were aware, it was his abiding faith that sustained Mr. Karaban's tireless and selfless dedication to helping children. When he passed away, Mr. Karaban was surrounded by his family and at peace. Perhaps Mr. Karaban himself best summed up the motivation behind his inspiring commitment to serving others: ``They say the greatest legacy anyone can leave is to leave the world a better place than you found it. I try very, very hard to practice faith. When you try to practice your faith, you want to love God. The easiest way I can love God is to love children. I can't put my arms around God, but I can put my arms around a kid.'' Mr. Karaban leaves behind a loving family, including his wife, Margaret, two sons and a daughter, and many other relatives, as well as countless loyal friends who have been touched by his kindness, generosity and warmth. In what Tom would no doubt consider a fitting tribute, the Karaban family has asked that, in lieu of flowers, contributions be made to the Rainbow Foundation. To keep the Rainbow Foundation going strong would be the best tribute we could make to the life and work of Mr. Thomas V. Karaban.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I just wanted to thank the gentleman from Florida (Mr. Bilirakis), who is the co-chair of our congressional caucus on Hellenic issues, for organizing this special order and for all that he does on a daily basis to try to resolve the situation in Cyprus. It has now been, as we know, 24 years since Turkey brutally invaded Cyprus and divided the island, and the facts surrounding that occurrence are well-known. Since the time of that invasion, not a single nation in the world, not one nation, has recognized this self- proclaimed Turkish republic of northern Cyprus, with the exception of the regime in Ankara. The international community, rather, has unmistakably and unequivocally called for a negotiated peaceful settlement through a number of U.N. resolutions. I just wanted to say, if I could, to the gentleman from Florida (Mr. Bilirakis) that sadly, after nearly a quarter of a century's worth of attempts to resolve this conflict, the situation appears as far away from being resolved as it ever has been. Turkey continues to reject the Cypriot government's proposal for demilitarization of the island, a proposal that is supported by both Congress and the Clinton administration. On May 3, Mr. Speaker, a newly-attempted American effort to resuscitate the peace talks in Cyprus, headed by Ambassador Holbrooke, collapsed when the Turkish side change its position and began insisting that three new preconditions be met for reunification. These unfounded demands brought a public rebuke from Ambassador Holbrooke, who to his credit pointedly assailed the Turks for not being truly interested in resolving this dispute and blamed them for the collapse of the talks. The gentleman from Florida (Mr. Bilirakis) and my colleague, the gentleman from New Jersey (Mr. Pappas) and others have pointed out how ridiculous these new Turkish demands are. Turkey's new demands represent a clear step backward and must be met with equal resolve by those who support an independent and sovereign state of Cyprus. I just wanted to say, if I could very quickly, that following the collapse of the May talks I sent a letter to the President which outlines the steps that I believe the U.S. should take in dealing with Turkey and I just wanted to read an excerpt from that, if I could, because I believe it describes what the true obstacle to peace in Cyprus is and what the United States needs to do. I wrote: Mr. President, I believe that the administration privately shares my views that the key to progress lies in Ankara and it is time to stop focusing public and private efforts on the Turkish Cypriots and intensify American efforts to move the peace process forward on the Turkish military, which has a real and substantial influence on decision-making in the Turkish government. To that end, I urge you to convey in forceful and unequivocal terms that there will be direct consequences in U.S.-Turkish relations if Ankara does not prevail upon the Turkish Cypriot leader to abandon these new conditions and return to the negotiating process set out in the U.N. resolutions. It is also essential that the Turkish government not be allowed to interfere in the accession negotiations between Cyprus and the European Union. These negotiations are already started and Turkey must not be allowed to hold Cyprus hostage for its own political purposes. Now, the latter part of what I just read is in response to the Turkish demand that the Cyprus government withdraw its application for membership in the European Union, and this was one of the preconditions that led to the collapse of the peace talks in May. If I could just say that I think that this special order is a small but important part of our overall efforts, and we just need to send a very clear signal to the administration that members of this body are steadfast in their determination to monitor this situation, are increasingly frustrated with the lack of progress and that we just are not going to stand for the Turkish government's intransigence anymore. I again want to thank the gentleman from Florida, who cochairs our caucus, for being so resolute in making it possible for us to continue to bring this point up.

Mr. PALLONE

Mr. PALLONE. The amazing thing that my colleague brings out about the preemption is usually, for most protections or legislation that is of a protective nature for health or safety on a Federal level, the Federal law reads that if the State wants to be more protective of the health or the safety or the environment, or whatever it happens to be, that they can do so. It is amazing that this bill does the opposite. This Republican bill says that if we are more protective of the patient's health, then we are going to preempt that and the Federal law is going to hold. Usually we do the opposite, as the gentleman knows. So, again, there is clearly an effort here to do what the insurance companies want rather than do what not only is right, the right thing for the average person, but also what the norm is here when we deal with health and safety and environmental and other protections of that nature. So we know there is sort of a cynical side to this Republican bill in terms of what they are trying do. The gentleman mentioned another thing that I think is important, and I have talked all evening about the Patients' Bill of Rights being a Democratic bill. But the fact of the matter is there are Republicans who not only cosponsored the bill but voted for the bill on the floor of the House and voted against the Republican bill. What the Republican bill is is a Republican leadership bill. There are Republicans who would join us in a bipartisan fashion, which is another indication of why the Patients' Bill of Rights really is a good bill. It is bipartisan. But, unfortunately, the Republican leadership is opposed to it. I want to thank the gentleman again.

Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Texas because he brought out a number of very important points, and when he mentioned the minimal cost, the 34 cents per month, I am always happy to mention the CBO saying that our Democratic plan would only be maybe as much as $2 a month. But I agree with the gentleman, I think it would even be less than that. And the reason there would be no additional cost is, essentially, these patient protections are things that make sense. They are common sense proposals. And if an insurance company knows, if an HMO knows that they have to provide these protections, they get involved in prevention and they do not let terrible things happen. They do not deny care that should be provided. So that avoids the extra cost that might come from a lawsuit or damages or whatever because an HMO is not doing what they are supposed to do. So I think what we are really talking about are basic common sense ideas and principles that can be easily provided for if the HMO is told that they have to do it, and that is why it really does not cost any more. The other thing I wanted to mention that the gentleman brought out was with regard to the preemption, which I think is so important. And, yes, the same thing would be true in my home State of New Jersey. We have very strong patient protections now on the books, similar to what the Democrats have proposed with our Patients' Bill of Rights. And it is quite clear when we look at the Republican bill that it would preempt many of those very strong provisions in New Jersey, just as in the State of Texas. The reason for all this is that, as we talked before, this bill was essentially drafted and put together by the Republican leadership in 1 week because they wanted to have a response to the fact that so many people around the country are clamoring for managed care reform. There are so many loopholes, so many problems, so many exceptions in this bill. Whether because of poor drafting or intentionally because it is basically the insurance companies that are writing it, essentially we are taking a step backward. The Republican leadership would take us a step backward with this legislation. I know the gentleman mentioned a couple of things, and I wanted to use them as examples, the kinds of loopholes that we have. The gentleman talked about the gag rule, where doctors are told by an HMO that they cannot talk about procedures or other means of doing things that the HMO will not cover. That is the gag rule, as we talk about it. Well, because of the complaints that the Democrats made, there were some changes made in the Republican bill so that there were some gag rule protections or some prohibitions on the gag rule. But when we looked at the fine print, we found that it only applied to doctors who were directly contracting with the HMO. But many physicians operate through group practices and they are not covered by it, so they still can impose a gag rule on those physicians. The gentleman mentioned the emergency room care. Well, again, that prudent layperson standard that we have in the Democratic bill says if I get severe chest pains and there is a hospital a mile away, I go to that hospital. I do not call for approval, and I do not go to the hospital 50 miles away that the HMO may say I am supposed to go to. Because the average person, prudent layperson, would not go 50 miles and call to get approval to go to a hospital when they have chest pains. Well, the Republican bill says the HMO can define medical necessity. So they could basically define a prudent layperson any way they want. And one of the things in the Democratic bill is that that includes severe pain. So if I have severe pain, I go to the local emergency room. But the Republicans do not provide for that, so they can define emergency care as not allowing for severe pain. Just an example. I do not want to keep mentioning all these examples, but it is just riddled with all these loopholes. And it is not really funny, I should not be laughing, but it is pretty sad because, in many cases, what it does is to preempt many good State laws and substitute very vague language that really does not provide any protection. I am glad that the gentleman brought that out this evening because I think it is very important. I appreciate it.

Mr. PALLONE. Mr. Speaker, this evening I would like to spend some time talking about the issue of managed care reform, or HMO reform. I wanted to start out by pointing out that the House Republican leaders brought a bill to the floor about 2 weeks ago which they are trying to use to essentially dupe Americans into believing that they are protected against HMOs, when in fact, if anything, the Republican bill makes people's situation with HMOs even worse off, in my opinion. There were no hearings on this Republican bill. It never went through any congressional committee, and it was literally changing up until the very last minute, when it came to the floor of the House of Representatives. For months Republicans have been working hand-in-hand with insurance companies to fight the Democratic alternative, the Patients' Bill of Rights, which is a real patient protection bill, which enjoys the strong support of doctors, nurses, and consumer advocates. Now all of a sudden the Republicans have rushed their bill, which they call a patient protection bill, to the floor in an effort to solve the political problem that their opposition to managed care reform has essentially become. Mr. Speaker, make no mistake, the differences between the Democratic Patients' Bill of Rights and the Republican HMO proposal are significant. The Republican bill excludes key provisions that are essential for consumer protection, and includes provisions that would reduce current consumer protections. The Republican HMO plan seeks to give the appearance of reform without the reality. Just to mention, among other things, some of the most serious problems with the Republican HMO plan, it leaves medical decisions in the hands of insurance company accountants instead of doctors. It does not limit HMOs and insurance companies' use of improper financial incentives to limit needed care. It allows drive-through mastectomies, and fails to contain a requirement of coverage for reconstructive surgery after mastectomies. It does not give access to specialty care when needed. It also does not guarantee patients access to needed drugs or clinical trials. Most important, it provides no effective mechanism to hold plans accountable when plans abuse, kill, or injure someone. Democrats have been insisting and will continue to insist on a bill that contains guarantees that are a significant gain for health plan consumers. The Republican plan, by contrast to the Democratic plan, is essentially a sham in providing patient protections. Mr. Speaker, I wanted to talk for a few minutes, if I could, about some of the specific problems that I see with the Republican HMO plan, and give some examples of how they essentially would not help. For example, one of the most important provisions in the Republican bill that contrasts it from the Democratic Patients' Bill of Rights is that the Democrats' Patients' Bill of Rights insures access to specialists, whereas the Republican plan does not. For example, under the Democratic bill, if you had cancer, you could go directly to an oncologist. If your child had a specific problem, you could bring your child to whatever type of specialist your child might need. Under the Republican plan, you would still have to go see your primary care physician for a referral, and there is no guarantee that you would get to see a specialist if you needed one. The differences between the two bills are even more pronounced when it comes to seeing specialists outside your HMO, outside your network. The Democrats' Patients' Bill of Rights ensures you will be able to go outside your network at no cost to you if you need to see a specialist that your HMO does not have within the network. But under the Republican bill, if you need to see a specialist outside of your network, you are out of luck. You do not get to see him. Another difference between the access each bill would provide is what we call ``standing referrals.'' If you were fortunate enough to be in an HMO that has the type of specialists you need when you get sick under the Republican plan, you still have to jump through hoops. The Republican plan does not allow patients who need care over a long period of time by a specialist to have standing referrals. The Democratic bill, the Patients' Bill of Rights, does not require patients to go back time and again to renew referrals. If you need to see a specialist over a long period of time, you are guaranteed the right to that doctor. The Democrats' Patients' Bill of Rights will also let you designate the specialist as your primary care physician. If you are a woman, you can choose your OB-GYN as your primary care physician. The Republican bill, by contrast, neither allows you to designate your specialist as your primary care physician nor your OB-GYN. Another major difference, and I think it is important, refers to access to physicians, again. That is, what the two bills do to protect the continuity of care. The Democrats' bill ensures that if you were in the middle of treatment and your plan drops the doctor that you were seeing or your employer switches insurance companies, that you will still be able to see that doctor at no cost to you. But under the Republican bill, if you are a woman in your last trimester of pregnancy, for example, you could be forced to see another doctor once that doctor is dropped from the plan. The same goes for any patient in similar circumstances. The differences in ensuring access between the two bills is not limited to just physicians. Under the Democrats' Patients' Bill of Rights, health plans are required to have a process for allowing certain patients to participate in a defined set of approved clinical trials. For many patients, clinical trials represent the last and only hope they have of surviving. But the Republican plan provides no access to clinical trials at all. If you are in an advanced stage of breast cancer, for example, the Democratic bill would give you not only the opportunity but the resources to fight that horrible disease. I do not see how the Republican bill does anything of the sort. One last difference I would like to point out in terms of access is access to needed drugs. The Republican plan does not guarantee that your HMO will pay for the drugs your doctor prescribes. If your doctor prescribes you a drug that is not on your HMO's approved list of drugs under the Republican plan, you will have to pay for it yourself. If it is too expensive for you, that is too bad. Even though you have health care, you find the prescribed remedy out of reach because the health plan you pay for refuses to cover it. The Democrats' Patients' Bill of Rights, on the other hand, guarantees access to whatever medication your doctor determines that you need. The Democrats' bill requires plans that have a limited set of drugs available to provide patients with access to drugs that are medically necessary. As I said, Mr. Speaker, really, the facts tell the story. When we compare these two bills, we find there is no comparison at all. Basically, the Republican bill does little to expand access and a lot to protect the insurance industry. Really, I think we should be helping patients get the care they need without the red tape and without the added trauma of wondering just how much sicker they are going to get, and have to wait for some bureaucrat somewhere to tell them they can see a doctor or have the medicine they need. If we want to address those problems, then we have to pass the Democrats' Patients' Bill of Rights. I wanted to mention another area that I consider a very important difference between the two bills. Then I will try to wrap up what I have to say tonight. That is, in my opinion, one of the most important aspects. That is the issue of enforcement. The point is clear that under the Democratic proposal, the Patients' Bill of Rights, we are getting certain patient protections. Under the Republican bill, we are getting very few patient protections. Even if there were some patient protections that were important under the Republican bill, it does not mean anything if we cannot enforce those patient protections and make sure we get them. Any legislation that fails to give patients the right of enforcement essentially renders the protections within the bill absolutely meaningless. The Democratic bill, most importantly, repeals the ERISA exemption. This is the 1974 law that shields HMOs from being sued if they deny people needed care. A lot of people do not realize that if your employer has a self-insured plan, which many people have, and they fall under ERISA, which is a Federal law, that basically says that the HMO cannot be sued if it denies people care. We repealed that, essentially, effectively, in the Democratic bill. The Republican bill, however, does nothing to hold HMOs accountable for their actions. It not only leaves ERISA essentially intact and still has the prohibition on suit, it actually exacerbates the problem, because its external appeals process, in other words, the ability to appeal the denial of care, only applies to people whose insurance comes under ERISA. Individuals in the private insurance market are left without any external recourse when they are denied care, and what is even worse is that those who were fortunate enough to be covered by ERISA are subject to the HMOs' definition of ``medical necessity.'' I just wanted to talk a little about that, because it goes to the whole issue of enforcement. What the Republican bill does, it allows the HMOs, and not the doctors and patients, to define ``medical necessity.'' Of course, this provision flies in the face of the whole idea of the managed care reform debate, that ``medical necessity'' should be the determinant of whether or not a patient needs care, and not cost considerations. So if we are really going to make reforms in HMOs and managed care, we have to make sure that doctors and patients decide what type of care is necessary, whether you have to stay a few extra days in the hospital, whether or not you need a certain procedure. But if the insurance company bureaucrats continue to make those medical decisions, people will continue to be denied care. That is what is going to happen with the Republican bill, because it lets the HMOs and not the doctors and patients define what is a ``medical necessity.'' I also want to dispel a myth that my Republican colleagues have been working overtime to spread. That is that the Democrats' Patients' Bill of Rights does not create any new Federal litigation. In other words, if you repeal ERISA, as we do, all that allows is for individuals to go back to the States and bring the kinds of suit they would normally be able to bring. So we are not really creating a new Federal remedy by repealing ERISA and allowing people to sue. We are just allowing people to exercise the rights that they would normally have if the Federal Government had not prohibited them from bringing suit under ERISA. Some of the other points that could be made with regard to enforcement of the Republican bill I do not think I need to go into tonight. I just want to stress again that if you have patient protections and you cannot enforce them, either through some external review process or through the ability to go to court and bring suit, then for all practical purposes, whatever patient protections you have under the Republican bill really are meaningless. If I could, Mr. Speaker, the last thing that I wanted to bring up tonight is the whole issue of cost, because I know that my colleagues on the other side of the aisle continue to talk about how if we put in place the Democrats' Patients Bill of Rights, which is a comprehensive patient protection act, that somehow it is going to cost more and it is going to drive the cost of HMOs up. Nothing really could be further from the truth. We had the Congressional Budget Office do an analysis, if you will, of the Democrats' Patients Bill of Rights. What they basically said is that the legislation would have a very minimal effect on premiums with most individuals paying only about $2 more per month. Keep in mind that for an extra $2, and it probably would not even be that much, you are going to get the return of medical decisionmaking to patients and health care professionals and not insurance company bureaucrats. You are going to get access to specialists, including access to pediatric specialists for children. You are going to get coverage for emergency room care. You are going to get the right to talk freely with doctors and nurses about every medical option. You have an appeals process and real legal accountability for insurance company decisions, and you have an end to financial incentives for doctors and nurses to limit the care that they can provide. These are the kinds of patient protections that we are providing with the Democratic bill. I know that when I talk to most Americans, and certainly, or most of my constituents, and certainly the polls have shown both Democratic and Republican polls, that when you talk to most Americans, they would rather have those protections. They would like to be able to go to the emergency room nearby and not have to worry that they are not going to be approved because they did not get a referral or that they have to go to an emergency room 50 miles away. They do not want the doctor to be gagged as some doctors are now with HMOs and told they cannot even tell you about certain medical options. They do not want doctors and nurses to be under a regime where if they do not meet assert quota, if they do not deny a certain number of cases or a certain number of procedures, that they will not get paid enough for their work. We know that the average American would not mind paying an extra dollar or two per month to have the kind of protections that we are talking about here tonight. Mr. Speaker, I would just say, in conclusion, that, of course, the Republican bill passed the House of Representatives a couple weeks ago but very narrowly. The Democratic proposal, the difference between the two was only about 5 votes. I think that shows very strong support in this body for strong patient protections that are enforceable. I only hope that when the legislation goes over to the Senate and that when the Senate reconvenes in September, the Senate will take up the stronger Democratic bill and that we will see a strong bill pass this Congress, pass both houses of this Congress, because President Clinton has said over and over again that if he gets the Republican version on his desk, he will veto it because it essentially does not provide the type of patient protections that we need to really have some significant managed care reform. If it is necessary for the legislation to come back to the House or back to the Senate after the President's veto, we know that we are going to have the support here to pass a strong bill because of the vote that took place on the floor of the House of Representatives two weeks ago. I see one of my colleagues is here who has been a strong supporter of the Democrats' Patients Bill of Rights, who is a member of the Committee on Commerce, the gentleman from Texas (Mr. Green), where they have on the State level passed very strong patient protections, but one of the things that we know, because New Jersey, my State, is another State that has passed State legislation that provides strong patient protections, but unfortunately many people are not covered by State law because, again, of the ERISA statute that I mentioned previously. ERISA, which applies to all employers that essentially self-insure, that is a big group in this country, ERISA essentially preempts State law. So that is the reason why, one of the reasons why we have to pass Federal legislation for even those States that do have strong patient protections to make sure that everybody is covered. Of course, also to take care of the States that have not passed strong patient protection legislation. That is why we need comprehensive Federal legislation. I yield to the gentleman from Texas (Mr. Green).

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, the Republican leadership has succeeded in steam rolling its HMO bill through the House, and patients should beware. The Republican bill is far worse than current law and riddled with loopholes. When you compare it to the Democrats' Patients Bill of Rights, you find there is no comparison at all. I just want to mention one negative aspect, just one negative aspect, of the Republican bill. It does not guarantee them access to a specialist. Under the Democratic bill, if they had cancer they could go directly to an oncologist. Under the Republican plan, they would still have to go see their primary care physician for a referral and there is no guarantee that they would get to see a specialist if they need one. Under the Republican bill, if they need to see a specialist outside of their HMO network and their HMO says no, they are out of luck. The Democrats' Patients Bill of Rights ensures that they will be able to go outside of their network at no cost to them if they need to see a specialist that their HMO does not have. Mr. Speaker, the President has said that he will veto the Republican bill if they send it to him in its current form, and the do-nothing 105th Congress is running out of time. Let us send the President a bill he will sign, one that is written for patients, not insurance companies. Support the Democrats' Patients Bill of Rights.