Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, Alan J. Gibbs, died Saturday, July 25, at the age of 60. Most recently, Alan served as the Director of the National Transit Institute (NTI) at Rutgers, the State University of New Jersey. He was dedicated to public service, having worked for over 35 years at the federal, state, and local levels of government. I join with his family, as well as my colleagues at Rutgers and throughout the State of New Jersey in remembering him, and honoring his accomplishments and great leadership. I know Rutgers is particularly proud of Alan's accomplishments at the National Transit Institute. Established at the Rutgers-New Brunswick campus in New Jersey's Sixth District in 1992, the NTI was created by Congress to develop education and training programs for transportation professionals and transit agencies across the nation. The NTI has trained thousands of individuals from transit agencies, metropolitan planning organizations, state departments of transportation, and employees of federal-aid transit systems to improve public transit in the United States. Prior to heading the NTI, Alan served as the State Commissioner of the Department of Human Services, to which he was appointed by Governor Jim Florio in 1990. Under his leadership, the largest department in the State government underwent a major downsizing, reallocated resources to focus on non-institutional care for the developmentally disabled and mentally ill, developed a managed care program for Medicaid recipients, and implemented a welfare reform program. Mr. Gibbs began his public service career in 1963 with the National Labor Relations Board. In 1968, Alan became the Equal Employment Opportunity Commission's (EEOC) first Area Director for Alabama and Tennessee. He then moved to Washington, DC to continue his work at the EEOC at the federal level. From 1970 to 1974, Alan served in the New York City Health Services Administration. In 1972, he was the first layperson to be appointed First Deputy Commissioner of Health. Then, in 1974, Governor Brendan Byrne of New Jersey appointed Mr. Gibbs to serve as Deputy Commissioner of the New Jersey Department of Human Services. In that capacity, hew was responsible for all management, planning, and budgetary activities in support of the State's corrections, mental health, mental retardation, public welfare, Medicaid, social services, and veteran programs. In 1981, as Secretary of the Washington State Department of Social and Health Services, Mr. Gibbs was honored by the National Governor's Association for reducing spending by $200 million, without eliminating or negatively affecting high-priority services for dependent populations. As President Carter's appointee to the Assistant Secretary of the Army, he was presented with the Distinguished Civilian Service Award for his contribution to our nation's defense in 1981. Clearly, Alan Gibbs' accomplishments were extensive. The national recognition he received throughout his career for his exemplary management of the most vital public services at all levels of government certainly was well deserved. I join his family, and those at Rutgers and elsewhere, in honoring Alan for his talent and deep commitment to public service. I know he will be missed.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I am proud to join my colleagues from both sides of the aisle in paying tribute to these fallen heroes, Capital Police Officers Jacob Chestnut and John Gibson, and in extending my deepest condolences to their families. As my colleague, the gentlewoman from Connecticut (Ms. DeLauro), mentioned a little while ago, several of us were upstairs briefing the media after the votes in the House on Friday when the shooting happened. Capitol Police officers immediately came up to the press gallery to secure the area and make sure that we were safe. The death of these police officers hits me in a personal way because my father is a retired police officer. Every day that my father headed off to work, I knew that he was potentially putting himself in danger to keep our community safe. There was, of course, a sense of fear and concern for his safety that I felt, but I also felt a sense of pride. I knew he was doing an extremely important job, and I know that the men and women who serve here in this Capitol feel that same sense of pride and purpose. For the families of Jacob Chestnut and John Gibson, I just hope that the sense of loss that they are experiencing will be alleviated somewhat by the tributes today, and, Mr. Speaker, I hope that their sadness will be mitigated by the private knowing that Officers Chestnut and Gibson gave their lives to protect the lives of others.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I do want to first thank the gentleman from Michigan (Mr. Dingell) and the gentleman from Iowa (Mr. Ganske) and the members of the Democratic Health Care Task Force and all those who worked very hard to make sure that this substitute came up today. The discharge petition effort, which I think has over 190 Members, and other efforts to appear before the Committee on Rules finally brought fruit, I think, and made it possible for us to bring the substitute up today, and that hard work, I believe, paid off. In my view, there is nothing more important in the managed care debate than giving patients the right to hold their HMO accountable when they are denied the care they need. Any legislation that fails to give patients that renders the protections within it absolutely meaningless. The Patient's Bill of Rights includes an enforcement mechanism which ensures patients will finally get that right. Our bill repeals the ERISA exemption, the 1974 law which shields HMOs from being sued if they deny people needed care. The other bill we are considering today, the Republican bill, does nothing to hold HMOs accountable for their actions. If not only leaves ERISA essentially intact, it actually exacerbates the problem. Its external appeals process 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. What is even worse is that those who are fortunate enough to be covered by ERISA are subject to the HMO's definition of ``medical necessity.'' The Republican bill allows HMOs, and not doctors and patients, to define ``medical necessity.'' This provision, of course, flies in the face of the whole idea of managed care debate, that medical necessity should be the determinant of whether or not a patient needs care and not cost considerations. It all but guarantees that insurance company bureaucrats will continue to make medical decisions and people will continue to be denied care because of it. I also want to dispel a myth that my Republican colleagues have been working overtime to spread. The Patients' Bill of Rights does not create any new Federal legislation. Repealing the ERISA exemption would simply allow patients to go back to their states, where individuals would normally bring suit. In other words, the Patients' Bill of Rights does not create a new Federal remedy. Its approach is essentially states' rights by repealing a Federal preemption. Another piece of propaganda the Republicans have been actively spreading is the charge that the Patients' Bill of Rights provides for employers to be sued for medical malpractice. This is patently false. In fact, the Patients' Bill of Rights specifically excludes employers from liability. Any employer can only be held liable if they intervene in a medical decision that leads to injury or death. Mr. Speaker, President Clinton recently said that ``a right without a remedy is not a right,'' referring to HMOs. If you want good patient protections, and, just as importantly, enforcement of those protections, vote ``yes'' on the Patients' Bill of Rights and vote ``no'' on the Republican bill.

Mr. PALLONE. Mr. Speaker, I just wanted to mention, the Republicans keep talking about the number of uninsured in this country. I would point out that 4 years ago, when President Clinton tried to put forward a health care plan that would insure all Americans, they fought it vigorously. The fact that we have more Americans now without health insurance is their fault, because they would not allow the Clinton plan to come forward. So now the numbers of uninsured continue to grow. Mr. Speaker, I just want to explain why the Democrats' bill is a vastly superior bill in terms of ensuring and expanding patients' access to physicians. For example, the Patients' Bill of Rights ensures access to specialists. The Republican bill does not. Under the Democratic bill, if a patient has cancer, they could go directly to an oncologist. If their child has a specific problem, they could bring their child to whatever type of specialist their child might need. But under the Republican plan that child would still have to go to their primary physician for a referral, and there is no guarantee that they would get to see a specialist if they need one. The differences between the two bills are more pronounced when it comes to seeing specialists outside of one's HMO. The Patients' Bill of Rights ensures that patients will be able to go outside their network, at no cost to them, if they need to see a specialist that their HMO does not have. Under the Republican bill, they are out of luck. Another difference between the access each bill would provide is standing referrals. If a patient is fortunate enough to have an HMO that has the type of specialist they need when they get sick, under the Republican plan they 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 Patients' Bill of Rights does not require patients to go back time and again to renew referrals. If a patient needs to see a specialist over a long period of time, they are guaranteed the right to see that doctor. The Patients' Bill of Rights would also allow patients to designate that specialist as their primary care physician. Women could choose their OB/GYN as their primary physician. The Republican bill does not allow patients to designate their specialist as their primary care physician, nor their OB/GYN. Another major difference is with the continuity of care issue. The Republican bill does not allow patients to continue to have the same doctor.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, make no mistake, the differences between the Democrats' Patients' Bill of Rights and the Republican HMO proposal are major. 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. Among other gaps, the Republican plan still 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 for coverage for reconstructive surgery after mastectomy. It does not give access to specialty care where needed. The Republican bill does not guarantee patients access to needed drugs or clinical trials. And most important, the Republican bill provides no effective mechanism to hold plans accountable when plan abuse kills or injures someone. Democrats will insist on a bill that contains guarantees that are a significant gain for health care consumers. The Republican plan is basically a sham.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I move to strike the requisite number of words, and I will not use the 5 minutes. Mr. Chairman, I thought I had to be in the Senate to listen to an old-fashioned filibuster, but at least the gentleman from Louisiana gave me the opportunity to witness one for the first time. So I appreciate that. Let me just say that I hope that the Republican leadership understands from this debate tonight that Democrats will not stand by and let the Republican assault on the environment through these various riders continue. I was very happy to see so much debate on the issue of the riders, because I think it shows that we, as Democrats, intend to draw the line on these various appropriations bills, and that is why we support the Waxman amendment tonight. I am just going to mention two brief things. First, with regard to the provision prohibiting the EPA from taking any action to remove contaminated sediments from rivers, lakes, and streams, I just wanted to point out that there are numerous sites in the United States that are on the national priority list of Superfunds and that might be listed on the Superfund site list in the future that could require the removal of contaminated sediments. Since 1984, the EPA has included the remedial dredging of 23 of 25 Superfund decisions at sites with PCB-contaminated sediments. To prohibit or delay the EPA's ability to use dredging at these sites is to greatly increase the risks for America's citizens or serious health impacts and even greater environmental degradation than has already occurred from these sites. So we have to pass this Waxman amendment, otherwise we are going to have even more problems with our Superfund sites. Secondly, with regard to a rider that would delay an already prolonged process from reducing mercury emissions from electric utilities, just last Thursday, I spoke at a press conference to launch the release of a report that addresses mercury emissions from utilities. My colleagues have talked about this because of the concern that this type of pollution from utilities causes to the environment, and I just wanted to say that, as States and eventually the Federal government move towards a more competitive electricity utility market, addressing mercury and these kind of emissions in a uniform and equitable and prompt matter is going to become increasingly important. We simply have to recognize that this rider will make it only more difficult to address mercury pollution in the context of electricity deregulation. So I just want to say, Mr. Chairman, I urge my colleagues to support this critical Waxman amendment, to protect the environment and America's taxpayers. This really is a serious issue. Although some on the other side think that we can just as easily read the telephone book, the fact of the matter is that this is important for us. I am very proud to see that so many of us on the Democratic side stood up tonight and pointed out that this continued assault on the environment will not continue to take place in this House as long as we are around here and able to express ourselves.

Mr. PALLONE

Mr. PALLONE. Well, I just wanted to say that my colleague from Texas has brought up a number of really important points here. Number one, the whole issue of costs, we have been criticized, Democrats have been criticized, for their patient protection bill by the allegations by the insurance industry that it is going to cost a lot more money. The gentleman points out that in Texas, there has actually been no premium increase. We had a report from the Congressional Budget Office that just came out a couple of weeks ago on our Democrat bill that said that even if everything passed and our bill was law, at the most, individuals would pay only about two dollars more per month for the patient protections that are so important to the American people. The other thing the gentleman pointed out is that we have, in effect, now, these two regimes, if you will, for people who are in ERISA and they are working for an employer that has a self-insured plan, which now preempts, the Federal law preempts it, and those people are not coming under ERISA. One of the things that is important is some of the proposals put forward by the Republicans, particularly the Senate proposal, actually does not even provide the patient protections if you are not under ERISA. So for those people who live in States other than Texas, that do not have the patient protections, they are not even going to get the patient protections if they are not in an ERISA self-insured type program. The other thing I wanted to say that the gentleman really brought out, and I think it is very important, too, is this whole issue of enforcement. We have been criticized by some of the opponents of managed care reform and they have said, well, the only difference or the only thing the Democrats want to do is they want to eliminate the ERISA exemption on the ability to bring suit, because under ERISA you cannot sue effectively for damages or to really recover the damages or the fact that you were not able to work or that you basically had a number of losses, you cannot bring a suit if you are under an ERISA plan because of the exemption from liability. What I wanted to point out is that if we do not repeal that ERISA exemption on liability, there is not going to be any effective enforcement of these patient protections. One of the criticisms I have is that under the Republican proposal in the House, basically not only do they not permit you to sue, they do not repeal the ERISA exemption on the ability to sue, but they also say that for individuals who have to buy the insurance in the individual market and not through a group plan, that they do not even have access to an appeal procedure where if they have been denied proper care, they do not even have a way of taking the appeal of that decision under the Republican proposal. So the Republican proposal in the House, on the one hand, excludes a lot of people from any kind of appeal if they have been denied coverage. It does not allow a lot of people to bring suit, if they are covered under ERISA, and essentially there is no enforcement. So there are tremendous loopholes in this Republican plan that we need to address and it is one of the reasons why we have been so critical of it. At this point, I yield to the gentleman from Pennsylvania (Mr. Klink), who is on the Committee on Commerce and has been really outspoken in bringing his concerns about managed care home to his constituents. I know the gentleman has had a lot of forums and he has heard a lot of horror stories over the last 6 months.

Mr. PALLONE. I just want to thank the gentleman again for his contribution here tonight, because I know how strongly he feels about this. He has all these cases. He has really spent the time in his district giving forums and opportunities, if you will, for individuals to come forward and talk about these abuses. We know how many there are. I just wanted to say briefly and then I will yield to the gentlewoman from Michigan. One of the major problems with the Republican bill is that when I talk to constituents and when I get feedback from different individuals, what they really want, most importantly, is the return of medical decision-making to patients and health care professionals, doctors, and not have medical decisions made by the insurance companies. The worst part I think of the Republican bill, the House bill and the Senate bill, is that it allows the insurance company, the HMO, to define medical necessity, so that we as Democrats have said that what we want to do is switch this whole phenomena so that the decision about whether or not you are going to be able to stay in the hospital a few more days or whether you have a certain medical procedure is made by the patient and the doctor. Well, if you leave it as the Republican bill does, if you leave the definition of what is medically necessary to the HMO, you do not have any patient protections. This is what I have been trying to say the last few days when this Republican bill was finally revealed last Friday, that it actually does not move us forward at all in terms of patient protections. This is one of the major reasons, because the definition of what is medically necessary is still going to be left up to the HMO. I just wanted to mention a few things briefly, because I do not know that we have specifically talked about some of the differences in terms of the actual patient protections. One is what I have mentioned, the protection of the doctor-patient relationship. It is still denied essentially by the Republican plan. The other is access to specialists. The Democratic plan lets you go to a specialist outside the network if there is not one available within the HMO network. The Republican bill does not allow that. The Republican bill does not do anything in terms of coverage of mastectomies and requirement of coverage for reconstructive surgery. In other words, in our bill, we have a prohibition on the drive-through mastectomies and we require coverage for reconstructive surgery after a mastectomy. This is a very important provision that we have talked about for some time that is not in the Republican bill. Point of service. A big issue for a lot of Americans is the ability to go outside of the HMO network and see a doctor outside the network even if they have to pay a little more if they want to do that. What the Democratic bill says is if your employer only offers you an HMO, a closed panel HMO, for only doctors or hospitals within the network, he also has to offer you initially the option of going outside the network if you are going to pay a little more. Well, in the Republican bill, they have so many loopholes in their point of service option that it might as well not exist. They say that there is an exemption for these new health insurance pools, there is an exemption if the employer does not want to contract with a plan to provide the point of service. They might as well not have anything. I mean, they have so many loopholes it is incredible. So there is no point of service. There is no option, really, to go outside of the plan for a doctor or a hospital under the Republican plan. Under emergency care, we of course require that you would be able to go to any emergency room. You do not have to go 50 miles away. You do not need prior authorization because we have what we call a prudent layperson standard. If the average person thinks that this is an emergency, then they go to the local emergency room and they do not need prior authorization; otherwise, it is not an emergency. In the Republican plan, again, they have so many loopholes. They say that severe pain is not a standard that a reasonable person could apply and go into the emergency room. So if you think you are in severe pain, and that is the reason you go to the emergency room without prior authorization, it turns out you did not have a problem, then they are not going to pay for it, because your basis was going there with severe pain. I can go on, and I do not want to because I think we can bring some of these things out. Essentially, there is no progress on the issue at all with the Republican plan. It is not a meaningful way to move forward at all on the issue of managed care reform. Mr. Chairman, I yield to the gentlewoman from Michigan who, again, has been outstanding on this issue and has been getting a lot of input back from her constituents on the need for this Democratic proposal.

Mr. PALLONE. Mr. Speaker, I am pleased tonight to be joined by two of my colleagues to talk about managed care reform, the gentleman from Texas (Mr. Turner) and the gentleman from Pennsylvania (Mr. Klink). Before I yield to them, I wanted to talk briefly about the Republicans' managed care reform bill, which to be accurate I like to call the Insurance Industry Protection Act. The reason I bring this up is because it has been noticed to be debated and, theoretically, I suppose approved or disapproved on the floor this Friday. This Republican version of managed care reform is in my opinion easily one of the worst pieces of legislation the Republicans have put forward since they took control of Congress in 1994. For weeks prior to the introduction of the Republicans' Insurance Industry Protection Act, supporters of the Democrat's alternative, the Patients' Bill of Rights, were speaking out about what we knew was coming. What we expected they would do is to introduce a bill that was greatly watered down as a sort of cosmetic fix with regard to managed care reform. We expected the Republican leadership, who really are not interested in passing a managed care reform bill, would come out with a bill that would purport to provide patient protections, but really would not. The managed care issue, Mr. Speaker, is too explosive for the Republicans to ignore, so they have to at least create the impression that they are trying to rectify the weaknesses in the current system that are leading to the abuses we hear about on a daily basis. Let me say, we are truly hearing about these abuses daily. One need only turn on the TV, as I did tonight on the 6 o'clock news or pick up the newspaper, and see what I am talking about. In any event, just as we expected, before Congress adjourned for the July 4th recess, the Republicans released a set of principles which they said would all be incorporated into their bill. Mr. Speaker, these principles confirmed what Democrats expected. The Republican bill was going to be written so as not to interrupt the flow of support streaming into the Republican Party from the insurance industry. Last Friday, we finally got to see the language, and I think the American people need to know that the Republican Party went far beyond a cosmetic fix. They have introduced a bill that is far, far worse in my opinion than the existing law. Finding themselves caught between the insurance industry and the American people, the Republicans chose the insurance industry. Now they are gearing up to stuff this bill down the throats of the American people without giving them a chance to look at it. The Republican bill is scheduled, as I said, to be on the floor on Friday. In order to ensure the American people know as little about it as possible before everyone in the House is asked to vote on it, the leadership has bypassed the committee process. Not one of the three committees that has jurisdiction over this bill has had or will have a hearing on the Republican bill. And I would stress again that the language was only available last Friday. Because the Republican leadership refused to have hearings on its own bill, this week the Democratic Health Care Task Force held two hearings on this legislation. That was yesterday and today. At these hearings we heard testimony from administration officials, including the Secretary of Health and Human Services, Donna Shalala, and patients who have been abused by HMOs, doctors, and others. These hearings generated some truly disturbing and chilling revelations, I think, about the Republican bill. Mr. Speaker, I am not going to go into all of those now, because I think we can bring them out this evening as I yield to my colleagues who are here to join me and talk about some of the protections that are missing from the Republican plan, but included in the Democrat's Patients' Bill of Rights. Also, at some point I would like to talk about the issue of enforcement and how effectively the Republican bill has no enforcement. But at this time, I yield to the gentleman from Texas (Mr. Turner).

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I rise today in strong support of the DeFazio-Herger- Capps amendment which would strike from this bill the automatic 2-year extension of the demonstration program. Many of us here in the House probably did not even know that we voted to authorize this program back in 1996 when we voted for the Balanced Budget Down Payment Act. And many of us probably would not have known that we were voting to extend the program for an additional 2 years if it were not brought to our attention by this amendment. Without the passage of this amendment, we will be perpetuating a program that has never had a hearing, never been debated in the committees of jurisdiction, and that is, unfortunately, putting a visit to a national forest, park, or recreation area out of the financial reach of many working Americans. I just want to give an example of the last point, and that is the Sandy Hook Unit of Gateway National Recreation Area, which is in my district. Sandy Hook is an extremely popular location and is highly valued by its 2.5 million annual visitors. These people come from throughout the New York, New Jersey, Philadelphia metropolitan area to take advantage of the recreational, historical and educational resources at Sandy Hook, including bathing beaches, fishing areas and historic structures. Sandy Hook has always been really the one place in the area where people of all economic backgrounds have been able to enjoy a day at the shore, and we would like to help them keep it that way. Sandy Hook is a national resource, and as such it should remain affordable to everyone, and that includes moderate and low-income people. Now, under this recreational fee demonstration program, daily per- vehicle beach user fees at Sandy Hook were doubled as of June 20th of this year from $4 to $8 on weekdays and from $5 to $10 on weekends. Such an increase, in my opinion, is exorbitant. It will put the cost of visiting Sandy Hook out of the reach for many working Americans, in effect turning them away from this national recreation area. I heard mention that people have not complained about these fee increases. Let me tell my colleagues that many of my constituents have complained to me, and loudly. I am also concerned about the false promises that have been made to justify the fee demonstration program. The extra money from the Feds is in no way sufficient to satisfy the multimillion dollar backlog of repair and rehabilitation needs at Sandy Hook. The fee demonstration program gives false incentives, in my opinion, to individual park units to raise park fees. The program gives the impression to Sandy Hook visitors that their increased generosity will result in significant park improvements from which they will benefit in the near future, and there is no reason to believe that that is the case at Sandy Hook. So I would simply urge my colleagues, again I used one example but I know there are many more, I would urge my colleagues to support this amendment so we can examine this program more closely before considering its extension.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks on the subject of my Special Order.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I rise today also in support of the Miller amendment to fully fund the administration's request of $2 million for the Urban Parks Recreation and Recovery, or UPARR. This invaluable program provides competitive matching grants for the revitalization of local recreation areas and the improvement of recreation programs and services in low income inner-city neighborhoods. These opportunities are targeted at urban youth and the expansion of pre and after school activities. Mr. Chairman, in my own district in the City of New Brunswick, which is located in the central part of New Jersey, UPARR grants have been used to renovate jogging paths and playing fields and to construct new playing fields at Buccleuch Park. The park is used as a recreational facility by local high school sports teams, as well as sports teams from Rutgers, the State University of New Jersey. In addition, a UPARR grant made additional renovations possible so that senior citizens and disabled persons from the senior citizen resource center next door could make use of the park's facilities. Other UPARR grants have facilitated similar activities at Feaster Park, Joyce Kilmer Park and Recreation Park, also located in New Brunswick. The National Park Service anticipates applications from 100 to 150 urban localities across the country for UPARR grants in fiscal year 1999, requests which will total approximately $20 million. The $2 million that we are trying to add to the bill today with this amendment will enable the Park Service to award 10 to 15 grants, only 10 percent of those requested. This, as has been mentioned by my colleagues, is a modestly funded program, but one that has a large impact on those communities that are fortunate enough to receive these grants, as I know from my own City of New Brunswick. I urge my colleagues to support urban neighborhoods and urban youth by voting for the Miller UPARR amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, for months now the movie ``As Good as It Gets'' has become symbolic here in Washington with the debate over managed care reform. Everyone knows by now that in the movie, actress Helen Hunt unleashes an epithet-laden attack on her HMO after her HMO gives her trouble when she is trying to get treatment for her asthmatic son. In an effort to stop getting beat over the head with this example and what it symbolizes, last Friday the Republican leadership unveiled the language of its long-awaited managed care reform bill. To state it simply, Mr. Speaker, this Republican bill is as bad as it gets. The Republican leadership has really outdone itself with this bill. It is easily one of the worst speaks pieces of legislation they have put forward since they took control of the House in 1994. It is an unabashed sell-out to the insurance industry. In fact, it looks as if it were written by the insurance industry itself. Although it is called the Patient Protection Act, in an attempt to confuse it with the Democrats' Patients' Bill of Rights, a more appropriate title for the Republican bill would be the Profit Protection Act. The worst aspect of this bill is that it allows the insurance companies, and not doctors and patients, to make medical choices. Remarkably, the Republican bill actually reaffirms the status quo and allows insurance company bureaucrats to decide what is medically necessary, so under the Republican plan, HMOs can define ``medically necessary'' any way they wanted. If you get sick and your insurance company decides the treatment you need is not medically necessary, you are simply out of luck. This is, in my opinion, truly a sell-out of the highest proportions. It ignores the central catalyst of the whole managed care debate, the strongly held belief among Americans that medical decisions should be made by doctors and their patients. The Democrats' Patient Bill of Rights, by contrast, insures that medical decisions would be made by doctors and patients. The Democratic bill defines ``medically necessary care'' based on the generally accepted principles of professional medical practice. What that means is that under the Democratic plan, patients and doctors determine what is the best course of treatment, not HMOs and insurance company bureaucrats. The Republican bill also fails to ensure access to specialists. If your child gets an illness and you want to bring your son or child to a specialist, you cannot, under the Republican bill. You may not be able to go to that specialist, depending on what the insurance company decides. But the Patient Bill of Rights, the Democratic bill, guarantees patients access to specialists when such access is needed. Another thing, the Republican plan does not even guarantee you full access to the nearest emergency room if you need emergency care, which has been a big issue during the course of this debate. The Republican bill includes a reasonable person's standard for access to emergency care, but it does not list severe pain as a reason why a person might determine that he or she needs to go to the emergency room. I want to repeat that, because it is really kind of mind-boggling. Under the Republican plan, severe pain is not considered a symptom of a possible emergency. So that means if you are suffering from severe pain and you rush to the emergency room to receive treatment for a legitimate problem, your HMO can still refuse to pay for it. The Democrats' Patient Bill of Rights also guarantees patients coverage if they go to an emergency room because they are suffering from severe pain. So regardless of the reason you go to the emergency room that is closest, if you get the emergency room care, the HMO has to pay for it. The Republican bill is also a failure when it comes to gag clauses. This is particularly interesting, because we passed prohibitions on gag rules here in the House of Representatives. But under the Republican bill, it would still allow a health plan to restrict communications between doctors and patients. The Democrats, on the other hand, prohibit plans from gagging doctors to inform patients about treatment options that are not covered by their health plan, and protects providers from retribution by the HMO for telling their patients the truth. When it comes to accountability, the GOP plan also is riddled with loopholes and omissions. The bill includes an external appeals process, but limits access to that process to individuals in plans under ERISA; in other words, only if your employer is self-insured. If you are covered by ERISA, you get the external review. Otherwise, you are out of luck. Then finally, and I want to stress this, the GOP plan also denies patients the right to sue their HMOs if they are denied needed care. Again, the right to sue is an enforcement mechanism that is necessary if these patient protections really are going to be enforced. The Democratic bill enforces all of the patient protections it provides by giving the patients the right to sue their HMO, and holding the HMOs accountable for the decisions they make. Again, this is an extremely important difference between the Democratic and the Republican plans.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I thank our ranking member for all the work he has done over so many years on important issues, particularly on his pro-environmental stance. Mr. Chairman, I rise today because of my concerns over the anti- environmental riders in this bill. As in years past, the Republican majority has once again inserted a number of anti-environmental riders into the bill and its accompanying report. As I am sure we all remember, similar efforts in years past came to no good, eventually resulting in a government shutdown in 1995. Many of these provisions are a waste of taxpayer dollars, calling for duplicative studies and other wasteful delay tactics that will block the implementation of important environmental protection measures, measures that the EPA has determined are in the best interests of protecting human health and the environment. Just as an example, one provision prohibits the EPA from taking any action to remove contaminated sediments from rivers, lakes and streams until a new National Academy of Science study has been completed and distributed and analyzed by all parties including Congress or, in other words, indefinitely. The need for this new study is questionable since the NAS just released a report last year entitled: Contaminated Sediments in Ports and Waterways Clean-up Strategies and Technologies. But the need to remove these contaminated sediments from America's waterways is not in question. Nowhere more than in New Jersey are people sensitive to the issue of contaminated sediments. In New Jersey we have witnessed firsthand the impact that contaminated sediments can have on our commercial and recreational fishing industries. This remedial dredging rider, I should say this dredging rider, is just one example of the numerous special interest riders in this bill. Others include restrictions on brownfields funding, limitations on the number of toxicological profiles that the Agency for Toxic Substances and Disease Registry can perform, delaying reductions of hazardous mercury emissions from utilities, lowering the bar for clean-ups of NRC-licensed facilities, and the list goes on. Mr. Chairman, my colleague, the gentleman from California (Mr. Waxman) will be offering an amendment to eliminate the anti- environmental riders later today, and I would urge my colleagues on a bipartisan basis to support the Waxman amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is very important for the American public to understand the difference between the Democrat's managed care reform proposal, the Patient's Bill of Rights, as opposed to the Republican sham managed care reform proposal which we will be considering most likely next week. First, we need a national remedy for a national problem. No State has passed legislation which deals with all the major areas of managed care consumer protection. Second, the Republican Senate proposal does not apply to most Americans. Many of its provisions will only cover individuals involved in self-insured, employer-sponsored plans. Third, the Congressional Budget Office has shown that the costs of the Democratic plan are minimal, only $2 per month for the average person. In addition, the Republican plans do not prohibit HMOs from offering bonuses to doctors for denying necessary care; the Republican proposals do not guarantee the right of patients to use specialists as their primary care providers; and, most important, the Republican plans do not provide for the enforcement of patient protections. They continue to protect health insurance companies' special interest exemption from legal responsibility; and, as the President said, a right without a remedy is worthless.

Mr. PALLONE

Mr. PALLONE. Well, the gentlewoman has brought up and highlighted, I think, the biggest gimmick of all with regard to this Republican bill. Essentially my understanding is that at least on the Senate side, if not on the House side, that the Republican bill only applies to ERISA plans, and of course ERISA plans are those that are preempted by the Federal Government because they are self-insured essentially, and these are the very ones that we discussed earlier where there is no enforcement because the patient cannot sue the HMO if they have denied care. So what you have here is hollow patient protections. Not only does the Republican bill limit the patient protections and not include some of the most important ones that the Democrats have talked about, like access to specialty care, for example, but, in addition, by limiting the patient protections to ERISA plans they guaranteed that the patient protections would never be enforced, because if you are in ERISA, you will have the patient protections, albeit limited, but you will not be able to sue so there will be no guarantee of the patient protections. If you are outside of ERISA, you can theoretically sue, but you do not have the patient protections. So they have essentially guaranteed that the whole thing is a fraud by narrowing it, the patient protections, to ERISA where this is no effective enforcer mechanism. The other things that you brought up and spoke so well about: You mentioned the emergency room situation. Again there the democratic proposal uses what we call in legal terms a prudent lay person standard. In other words, the HMO cannot say that you can only use an emergency room at a particular hospital or that you have to have prior authorization to use the emergency room, which of course that, as you point out, is absurd. How can it be an emergency? I think most people would not believe that that is the case, and they are probably shocked if they go to an emergency room to think they need prior authorization. Our bill says that you can have access to emergency care, any emergency room, without authorization if a reasonable person would assume that it is an emergency. Even if it is not, if you can assume that based on your injury or whatever. The other thing that you mentioned with regard to the cost and how so many HMOs are simply prioritized cost savings without any reference to quality of health care, that was brought out so vividly in one of the other witnesses that I did not mention tonight but who testified yesterday before our Health Care Task Force hearing, and this was one of two individuals who had to disguise their voice. We just saw them over the TV monitor with their words sort of disrupted, if you will, so they could not be recognized because the HMO would retaliate against them if they knew that they were testifying. And this one woman, if I could just mention her, was announced as Case Manager X, and she is a mental health therapist for the mid- Atlantic region, my region, with more than 10 years experience. In her role as a case manager she was forced to deny approval for mental therapy even though she knew it was medically necessary. Basically the document, the contract, for the HMO said that you would have 10 to 26 visits for a patient who needed some kind of mental health therapy, but they told her, the higher-ups in the insurance company, that she should not authorize any more than 3 to 5 visits. Sometimes they said 3, sometimes they said 5. And I asked her the question. I said: Well, you know, theoretically, because maybe I am being naive, but theoretically, you know, they must have some sort of theory as to why they are giving you only 3 to 5 visits, even though the contract requires 10 to 26. I mean how do they justify that? And she said: Oh, they came up with a model for mental health treatment known as ultrabrief therapy and told the case managers they should resign if they did not agree with this treatment policy. So because they wanted to save money, they came up with a new mental health therapy theory called ultrabrief therapy, and the theory was that that is all you needed was the 3 or 5 days because, if we did it this way, you would still have the same amount of therapy or the same impact on your mental health. Of course there is no clinical evidence to support the theory of ultrabrief therapy. It was just made up. And she said that the reason why the HMO was really totally getting out of hand was because for the last 6 months they knew that there was a possibility of being bought out by a larger HMO, and so they wanted to prove that, you know, they were really cost-conscience and they were really cutting costs so that the larger HMO would buy them out. So you talk about cost cutting, that was the only thing that was motivating this agent.

Mr. PALLONE. I just wanted to mention again, because the gentlewoman brings up these cases, and you stated it, these are not isolated incidents. When we had the hearing yesterday, again, we asked each of the health care professionals who testified, whether they were the case managers or the physicians, the kinds of stories you tell us, how often do they happen? Generally they would say at least once a week. Once a week each of these individuals, whether they were a doctor or a caseworker who was detailing, working for the HMO, had to face a situation where they felt there was clear abuse and the patient was going to suffer. So we are not talking about a few horror stories, we are talking about things that occur on a regular basis throughout the country, and that is the reason I think why so many people now all over the country are demanding the kind of reform that the Democrats are putting forward. I agree with the gentlewoman, it is bipartisan. I do not mean to suggest that we do not have Republicans with us. We have the gentleman from Iowa (Mr. Ganske), and we have quite few people with us on the other side. But it is the Republican leadership that refuses to bring a good bill it to the floor, actually refused to bring any bill to the floor. Now we hear they are willing to bring up their sham bill and have that voted on as possibly as early as next week. But it is their control of this house and their unwillingness, if you will, to bring up the Democratic proposal, the Patient Bill of Rights, that I think we have to continue to speak out against, because I believe, I am optimistic, and I know the gentlewoman is, if we keep demanding that the Patient Bill of Rights come to the floor, and if we get enough people to sign the discharge petition, we will have the opportunity to vote on that bill. I just want to say one last thing, because I think we are almost out of time. The gentlewoman mentioned the enforcement again. Again, I do not want people to think the distinction between these two approaches, Democrat versus Republican, is based on litigation and the ability to sue, because it is not. There are many differences, important differences. But the ability to sue is an important part of the ability to enforce your rights, and if you have patient protections, but you do not have ultimately the right to bring suit for damages, then you know that the HMOs are not going to be held accountable. They will say that is fine that these rights exist, but what do we care if you cannot enforce them ultimately in a court of law? So, again, we are not trying to be litigious or whatever, but we have to demand that ultimately there is some way for the people to enforce these patients' protections. Otherwise they are false, they do not exist, and are not real.

Mr. PALLONE. Mr. Speaker, I thank the gentlewoman for her participation in this special order.

Mr. PALLONE. Mr. Speaker, tonight, once again, I would like to take up the issue of managed care reform and particularly to draw a contrast which I think is very important between the Democratic bill, the Patient's Bill of Rights introduced by the gentleman from Michigan (Mr. Dingell) and the proposal that has been put forward by the Republican task force both here in the House and another one in the Senate. The Republican health care task force here in the House is supposed to release the language for their so-called managed care reform bill tonight or possibly tomorrow. We know from what the task force has already released publicly that this bill is essentially a response to polling that the Republicans have asked for and requested that shows that they will lose the majority in November if they do not address the issue of managed care reform. But their proposal is essentially a cosmetic fix, a farce, that lacks some of the most important patient protections that are included in the Democratic Patient's Bill of Rights. I also would mention that in the Senate, the Senate Republicans have responded to this overwhelming outcry by the American people for managed care reform, but they have responded with, again, with a rhetoric-laced, partisan proposal that places the interests of insurers far above the needs of patients. I think that the American people simply do not want a bill that does not measure up on the issue of managed care reform. They want an approach that is endorsed by not only most Americans but by the health care professionals, the doctors, the nurses, the Democratic proposal, the Patient's Bill of Rights that takes health care decisions away from insurance company bureaucrats and gives them back to doctors and patients where they belong. Let me just mention some of the faults in the Republican proposal and then give you some idea, if I can, of what is in the Democratic Patient's Bill of Rights. The Republican plan that has been announced, and we have not seen the language yet, but it lacks an enforcement mechanism. It denies patients the right to sue an HMO when they are denied needed care and actually expands the ERISA liability that does not allow those who are now in self-insured plans to sue the HMO. It expands this liability exemption to health insurance pools, private health insurance, that will now have the same basic liability exemption that now exists for self-insured organizations under ERISA. In addition, the Republican plan does not provide access to specialists. It allows insurance companies, not doctors and patients, to make medical decisions. And the Republican proposals contain several poison pills. In other words, these are added provisions unrelated to managed care reform but which are included because the Republican leadership knows that if they are included, a managed care reform bill will never pass and never get to the President's desk. These poison pills include medical malpractice damage caps and also an expansion of the medical savings accounts, two issues that are very controversial and could very easily lead to a situation where we do not get a bill, a managed care reform bill passed this session of Congress. Let me just mention some of the valuable patients protections that are in our Democratic Patient's Bill of Rights. This will apply to the majority of Americans, everyone who has health insurance, who has any kind of health insurance. The patient protections include the return of medical decisionmaking to patients and health care professionals, not insurance company bureaucrats. That would be, for example, the length of stay in the hospital or whether or not you would have access to certain procedures. Those decisions would be made by the patient and the doctor, not by the insurance company. The Democratic bill also includes access to specialists including access to pediatric specialists for children, includes coverage for emergency room care so that you can go to any emergency room when the need arises. It also eliminates the gag rule by saying that doctors and nurses can talk freely about every medical option. And it also includes an appeals process and real legal accountability for insurance company decisions. In other words, the Democrats would allow you to sue the HMO. They would allow a procedure where you could appeal your decision to an unbiased arbiter. It also, the Democratic proposal puts an end to financial incentives for doctors and nurses to limit the care that they provide. Today the CBO, the Congressional Budget Office, put out a study which I thought was very interesting, because many of my colleagues, I should say the Republican leadership and my colleagues on the Republican side that oppose the Democratic Patient's Bill of Rights, have talked about the cost and suggested that somehow patient protections are going to be very costly. The Congressional Budget Office released a report today or an analysis that says that the Democratic bill, the Patient's Bill of Rights, would have only a minimal effect on premiums with most individuals paying only $2 per month. In actuality, the cost would be even less than $2 per month for the many fortunate Americans enrolled in a responsible health plan that has already provided most of the patient protections. Again, cost is not a factor here. Even if it is as much as $2 a month, most Americans would not find that objectionable in order to have the valuable patient protections that increasingly they are demanding. I just wanted to mention, and then I would like to yield to my colleague from Texas who has joined me many times on this issue on the floor and talked about our own States where we have already enacted some of the Patient's Bill of Rights, yesterday we had a very important hearing of our House democratic task force on health care reform. And I would stress that the reason that we have to have Democratic hearings is because the Republican leadership that controls the process in the House has refused to have hearings on managed care reform, refused to have a bill brought up and marked up or considered in committee and refused so far to bring any bill to the floor. So the only way that we can hear the horror stories and the abuses from the American people and from some of our constituents is if we have our own hearings and hear from some of the people that have had problems. I will not mention too many of the witnesses that we had yesterday, but there were a couple that I think that were particularly important, I thought. I will just mention two of the witnesses who were physicians. One was a doctor, Tom Self, who is a pediatric gastroenterologist from San Diego, California. He won a lawsuit against a managed care group that fired him for refusing to curtail patient visits, for limiting diagnostic tests. They fired him because he refused to do these things, refused to curtail patient visits, refused to limit diagnostic tests, and required him to abide by a gag rule whereby he would not disclose recommended treatments to his patients. But despite more than 28 years of experience and excellent credentials, the medical group attacked Dr. Self's reputation by fabricating charges of poor medical practice. Employees for the medical group told Dr. Self's patients he had left town and was no longer practicing, when in fact he had set up his own practice across the street. This is after they had fired him. Well, he won his lawsuit and he is now practicing again. But that is an example of the kinds of things HMOs do for practicing physicians. One other physician, Dr. Boyle, a trained emergency room physician from San Antonio, Texas, the home state of my colleague. He currently serves as the attending staff physician for Texas Trauma Rehabilitation Associates. He was treating a 49-year-old auto mechanic with a strong history of hypertension who had been rushed to the emergency room. After lengthy unsuccessful arguing with the HMO's utilization review physician, Dr. Boyle informed his patient that his HMO would not authorize his admission into the hospital. And despite his extreme condition, the patient left after hearing his care would not be covered. He then suffered a stroke on his way home that resulted in permanent paralysis and medical costs totaling more than $75,000 that the HMO had to later pay. But the patient can no longer work and survive on Social Security payments. Mr. Speaker, we can give endless stories and we already have about people that had been negatively impacted and abuses that many HMOs have actually committed on individuals as well. But I have to say that my concern tonight is that the Republicans will bring their sham managed care reform proposals to the floor next week. In fact, even though we do not have the language to the House bill, the Republican House bill, they have already noticed the bill to come to the floor at the end ever next week. And by noticing it and not allowing hearings, not allowing committee markups, not allowing really the American public to speak out on this legislation, what they are trying to do is simply railroad and bring up this cosmetic sham proposals for so-called managed care reform to the House and have this vote on it and be done with it. And what we have to do as Democrats, and we have some Republicans also who have joined us, is we have to demand that the Democratic proposal, which is really a bipartisan proposal now, the Patients' Bill of Rights, be considered on the floor of the House of Representatives next week at the same time as the Republican alternative. We have asked and we have I think well over maybe close to 200 Members now who have agreed to sign a discharge petition next week that would allow the Patients' Bill of Rights to come to the floor when the Republican proposal alternative also comes to the floor. And I would simply urge my colleagues over the next few days and once this discharge petition is available this coming Monday to sign the discharge petition. Because we must allow a real managed care reform bill, the Patients' Bill of Rights, to be considered by the House of Representatives. The American people deserve no less. Let me yield now to my colleague the gentlewoman from Texas (Ms. Jackson-Lee) who has done such a wonderful job in bringing this issue to the attention of the American people.

Mr. PALLONE

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

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, Republican leaders in both Chambers are now pushing managed care reform plans that will not provide enforcement of patient protections because they deny patients the right to sue their HMO when their health suffers because they are denied the care that they need. Federal judges around the country are increasingly frustrated by the current law which prohibits patients from holding their HMOs accountable. Take the case, for example, in Denver, where Judge John C. Porfillo of the United States Court of Appeals for the Tenth Circuit noted that current law gives the courts no choice in such cases. Judge Porfillo told the New York Times he was deeply moved by the tragic circumstances of a woman who died of leukemia after her HMO denied her care. The right to sue, Mr. Speaker, is the enforcement mechanism for all the patient protections that we are advocating as Democrats. President Clinton summed it up best when he said a right without a remedy is not a right. The Democrats' Patients' Bill of Rights would hold HMOs accountable and give patients the right to sue when they are denied the care that they need. The Republican leadership should abandon its charade and stop pushing its sham proposal and get behind the Patients' Bill of Rights.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this week the Republican health care task force here in the House is supposed to release the language for its so- called managed care reform bill. And we know from what the task force has already released publicly that this bill will be a farce, a cosmetic fix that lacks some of the most important patient protections. Despite an avalanche of real-life examples of people who have died because their HMOs refuse to approve needed care, the Republican leadership has kowtowed to the insurance industry. The Republican plan will not allow patients to sue their HMOs when they are denied needed care. This weekend Senate majority leader Trent Lott announced that Republicans in the Senate are following suit. The Senate Republican bill will also deny patients the right to sue their HMOs. Unlike the Republicans' proposals, the Democrats' patient bill of rights would give patients the right to sue their HMOs. Although this provision is included in the Patient's Bill of Rights, support for giving patients a legal mechanism to hold HMOs accountable is hardly limited to Democrats in Congress. Federal judges around the country are increasingly frustrated by the Employee Retirement Income Security Act, or ERISA law, which is the source of the problem. ERISA shields HMOs and insurance companies from being sued by patients. I would like to give some examples, Mr. Speaker. Take the case, for example, of a Louisiana woman named Florence B. Corcoran. Miss Corcoran brought suit against her HMO after her fetus died following the HMO's refusal to hospitalize her for a high-risk pregnancy. After the suit was thrown out, the U.S. Court of Appeals for the fifth circuit in New Orleans said the Corcorans have no remedy for what may have been a serious mistake. The court observed that the death of Mrs. Corcoran's unborn child would seem to warrant a reevaluation of ERISA so that it can continue to serve its noble purpose of safeguarding the interests of employees. There are other courts around the country, other Federal courts, that have also been critical of ERISA and the fact that patients cannot bring suit against their HMOs. In Boston, Judge William C. Young of the Federal court expressed his deep concern by the failure of Congress to amend the statute that due do the changing realities of the modern health care system has gone conspicuously awry. ``It is deeply troubling,'' Judge Young said, ``that in the health insurance context ERISA has evolved into a shield of immunity which thwarts the legitimate claims of the very people it was designed to protect.'' I could give other examples. I will give one more, Mr. Speaker. In San Francisco, the U.S. Court of Appeals for the Ninth Circuit ruled just last month than an insurance company that denied Ms. Rhonda Bast from Seattle treatment for breast cancer. She had died from the disease. ``This case presents a tragic set of facts,'' said Judge David R. Thompson. ``Without action by Congress,'' he added, ``there is nothing we can do to help the Basts and others who may find themselves in the same unfortunate situation.'' I think that these examples clearly demonstrate the severity of the problem. From coast to coast, Federal courts are forced to tell patients and families of patients who have died that they would like to help but cannot. The law does not allow for it. The law does not allow for a patient to bring suit effectively for damages against an HMO. And this, I would remind my colleagues, is what the Republicans now are ardently defending. No matter what the cost, the Republican leadership will not break its alliance with the insurance industry and allow for adequate enforcement of patient protections. Giving patients the right to sue HMOs is an absolutely vital component of managed care reform. The right to sue is the enforcement mechanism through which all the patient protections we are advocating are to be protected. President Clinton summed it up best when he said the other day that ``a right without a remedy is not a right.'' The public's support, Mr. Speaker, for true managed care reform I think has translated into an enormous amount of support for the Patients' Bill of Rights, the Democratic proposal, which offers the most comprehensive set of protections of any managed care reform bill in Congress today. Currently, the Patients' Bill of Rights has the support of over 175 patients, physicians, consumer medical and public health groups. It has 190 cosponsors in the House, including some Republicans. Despite this groundswell of grassroots support, the Republican leadership is still throwing up roadblocks to progress. Their are reports today that the Republican leadership may bring its sham proposal directly to the floor for a vote as early as next week. This week, supporters of the Patients' Bill of Rights will be working hard to gather support for the bipartisan Dingell-Ganske discharge petition, which was introduced before Congress adjourned for the July 4 recess. This discharge petition would force the Republican leadership to allow the Patients' Bill of Rights to come to the floor for a vote. The discharge petition will play a crucial role in ensuring Members of this body are given the opportunity to vote on the Patients' Bill of Rights if the Republicans bring their sham proposal to the floor next week. I think, Mr. Speaker, it is time that we all took stock of the fact that if we are going to pass patient protections, and we certainly should, that it should be patient protections that is real managed care reform.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to express support for the Agricultural Export Relief Act of 1998 that is before us. This is the first effort by Congress to lift the sanctions imposed pursuant to the Glenn amendment after India and Pakistan conducted underground nuclear tests earlier this year. While I support this legislation, I think the President needs greater discretion in lifting these sanctions. Last week the task force empowered by the Senate leadership to look at the sanctions regime put forth a proposal that would give the President greater discretion in waiving unilateral sanctions against India and Pakistan, for example in international trade and finance. It would also allow for the President to clear the way for the U.S. to support international financial institutions to resume loan payments to India and Pakistan. The proposal, however, would not allow the President to waive sanctions that limit the transfer or sale of military and dual use technology. Mr. Speaker, I plan to introduce a House bill today that is identical to the Senate task force proposal. I believe U.S. policy has proven to be ineffective in deterring the proliferation of nuclear weapons in South Asia, and it is time that Congress review this policy and implement legislation that gives the President greater flexibility in addressing nuclear crises. I believe we must keep working for nonproliferation, but that the economic sanctions now in place are not the best way to achieve that goal. We have limited our diplomatic options in terms of nonproliferation in South Asia while damaging the growing economic relationship between India and the United States. The administration has conducted several senior level meetings with the Indian government since the tests. India and Pakistan have expressed a desire to work with the U.S. in resolving these issues. Later this week Deputy Secretary of State Strobe Talbot and Assistant Secretary of State Karl Inderfurth will be visiting New Delhi and Islamabad to continue discussions and negotiations. This is following very successful meetings last week between the U.S. and India in Frankfurt, Germany. During this critical time it is important that we give the President the necessary tools to help achieve our nonproliferation goals. I urge my colleagues from both chambers to work together so we can rectify this serious problem.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I want to support the gentlewoman from Hawaii, and say that I was one of those, part of that overwhelming 300 or so, who voted when we had this amendment on suspension a couple of months ago, who voted in favor of eliminating the right for permanent residents to be able to contribute. After that time I was overwhelmed, if you will, by so many constituents in my district, which is a very multi-ethnic district. A lot of Asian Americans live in my district. They explained to me how insulting this was, if you will, that to say that people who are here, who become permanent residents, who would like and in most cases are trying to become citizens of the United States, that this is the one opportunity they have, really, or one of the few opportunities they have to express their will and get involved in the political process. I think it is a mistake for us to deny them that. I think that I understand the point of view that says, well, you should be a citizen to fully participate in our democracy, but this is not--this is a form of participation, a very small form of participation, that I think we should allow permanent residents to be able to contribute and participate in this way.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, it is my good fortune to represent Monmouth County, N.J., a beautiful, seashore county that produced our current Poet Laureate, Robert Pinsky. Another accomplished poet also called Monmouth County home. That was Marjorie Hirshberg who died last year at the age of 54, a victim of Amyotrophic Lateral Sclerosis or Lou Gehrig's disease. Before succumbing to that most vicious, crippling disease, Marjorie wrote poetry on her computer, touching her cheek to a wand until she could no longer even move her head. Her mother said that through all of this struggle, Marjorie exhibited a bravery and spirit that gave strength to everyone--mother, father, husband and children and enabled them to cope with her rapid deterioration. ``Bravo, my child,'' said her mother in a recent letter to me. Well, I want to say ``bravo'' too, for the excellent and moving poetry that Marjorie Hirschberg produced and I would like to share two of these poems with my colleagues. I would also like to include an article that appeared in the Atlanta Journal-Constitution that highlights some of her many other contributions to the arts, women and children. The poems follow: My Wonderful Mother is Eighty Today I would like to drive her through my neighborhood Honking the horn to let everyone know How proud I am of her. Visit all my friends with her Accepting tea and cake Or turkish coffee As tokens of their love and respect. Then I would take her to lunch some place Where the prices would scandalize her. We will talk of bess as suffragette, Of pearl and the coat and evey and the wagon. Sid Sid and the store and millie's phone call on January 1. And Bobby's announcement of joy to the world. Then we get to newborn Ethan in our shaker bed, Elizabeth of the tumbling Brown ringlets. Of eloping with the brown-haired adonis who came to the door All this while eating our fill, sharing two extravagant desserts Then rolling home, Knowing the best daydreams Have a life of their own.