Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, next week I plan to introduce the Affordable Health Insurance Act of 1998. This is the House companion bill to Senator Kennedy's legislation that he will also shortly introduce. Mr. Speaker, in 1996, 2 years ago, Senators Kennedy and Kassebaum introduced the Health Insurance Portability and Accountability Act of 1996, which became known as the Kennedy-Kassebaum bill. The Kennedy- Kassebaum bill sought to improve portability and continuity of health insurance coverage and to limit preexisting conditions exclusions. This was part of our overall effort to reform health care and health insurance and try to make it easier for people to transfer their health insurance when they moved from job to job and to make sure that people who had preexisting conditions were not excluded from being able to obtain health insurance because they lost their job or changed their job or decided that they needed health insurance. At the time, 2 years ago, as cochair of our Democratic Health Care Task Force, I worked with a majority of Democrats and some moderate Republicans to push for passage of the Kennedy-Kassebaum bill. On August 21, 1996, it was signed into law by President Clinton as Public Law 104-191. Those of us who pushed for the Kennedy-Kassebaum legislation were hopeful that what we set out to do would be accomplished in the 2 years since it was enacted into law. However, the General Accounting Office recently issued a report. The GAO is the nonpartisan investigative arm of Congress. They recently, just this past week, issued a report that said that many people who tried to move from the group health insurance market to the individual health insurance market under the Kennedy-Kassebaum law may, and I quote, ``may be effectively priced out of the market.'' Those who fought for the original Kennedy-Kassebaum legislation thought that people who left the group market would be provided access to the individual health insurance market. Unfortunately, what the GAO found is that consumers who either leave their job or for other reasons leave the group market are being charged between 140 percent to 600 percent of the standard premiums when invoking Kennedy-Kassebaum to obtain insurance in the individual market. Kennedy-Kassebaum was intended to provide access for people, for Americans, to health insurance. Unfortunately, when the price of the premiums becomes so outrageously unaffordable, essentially that access is denied. And so the promise of Kennedy-Kassebaum to provide access is essentially denied because the health insurance is unaffordable. I wanted to, if I could, Mr. Speaker, talk a little bit more about the recommendations and the concerns that came out of this GAO report. As I said, the main concern was that the high rates that are being charged individuals basically make the guarantee of health insurance in Kennedy-Kassebaum not real. But the GAO mentioned a number of things in addition to the high rates which I think should be brought to my colleagues' attention and to the American people. The GAO identified these problems. They said, first, that some States, including California, have not passed all the laws needed to carry out the Federal statute. And the Federal Government does not have enough money or personnel to fill the breach. I am reading, I should say, Mr. Speaker, from a New York Times article from this past Tuesday, March 17, on the front page, which went into some of the recommendations and some of the concerns expressed in the GAO report. The second thing that the GAO mentioned was that the regulations are vague and ambiguous, so insurers do not fully understand their obligations. Then they said the consumers lose most of their rights if they do not buy an individual insurance policy within 63 days of losing group coverage, but they are often unaware of this time line. The GAO also said that some insurers have redesigned their benefits in ways that exclude coverage of particular illnesses or costly procedures for a specified period of time and that these tactics may not be illegal, but defeat the purpose of the law. Finally, the GAO report says that some companies have told insurance agents that they will not get commissions for selling policies to individuals with medical problems; in other words, those with the preexisting conditions that we were concerned about. President Clinton has said that he will address one problem this week by notifying State officials that it was against the law for insurers to penalize agents who sell policies to high-risk individuals. These are all concerns that we certainly need to address in Congress or that need to be addressed through agency action by the executive branch. But really, the whole focus of the law and the main concern that I have is the issue of affordability. A lot of consumers I think may be disappointed because they cannot buy affordable policies pursuant to Kennedy-Kassebaum, and in The New York Times article it actually mentions that one insurer, American Medical Security of Green Bay, Wisconsin, a subsidiary of United Wisconsin Services, said it reserved the right to charge high-risk individuals 5 times the rates charged to healthy people. Now, the law does not restrict the premiums that a company may charge for individual health insurance coverage. I think our feeling was, those of us who voted for this bill, was that we were hopeful that the insurance companies, even if it was not required by law, that there be a limit on how much they could charge, that they would voluntarily exercise some restraint in how much they would charge high-risk people or those with preexisting conditions. Obviously, the GAO report says that that is not necessarily happening, and I think, therefore, it means that the Federal Government must, and this Congress must, intervene to pass legislation that would limit how much could be charged these high-risk or these people with preexisting conditions. The legislation that Senator Kennedy and I will be introducing will end this price-gouging practice. It will ensure that the true intent of the original Kennedy-Kassebaum legislation will be guaranteed. Those who enter the individual market should not be denied health care for being responsible citizens by seeking to maintain health care coverage. The Affordable Health Insurance Act of 1998 is responsible legislation, and I would urge my colleagues that they cosponsor the bill before we put it in next week, and that we see action swiftly to pass the legislation. Congress, I do not believe, can allow these excessive premium increases to go unchecked. Mr. Speaker, I wanted to say that in many ways, the issue of affordability and the denial of access because of the lack of affordability that I mentioned in the context of Kennedy-Kassebaum makes me also feel that we should address the issue of affordability in the context of the Medicare expansion legislation that has been proposed by President Clinton and that I support 100 percent. Democrats earlier this week announced expansion of health coverage for Americans aged 55 to 65, basically putting in legislation that would enact into law what the President has articulated. The President has been saying for the near elderly, the people between 55 and 65 that are not yet eligible for Medicare, that they should be able to buy into the Medicare system in certain circumstances, depending upon their age or circumstances, because what we find is that increasingly, this group of people in that 10-year, from 55 to 65, are the ones who lose their job or whose spouse loses their job or loses their coverage and cannot find health insurance, affordable health insurance, on the private market. And so what we are saying, let us expand Medicare in certain circumstances so that they can buy into Medicare without additional cost to the Medicare program. The President's bill that is now supported by the Democratic leadership both in the House and in the Senate, presents three options to this age group to obtain insurance, and I will just briefly mention it. It says, individuals 62 to 65 years old with no access to health insurance may buy into Medicare by paying a base premium now and deferred premium during their post-65 Medicare enrollment. Individuals in the second category from 55 to 62 who have been laid off and have no access to health insurance, as well as their spouse, may buy into Medicare by paying a monthly premium of about $400. Now, $400 generally is about what the cost would be to buy into the Medicare program. Then the third category, retirees age 55 or older whose employer- sponsored coverage is terminated may buy into their employer's health insurance for active workers at 125 percent of the group rate. I wanted to say, though, again, going back to the issue of affordability and how it may impact the Kennedy-Kassebaum legislation, I think again we may face a situation where the President's buy-into Medicare provides access, but for many people who cannot afford the $400 a month or can only afford to pay part of the $400 a month, they may be still denied access to Medicare and to health insurance because of the cost. So while I applaud the President's buy-into Medicare proposal as a means to provide additional access, I believe that providing some financial assistance to the near elderly will address issues surrounding its affordability. I am working on legislation that will provide economic assistance for those aged 62 to 64 who choose to buy into the Medicare program and for those age 55 to 64 who have been laid off or displaced. As is the President, I am not necessarily seeking to increase Medicare costs, but am seeking to make one of the best health care programs in the world accessible and affordable to an important segment of the uninsured population. My idea, which would be to create a sliding scale of assistance in which any near elderly who chose to participate into the buy-into Medicare would still pay most of the costs, but would receive some assistance, depending on need. While Medicare is now at one of its strongest points since its inception, I believe that now is not the time to further increase Medicare expenditures in an irresponsible manner. Instead, I would seek to offset any additional costs associated with this plan over and beyond the President's proposal. Potential sources would include additional Medicare fraud and abuse provisions and potential monies from the tobacco settlement. Mr. Speaker, again, for those of us who believe, and I do very strongly, that health insurance should be guaranteed to every American, we have been, of course, disappointed in the last 4 or 5 years since the President proposed his universal health insurance proposal that more and more people are now uninsured. The number of Americans who have no health insurance continues to grow. And we have tried to address this issue by passing the Kennedy-Kassebaum legislation; by initiating a health care program for kids on the Federal level last year; and now by trying to address managed care reform, patient protections, and also by the Medicare expansion that I just spoke about. The bottom line is that we have to do whatever we can to make health insurance more available to those Americans who have do not have coverage, because I am very fearful that as time goes on, more and more people will enter the ranks of the uninsured, and I see absolutely no positive benefit to our society or to our economy if that continues. I think in the long run, it will make health insurance in this country not only less accessible, but also will ultimately affect the quality of our health care as well. So it is something that every American needs to be worried about. The International Arena: Armenia and India Mr. Speaker, I would like to now switch, if I could, to a couple issues related to the international arena and focus on two areas where I have been very concerned. One is Armenia, and the other is India. I am the cochairman of our caucus on Armenia and our other caucus on India, and both of these two countries, interestingly enough, recently went through elections in a very democratic way, one that I think can be emulated, if you will, by the rest of the world. If I could turn to Armenia, because of the election, this has been a very important week for the Republic of Armenia. On Monday, March 16, the first round of elections for the Presidency of Armenia took place. The turnout was approximately 66 percent. A runoff election between the 2 top vote-getters will be held on Monday, March 30. Mr. Speaker, this election is an important development in Armenian democracy. Since gaining its independence from the Soviet Union in 1991, Armenia has worked to establish the procedures and institutions of civil society while adopting economic reforms. Despite being surrounded by hostile neighbors that have imposed economically devastating blockades, Armenia has overcome years of oppression and dictatorship to become a functioning democracy. When former President Levon Ter-Petrosian, who led the Nation through the early years of independence, resigned last month, the succession of the Prime Minister to the post of acting President was held in a peaceful, orderly and lawful way. Although it is disappointing to see the extremely critical and often inaccurate portrayal provided by much of the media, I am proud to say, Mr. Speaker, that Armenia has become one of the true success stories of the former Soviet empire, and this week's elections are further proof of that. As we celebrate the progress of democracy in Armenia, we cannot forget the suffering that has been and continues to be visited upon the Armenian people by Turkey. The latest Turkish assault on Armenians takes the form of an affront to the history, culture and religion of Armenians in Turkish-occupied northern Cyprus. Many Members of this body, including myself, have been very critical of the Turkish occupation of Cyprus and the fact that Turkey has not been willing to heed international calls that it withdraw from Cyprus. The latest development is that the ancient Sourp Magar monastery, referred to as the ``Armenian Monastery,'' near Kyrenia in the northern part of Cyprus, which Turkey illegally occupies, is now to be converted into a tourist hotel. That is right, Mr. Speaker. A monastery that dates to 1,000 A.D., which was bombed during Turkey's invasion of the island 24 years ago, and which has been plundered and neglected, will be restored for the purpose of turning the property into a hotel. I have to say, Mr. Speaker, that I am pleased to note that this desecration of the monastery has not gone unchallenged. The Honorable Nikitas Kaklaminis, member of the European Parliament from Greece, has officially raised a question with the European Parliament which I would like to quote from. He says, ``This plan by the Turks proves that the Turkish occupation authorities do not respect the cultural heritage of the island, and obviously the monuments of Christianity in the north part of Cyprus. I would like the European Commission to inform me about the way it intends to react against the practice of a brutal regime, which is supported by 40,000 Turkish soldiers who occupy almost 40 percent of Cyprus, something that has lasted for 24 years.'' Catholicos Aram I of the Armenian Church of Antelias, Lebanon, who I had the honor to meet last year when he visited New Jersey, has also addressed a letter of complaint to the Executive Director of the U.N. Education, Scientific and Cultural Organization, UNESCO, also to the Secretary General, the President of Cyprus, the President of Armenia, the International Religious Council, the National Assembly of Armenia, and the Catholicos of All Armenians and other organizations, calling the restoration conversion scheme of this monastery sacrilegious and nonhumanitarian and a violation of our religious and cultural values. Mr. Speaker, the plans for this monastery are consistent with the Turkish disrespect of both Armenian and Greek holy places in Cyprus and throughout Asia Minor. Turkey has tried to remove traces of Greek in Armenian history, change place names and generally tried to assert Turkish supremacy. I hope that the European Commission and other international organizations will make it clear to Turkey that this type of behavior is simply not acceptable. I am also asking my colleagues in this House to join me in appealing to UNESCO to take a stand against this wanton disregard for a site with great religious, historic and cultural significance. I will also be calling to our administration to raise this issue with the Government of Turkey. While our list of grievances with Turkey is a long one, perhaps this issue can serve to convince the Turkish regime that it must have more respect for its neighbors. Tribute to Patriarch Karekin II Finally, Mr. Speaker, I wanted to pay tribute this afternoon to a great Armenian religious leader who labored for decades under Turkish rule, and this is Patriarch Karekin II, the spiritual leader of Turkey's Armenian Christians, who died on March 10 of this year at the age of 71 after a long illness. An estimated 50,000 ethnic Armenians live in Turkey, the majority of them members of the Patriarch's church. Karekin II was the 83rd holder of the position of Patriarch of Istanbul, obviously a title with a great historical legacy. The Armenian Patriarchate will begin the process of electing a successor on April 14th. Mr. Speaker, Armenia was the first Christian state, and the church continues to play an important unifying role in the life of the Armenian community, both in Armenia itself and throughout the Armenian Diaspora, including here in the United States. I join Armenians everywhere in paying tribute to this great leader and mourning his passing. AAPI Legislative Conference Mr. Speaker, finally this afternoon I would like to mention an issue of concern to those of us who are in the India Caucus, and I mentioned that I cochair the India Caucus in Congress. Next week the American Association of Physicians of Indian Origin, AAPI, will be having a legislative conference. They come to Washington every year, and they go around and visit various Members of Congress and also Senators to talk about the issues that they are concerned about that impact physicians of Indian origin. This conference will focus a great deal on the issue of health care reform, particularly managed care reform. I wanted to say that, with approximately 30,000 physicians of Indian origin in the United States practicing medicine, AAPI has begun to be heard in Washington, D.C. I have a number of Indian physicians and members of AAPI in my district and throughout the State of New Jersey. They have become very politically active, and this legislative conference is just another manifestation of that. Two issues of particular importance to the AAPI members that they will be discussing next week are managed care reform and International Medical Graduate or IMG equity. I would just like to take a little time now to talk about these two issues. On the issue of managed care reform, AAPI has played an active role for pushing for comprehensive managed care reform. At the end of 1996, I received a copy of AAPI's policy statement on managed care. This statement outlined five basic principles for managed care reform: first, to ensure patient choice; second, to provide for contract and termination nondiscrimination; third, to limit financial incentives that reduce appropriate health care; fourth, to eliminate gag clauses that restrict physician-patient communications; and, fifth, to ensure that medical decisions are in the hands of physicians and not a managed care bureaucrat. These positions or these concerns that were outlined by AAPI are, of course, also the concerns that many Americans have with regard to managed care and HMOs. They are the same concerns, essentially, or among the same concerns that the President and the Democratic leadership in the House and the Senate have identified in putting together patient protection legislation, which is probably the number one priority for the President and for the Congress, for the congressional Democrats this year. Of course, we have been thwarted so far in our efforts to move managed care reform legislation by the Republican leadership that has refused to move any bill in this regard. Let me say that AAPI, after having read AAPI's white paper on managed care reform and working with AAPI and the Indian physicians, I introduced the Health Care Consumer Protection Act, H.R. 3009, last November. It is modeled after the AAPI policy statement and includes strong language prohibiting provider discrimination based on race, national origin, and place or institution in which a health professional's education was received. In addition, important due process provisions will work to create objective, not subjective, criteria for choosing network physicians. This bipartisan legislation has 31 additional cosponsors. Since that time, managed care reform has gained momentum. It is likely to become one of the biggest issue this year, 1998. I want to say that AAPI recognized managed care reform as the key issue years ago. I believe that their hard work and determination will ultimately lead to results for all physicians and for the benefit of American people. The second major issue that AAPI is concerned about relates to international medical graduates, the so-called IMGs, those physicians who went to medical school abroad before they came to the United States. As a result of the Balanced Budget Act that we passed in Congress and that the President signed into law last summer, residency slots at medical colleges or medical schools are expected to decline. Representing the largest group of international medical graduates, physicians of Indian origin are rightly concerned that IMG slots may be the ones that see the largest reductions in the context of these residency reductions. Determining which slots will be reduced, I would say, and AAPI certainly says, should not be done in an arbitrary fashion; in other words, in deciding who is going to fill the reduced residency slots for medical education. It should be done in an objective way so that those who are IMGs can compete. The criteria should be objective and equitable. Qualifications of physicians, not national origin or geographic location of medical education, should be the deciding factor. The reason why this is important to the average American is because approximately 85 percent of the IMGs are in practice serving predominantly in urban and underserved areas. They are the ones that go into the cities and into the rural areas where other doctors do not want to practice, particularly in public hospitals. It is very important for us and for those who need health care in those urban centers as well as in those rural areas to be able to have a physician. If they cannot get a physician who happens to be an IMG, then, oftentimes, they are not going to get any physician at all. So I am trying to point out why IMGs play a very vital role in the health care delivery system in the United States. AAPI has been in the lead both on managed care reform to guarantee objective due process and then now leading the charge to ensure that IMGs are not discriminated against. I will continue to work with AAPI and other organizations that continue to fight for the same principles. As this session of Congress moves forward, it is my hope that both issues will be addressed. Certainly the Indian physicians who come here next week for the legislative conference will go around to the various congressional offices and explain why managed care reform and objective criteria for international medical graduates is something that they should all support in the interests of the American people.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I just wanted to mention today how important it is for this Congress and this House to address the issue of Medicare expansion with regard to Americans age 55 to 65. The President in his State of the Union Address, and just this past Tuesday, just yesterday, had a press conference where he discussed the need to move quickly on the issue of Medicare expansion for what we call the near elderly, those between 55 and 65. I believe it is crucial for us to address this issue. The Democrats are making it one of their priorities for this Congress. So far the Republican leadership has refused to acknowledge the need for such legislation, or to even suggest that it be moved in committee and moved out to the floor of the House of Representatives. Today, for a variety of reasons, more and more Americans are losing their employment-based health insurance before they become eligible for Medicare at age 65. Some of these Americans lose their health coverage because their older spouse becomes eligible for Medicare and retires, ending their work-based coverage. Others lose their coverage because of downsizing or layoffs. Still others lose their insurance when their employers unexpectedly drop their retirement health care plans. These people worked hard, usually in most cases for a lifetime, supporting their families and contributing to society. Now, just when they need it most, they lose their coverage and are unattractive to health insurers, who demand high premiums or simply deny coverage outright. I am getting more and more of my constituents who come into my office in New Jersey and complain about the fact that they cannot get access to affordable health care when they are in this age bracket, from 55 to 65. They find it very difficult in this age group to get coverage outside of the workplace. Many are often left with no alternative but to buy into the individual insurance market, where premiums can exceed $1,000 per month for a person with a preexisting condition. For those with serious health problems, they may not be able to find insurance at all, at any price. What the President has proposed, and what the Democrats in the Congress are suggesting be done and be moved, is a bill that presents three options to this age group to obtain health insurance. One, individuals 62 to 65 years old with no access to health insurance may buy into Medicare by paying a base premium now and a deferred premium during their post-65 Medicare enrollment. Individuals in the second category, from 55 to 62, who have been laid off and have no access to health insurance, as well as their spouse, may buy into Medicare by paying a monthly premium of about $400. Retirees, and this is the third category, aged 65 or older whose employer-sponsored coverage is terminated may buy into their employer's health insurance for active workers at 125 percent of the group rate. So we are talking about three categories of people in this age bracket who face different problems. But the main thing, Mr. Speaker, is the Democrats understand that Americans in this age group have difficulty getting health insurance at one of the most vulnerable times in their lives. We want to help these people out. They have greater risks of health problems, with twice the risk of heart disease, strokes, and cancer as people whose ages are in the 10 years from 45 to 54 or below, but they are having a very hard time obtaining affordable health insurance for themselves and their spouse. This is a problem that is growing. It is getting to crisis proportions. It will only grow as retiree health coverage is reduced and as the baby boom generation ages. What we are trying to do here is address a health concern without putting any additional financial burden on the Medicare program. I think this is a very good piece of legislation. The Republican leadership has not addressed it, but they should address it. One issue that also comes up, and I have actually suggested it, is that we find some way to provide some financial assistance to the near elderly who will have a problem buying into the Medicare system because of the cost of the monthly premium. I have been working on legislation that would provide economic assistance for those age 62 to 64 who choose to buy into the Medicare program, and for those age 55 to 64 who have been laid off or displaced. There may be some way to provide some sort of subsidy so that those who cannot afford the full cost of the Medicare premium on a sliding scale, based on their affordability, would be able to get some sort of subsidy so that they could successfully buy into this program. With or without that type of subsidy, though, this is a good program. It is something that needs to be addressed. Like the issue of managed care reform or like the issue of kids' health care that was addressed in the last Congress, I hope that, as the Democrats keep pushing for this, the Republican leadership will eventually wake up and allow this type of legislation to be taken up so that those in that 55 to 65 category can buy into Medicare, and we can see Medicare expanded in a way that is both fiscally responsible, but also addresses a growing health care concern.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I agree with the gentleman. My understanding is that the Clinton Administration, as the gentleman said, supports expansion to five seats: one for Germany, one for Japan, and then one each for Asia, Africa and Latin America. The Clinton Administration is not saying that the Asian seat should be India at this point, but we believe that it should be, and we are hoping that at some point we can get this administration and the State Department to agree that that Asian seat should belong to India. Mr. Speaker, I just wanted to say that we understand that this process of expanding the Security Council and gaining India access to one of the seats may take some time. It seems like to some extent it has been somewhat slowed down in 1998, but if it does not come up this year, it probably will come up again, and we are going to continue to make the fight that the United States should take the position that India be included as one of the permanent members; again, part of the process of stressing the importance of India not only in terms of the world but also in terms of our foreign policy, and I think that our caucus members have played a major role in trying to make that point. So at this point I would like to yield to my colleague from California and thank him for participating with me in this Special Order where we talk about these issues relating to Armenia and India, and thank him for all of his support with the caucus. Foreign Policy and Domestic Concerns

Mr. PALLONE. Mr. Speaker, we of course are going to make a major effort over the next few months to monitor this assistance going to Karabakh and to make sure that it does get to those who need it, and also to make sure that section 907 is not repealed. Obviously, we are going to have the battle over the next few months also to make sure that over the next fiscal year this humanitarian assistance gets to both Armenia and Nagorno- Karabakh. I wanted to move on, if I could, to our other area of concern and that is India, because India in fact just went through a very successful election. Once again, India of course is the largest democracy in the world, and it amazes me every time they have an election that so many hundreds of millions of people are able to vote in an election and that it is essentially a fair election and that people vote and take part in a very orderly process. One of the things that I know that the gentleman from California (Mr. Sherman) and I have been concerned about is that we want to make sure that India continues to rise in importance, if you will, and be a priority of American foreign policy. I think that we have seen that happen over the last few years. We have seen that the amount of trade that takes place between the United States and India continues to grow. The United States is India's largest trading partner right now, and in addition, at the presidential level, at the cabinet level, we have seen many of the cabinet members visit India to show that India continues to be more and more important as part of the United States' foreign policy, and the President, President Clinton is again committed to going to India sometime in 1998, which again shows the significance of India. One of the things that we have been working on, though, in the same vein, we had the opportunity earlier this week on Tuesday at our India Caucus meeting to hear from Bill Richardson, who is the United States Ambassador to the U.N., one of our former colleagues here from the House of Representatives, and we discussed a number of issues that pertain to current U.S.-India relations at the United Nations. However, I just wanted to talk briefly about the topic of India's permanent membership to the U.N. Security Council. I introduced a House Resolution, along with the gentleman from California (Mr. Sherman) and other Members of our India Caucus last year, that calls upon this body to express our support for India becoming a permanent member to the U.N. Security Council. Last year the president of the U.N. General Assembly, Mr. Razali Ismail, introduced a plan to expand the U.N. Security Council permanent membership, and although this plan has not moved forward, I believe that expansion of the Security Council is extremely important. It is the only organization within the U.N. that can apply economic sanctions and military force to carry out its decisions. I also believe that membership to the Security Council should better reflect developing countries, and India in particular qualifies for membership because of its size and crucial role in South Asia. I wanted to talk about this a little more, but I would like to yield to my colleague on the same subject.

Mr. PALLONE. Mr. Speaker, I am joined tonight by my colleague and friend the gentleman from California (Mr. Sherman). Both of us are members of the Armenia Caucus in the House of Representatives and also the India Caucus. We have been active in dealing with some of the issues that would bring Armenia and the United States closer together as well as India and the United States. There are a number of issues that we wanted to discuss this afternoon. I wanted to start out by talking about a recent development related to the Turkish Government, and what I consider a serious threat to academic integrity at two great American universities. Negotiations are now under way between the Republic of Turkey and the University of California at Berkeley to establish a Turkish studies program at that university. In addition, Portland State University in Oregon has signed a contract with the government of Turkey to establish a similar program, although Portland State is currently reviewing the conditions of the grant. These efforts, I want to stress, are part of a pattern that set up Turkish studies programs at great American universities, all funded with strings attached, I should stress, by the government of Turkey. A similar study program was, in fact, set up at Princeton University in my home State of New Jersey and at other schools, all with endowments from the Turkish Government. Last year, yet another effort by the Turkish Government to set up a program at a major American university, I think it was the alma mater of the gentleman from California (Mr. Sherman), the University of California, Los Angeles, UCLA, was rejected by the school's history faculty. I know that the gentleman from California (Mr. Sherman) played a major role in that, and I also spoke out against UCLA setting up this type of chair or program with the funding from the Turkish Government. I just wanted to say that I believe that everyone associated with UCLA should be proud of the stand taken by that university. UCLA is not only a university with a grade academic reputation, it is also a school that receives public funds giving it an added responsibility to the community for maintaining standards of academic excellence and integrity. I hope that Berkeley and Portland State will also take this factor into consideration. Mr. Speaker, I yield to my colleague from California (Mr. Sherman).

Mr. PALLONE. I was looking at what the gentleman said about this advisory committee and its makeup. They are actually in charge of providing advice on the disposition of the proceeds of the endowment, the choice of teaching personnel, visiting faculty, the planning of lectures and cultural events, fund-raising. They basically are going to have input into the whole process.

Mr. PALLONE. I just want to follow up on what my colleague from California said. As the gentleman said, there are countries that have contributed funds to American universities for various history, language and cultural programs, and in many cases these programs have a high academic repute. The difference between these programs and what Turkey is trying to accomplish and has already accomplished because unlike UCLA, Princeton University in my State accepted these funds, and that is that the Turkish studies program stipulate that their money goes to hire only scholars with close and cordial relations with academic circles in Turkey and those with access to that country's libraries and historical archives. The programs are not intended to encourage objective research into Turkish history, but rather to further the Turkish Government's goal of using a selective interpretation of history to advance official government propaganda. To that end, Turkey restricts access to its historical archives to those supportive of the official version of Ottoman and Turkish history. The gentleman from California (Mr. Sherman) talked about the Armenian genocide, this terrible crime against humanity, the first example of genocide in the 20th century. Surely, Mr. Speaker, this historic tragedy should figure in any account of Ottoman and Turkish history. Yet that is not the intent. The Turkish Government is not interested in presenting an accurate, complete or truthful overview of Turkish history, but rather uses cash payments to major universities as a way of manipulating the teaching of the history of the genocide. The consequences are severe, including the denial or whitewashing of historically verified genocide of the Armenian people, as well as other dark chapters in Turkish history, such as the ongoing oppression of the Turkish people, the massacres at Smyrna in the early part of this century and the invasion and occupation of Cyprus. This is basically a continued suppression of democracy and free speech. That is why the gentleman from California (Mr. Sherman) and I are so much opposed to what the Turkish Government is trying to do when they donate and they give this money to major universities such as Princeton, UCLA and now Berkeley and Portland State. I wanted to just say briefly, we had a very interesting Armenian Caucus reception a few weeks ago where we had Peter Balakian, a native of my State of New Jersey and a renowned poet and professor at Colgate University and the descendant of genocide survivors. Mr. Balakian consistently cautioned against the efforts of the Turkish Government to put its spin on Turkish history in major American universities. I just wanted to take note where he said that the proposed chair, we are talking now about, I think at the time it was either UCLA or Berkeley, would be generated by a country with one of the worst and most violent and most repressive regimes in human rights on this planet. And so this issue is not just about Turkey, but about academic freedom and academic integrity. So it really goes beyond the issue of even what Turkey is trying to do, but just the issue of academic freedom and integrity at these universities. If the Turkish chair were proposed at a university that included as part of its curriculum the work of scholars like Peter Balakian and others who documented the Armenian genocide, then I think they would have a credible academic program that we would support. But the effort by a foreign government in this way, to buy its way into our universities to rewrite history, should not be tolerated. I know both the Armenian-American and the Greek-American communities have led the fight against this ongoing campaign. What is happening now at Berkeley and Portland State is just another manifestation. I just hope that these two universities will follow the example of UCLA and reject this effort by Turkey to buy its way into our country's higher learning institutions.

Mr. PALLONE. I was listening to what my colleague from California said. One of the things that Peter Balakian mentioned to me, and I think that he is actually going to be writing a book on this subject, is that at the time when the Armenian genocide was taking place in the early part of this century, there was a tremendous amount of documentation; it was written up rather frequently in just normal daily newspapers in the United States and throughout Western Europe. It was a major topic. People were concerned about it. Help was sent over to the survivors. Efforts were made on a diplomatic level by the United States and other Western countries to prevent it. And all of a sudden, by the time, I guess, sometime in the mid-1920s when it was over, all that disappeared. In other words, the emphasis that existed at the time, the public concern and fury just simply died out. At that point and ever since then, either the Ottoman and then finally the Turkish Government began this process of trying to deny that it ever occurred. One of the things that he said that he was going to do was to bring out some of those old accounts at the time. I was surprised to hear that, because I figured that there was not a great deal of attention devoted to it at the time, but in fact the opposite was true. It is kind of scary to think that something that was so much the focus of attention at the time it occurred, in a matter of 10 or 20 or 30 years could sort of be buried in the fashion that it was. As the gentleman said, what we have seen in the last few years, really in the last 5 years, is sort of a flowering of research and books and renewed interest in the genocide. I think that is all very valuable, because that is the only way we could ever get to the point where it is recognized here in the United States and other countries. One of the things that I know you and I are very concerned about is that we still do not recognize here in our Government of the United States, we still do not have an official recognition of the genocide. That is very disturbing and something that hopefully we will be able to correct at some point in the future. If the gentleman will allow me, I want to talk about two other issues that are of concern with regard to U.S.-Armenian relations. Both the gentleman from California (Mr. Sherman) and I have been very concerned about the fact that Armenia continues to be blockaded by two of its most significant neighbors, both Turkey and Azerbaijan. Of course, we are very supportive of section 907 of the Freedom Support Act, which denies any assistance to Azerbaijan until they lift the blockade of Armenia and Nagorno-Karabagh. We have also played a role in trying to get assistance to Armenia and Nagorno-Karabagh, humanitarian assistance, which is necessitated by the fact that they do continue to be blockaded, and they have difficulty receiving certain supplies and humanitarian assistance. I just want to mention very briefly that it is very unfortunate, and I know, as a member of the Committee on International Relations, that the gentleman from California (Mr. Sherman) has addressed this, that this year once again our Secretary of State, Madeleine Albright, again essentially articulating the administration's policy, came before his committee and suggested very strongly once again that section 907 be repealed. We are very much opposed to that. We think that it is totally inappropriate, given that the blockade continues to do anything to water down section 907. We have also been concerned that even though this House in this Congress and the President signed a bill last year that appropriated $12.5 million in humanitarian assistance to Nagorno- Karabakh, that it has not been forthcoming. I do not believe any of that money has actually gone to Nagorno-Karabakh, and the need is there. I would ask my colleague to comment on it, that there has been some suggestion by the State Department that some of that money will be forthcoming soon, but I am still very concerned that Karabakh will not receive the full $12.5 million and that the State Department is not doing enough to make sure that that money gets there. I yield to my colleague.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this year Congress has been the do-nothing Congress. The Republican leadership sits idle while each day 3,000 children get hooked on tobacco products. Of those, 1,000 who start today will die early because of tobacco-related diseases. This is an epidemic that deserves congressional action now. While the Republican leadership continues to cash in on big tobacco campaign contributions, Democrats today will roll out legislation that stops tobacco companies dead in their tracks from peddling their poison to children. So far in this Congress we have managed to rename airports, post offices and public buildings. Congress needs to step up to the plate and pass tobacco legislation for America's children. The evidence is clear: Big tobacco has pushed their product onto children. Democrats are fighting to prevent tobacco companies from this nasty habit. The Republican leadership would rather protect their special interest friends than protect the Nation's children from joining the tobacco ranks. The American people will not stand for this inaction.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this evening I would like to discuss an issue which I have addressed on the floor of the House many times before and probably will deal with a lot more as we move through the session in this year, 1998; and that is the need for managed care reform. I believe that the American people have the best health care in the world. Unfortunately, the quality of care is being limited by HMOs or managed care plans. I think that Congress must act now to enact basic patient protections, but to put the ``care'' back in managed care. Many of us have talked for the last year or so about the types of things that should be included in an effort to reform managed care. The President had an advisory committee that issued a report that went through various patient protections that could be included. At the same time, in his State of the Union address the President talked about the need for patient protections and basically called upon the Congress on a bipartisan basis to pass managed care reform. I have actually introduced a bill, a number of our colleagues have introduced legislation that would put patient protections in effect in the context of managed care organizations. But what has not happened and what needs to happen is that this House and this Congress must pass legislation and should get to doing so as quickly as possible. The time for talk is over. The time for action is now. We do not have a lot of time left because of a shortened legislative calendar in 1998, and I think we need to move in committee, we need to move on the floor and we need to move in both Houses towards managed care reform. I have to say that I believe very strongly from every indication that I have received that the Republican leadership is not interested in moving forward on managed care reform. There has been a tremendous amount of money coming from special interest groups, from the insurance companies, in particular, that have been lobbying Members of Congress not to pass a managed care reform or patient protection act legislation in this session of Congress. The Republican leadership has been out there saying that they do not want to do it, and I think what we have to do as Democrats and those Republicans that are willing to join us, is to push the Republican leadership. Because they are in the majority, we have to push them to bring this legislation through committee to the floor so that the President can sign it. I have to say that this is a very important issue for our constituents. Every time I go back home and hold a town meeting, constituents ask me when Congress is going to provide common-sense managed care reform. In New Jersey, the voters spoke loud and clear and the State legislature, along with Governor Whitman, a Republican, enacted model patient protections. It was not radical legislation in New Jersey. It has not substantially increased costs as the special interest lobbyists would have us believe. Instead, it was principled on choice, access and quality health care. Let me just give my colleagues an idea, if I could, about the types of things that we are talking about when we talk about a Democratic managed care reform initiative. Basically what we are saying is that individuals enrolled in managed care plans would be guaranteed that their health plan will have enough doctors and health providers in its network to ensure that they get the care they need on a timely basis, that they would have the right to choose to see providers outside their health plan, that they would have the right to see specialists when necessary outside their health plan, that they would be guaranteed that their doctor would be allowed to tell them about all their treatment options, that is, no plan would be able to use gag rules to restrict doctors' communications with patients, that they would have access to emergency care without prior authorization in any situation that a prudent lay person would regard as an emergency. For women with breast cancer, they would be allowed to stay in the hospital following surgery for a minimum of 48 hours for a mastectomy, or 24 hours for a lymph node dissection. For a women to be guaranteed the right to direct access to their obstetrician-gynecologist and be able to choose their obstetrician-gynecologist as their primary care physician. When a service and procedure is covered by their plan, that they be guaranteed that they and their doctor, not the insurance bureaucrats, would decide what care is medically necessary for their treatment, that they be able to get authorization for care from their plan in a timely manner based on clear, objective written guidelines, that they be guaranteed that if they were denied care by their plan, there would be a timely, reasonable and meaningful system of recourse for those with life-threatening illnesses allowing them to participate in a clinical trial for experimental therapies at no extra cost to them, that they have protections against discrimination on the basis of health status, genetic information and other factors, that for women who have had a mastectomy, guaranteed coverage for reconstructive breast surgery, that they have access to medically necessary drugs, that they be guaranteed that their health plan does not use discriminatory practices when choosing doctors or other health providers who participate in its network, that they be guaranteed that their health plan would be subject to these new protections regardless of whether it is licensed at the State or Federal level and that they be provided full, relevant information about their plan, including which benefits are covered and which are excluded, what the individual costs are, what the plan policies are regarding authorization and denial of care and what their plan's policies are regarding selection and payment of providers. Mr. Speaker, these are a few of the common-sense provisions that the American people want enacted. New Jerseyans in my State are fortunate to have a responsive State legislature that addressed these issues but unfortunately not all in New Jerseyans will be able to enjoy the same level of patient protections. That is because the Employee Retirement Income Security Act of 1974, ERISA, says that State laws do not apply to companies that self-insure. This means that many of the constituents of my State are left without adequate health care quality standards. In a sense there is a two-tiered standard in my State and in many others. Only Congress can act to address this shortfall. ERISA comes under Federal law. The Democrats are gearing up to fight for the rest of the American public's right to common-sense, quality health care. We understand that it is good that State legislatures passed these individual laws in their State, but it does not apply to a lot of people who are self- insured. It also obviously does not apply from one State to the other. That is why we need Federal action. I am pleading with the Republican leadership not to sit on the sidelines. They have to basically realize that regardless of what the special interests say, this is the type of legislation that the American public wants, that the American public needs, and that we should be addressing here during our debate this year in 1998. One of the things that I noticed, Mr. Speaker, is that when we have forums back in my district in New Jersey, and we have had some and we are going to have a lot more on the issue of managed care reform, that many people will show up and basically tell the story, if you will, about their individual problems that they have had, or their children have had or their mothers, their fathers have had, or friends with managed care plans that have denied them coverage or denied them certain services, and how difficult it has been for them to appeal with the denial of certain coverage and to get through the bureaucratic process that many managed care plans necessitate when you try to get some service or some procedure that they deny or that they will not allow. I could give my colleagues many examples of that, but I wanted to give one example tonight because this was a woman who came to our hearing that we held in January. Her name is Cheryl Bolinger. She in particular, I thought, explained very well the morass or the maze, if you will, that one has to go through when trying to get the managed care plan to approve a service or procedure that they do not want to approve. I do not know if I am going to read the entire thing, because I know I am going to be joined by another Member here, but I wanted to at least start with some of the testimony that Ms. Bolinger gave at a hearing that I held, along with Senator Torricelli, back in January on the issue of managed care reform. She said that she is the mother, Mrs. Cheryl Bolinger from New Jersey, of a 15-year-old child who has multiple developmental disabilities and complex chronic mental problems. Her daughter Kristin's medical problems began shortly after her birth. At 6 weeks of age, she developed unexplained intractable seizures. Because of the severity and the debilitating effects of her condition, she must be followed by many specialists and undergo many specialized and expensive diagnostic tests. ``Today, that was in January, Kristin remains nonverbal and nonambulatory and requires customized durable medical equipment for every aspect of daily living. Customized equipment is also needed to prevent and minimize the effects of orthopedic problems. She also requires physical and occupational therapy to enhance and maximize her potential in terms of her orthopedic status and general medical condition. ``During Kristin's infancy and early childhood we were fortunate enough to have a fee-for-service insurance plan. As long as our medical documentation was current and in place, in other words, prescriptions, follow-up care and letters of medical necessity, we did not encounter problems obtaining adequate and proper medical care regarding all areas of our daughter's acute and long-term care. In 1993, however, our insurance plan was changed to an HMO.'' This is something, Mr. Speaker, that of course has happened to many people who had a fee-for-service plan where they could choose their doctor and switched and were forced basically because their employer switched to an HMO. Ms. Bolinger goes on to say that at that point, when she changed to the HMO, ``We encountered many difficulties regarding Kristin's medical care. According to the plan, we had to choose a pediatrician who had contracted with the HMO to serve as her primary care physician. The pediatrician who had been seeing Kristin for many years was not a participant in the plan. Likewise the specialists who had been treating her for so long also were not plan participants. ``My husband and I were very upset over this change and need to give up the excellent care Kristin had been receiving from these physicians. We were very concerned about the future of our child's health care. Nevertheless, we tried to be optimistic, and we visited a plan-approved pediatrician who would serve as Kristin's primary care physician. To our dismay and disappointment, we were not satisfied with the level and quality of care provided. ``Our freedom to choose a suitable physician for our child, while receiving adequate insurance coverage have been taken away by the HMO.'' If I could just stop here, Mr. Speaker, from Ms. Bolinger's statement before our hearing, this is, of course, the problem. Now that people who for many years had been taken care of by primary care physicians whom they knew and whom they respected and who they felt were doing a good job, now all of a sudden had to be replaced by someone within the HMO. I think what I am going to do at this point is to stop here in talking about Ms. Bolinger's case, because I can go back to it later on, because I want to, if I can, give time to one of my colleagues from the Committee on Commerce, the gentleman from Texas (Mr. Green). He, I know, has been involved with this managed care issue for some time now and has had many experiences in his own district where people have come up to him and talked about some of the problems that they have had.

Mr. PALLONE. Mr. Speaker, if I could just interrupt my colleague for a second on that last point, when I was using this example of Ms. Bollinger as one of the people that has written to me and talked to me about the problem that she had with her child, one of the things that was most important to her was the last thing you mentioned about the grievance and appeal procedure. Because my colleague understands and I understand, but I think a lot of people do not, that if you are an individual like her that has a daughter that needs this kind of care that has been denied, it is very difficult, first of all, in that strenuous situation which she was in, to be calling up the bureaucrats and telling them this is what you want them to do, and getting the papers together and trying to find a means, if you will, to overturn a decision that they have made to deny the care. So if there is not some sort of expedited procedure that is easily accessed by someone to make an appeal or to express a grievance, they are not going to be able to succeed in changing the decision the insurance companies made. So I just wanted to mention that, because even though it does not seem like it is very important, it is crucial to these people that are trying to get justice and make sure that the coverage is there.

Mr. PALLONE. Mr. Speaker, I appreciate the gentleman's remarks, and I just want to point out what the gentleman pointed out over and over again, that this is really pretty common sense. The things that the gentleman listed are things that we really should have in place on the Federal level. Even though it is true that the gentleman's State and my State have adopted some patient protections, it does not help a lot of people, even in our own States, and certainly does not help anybody who is not in our States, and that is why we need Federal action. Maybe tonight we can go through some of these patient protections in a little more detail and give some examples of how it might impact people, because I think as the public understands what we are talking about, they understand how simple and common sense these principles are and why they should be enacted into Federal law.

Mr. PALLONE. I yield to the gentlewoman from Texas.

Mr. PALLONE. Mr. Speaker, if I could interrupt 1 minute, I think this issue of choice of doctors is so crucial to the whole emphasis that we as Democrats are putting on managed care reform. The President has talked about this, and, of course, as the gentleman from Texas (Mr. Green) mentioned, our health care task force, which is about to put out a bill that the gentleman from Michigan (Mr. Dingell) is going to be the lead sponsor of, talks about patient choice. I am not saying, and I do not think we can maybe say that, in a network, in an HMO network, that we have to guarantee in every case that we can choose any doctor we want.

Mr. PALLONE. But that maybe would break up the whole idea of managed care.

Mr. PALLONE. But at least people, when they initially choose a plan, should have a choice that, if they want a point of service option so they can go outside the network, they can. That means they might have to pay a little more of a nominal fee; I do not have a problem with that. But there has to be some way so that people have the option of choosing a doctor if they are not satisfied with the doctor they have. That is the problem I think that so many people bring to my attention now that they do not have that choice anymore. It has been denied them.

Mr. PALLONE. If I could ask the gentlewoman from Texas to yield back to me, I think it is particularly important when the gentlewoman talks about access to specialists, because, oftentimes, the HMO, the network will not have the specialty care that is needed. And I think that there should be a guarantee. One of the things we have talked about as part of this managed care reform, that if the plan, if a network does not have a specialist that is qualified or can handle that particular situation, that we should be able to go outside of the network to get the specialist. That is another complaint that I hear quite a bit about.

Mr. PALLONE. If I could interrupt the gentlewoman from Texas again, we had a perfect example of this, of course, with the drive-through deliveries for pregnant moms, where it had gotten to the point where many of the women, when they went to the hospital, actually had to leave within 24 hours. It did not matter whether or not the physician thought that was appropriate or whether the women felt that it was not appropriate, the health insurance company said that is it. She is there for 24 hours. I think it was 2 days for C-section. Again, I think that was a perfect example.

Mr. PALLONE. Exactly. It has got to be that that decision is made by the doctor with the patient, not by the insurance company. Unfortunately, that is getting to be the case with so many different types of care, not only mastectomies and child birth, but so many of the situations.

Mr. PALLONE. One of the areas that concerns me the most in this regard is emergency care, because what I find increasingly is that the people are denied emergency care in the emergency room, or they are allowed into the emergency room, and they are provided care, and, later, the health insurance company does not cover it because they say it was not necessary; it was not an emergency. So one of the things I think is really crucial is this sort of prudent layperson standard; in other words, that you have to be provided and you have to cover the emergency care if a rational or reasonable person would think that that was an emergency, again, a decision based on what a doctor would think or what the average patient would think, not what the insurance company would think. Because I am getting more and more cases where, as I said, either people have been denied emergency care or they simply do not cover it, and they send them the bill on their own, which they cannot afford, which, as we know, emergency room care can be exorbitant if we are paying for it privately.

Mr. PALLONE. One of the things that the gentlewoman has really brought out, and I think is so important, is that the emphasis, again, has to be on the quality of care and not so much on the cost of it. We understand that managed care reform has brought great cost savings, but the bottom line is that now it is just out of hand. If we implemented these patient protections that we are talking about, the cost really is very minimal. I know that that is an argument that is used that, oh, this is going to increase costs, but I do not believe it when we are looking at the kind of common sense approaches that we are talking about here that there is any significant cost increase. It seems to me, in the long run, we will probably save money, because a lot of it is preventative, and we end up helping people so they do not get sicker.

Mr. PALLONE. If I could give the gentlewoman an example, just an example of this, when my wife and I had our son 2 years ago, they had just implemented this policy with the pregnant women that they were only allowed the 2 days for a C-section, because he was born with a C- section. She had a C-section. As they were about to release him from the hospital for the 2 days, they had a pediatrician that was required, I think under the law, had to come in and look at him before he was checked out. They found that he was jaundiced. So they let him stay an extra day. They let her stay an extra day. If that had not happened and had not been detected, he could have easily gone out of the hospital, gotten worse with the jaundice, end up having to come back to the hospital and stayed a week or more, which would, of course, cost more money. So, to me, a lot of this is just preventative and actually saves the system money in the long run.

Mr. PALLONE. I appreciate the gentlewoman's comments. I think it is absolutely to the point. I guess I started out today by saying that I really think that we know what has to be done here now. We have talked about this, and the President came forward with a Bill of Rights. Some of the Republicans have sponsored legislation. As we mentioned before, our Democratic health care task force has put forth a set of principles which are going to be put forward in a managed care consumer protection bill that will be introduced very shortly that we are going to be talking about and that we believe we have support for amongst the Senators as well as the White House in favor of this legislation. But what really needs to be done is, we need to push the Republican leadership to bring this managed care reform to the floor of the House, to bring it up in the relevant committees, to push that it come to the floor of the House, and do the same in the Senate. We do not have a lot of time here between now and the end of this legislative year. If we do not act quickly, and after all the Republicans are in charge of the process, they are in the majority; they are the ones that are going to decide what can come to the floor. If they do not bring this up and allow for debate and allow for a vote, then it is not going to happen. Part of the reason why we, as Democrats, constantly talk about this and will continue to talk about it is because we know that we need to push them to bring it up. Otherwise, it is not going to happen this year.

Mr. PALLONE. I thank my colleague from Texas also for joining me, and for her insight into this as a nurse, as well, because it is often those who are involved in the health care system as nurses, physicians, they are the ones that have the most knowledge and understand the kind of problems that many patients now face with the existing managed care or HMO systems. I was going to ask my colleague, if I could indulge the Speaker tonight, I began this evening by going through the testimony of a New Jerseyan, Cheryl Bolinger, who had experienced some severe problems dealing with the managed care system with her daughter. I did not complete her statement. I know that there is not enough time in the time that is allotted to us to complete it. I would like to either include it in the record now, if I could; or if not, I will put it in as an extension of remarks this evening because she really outlines very well the kinds of problems that a mother or somebody goes through when they are trying to get through this sort of Byzantine labyrinth of managed care. I just cannot imagine myself, if it was my daughter or my son, to have to go through this experience to get the proper care and to make the appeals and to deal with the objections and follow a grievance procedure. She was spending, from what I can see, more time doing this than she was with her job. She was not a woman who was in a position to be able to spend the time from 9:00 to 5:00 taking appeals of decisions that were made by HMOs. So many people face this on a regular basis. Fortunately, her daughter had a mother who had the willingness and aggressiveness and understanding about what to do, but many people do not. That is the problem. That is why we need our legislation.

Mr. PALLONE. Mr. Speaker, it is important for us to tell these stories because I think that it is only when we tell the stories of our constituents and the people that have been through the system and the public and the other colleagues down here understand what our constituents are going through that we will get a ground-swell of support for managed care reform. I think it is very important that we relate those stories. I want to thank my colleague again. Mr. Speaker, I include for the Record the testimony to which I referred: Testimony of Cheryl Bolinger January 22, 1998. Good morning Senator Torricelli and Congressman Pallone. Thank you for your interest in hearing about the struggles my family has had in trying to receive good, quality medical care from an HMO for our daughter. My name is Cheryl Bolinger and I am the mother of a 15-year old child who has multiple developmental disabilities and complex, chronic medical problems. My daughter Kristin's medical problems began shortly after her birth. At six weeks of age, she developed unexplained intractable seizures. Because of the severity and the debilitating effects of her condition, she must be followed by many specialists and undergo many specialized and expensive diagnostic tests. Today, Kristin remains non-verbal and non-ambulatory, and requires customized durable medical equipment for every aspect of daily living. Customized equipment is also needed to prevent and minimize the effects of orthopedic problems. She also requires physical and occupational therapy to enhance and maximize her potential in terms of her orthopedic status and general medical condition. During Kristin's infancy and early childhood, we were fortunate enough to have a free-for-service insurance plan. As long as our medical documentation was current and in place, (i.e., prescriptions, follow-up care, and letters of medical necessity), we did not encounter problems obtaining adequate and proper medical care regarding all areas of our daughter's acute and long-term care. In 1993, however, our insurance plan was changed to an HMO. At that point, we encountered many difficulties regarding Kristin's medical care. According to the plan, we had to choose a pediatrician who had contracted with the HMO to serve as her primary care physician. The pediatrician who had been seeing Kristin for many years was not a participant in the plan. Likewise, the specialists who had been treating her for so long also were not plan participants. My husband and I were very upset over this change and need to give up the excellent care Kristin had been receiving from these physicians. We were very concerned about the future of our child's health care. Nevertheless, we tried to be optimistic and we visited a plan-approved pediatrician who would serve as Kristin's primary-care physician. To our dismay and disappointment, we were not satisfied with the level and quality of care provided. Our freedom to choose a suitable physician for our child while receiving adequate insurance coverage had been taken away by the HMO. After such a disheartening experience, we decided that it would be in Kristin's best interest to remain with her current pediatrician and specialists. They were the doctors who knew her best. As a result of our decision, our benefits were reduced and we were required to pay out of pocket. Also in 1993, we were advised by our insurance company's medical review board that it had deemed Kristin's therapies to be not medically necessary. Even though medical documentation recommending these therapies was in place, benefits were ceased. Because of the importance and necessity of therapies for our child, we paid for them out of pocket. In 1994, Kristin developed a scoliosis curve which required bracing. We used an orthotist in our HMO plan to manufacture the brace. When I returned to our orthopedist with the brace, he told me it was worthless and would probably increase the curvature rather than inhibit it. My doctor was irate that the HMO had contracted with a company that provided substandard equipment; he referred us to an orthotist of his choice who manufactured the brace free of charge. I called and wrote to my HMO regarding the inferior quality of the brace the orthotist in their plan had made for us. They responded by telling me they wouldn't handle the problem and to contact the agency they contract with. I phoned and sent written correspondence to the agency regarding the problem. However, other than someone saying they would make a note of the situation, I never received a satisfactory answer or explanation regarding the inadequate and inferior quality of the brace. In August 1997, Kristin underwent scoliosis surgery, which required spinal fusion and instrumentation--a complicated and serious surgical procedure. Fortunately, we were able to use a reputable prominent surgeon in New York City who was on our plan as a participating specialist. At this time, Kristin's post-operative condition was very fragile. Upon discharge from the hospital, Kristin was to receive nursing care and physical therapy at home. The surgeon wrote very specific orders regarding the medical care and rehabilitation needed at home. After Kristin had been home for nine days, I received a phone call from the contracted nursing agency informing me that nursing services would no longer be covered and were to cease. Contrary to our surgeon's recommendations, the HMO opted to provide a home health aide instead of a nurse to care for Kristin's nursing needs. The level and quality of care provided by a home health aide was not adequate for my daughter's complex medical needs. I immediately became actively involved in requesting that the HMO cover the necessary nursing care. After several additional letters of medical justification, repeated taxes, phone calls, and communication, the HMO conceded that they should follow the initial recommendations of their surgeon. Nursing care was reinstated after seven days. The surgeon also wrote very specific instructions regarding special therapy for rehabilitation. Physical therapy was ordered for 12 weeks. However, after only about six weeks-- half the period recommended by the surgeon--I received another phone call from the contracted agency stating that physical therapy would no longer be covered and would cease. Once again after my repeated attempts to correct the situation, the insurance company reinstated therapy after a two-week lapse. In both situations, continuity of vital services for my daughter was interrupted due to poor decisions made by the HMO. On our most recent follow-up visit to the surgeon (January 14, 1998) he was not satisfied with Kristin's post-operative rehabilitation. He requested Kristin receive additional physical therapy so that she could regain her post-operative abilities and level of functioning. To date, I am still awaiting a response to this request from the HMO. Because of surgery and the changes in Kristin's body alignment, a new wheelchair is needed to accommodate her post-operative status. We have been waiting for three-and-a- half months for secondary approval of this crucial and essential piece of equipment and have still not received a decision from the HMO. In the meantime, we have no choice but to keep our daughter in a wheelchair that no longer meets her needs while we continue to wait for a response. In conclusion, I would like to state that HMO's present the following problems to families trying to obtain health care for a family member who has developmental disabilities and requires long-term care. Freedom to choose qualified physicians is compromised. The quality, continuity, and duration of care is subjected and often does not meet the medical need of the patient. Durable medical equipment that must be customized and is not a stock item is often inadequate and inappropriate for specific medical needs. Many crucial requests are denied or delayed for too long a time. The time and effort our family invests in trying to correct the poor judgement of our HMO and the stress this creates takes away from the valuable time we need to care for our child. Unfortunately, this is the constant battle we must wage to try to obtain proper, quality care for our daughter. Thank you very much Senator Torricelli and Congressman Pallone for listening to the problems I have had in obtaining good quality medical care for my daughter, Kristin.