Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise tonight to join with the people of India and the Indian-American community to commemorate India's Independence Day. The 54th anniversary of India's Independence will actually occur on August 15th, while Congress is in recess, so I wanted to take this opportunity tonight, before we adjourn, to mark this important occasion before my colleagues in this House and the American people. Last month, Americans celebrated the Fourth of July. For a billion people in India, one-sixth of the human race, the 15th of August holds the same significance. I am proud to extend my congratulations to the people of India, and to the sons and daughters of India who have come to the United States, enriching American society in so many ways. On August 15, 1947, the people of India finally gained their independence from Britain, following a long and determined struggle that continues to inspire the world. In his stirring ``midnight hour'' speech, India's first Prime Minister, Jawaharlal Nehru, set the tone for the newly established Republic, a Republic devoted to the principles of democracy and secularism. In more than half a century since then, India has stuck to the path of free and fair elections, a multi-party political system and the orderly transfer of power from one government to its successor. India continues to grapple with the challenges of delivering broad- based economic development to a large and growing population. India has sought to provide full rights and representation to its many ethnic, religious and linguistic communities. And India seeks to be a force for stability and cooperation in the strategically vital South Asia region. In all of these respects, India stands out as a model for other Asian nations, and developing countries everywhere, to follow. Mr. Speaker, one of the most difficult situations for a democracy is their relationships with their neighbors, especially if they do not share the same democratic ideals. India has struggled to establish a peaceful cooperation with the nation of Pakistan. As you know, Pakistan has made a transition from the thin guise of democracy to an outright military state. Despite this fact, India has made repeated efforts to establish peaceful and economically prosperous relations with Pakistan. Evidence of this can be found in India's Prime Minister Atal Behari Vajpayee extending the hand of friendship to Pakistan President Musharraf. This is the latest act of good faith by India even though Pakistan has consistently reverted in their promises to uphold their end in recent years. In February of 1999 India and Pakistan signed the Lahore Declaration under which they pledged to establish a procedure for resolving their differences through bilateral negotiations. Pakistan subsequently betrayed this when their forces crossed the Line of Control in Kashmir, resulting in the loss of hundreds of lives and international condemnation. Pakistan also broke the latest cease-fire initiated by India, yet Vajpayee still decided to invite Musharraf to a summit this past month. While the summit collapsed, Vajpayee has vowed to continue dialogue to try to bring about peace with India's neighbor. India is of utmost importance to the United States, not only because of our shared principles, but also because of India's strategic importance. They have showed the Western World time and time again that they serve as a vital stabilizing force in the South Asian region. India has committed itself both politically and economically with the United States. In March of 2000, our countries participated in the U.S.-India Summit in New Dehli, where a Vision Statement was crafted. This statement committed both countries to fight against terrorism, prevent the proliferation of nuclear weapons, expand trade, and a variety of other important issues. To this day, India continues to reduce barriers to trade, and bilateral trade has grown from less than $5 billion in 1993 to over $15 billion in 2000. India has not just passed the litmus test of foreign governments, but they have passed the much harder test of Western corporations that look for a profitable environment. There are hundreds of U.S. companies investing in India: AT&T, Citicorp, Morgan Stanley, Ford Motor Company, and IBM just to name a few. Mr. Speaker, it is with great pleasure that I rise on behalf of the Indian-Americans in my district, and the 1.6 million all over this country to extend my congratulations to the largest democracy in the world. India has survived hostile neighbors, the transition from colonialism, recent earthquakes and droughts, and adaptation to the world economy, and with the continued support of the United States, will do so for many years to come.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, it upsets me a great deal to hear my Republican colleagues on the other side say that their plan today is going to provide more access for the uninsured, more access to health care, and somehow, the President is going to sign this. How cynical. The President has never signed an HMO reform bill. The President has no intention of signing a bill. If that were the case, then why are they mucking it up? He talks about bureaucracy, mucking up this bill with all the things that are unrelated to HMO reform: malpractice, medical malpractice, MSAs, medical savings accounts. These things do not belong in this bill. These things are being put in this bill today so when it goes to conference, the bill is killed and is dead just like it was 2 years ago. They talk about providing more people access to care or somehow, they are going to redress the denial of care. Well, then, if that is the case, why in the world are they putting in these roadblocks so that if I am denied care, I cannot even get to an external review panel that is going to be independent and is going to reverse that denial of care? They put in so many roadblocks in here, nobody is ever going to be able to reverse a denial of care. Forget the courts. That is not the issue.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would like to call the attention of Congress to an event on Thursday, August 16 in New Jersey. The Jewish Family and Children's Service of Greater Monmouth County is holding a dinner and tribute at Temple Beth El of Oakhurst to honor Ruth Hyman. Ruth will have the distinction of being honored for her work as a philanthropist and her support of Jewish causes in the area, as well as in Israel. Ruth, a close friend of mine, was born in my hometown of Long Branch, New Jersey into a family of four boys and four girls. She says that her parents' direction and teachings of tzedakah, menschlichkeit, and the Torah guided her to be the person that she is today. Ruth's teachings as a child can well be seen in her community involvement. She is a life member of Daughters of Miriam, charter and life member of the Central Jersey Jewish Home for the Aged, founder and past chairperson of the Federation Women's Business and Professional Division, benefactor and board member of the Jewish Community Center, and an active member of B'nai Brith, AMIT, and Congregation Brothers of Israel. For the past twenty-five years Ms. Hyman has been the Chairperson of the Women's Division of Israel Bonds, and for the past twenty-six years she has been the president of the Long Branch Hadassah. This is not the first time that Ruth has been honored for her service to the community. Ruth has received the Service Award from the Jewish Federation Women's Campaign, Woman of Valor of the Long Branch chapter of Hadassah, Israel Bonds Golda Meir Award and the Ben Gurion Award, Lay Leader of the Year by the Jewish Federation, and the Hadassah National Leadership Award. The community cannot express the debt that we owe to my friend Ruth who has shown us all that selflessness will never go unrecognized. I want to personally thank Ruth Hyman for being a leader of the Jewish community and an excellent role model for our youth.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, when you are sick and you have been denied care and often do not have the energy to fight, the Norwood amendment puts all sorts of roadblocks in the way of a real independent review. The real Patients' Bill of Rights allows you to quickly and informally go to an independent review board. They look at the patient, they look at the medical record, look at whatever they want and decide what care you need. Norwood turns this around and puts roadblocks in your way. It makes it a judicial-type procedure stacked against you. The HMO picks the information it sends to the board, the patient has no right to see it and no right to ask witnesses any questions. You will need a lawyer under Norwood in order to make your case. You have to prove that the HMO's decision was wrong and should be either affirmed or overturned. There is no flexibility with the board to craft a plan of care somewhere in between. Worse, if the board agrees with the HMO, a presumption in favor of the HMO makes an appeal to the courts almost impossible. Norwood stacks the deck against you. And it gives all the cards to the HMO.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I deeply resent the suggestions on the other side that somehow what they are doing today is going to help a person who is denied care get the care, get to the hospital, get the operation. Just the opposite is going to happen here. This rule allows for amendments to be brought up on things totally unrelated to care, malpractice reform, medical savings accounts. These are the kinds of provisions that, if they are included in this bill, when we go to conference with the Senate, will kill the bill, just like it did last time. And then you have the other amendment that changes the liability and makes it almost impossible for someone who has been denied care to even have an independent review by an outside board. All sorts of roadblocks are put in the way so that a person can never have an actual review. Forget the court. They will never get to the court. They will never have that kind of independent review by an external review board that will let them have their care, let them go to the hospital. Finally, most insidious of all, you change the State law so progressive States like my own of New Jersey or Texas or others that have put in place a real Patients' Bill of Rights, are now going to be preempted. That person will never get to the hospital. You are making the situation even worse for them than it is now.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I come to the House floor tonight to respond to statements made by some of my colleagues in their extensions of remarks on July 24. Their reference is to various secessionist movements in India. My colleagues suggest that Muslims in Kashmir and Sikhs in Punjab, among other religious and ethnic groups in certain Indian states, have the right to separate their states from the Indian Nation. They seek the United States' support for secession. But their theory is not based on the American experience. These critics deem the recent landmark summit between India and Pakistan a failure because it did not produce any substantive agreement over Kashmir. They argue that Indian Prime Minister Vajpayee's refusal to speak extensively on Kashmir was a testament to India's contempt for democracy. Mr. Speaker, I would like to draw a parallel between India, the world's largest democracy, and our own democracy in the United States. We cannot forget the principles on which this Nation was founded and the war we fought to maintain these principles, for it was in the Civil War that the Union fought to keep the South from seceding and to keep this Nation united. It was South Carolina's act of secession that was fiercely battled on American soil to keep the United States together at any cost. Americans refused to give in to the South's secession on idealogical grounds and vehemently denied any right to secession based on the Constitution or the American historical experience. The framework of this Nation is founded on the fundamental notion that States cannot secede. My colleagues condemned India for trying to keep the Nation together. India is a model for democracy in the South Asia region. India is supporting the same ideals that shaped the history and success of the United States. We should support India in its opposition to State secession. Americans cherish the unity and patriotism that we fought so hard to maintain during the Civil War. India is fighting a battle that America fought in the 19th century and all for the same outcome: a united country. My colleagues have made claims that India is not one nation, but rather a multinational state put together by the British for administrative convenience. Their claims ignore India's history, its independence movement, and the principles on which India was founded. India was founded as a secular state based on an equality of religions. Secularism is the thread that holds together the fabric of diversity that characterizes India. Muslims and Sikhs do not need to secede from such a nation. Secession based on religion or any other idealogical principle goes against the secularism that India stands for, and it is the secularism that India cannot afford to compromise in its fight for democracy. Mr. Speaker, a divided India is a recipe for chaos. A peaceful and smooth transition to a split India is not feasible. With the diverse array of regions, 18 official languages and 17 freedom movements in India, the breakdown of India would be disruptive for its people and the international community. A divided India is more susceptible to outside influence and the possible resurgence of colonialism. For a country such as India, unity is its strength. While a joint agreement may not have come out of the India-Pakistan summit in July, we must realize that India has a sincere desire to improve relations with its neighbors. A united and strong India is a necessary prerequisite for cultivating a positive relationship with not only Pakistan, but all of South Asia.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I rise in opposition to this amendment. It is not going to fix the problem. Oil development will still cause major impacts to the Arctic wildlife, water quality, and wilderness values. Today, because President Bush and some in the majority feel the political atmosphere is again ripe, they are willing to disregard public opinion and force open a vestige of pristine wilderness to an industry that will desecrate the land. The administration touts an environmentally friendly way to drill. I do not believe it is possible. In fact, drilling is inherently detrimental to every bit of nature that surrounds it. Every year, 400 spills occur from oil-related activity in Alaska. From 1996 to 1999, over 1.3 million gallons were released from faulty spill prevention systems, sloppy practices, and inadequate oversight and enforcement. Alaska has only five safety inspectors. I urge my colleagues, do what the American people have delegated us to do: oppose drilling in the refuge. It is that simple.

Mr. PALLONE. Mr. Chairman, I thank the gentleman for yielding time to me. I rise in support of the amendment offered by the gentleman from Arizona (Mr. Hayworth) that would assist the American Indian community by making energy products and energy by-products eligible under the Buy Indian Act. Although I agree with this amendment, I believe it does fall short, much like the rest of this bill, in addressing the real problems of American Indian tribes. As my colleague, the gentleman from West Virginia (Mr. Rahall), mentioned earlier, Members of this House introduced H.R. 2412, the Tribal Energy Self-Sufficiency Act, and I cosponsored that bill because I believe it incorporates real solutions for Indian country's energy needs. But I was sorely disappointed that when parts of this bill were offered as the Democratic substitute in the Committee on Resources, it failed on a nearly party line vote. A week ago, it was wrong not to incorporate solutions for tribes into this bill; and today, aside from this amendment, we are doing the same thing. In fact, American Indians, as we know, face a myriad of energy- related problems. Problem areas include inability for tribes to get financing for new generation projects, difficulties with interconnections, and the list goes on. While visiting with representatives from Indian country, I have listened to them closely. They have explained to me their view of the history of America's energy industry. Basically, they have been shortchanged. Again, I support the amendment of the gentleman from Arizona (Mr. Hayworth), but like the rest of the good provisions of this bill, it is only a fraction of the positive actions we can and should be taking to make energy resources mutually beneficial for American Indians and this country.

Mr. PALLONE

Mr. PALLONE. I agree. Reclaiming my time, the bottom line is that even in the states that have strong patient protections, like Texas, a significant amount of people, sometimes the majority, are not covered by those protections, because of the Federal preemption. I would say right now there are only about 10 states that have protections as strong as Texas, my own being one of them. But the other 40, some have no protections, some have much weaker laws. So this notion that somehow everybody out there is already getting some kind of help is not really accurate for most Americans. That is why we really need this bill. I think we only have a couple of minutes, so if I could conclude and thank the gentlewoman and my other colleagues from Texas for joining us tonight in saying that we are going to be watching. We will be here again demanding that we have a vote on the real Patients' Bill of Rights. Let us hope we have it on Thursday. But, if we do not, we will continue to demand that the Republican leadership allow a vote.

Mr. PALLONE. I want to thank the gentlewoman for coming down again tonight as she has so many other times to express her opinion on the Patients' Bill of Rights. I know it is tough for us because we keep hearing that this bill is going to come up. We are hearing again that it is going to come up this Thursday. I guess we are at the point we will not believe it until it actually occurs. The gentlewoman mentioned a few points that I have to bring up, because we did not include them as part of the debate tonight, and I think they are very important. One is the number of health professional groups that support the real Patients' Bill of Rights, the Dingell-Norwood-Ganske bill. The gentlewoman mentioned the American Medical Association, the Nurses Association, all the specialty doctors groups. I think there are something like 700 different groups, all the major health care professional groups. The bottom line is it is because they are very concerned about the fact they cannot provide care now with the way some of the HMOs operate, and they want the freedom and sort of the ability, we call it the American way, to be able to provide the best care that they think is necessary for their patients. The other thing that the gentlewoman mentioned, which I think is so important, is, again, the Texas experience; the fact that even though President, then Governor, Bush complained at the time when this legislation was being considered in the Texas legislature that it was going to increase costs for health insurance and was going to cause all this litigation. None of that turned out to be true. The gentleman from Texas (Mr. Turner) mentioned earlier that the increased costs for health insurance in Texas is half of the national average. The gentlewoman mentioned approximately 20 or so lawsuits that have been brought in 4 years, which is nothing. What is that, that is like five per year. Because basically what happens is now people have the ability to go to an external independent review to overturn the HMO if they did the wrong thing. We have had almost 1,500 cases of that, and they are handled easily and that is the end of it. The other thing the gentlewoman mentioned, which I think is so important, I said earlier this evening that my fear is the Committee on Rules, when they meet later this evening, I think they are supposed to go in at midnight, which says a lot about the procedure around here with the Republican leadership, that they may put in order some of these poison pills from the Fletcher bill. I mentioned earlier in Congress Daily they said likely amendments include a so-called access package, a proposal seeking to expand insurance through broader access to medical savings accounts and creation of association health plans. Further, it says in Congress Daily, it is possible there will be an amendment to impose caps on medical malpractice awards. Now, I do not happen to like the medical savings accounts. I think they are sort of a ruse. But whether or not you approve of MSAs or approve of caps on malpractice or approve of these association health plans, the bottom line is there is no reason why these need to be included in this legislation. We know that the majority of the House supports the Patients' Bill of Rights, and they support it because of the patient protections. We do not need to deal with these other much more controversial issues like malpractice and medical savings accounts in the context of this bill. The only reason the Fletcher bill includes some of those things and the only reason why those parts of the Fletcher bill would be considered under the procedure is because the Republican leadership wants to throw them in, mess this whole thing up, and create a situation where it goes to conference, like it did last time, between the House and Senate, and nothing happens because there is too much controversy over all these other things that are unrelated. That is what I am fearful of, to be honest. I know we do not have a lot of time left here tonight, but I would, again, appeal to the Republican leadership: All we are asking for is to bring this bill up and allow us a clean vote on the real Patients' Bill of Rights. You can have all the other votes you want, but let us have a clean vote on this bill. I am confident that if that happens, this bill will pass, because I know that almost every Democrat will vote for it, and that there are probably a significant number of Republicans that will as well. But I am fearful, honestly, that we are not going to have that opportunity, because we do not control the process. The Republican leadership controls the process. They are particularly mad right now. As the gentlewoman knows, their wrath is against some of the Republicans that are willing to join us and support the real Patients' Bill of Rights, they are being criticized, hauled down to the White House and being told you are not a real Republican. This is not about who is a real Republican or who is a real Democrat, this is about who is a real American and who is going to stand up for the people that need help.

Mr. PALLONE. I want to thank my colleague, because I think, number one, when you give examples and particularly one from your own personal life, it really highlights and makes people understand, both our colleagues and the public, what we are talking about and how significant it is to pass a Patients' Bill of Rights. The other thing that my colleague from Texas did which I think is very important is that he pointed out some of the patient protections that are in the real Patients' Bill of Rights, the Dingell-Norwood- Ganske bill, and why they do make a difference. One of the concerns that I have is that, as I mentioned earlier, one of the possible amendments that we may get or that the Republican leadership may make in order and try to push if this bill comes up on Thursday is replacing the patient protections in the Dingell-Norwood-Ganske, the bipartisan bill, with the patient protections in the Fletcher bill, in the Republican leadership bill. I assure my colleagues that effectively there are no significant protections in the Fletcher bill. If I could just contrast that a little bit to give us an idea of the differences, some of those differences were mentioned by the gentleman from Texas. He talked about the gag rule and how under the Fletcher bill HMOs could continue to tell physicians that they are not entitled to tell their patients about procedures or medical activity or medical equipment or stay in a hospital or any kind of medical procedure that the HMO does not plan to cover. It is called the gag rule because you never find out what the doctor really thinks you should have done to you because he is not allowed to tell you if the HMO says he is not allowed to. The other one that comes to mind is the financial incentives. Right now a lot of the HMOs have financial incentives so that if the HMO wants to give the physician a little more money because he is not providing as much care or not having as many operations or not having his patients stay in the hospital for too long, they can provide a financial incentive to him at the end of the month so he gets more money if those things occur, which is an awful thing; but it is the reality with many of the plans today. The other thing that I think was so important is when the gentleman from Texas (Mr. Lampson) talked about how some of these things work out in terms of actual protections for particular kinds of procedures. For example, one of the concerns is that access to specialty care is severely limited both under current law and can be limited by the HMO under the Fletcher bill. The Fletcher bill really does not do much to provide access to specialty care. That can manifest itself in a number of ways. For example, with regard to some of the patient protections for women. In the real Patients' Bill of Rights, the Dingell-Norwood- Ganske bill, you get direct access to OB-GYN care. But the Fletcher bill allows plans or HMOs to require prior authorization for items of services beyond an annual prenatal or perinatal exam. The Fletcher bill also creates a loophole which allows plans to avoid the requirement of saying that you can go directly to the OB-GYN. It lets the HMOs off the hook for providing direct access to OB-GYN care if they merely allow patients a choice of primary care providers that includes at least one OB-GYN provider. There are a lot of other differences with regard to care that impacts women. Breast cancer treatment, for example; the hospital length of stay. The Dingell-Norwood-Ganske bill requires coverage for the length of the hospital stay the provider and patient deem appropriate for mastectomies and lymph node dissections for the treatment of breast cancer. The Fletcher bill omits this coverage as well as coverage for second opinions. Emergency care, another example that affects not only women but anyone. The Fletcher bill uses a prudent health professional standard rather than the prudent layperson for neonatal emergency care. Let me give Members an example. Right now, as many people in HMOs know, they often cannot go to the emergency room of the hospital closest to them but rather may have to travel 50, 60 miles away to a different hospital. What we are saying is that in the case of an emergency, if the average person would think that they cannot travel that distance and they have to go to the local hospital because otherwise, for example, if they have chest pain and they think that they are having a heart attack, well, that is the prudent layperson's standard, which basically says that if the average person would think that if I get chest pains of this severity that I have got to go to the local hospital rather than 50 miles away, then I go to the local hospital and the HMO has to pay for it. You do not have that kind of standard in the Fletcher bill with regard to neonatal emergency care. There are so many other cases. Clinical trials. An astonishing number of women suffer from Alzheimer's, Parkinson's, cystic fibrosis and other debilitating disorders. Under the Dingell-Ganske-Norwood bill, it covers all FDA clinical trials. But the Fletcher bill, the Republican leadership bill, only covers FDA cancer trials, preventing women with other serious conditions from receiving potentially lifesaving care. There are so many examples like this. The bottom line is the Fletcher bill makes it very difficult to access specialty care. We used another example the other night on the floor about pediatricians. Under the Dingell-Norwood-Ganske bill, you have direct access to a pediatrician for your child. You do not have to have prior authorization. But you also have the opportunity to go to a pediatric specialist which now, I have three children, and now you often go to a pediatric specialist rather than a pediatrician, who is almost like a general practitioner. What happens under the Fletcher bill is you do not have that option. So a lot of these specialty-care initiatives which are a very important part of the patient protections simply do not exist under the Republican leadership alternative. As I said, what we are hearing is that it is very likely that the Committee on Rules tonight will allow all these different provisions in the Fletcher bill that weaken patient protections to be included as amendments and voted on in an effort to try to achieve a bill that is a lot weaker than the real Patients' Bill of Rights. I could go on, but I see that another colleague from Texas is here and she again has been here many nights talking about the Patients' Bill of Rights and has been a champion on the issue. I yield to her at this time.

Mr. PALLONE. Mr. Speaker, I thank the gentleman; and I know that he raises a number of points. I think one of the major things I do need to stress, and again because I have two colleagues here from the State of Texas which was the first State to pass a really good Patients' Bill of Rights, it is very unfortunate that the Fletcher bill, the Republican leadership bill, would seek to preempt State laws like those in Texas; and I think this is another indication that the purpose of the Fletcher bill is not to provide for greater protections for people who are in HMOs, but rather to weaken existing protections and essentially kill the effort we have here to have a strong Patients' Bill of Rights. There is no better manifestation than the fact that the Fletcher bill preempts stronger State laws that protect patients. The Supreme Court made it clear that patients can seek compensation in State courts; yet this Republican bill effectively blocks action in State court and forces patients to pursue these limited remedies in Federal court, which is a much more difficult place to achieve relief. Going to Federal court is not easy. It costs more, it takes longer, and it is a much more difficult place to get any kind of relief. As the gentleman says, the Fletcher bill continues to shield the HMOs from accountability in State courts where doctors and hospitals are currently held accountable. It is real unfortunate because as the gentleman said, what we have been trying to do with the Patients' Bill of Rights is extend the kinds of protections that exist in Texas to everyone throughout the country, particularly those people who, as the gentleman says, are under ERISA right now, a majority of Americans, who do not even receive protections if they happen to be in Texas or another State which happens to have these good laws. Mr. Speaker, I yield to the other gentleman from Texas (Mr. Lampson), who also has been in the forefront on this and other health care issues.

Mr. PALLONE. Mr. Speaker, this evening I plan to talk about HMO reform and what I call the real Patients' Bill of Rights. Mr. Speaker, I have been here many times before in the last few weeks and even in the last few years to talk about this issue, because I do think it is so important to the American people. We know about many abuses that have occurred within managed care where people have HMOs as their insurance; and frankly, almost a day does not pass by without somebody mentioning to me the problems that they have had with HMOs. Over the last few years our concern over this, particularly in our Health Care Task Force on the Democratic side, has manifested itself by supporting a bill called the Patients' Bill of Rights, which is sponsored by the gentleman from Michigan (Mr. Dingell), a Democrat, the gentleman from Iowa (Mr. Ganske), and the gentleman from Georgia (Mr. Norwood), who happen to be two Republicans. We had a vote in the House of Representatives in the last session of Congress, at which time almost every Democrat supported the Patients' Bill of Rights, and 68 Republicans also supported it. Unfortunately, the Republican leadership here in the House of Representatives has never supported the bill, and continues to oppose it. Also unfortunately, now President Bush has indicated since he took office his opposition to this legislation. What is happening now is that we had a commitment from the Speaker to bring up the Patients' Bill of Rights over the last few weeks, and specifically last week; but he announced last week that that vote was postponed and delayed because the votes did not exist for an alternative HMO reform bill sponsored by the gentleman from Kentucky (Mr. Fletcher). I hate to say it, Mr. Speaker, but the bottom line is that this alternative Fletcher bill is not a real Patients' Bill of Rights; it is a much weaker version, if you will, of HMO reform. I could make a very good case for saying that it does not accomplish anything at all and continues the status quo. What we hear today is that the Republican leadership plans to bring up HMO reform on Thursday of this week. In fact, in just a few hours there might actually be a markup in the Committee on Rules on the legislation. But again, the issue, Mr. Speaker, is what are we going to be able to vote on. Will we be able to vote on the real Patients' Bill of Rights, the Dingell-Ganske-Norwood bill, or are we going to see the Fletcher alternative or some other weakening effort, so we do not have a clean vote on the Patients' Bill of Rights? Unfortunately, Mr. Speaker, I was reading in Congress Daily, the publication that we receive about what is going on on Capitol Hill. It actually indicates tonight that the Republican plan is to somehow separate out various pieces of the Fletcher bill and propose them as amendments to the real Patients' Bill of Rights. I do not really know what the Republicans' procedure is going to be; but if this is the case, once again, it is a sort of insidious way of trying to kill the real Patients' Bill of Rights. The Congress Daily says that ``likely amendments include the Fletcher liability provisions, an access package of proposals seeking to expand insurance, possibly an amendment replacing the bipartisan bill's patient protections with those in the Fletcher bill. Also possible is an amendment to impose caps on medical malpractice awards.'' Let me tell the Members, if any of these things do in fact happen, if this is how the Republican leadership intends to proceed, it once again indicates that they are not in favor of a real Patients' Bill of Rights; that they are not making an effort to bring up this bill, but rather, to kill the bill. I think that is very unfortunate. I have some of my colleagues here, and I will yield to them. But I just wanted to point out why this Fletcher bill is nothing more than a fig leaf for real HMO reform. It is an effort essentially to peel off votes from the bipartisan Patients' Bill of Rights and undermine the effort to pass real HMO reform this year. Just as an example, the Fletcher bill contains almost no protections for patients; and it gives patients almost no ability to appeal their HMO's decisions to an independent panel, or to take HMOs to court when they are denied treatment or harmed in any other way. The real key to HMO reform that is personified, if you will, that is manifested in the Patients' Bill of Rights, the Dingell-Ganske-Norwood bill, is the ability to say that your physician and you as a patient would make decisions about what kind of medical care you get, not the insurance company. The second most important aspect of the real Patients' Bill of Rights is that if one is denied care because the HMO does not want to give it to us, we have a right to redress our grievances and go to an independent panel, separate and independent of the HMO, to overturn that initial decision. If the Fletcher bill basically does not accomplish those goals, which it does not, then it does not achieve real HMO reform. I have a lot of other things that I could talk about this evening, and hopefully that we will get to, but I have two of my colleagues here who happen to be both of them from the State of Texas. The State of Texas has a real Patients' Bill of Rights in effect. It has had that since 1997. I heard some of my Republican colleagues on the other side of this issue say, We do not want the Dingell-Norwood-Ganske bill to pass because if it does, it will mean there will be a lot more lawsuits. The cost of health care will go up, health insurance will go up, and people will lose their health insurance. Well, the Texas experience tells us that that is simply not the case. In Texas, over the last 4 years, there have only been 17 suits filed. In Texas, the cost of health insurance has gone up somewhat, but not as much as the national average. So it simply is not the case. The one thing that I think is most crucial, that I want to mention before I introduce and yield to my two colleagues from Texas, is that what the Fletcher bill does is to preempt a lot of the rights and patient protections that Texas and other States have. Because the Fletcher bill essentially preempts the States' rights and makes all the protections under the Federal law. What that would mean for States like Texas and New Jersey and about 11 other States that have good patients' bills of rights on the State level, is that they would even be undermined because of what is happening with the Fletcher bill. This is just the opposite of what we would like to see and what we have all been striving for here. It is very unfortunate that we might see this Fletcher bill, or some parts of it, become the focus of debate on Thursday, when this bill comes up. Mr. Speaker, I wish to yield to a colleague who has been very active on health care issues, not only this one but many of the other health care issues, and who has been speaking out on this issue for a long time, the gentleman from Texas (Mr. Turner).

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, many of us know now that the Republican leadership postponed any debate or vote on the patients' bill of rights, the HMO reform even though it was scheduled for last week. Now, of course, we are hearing that it may come up this week perhaps as early as Thursday, later on this week. Mr. Speaker, I mention it because myself and many other Democrats have come to the floor frequently over the last year, and perhaps over the last 2 or 3 years, demanding that we have an opportunity for a clean vote on a real patients' bill of rights because we know of the problems that Americans and our constituents face with abuses when they are in the managed care system, where they have an HMO as their insurer. What I fear though, Mr. Speaker, from the pronouncements that we are hearing from the Republican leadership is that there will not be an opportunity for a vote on HMO reform unless they have the votes for a weaker version of HMO reform or they call it the patients' bill of rights than what the majority of the Members of this House have been seeking. The majority of the Members of the House, almost every Democrat and a significant number of Republicans, in the last session of Congress voted for a very strong patients' bill of rights, the one sponsored by the gentleman from Michigan (Mr. Dingell), who is a Democrat and also by some Republicans, the gentleman from Iowa (Mr. Ganske), and the gentleman from Georgia (Mr. Norwood), who are Republicans. It is very important that the opportunities be presented here in the House if it is going to happen this week to have a clean vote on the real patients' bill of rights. I think it is crucial that my colleagues and the public understand that there is a difference between some of the different versions that have been sort of circulating around this Chamber, and to suggest that we are going to have a vote on the patients' bill of rights but not have the opportunity to deal with the really effective strong one, I think would be a major mistake. Let me give an example of the differences and why I think it is important that we have a vote on the real bill, on the one that is going to make a difference for the average American. President Bush has said over and over again that he does not support a real patients' bill of rights. He does not support the Dingell- Ganske-Norwood bill because, first of all, there will be too much litigation, too much opportunity to go to court. Secondly, because it will drive up the cost of health insurance. We know from the Texas insurance, and there are ten other States that have the good bill of rights including my own in New Jersey, that the fear of lawsuits is not real and the fear about increased cost of health insurance or people having their health insurance dropped is not real. In the case of Texas, it is well documented since 1997 when the patients' bill of rights went into effect in that State there were only 17 lawsuits. The average cost of health insurance in Texas has not gone up nearly as much as the national average. So we know that these fears that President Bush talks about are not legitimate. What the President has been supporting and what the Republican leadership has been supporting is a weakened version of the patients' bill of rights that has been introduced by the gentleman from Kentucky (Mr. Fletcher). Just to give an example of what the differences can be on these bills, let me talk about some of the patients' protections that are guaranteed in the real patients' bill of rights that we would not have in the Fletcher Republican leadership bill. For example, we know that what we want is we want doctors to be able to practice medicine and be able to provide us with the care that they think we need. Well, under the Fletcher bill, for example, doctors could be told by their HMO that they cannot even talk to a patient about a medical procedure that they think a patient needs. It is called the gag rule. Doctors also would continue to be provided financial incentive, or could under their Fletcher bill by their HMO, financial incentives not to provide us with care because they get more money at the end of the month if they do not have as much procedure, if they do not care for as many people, if they do not do as many operations. Another very good example is with regard to specialty care. Under the real patients' bill of rights, the Dingell-Norwood-Ganske bill, we basically are able to go to a specialist on a regular basis without having to get authorization each time we want to go. Well, that is not true under the Fletcher bill. For example, under the real patients' bill of rights, a woman can have her OB-GYN as her family practitioner. She does not have to have authorization each time she goes. Under the real patients' bill of rights, if we need pediatric care, we are guaranteed specialty care for our children, for speciality pediatric care. Under the Fletcher bill neither of these things are true. So there are real differences here. That is why it is important that we have an opportunity this week to vote on the real patients' bill of rights. I ask the Republican leadership, do not put any roadblocks procedurally in the way through the Committee on Rules so that we do not have a clean vote on the real patients' bill of rights. Let me talk about another area. Well, I guess my time has run out, Mr. Speaker. But I would ask that we have an opportunity this week to vote on a clean bill.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, let me say, first of all, that this is a bipartisan amendment. It is sponsored by myself and the gentlemen from New Jersey (Mr. Saxton) and (Mr. Smith), my two colleagues on the Republican side. Last year, Mr. Chairman, Congress unanimously passed the Beaches Environmental Assessment and Coastal Health Act; it is also known as the Beaches Act. The Beaches Act established consistent water quality standards for beach water and provides grants to help States develop and implement water quality testing and notification programs to warn the public about unsafe conditions at our Nation's beaches. The reason we needed the Beaches Act and why it is so important is because beach waters are often contaminated by pathogens, which are disease-causing bacteria and viruses found in human and animal wastes from polluted runoffs, storm drains, sewer overflows and malfunctioning septic systems. These pathogens can cause ear, nose and throat infections, dysentery, hepatitis. The risks of infections are higher for children, the elderly, and those with weak immune systems. Just as an example, Mr. Chairman, during 1999, there were more than 6,000 beach closings and advisories posted at U.S. beaches. Since 1988, more than 36,000 beach closures and health advisories have been issued across the Nation, but only 11 States regularly monitor most or all of their beaches and notify the public. One of the reasons why this amendment is sponsored by three Members from New Jersey is because we had New Jersey as an example of the type of monitoring, and we used this as an example in trying to get this bill passed last year. Mr. Chairman, I just want to urge my colleagues to support this amendment. It increases EPA's budget by $3 million for grants to States for beach water quality testing and notification. Last year, Congress unanimously passed the Beaches Act, and the Beaches Act authorizes $30 million in EPA grants. However, even though it authorizes $30 million, I think the President recommended only $2 million. The committee was generous in increasing it to $7 million. But we really think that a lot more money is needed and, if we are able to increase this by $3 million to $10 million, it would really make a big difference. Mr. Chairman, if I could just say a few more things. In some ways, I see it almost as an unfunded mandate, that now we are asking States to do all of these things, but we are not providing them with enough money, and that is why I think this amendment is very important. I should also mention that there are 23 national and regional organizations, environmental groups representing millions of Americans who support this. Mr. Chairman, I reserve the balance of my time.

Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume to just thank the chairman of the subcommittee for his support and the statement that he made. I understand the limitations under which the subcommittee is living and the problem with the offset, but I do appreciate the fact that he, first of all, was willing to increase the amount from what the President recommended and now also go along with this amendment. So with that, I thank the chairman and the ranking member, and I yield back the balance of my time.

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

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I am listening to my colleagues on the other side of the aisle talk about the science; but this is not about science, this is about special interests. If we remember at the time when this decision was made by the administrator of the EPA in March to delay, we read about all the reports and the papers about the chemical and mining industries that were at the White House asking that these arsenic standards, the good standard, be delayed. One of the worst was the American Timber Industry. There was an article in The Washington Post the day before about how the American timber interests had come to the White House and demanded that the standard be delayed because they were concerned about wood beams that were treated and used for decks on boardwalks or in beaches or in people's backyards. Let me tell you, my constituents who are very concerned about drinking water would much rather have the knowledge that they can drink water that is safe, rather than worrying about whether or not a board that is used for the boardwalk or their backyard deck is treated. This is ridiculous. To suggest somehow that the science is still out there and that we do not know what the science is, we have said over and over again, the European Union, the World Health Organization, used the 10 parts per billion. The National Academy of Science talks about exposure at the current level and how it can result in serious cancer risk. The level of risk is much higher than the maximum cancer risk typically allowed by the Safe Drinking Water Act. Even the EPA administrator, my own former Governor, has said that the standard needs to be reduced. She talks about a reduction of at least 60 percent. Well, we know the science is out there, and that this level, this standard that we are using now of 50 parts per billion, is going to cause people to have cancer and die. What are we talking about here? We have statistics that show if you just go from 10 to 20 parts per billion, which maybe is what the EPA could ultimately do, that 3.5 million people would be impacted. It is ridiculous to suggest this standard. We know what the standard is. Let us adopt it. Let us adopt this amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I have great respect for the chairman of the subcommittee, but the reality is that if we do not provide enough money to keep these Federal enforcement officers in place and they have to be laid off, then, in effect, this is a cut and it means we cannot enforce the law. That is what we face here today. We saw the same thing in New Jersey. The current EPA administrator used to be our governor in New Jersey. When she was governor, she cut back on the amount of money for the personnel, for the people that go out and do the inspections, for the people that conduct the criminal investigations against the polluters; and the consequence was that in New Jersey the environmental laws were not enforced. That is what is going to happen here again with this budget unless the Menendez amendment passes today. It is a very insidious thing. People do not pay a lot of attention to enforcement. They pay attention to when the Clean Air Act or the Clean Water Act is weakened. But when an attempt is made to weaken the enforcement by not providing the personnel, the public does not notice. But it is more damaging, and I would suggest what is happening in this budget and the laying off these enforcement personnel will be more damaging to the environment than almost anything else the Republican leadership or the President has proposed since he came to office. So we must speak out against it. I want to give an example how it also impacts the taxpayer. New Jersey has more Superfund sites than any other State. My district has more than any other district in New Jersey. When we cut back on the inspections for Superfund and we do not go after the polluters, then we do not get the money from the polluters to clean up the Superfund sites and then we have to spend the money out of the Superfund, which is taxpayers' money. And my colleagues on the other side know that, in the case of the Superfund, we do not even have the tax in place on the chemical and oil polluting companies to pay for the Superfund. The money increasingly is coming out of the general funds, which means income taxes. So the consequence of this is not only that we weaken the environmental laws but also that we put more of a burden on the taxpayer rather than on the polluters these inspectors go out and find and go out and enforce to clean up their act. What is happening here is very insidious. I am sure this is only going to be the beginning. We will see the same thing next year with the President's budget. We have to put a stop to it. Pass the Menendez amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, tonight I join my other colleague, the gentlewoman from New York (Mrs. Maloney), on the House floor to remember a horrific act taken by Turkey against the citizens of Cyprus 27 years ago. On July 20, 1974, the Nation of Turkey violated international law when it brutally invaded the sovereign Republic of Cyprus. Following the Turkish invasion, 200,000 people were forcibly displaced from their homes and a large number of Cypriot people, who were captured during the invasion, including five American citizens, are still missing today. Earlier this year, the Turkish government was rebuked by the European Court of Human Rights when the court overwhelmingly found Turkey guilty of massive human rights violations over the last 27 years in a scathing 146-page decision. In the case of Cyprus versus Turkey, the court concluded Turkey had not done enough to investigate the whereabouts of Greek-Cypriot missing persons who disappeared during life-threatening situations after the occupation. The court also found Turkey guilty of refusing to allow the return of any Greek-Cypriot displaced persons to their homes in Northern Cyprus. Families continue to be separated by the 113-mile barbed wire fence that runs across the island. The court found this to be unacceptable. Mr. Speaker, I was also troubled by the court's findings on the living conditions of Greek Cypriots living in the Karpas region of Northern Cyprus. Residents in this region face strict restrictions on access to religious worship, no access to appropriate secondary schools for their children, and no security that their possessions will be passed on to their families after their death. By disregarding international law and order, and by defying democratic principles, Turkey has over the past 27 years remained an anachronistic hostage to the past rather than choosing to look to the future with renewed vitality for cooperation and development. Since the invasion, all efforts towards finding a just, peaceful, and viable solution to the problem have been constantly met with intransigence and the lack of political will by Turkey. The United States, which is trusted by all sides in this conflict, has the ability to help move the peace process forward. We must continue to support the United Nations' framework for negotiations between the Greek-Cypriot and Turkish-Cypriot communities. But currently peace negotiations are at a standstill. Over the years, I have become quite familiar with the Turkish side's of well-known negotiation tactics. The Turkish side agrees to peace negotiations on the Cyprus problem only for the purpose of undermining them once they begin and then blames the Greek Cypriots for their failure. Once again, face-to-face negotiations that were scheduled for January have never occurred because Turkish Cypriot leader Rauf Denktash refuses to attend. Mr. Speaker, while the U.S. should do everything possible to restart the U.N. negotiations, it should be made crystal clear to the Turkish leadership and Mr. Denktash that their unacceptable demand for recognition of a separate state in order to return to the negotiating table are completely unacceptable. No effort should be made to appease the Turkish Cypriot leader in order to return to the negotiating table. And not only should Mr. Denktash return to the negotiating table, but he should negotiate in good faith in order to reach a comprehensive settlement within the framework provided by the relevant United Nations Security Council's Resolutions. These resolutions establish a bizonal, bicommunal federation with a single international personality and sovereignty and a single citizenship. Mr. Speaker, for 27 years now, the people of Cyprus have been denied their independence and freedom because of a foreign aggressor. I urge all of my colleagues to join me in remembering what the Cypriot people have suffered and continue to suffer at the hands of the Turks. I also urge my colleagues to join me in pressuring the administration to focus American efforts to move the peace process forward on the Turkish military, which has real and substantial influence on decision-making in the Turkish government.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, let me say this morning as I did last evening that I am very hopeful that the Republican leadership will bring up HMO reform this week. We are hearing this perhaps Thursday or maybe Friday. My greatest fear is that the true HMO reform, the real Patients' Bill of Rights, the Dingell-Ganske-Norwood bill, will not have an opportunity for a clean vote. What we are hearing is that the President is coming back from Europe today. He is going to make one final effort to try to convince my Republican colleagues who voted for the Dingell-Norwood-Ganske bill in the last session to come off that bill and to vote for what I consider a very weak alternative sponsored by the gentleman from Kentucky (Mr. Fletcher), one of my Republican colleagues. Let me stress again that there is a real difference between the Patients' Bill of Rights that almost all Democrats and a significant number of Republicans support that we voted on 2 years ago and would make the real reforms that are necessary to correct the problems and the abuses of HMOs, as opposed to this alternative bill that the Republican leadership is putting up sponsored by the gentleman from Kentucky (Mr. Fletcher), which is a lot weaker and does not really achieve HMO reform. Let me explain that a little bit. The two main focuses of HMO reform, one is to make sure that decisions about what kind of care you get, what kind of medical care you get, whether you are able to have a particular medical procedure, whether or not you are able to stay in the hospital for a certain length of time, these kinds of medical decisions should be made by the physician and the patient, not by the HMO, not by the insurance company. We need to switch that around. Right now, unfortunately, many Americans are denied the care that they really need that is medically necessary because the HMO is not willing to pay or denies the care. The second point that we are trying to achieve with true HMO reform is to make sure that if your care has been denied, if your doctor says that you need an operation and the HMO says we are not going to pay for it, that you have a way to redress that grievance, which is that you can go to an external review board quickly that can overturn that decision that can make sure that you get the procedure or operation; or, ultimately, if that does not work, that you can go to court. The problem is that the Fletcher bill, the bill that the Republican leadership wants to bring up and supports, really does not guarantee those two points, does not achieve what is necessary for HMO reform in those two major areas. Let me explain why. The decision about what is medically necessary, about whether or not you are going to be able to get a particular type of treatment, well, unfortunately, the standard of review for what is medically necessary in the Fletcher bill is a lot weaker. It allows for the HMO to use all the kinds of bureaucratic tricks to make sure that they still control the process or the standard as to what kind of care that you get. The Dingell-Ganske-Norwood bill, the real Patients' Bill of Rights, guarantees that that standard of review is one that is the normal practice by medical practitioners, by doctors in your community, and also with regard to specialty care. For example, if you need a cardiological procedure, if it is a child and a pediatrician has to come into play, that that specialty care, the standard of review of what is medically necessary is made by the physicians by the standard in the medical community, by the standard in that specialty care community. You do not have that guarantee under the Fletcher bill. On the second point, which is that if you are denied the care that you have the ability quickly to overturn that decision. Once again, the Fletcher bill falls short. It does not have the guarantee that we have in the real Patients' Bill of Rights that says that you have to be able to act quickly. That if you need an operation and you are being denied or you are in an emergency room and you are being denied something, that you can quickly go to an outside review board and have that overturned. There are so many procedural roadblocks to your ability to overturn the decision in the Fletcher bill that you really do not have the ability to effectively address your grievances and to overturn that denial of care. Mr. Speaker, I do not want anybody to be confused about what is going on here. What is going on here is that, once again, the Republican leadership is trying to deny the majority, most Democrats and enough Republicans that make up the majority for the real Patients' Bill of Rights, the opportunity to have a vote, a clean vote on that bill. That is what we want. That is what we demand. That is what we hope the Committee on Rules will achieve when we vote on this bill later this week. My greatest fear is we will not have this that clean vote, and I would ask that that be accomplished.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I move to strike the requisite number of words, and I rise in support of the Crowley amendment to the foreign ops bill that would add $10 million to the Office of Foreign Disaster Assistance at USAID. It is my understanding that this amendment is going to be changed somewhat so that it is $1 million instead of $10 million but that we will try in conference to get the larger amount. I know that there is likely to be more money available at that level in conference, so I commend the author of this amendment for his efforts here. I think this is very important, and let me stress that those of us who have been around here for a few years know that there are many natural disasters that befall the South Asia area, whether it be cyclones in Bangladesh, or earthquakes in India, or some of the other natural disasters that we have seen over the years. And, of course, the U.S. is always there to help out and to provide assistance when those disasters occur in India and surrounding countries. But the bottom line is what we are trying to do here today is, I think in many ways, much more important than disaster relief, and that is preparedness. The idea of having a FEMA-type organization in place in South Asia to address a long-term disaster management program is probably the best idea I have seen around here in years in trying to cope with these natural disasters. I can tell you from my experience as I live along the shore in New Jersey, we have had FEMA many times coming down and helping us with hurricane or Northeasterner preparedness. It has saved millions of dollars and so many lives over the years because we have FEMA and we have preparedness in place. I have to imagine that in the case of South Asia, this will make a tremendous difference. That is why I encourage this effort whether it is $1 million or the $10 million that we hopefully will get eventually. Let me say South Asia's geographic location makes it very vulnerable to disaster. The Gujarat earthquake in January was just one in a long series of natural disasters that has plagued the subcontinent. In fact, many states in India alone are continually ravaged by massive cyclones; and drought is a way of life in western India. Bangladesh sees thousands die in flooding, and the instability of the Himalayan Mountains force Nepal and Northern India to constantly dig out from avalanches and other slides. India, and certainly no other country in this region, fully has the capability to institute disaster preparedness and response programs in a manner that will be sufficient to deal with these disasters. Several countries in the region have approached the U.S. for technical assistance in order to establish their own agencies for disaster management. The establishment for a FEMA-like organization in South Asia would greatly increase the capacity of nations to deal with such disasters. USAID's Office of Foreign Disaster Assistance currently has a lone representative based in Kathmandu, Nepal who is charged with covering the whole region. An increase in that office would allow that representative to expand in and enhance our programs in the region to help these nations develop the needed programs. Mr. Chairman, this amendment is very important. I cannot stress how important it is. I offer my full support to the gentleman from New York (Mr. Crowley), the gentleman from California (Mr. Royce), and other Members of our India caucus and encourage all of my colleagues to do the same.

Mr. PALLONE

Mr. PALLONE. I want to thank the gentlewoman, and both of my colleagues from Texas. I think we only have another minute or so. I wanted to say that my real concern, of course, is that we never get a chance to vote on the Patients' Bill of Rights this week or even this year. We know that the leadership, the Republican leadership, has promised that the bill will come up for a vote this week. We are going to hold them to the fire on that, that it must come up and that we must have a clear vote, a clean vote on the real Patients' Bill of Rights. We will be here every night, if necessary, this week to make that point until that opportunity occurs.

Mr. PALLONE. Mr. Speaker, I intend this evening with some of my colleagues on the Democratic side to focus on the same issue that the previous Republican Members focused on, and, that is, the Patients' Bill of Rights, the HMO reform bill. I must say that it disturbs me a great deal to see some of the opponents of the real Patients' Bill of Rights, the bill that has been sponsored by the gentleman from Michigan (Mr. Dingell), who is a Democrat; the gentleman from Iowa (Mr. Ganske), who is a Republican and a physician; and the gentleman from Georgia (Mr. Norwood), who is a Republican and a dentist, and that was voted on overwhelmingly by every Democratic Member of the House of Representatives in the last session and about 68 Republican Members, the real Patients' Bill of Rights, is now being superseded on the other side of the aisle by the Republican leadership which is now promising to bring an alternative bill which they also refer to as the Patients' Bill of Rights to the floor. I would remind my colleagues that the real Patients' Bill of Rights, the one that we voted on, one that all of us, most Democrats and a significant number of Republicans have been pushing for for probably 5 or 6 years, is the bill that should be allowed to come to the floor rather than the Republican alternative, the Fletcher bill, which is in my opinion nothing but a fig leaf and which does not accomplish the goal of truly reforming HMOs. There are two essential goals of HMO reform that are in the real Patients' Bill of Rights. One goal is to make sure that medical decisions are made by the physician, the health care professional and the patients, not by the HMOs, not by the insurance companies; and the second goal is to make sure that if you have been denied care by the HMO that you have a legitimate and reasonable way of seeking a redress of grievances and overturning that decision so you can get the care that you need. I would maintain, and we will show this evening once again, that the Fletcher bill does not accomplish that goal; and the real Patients' Bill of Rights, the Dingell-Ganske-Norwood bill, does. I wanted to, if I could this evening before I yield to some of my colleagues, really point to the two major criticisms that I heard on the Republican side of the aisle tonight against the real Patients' Bill of Rights. One is that there are going to be too many lawsuits. The second is that it is going to drive up health insurance costs. The best way to refute that is to refer back to the Texas law that has been on the books for a number of years now which is exactly the same really as the real Patients' Bill of Rights and which shows dramatically that neither one of those disasters, all these lawsuits, all this litigation, or the other disaster that my Republican colleagues talked about, that health care costs are going to be going up, that insurance companies are going to drop their patients, neither one of those disasters befell the State of Texas because a real Patients' Bill of Rights was put into effect. It is interesting because, in reality, what President Bush is doing in the last few weeks and leading up to hopefully a vote this week on the Patients' Bill of Rights is that President Bush is waving the same flags that he used in the State of Texas when he was Governor to say there is going to be too much litigation and that insurance companies are going to drop patients and not let Americans have health insurance, that they are going to drop health insurance. These were the arguments that the President used when he was the Governor, they are the arguments that he is using now, and it is simply not true. Mr. Speaker, if I could just give some statistics. This goes back to 1997 when then Governor Bush said of the Texas law and I quote, ``I'm concerned that this legislation has the potential to drive up health care costs and increase the number of lawsuits against doctors and other health care providers.'' What did the President, then Governor do? He vetoed a bill similar to the Patients' Bill of Rights in 1994. In 1997, when it came up again, he did everything he could to sabotage the bill to the point that he actually refused to sign it but I guess for political reasons figured that he could not veto it again and so he simply let it become law without his signature. But we are getting the same rhetoric again. Last week as the Patients' Bill of Rights, the real one, made its way towards debate in the House, the President said almost the same thing; and I quote. He said, ``This is how best to improve the quality of care without unnecessarily running up the cost of medicine, without encouraging more lawsuits which would eventually cause people not to be able to have health insurance.'' Again, that people are going to have their health insurance dropped, that litigation is going to increase. Let us look at the facts. Since the 1997 Texas law that Bush opposed so strongly has taken hold, the disastrous effects he had predicted have yet to occur in the Lone Star State. In the 4 years since, even the law's opponents acknowledge that none of then Governor Bush's predictions have come true. Instead of becoming a bonanza for all these trial lawyers, the right to sue an HMO or an insurance company in Texas has been exercised just 17 times. In all the years since 1997 that it has become law, only 17 lawsuits. That is an average of three or four per year. According to the Texas Department of Insurance, the number of Texans enrolled in health insurance or HMO plans has actually increased steadily since the 1997 law was passed. Enrollment has grown from 2,945,000 Texans at the end of 1996 before the law was passed to 3.2 million at the end of 1997 to 3.9 million at the end of 2000. There is just no truth to this. In fact, when you talk about the cost, the cost of HMO premiums in Texas have risen but less than the national average. So the bottom line is the disaster has not occurred. I know I almost hesitated to talk about what is happening in Texas because my two colleagues whom I know are going to join me tonight are both from Texas and I do not like to speak about another State, but it is all positive. The experience has been totally positive. How can the President or any of our Republican colleagues on the other side of the aisle suggest the same kind of thing, the same kind of disaster that is going to befall the Nation when Texas has been such a success story? Just to give an example, one of the reasons, of course, and I always maintain that what the HMO reform would do and what the Patients' Bill of Rights would do was essentially correct the errors of the system. Because once the HMOs know that they cannot get away with these things, then they start taking corrective action and making sure that patients get the type of care that they want. Because they know that if they deny care there is going to be an external review by independent people outside the HMO, or they know that ultimately people can go to court. So they correct the situation. It becomes preventative. That is essentially what the Patients' Bill of Rights will do. Again, the Texas situation points that out very dramatically. In Texas, you could go straight to the courts if you want to, but people overwhelmingly go to the independent review. This is an external review, a group of people that review a denial of care that are not appointed by the HMO and not influenced by the HMO. From November, 1997, through May, 2001, independent review doctors have considered 1,349 complaints in Texas. In 672 of these assessments, or 50 percent, they overturned the HMO or the insurance company's original ruling, I guess in about half the cases. What we are seeing is now that patients know that they can go outside the HMO and have an independent review of a denial of care. They are exercising that. They are not going to court because nobody wants to go to court and have litigation and spend money and go on and on for years. Nobody wants to do that, not the patients any more than the HMOs or the insurance companies. What they set forth in Texas is a very easy way to review denial of care. It has been largely successful. The bottom line is there is absolutely no reason why we should not try to implement it on the national level. Some people have said to me, well, if the States are doing this, why do we need the national law? First of all, not every State is doing it. Texas has probably the best law. None of the others are as good. Most States still do not have anything near the protection that Texas offers. In addition to that, because of a statute called the Employee Retirement Income Security Act, or ERISA, those people who are insured through employers who are self-insured, and I do not want to get into all the bureaucracy of that, but that is about 60 percent of the people who are insured in this country, they are not subject to the State laws. You need the national law like the Patients' Bill of Rights to make sure that they have the same kind of protections that they would get in States like Texas if they were covered by the Texas law. The other thing that really upsets me, and I have to be honest about the Fletcher bill, the Republican alternative that we heard about earlier this evening, is that it would preempt the State law. Experts in Texas will tell you that if the Fletcher bill, the one that my Republican colleagues were talking about tonight, were to become law, it would supersede the Texas law and we could have a situation where the very people that are being protected by that law now and have that independent review or the ability to go to court might not have that kind of protection because the Federal law, the Fletcher bill, would preempt it. What is happening down here? Mr. Speaker, my colleagues might say, are we ever going to get to this Patients' Bill of Rights? Are we ever going to get to HMO reform? Is it even going to come up in this House? The leadership on the Republican side have said that they are going to post the bill this week. What bill? We do not know. Are they going to give us a clean vote on the real Patients' Bill of Rights, the Dingell- Norwood-Ganske bill? Or are they just going to let us consider the Fletcher bill, which is a weak alternative? Are they going to give us the chance to consider any bill? I would suggest that there is a serious question of that. What is happening right now, from what I understand, and I am just reading some news clips as well as what I hear, the scuttlebutt around the floor here in the House of Representatives is that the votes are not there for the Fletcher bill. In other words, almost every Democrat is going to vote for the real Patients' Bill of Rights and a good percentage of the Republicans are going to do it, also, as they did last session. The votes are not there to pass the weak alternative, the Fletcher bill that my Republican colleagues were talking about earlier this evening. So what is going to happen is that we hear the President is coming back tomorrow from Europe and that he is going to spend the rest of Tuesday, Wednesday, maybe Thursday trying to twist arms to convince Republicans who supported the real Patients' Bill of Rights last year to not support it this year and vote for the weaker Fletcher bill. Then if that does not happen and there are not enough votes, then we are not going to have an opportunity to vote on the Patients' Bill of Rights this year. That is not fair. I know that Democrats are in the minority here in the House of Representatives. Republicans control the agenda, and they can bring up whatever they want. But the bottom line is that we know that there is a majority for the real Patients' Bill of Rights, for the Norwood-Dingell-Ganske bill that is made up of almost every Democrat and enough Republicans to create a majority. We have a right, given that that majority exists, to have that bill come up for a clean vote this week. I will say right now to the Speaker and to my colleagues that if that right is denied us because the Republican leadership realizes that there are enough votes to pass the real Patients' Bill of Rights and not enough to kill it with the Fletcher alternative, there is going to be a lot of recriminations around here because we do not have the right to vote on that bill. So I would say to the Republican leadership, bring up the Patients' Bill of Rights. You want us to vote on the Fletcher bill? The votes will not be there. Bring it up. Then let us vote on the real Patients' Bill of Rights, the Dingell-Ganske-Norwood bill. But either way, let us have a clean vote this week, because that was the commitment that the Republican leadership and the Speaker made, and they should fulfill that commitment this week and let us vote on the patients' bill of rights on HMO reform. Mr. Speaker, I would like to yield now to one of my two colleagues from Texas, both of whom have been here on a regular basis with me speaking out on this issue, and I particularly like to see the two of them tonight, because I know of their experience with the Texas law and their involvement in the health care issue and the HMO issue for so many years as Members of our Health Care Task Force. I yield to the gentlewoman from Texas.

Mr. PALLONE. I want to thank my colleague from Texas. I know that my other colleague wants to add something too, so I yield got to the gentlewoman from Texas (Ms. Jackson-Lee).