Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I appreciate what the gentlewoman has said. And this whole idea of a truth squad is what is so crucial here. The gentlewoman is pointing out that what the Republicans are doing, and this is the strategy of the gentleman from Texas (Mr. Delay), and he said it back in August, his strategy is spend, spend, spend, call everything an emergency, spend all the money, and then force the President to sign some omnibus bill at the end. I just find it so ironic that my colleagues earlier on the Republican side came to the floor and criticized the President for vetoing a spending bill. What the President has said is that he wants to see what they are up to. He wants to see where all this spending is, all these emergencies, all these bills that are out there. And he is very much afraid that when it all adds up, it is going to add up to a lot of money that is dipping into the Social Security surplus. And he is basically saying, I am going to put a stop to it. We are going to see what they are up to. We are not going to just let them spend, spend, spend as the gentleman from Texas (Mr. DeLay) said. It is really ironic that they are the ones that are suggesting that somehow we are spending the money. They are in charge. The Congress appropriates the money. The Congress does the spending, not the President. They are passing the bills that spend the money. I want to thank the gentlewoman.

Mr. PALLONE. I appreciate that. Not one of those bills that they sent to the President for his signature would ever have passed here without the Republican majority's support. They are the ones spending the money. Mr. Speaker, I yield now to the gentleman from Oregon (Mr. DeFazio).

Mr. PALLONE. Four.

Mr. PALLONE. I want to thank the gentleman. He has said it all. I would like to yield at this time to my colleague from the district next door to mine, the gentleman from New Jersey (Mr. Holt).

Mr. PALLONE. We are.

Mr. PALLONE. I want to thank the gentleman for bringing up the paying down on the national debt, too, because, again, before I started the hour special order we had two of my Republican colleagues, and the gentleman from Georgia (Mr. Kingston) specifically talked about he and the Republicans wanted to pay down the national debt. And I laughed because we know that if that tax cut that the Republicans put forward that the President vetoed had actually been signed into law and would be in place, the opposite would have happened. We would have been spending Social Security. We would not have had any money to pay down the national debt. And President Clinton, from the beginning of the year, said what he would like to do with any general revenue surplus that was to be generated over the next 5 or 10 years was that he wanted to take 60 percent of it and use it to contribute to Social Security, to shore up Social Security for the future; and he wanted to take, I think 15 percent for Medicare, and then he talked about also paying down some of the national debt. In fact, that was already done a few months ago. He actually did spend some of general revenue surplus to help pay down the national debt or to transfer the bonds in some ways so that the debt was being paid off. And I just listened to my Republican colleagues somehow turn that around and say, oh, no, the President wanted to spend the Social Security surplus. Just the opposite was the case. He was saying we, over the next 5 or 10 years, we are going to generate some general revenue surplus. Let us take that and use it for Social Security. Let us take that and use it to pay down the national debt. And the total effort to confuse the public in the debate by somehow suggesting that by using general revenue surplus to help Social Security that that was somehow using Social Security surplus, it is just the opposite.

Mr. PALLONE. Mr. Speaker, I appreciate the comments of the gentleman. Mr. Speaker, I yield to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. PALLONE. Mr. Speaker, reclaiming my time, I agree with the gentleman. I want to say I was amazed when my two Republican colleagues earlier this evening criticized the President for using his veto pen on appropriations or a spending bill. Because I see veto, veto, veto. They keep sending over these bills that spend all this money, and the most responsible thing the President can do is to continue to veto those bills until we have some idea of what this all adds up to. Because it is clear that when we add it all up, it is going to be a lot of money out of the Social Security surplus; and it is just the opposite, if you will, of what they are suggesting. Mr. Speaker, I yield to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. PALLONE. Mr. Speaker, I would suggest that perhaps today when the President vetoed, or whenever it was, yesterday he vetoed the foreign ops bill and said that he is going to continue to veto until he sees and the Republicans lay out their entire budget, maybe he should even go so far as to suggest that he will not sign anything until they actually address the long-term needs of Social Security and Medicare. Because so far they have completely refused to do that. I would not have a problem if he says, I am not going to sign any more of your bills unless you address Social Security and Medicare long-term and show how over the next 5 and 10 years you are going to use whatever general revenue surplus that might be generated to shore up those programs. I do not know if he mentioned that or not. But I do not have a problem if he goes that much further. Because I think what they are doing is setting the American people up for an incredible spending plan that is ultimately going to spend the Social Security surplus. Mr. Speaker, I yield to the gentleman from New Jersey (Mr. Holt).

Mr. PALLONE. Mr. Speaker, I was looking at the original Democratic budget plan, the one that was presented at the beginning of the year that looked at Social Security and Medicare and the national debt long- term; and basically, in setting aside the general revenue surplus, it would have extended the life of the Social Security Trust Fund beyond 2050 and the life of the Medicare trust funds until 2027 and would also use the projected surpluses, and again, as the gentleman from Oregon (Mr. DeFazio) said, who knows if these surpluses would be there, but if they were, the Democratic plan would completely eliminate the national debt by the year 2015 by using a certain percentage of that general revenue surplus to pay down the national debt.

Mr. PALLONE. Mr. Speaker, I watched the President over the last few weeks and he has repeatedly said, look, this process of sending me bills that the Republican leadership know do not make any sense has to stop. So sit down with me, meet with me. Let us see if we can iron out our difference and hopefully, that process will lead to that. But the bottom line is that they, as the Congress and as the appropriators and the ones who have to pass the spending bills, they cannot act as if that is not their responsibility and that they are not responsible for sending him these bills that do all this emergency spending and that take the money out of the Social Security surplus. I think we just have to keep their feet to the fire. We have to come here every day, every night if necessary, until the budget process is finally arrived at in some sort of consensus. But the bottom line is that they cannot continue to argue that somehow by passing these bills and sending them to the President that they are not spending more and more money. That is the reality. That is what they are up to. And I am going to say it again, I encourage him to veto the bills because we know that if we add them up, they are going to add up to a lot more spending and a lot more money coming out the Social Security surplus.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, yesterday I introduced legislation to prevent the administration from waiving the Pressler amendment, a provision of law which prohibits U.S. military assistance to Pakistan. I would like to take this opportunity to urge my colleagues to join me in this initiative. While I have offered this legislation as a freestanding bill, I am also looking into other legislative vehicles that my proposal could be attached to. Mr. Speaker, the fiscal year 2000 Defense Appropriations Conference Report approved by the House last week contains provisions giving the President broad waiver authority over several sanctions against India and Pakistan, including the Pressler amendment. There are indications that the President will veto this bill, although for unrelated reasons. The intent of my legislation is essentially to return to the status quo on the Pressler amendment. It is my hope that last week's military coup in Pakistan, which certainly is very regrettable, may help to refocus congressional attention to the danger of the giving military aid to Pakistan and result in renewed congressional support for retaining the Pressler amendment. Mr. Speaker, I have long supported lifting the economic sanctions against India and Pakistan, which is also accomplished in the Defense Appropriations Conference Report. I also want to thank the conferees for another positive provision: a Sense of the Congress Resolution that the broad application of export controls to nearly 300 Indian and Pakistani entities listed on the so- called ``Entities List'' adopted by the Bureau of Export Administration (BXA) should be applied only to those entities that make ``direct and material contributions'' to weapons of mass destruction and missile programs and only to those items that so contribute. But I am concerned that other provisions in the conference report could result in renewal of U.S. arms transfers to Pakistan, a government that has engaged in an ongoing pattern of hostile and destabilizing actions. Indeed, keeping the Pressler amendment on the books is the best way to accomplish the goal behind the entities list: Namely for the United States not to contribute to Pakistan's drive to develop or acquire weapons of mass destruction. Mr. Speaker, it does not make sense to apply sanctions against commercial entities that have barely a passing relationship with weapons programs while waiving the Pressler amendment and thereby allowing for direct transfer of military technology. It has been widely reported, Mr. Speaker, last week that the Pakistani Army Chief of Staff led a military coup against the civilian government. Ironically, we have seen several recent efforts from Pakistan to win concessions from the U.S. as a means of propping up Prime Minister Sharif's government and forestalling a military coup. These include the ill-advised attempts to have a special mediator appointed for the Kashmir conflict as well as efforts to reopen the supply of U.S. military equipment to Pakistan. But in light of the latest Pakistani coup, the futility of the strategy is apparent. The Pressler amendment, named for the former Senator from South Dakota, was invoked by President Bush in response to Pakistan's weapons development program. It was good law when it was first adopted and it is still good law today. Earlier this year we were reminded about why the Pressler amendment was needed because of the way Pakistan instigated the hostilities in the Kargil region of Kashmir. In fact, it was the same generals who masterminded last week's coup who pressed for the disastrous military campaign in Kashmir, and we are continually confronted with evidence of Pakistani involvement in nuclear weapons and missile proliferation in other hostile or unstable regions. Last week's coup only further reminds us of the danger of renewing U.S. military ties with Pakistan. Mr. Speaker, I want also to register my concern over recent published reports attributing to State Department officials the suggestion that a resumption of arms supplies to Pakistan would be considered as an incentive for the return to civilian rule. On this point I want to reiterate that the purpose of the legislation I have introduced is to make sure that this administration and future administrations do not provide arms to Pakistan. Mr. Speaker, last Friday The New York Times columnist, A.M. Rosenthal, who once covered South Asia, wrote a column called ``The Himalayan Error.'' He focused on something I have often criticized, namely the pronounced tilt toward Pakistan in U.S. foreign policy. This tilt has resulted in neither democracy for Pakistan nor stability for the region. On Sunday, another New York Times op-ed writer, Steven R. Weisman, wrote an article entitled, ``Pakistan's Dangerous Addiction to Its Military.'' And quoting from that piece, ``[A] major reason Pakistan has such a stunted political tradition compared with India is that the Army has run the country for nearly half of its short history.'' Mr. Speaker, the U.S. obviously cannot bring about democracy in Pakistan or change the Pakistanis' international behavior overnight, but we can avoid the policies that encourage Pakistan's military leaders to seize power, to foment instability in South Asia, to threaten their neighbors and to collaborate with other unstable regimes in the development and transfer of weapons of mass destruction. Clearly, reopening the American arms pipeline to Pakistan would be a disastrous mistake. Mr. Speaker, I include those two New York Times articles for the Record. [From the New York Times, Oct. 15, 1999] The Himalayan Error (By A.M. Rosenthal) Ever since their independence, the U.S. has made decisions about India and Pakistan fully aware that it was dealing with countries that would have increasing political and military significance, for international good or evil. Now that both have nuclear arms capability and Pakistan has been taken over again by the hard-wing military, the American Government and people stare at them as if they were creatures that had suddenly popped out of nowhere--and as if their crises had no connection at all to those 50 years of American involvement in the India-Pakistan subcontinent. The destiny of the two countries--war or peace, democracy or despotism--lies with their billion-plus people, their needs and passions. But American decision-making about them has been of Himalayan importance--because from the beginning it was almost entirely based on a great error. America chose Pakistan as more important to its interests than India. Both countries have a powerful sliver of their population who are plain villains--politicians who deliberately splinter their society instead of knitting it, men of immense wealth who zealously evade taxes and the public good, religious bottom-feeders who spread violence between Hindu and Muslim in India and Muslim and Muslim in Pakistan. But living for about four years as a New York Times correspondent based in India and traveling often in Pakistan, I knew that the American error was widening and catastrophic. Although there were important mavericks, American officialdom clearly tilted toward Pakistan, knighted it a military ally and looked with contempt or condescension on India. Pakistan--a country whose leadership provided a virtually unbroken record of economic, social and military failure and increasing influence of Islamicists. Many U.S. officials preferred to deal with the Pakistanis over the Indians not despite Pakistan's tendency to militarism but because of it. Man, the military fellows can get things done for you. Washington saw the country as some kind of barrier-post against China, which it never was, and against Soviet invasion of Afghanistan. The Pakistanis did their part there. But when the Taliban fanatics seized Afghanistan, Pakistan's military helped them pass arms for terrorists to the Mideast. Pakistan's weakness as an American ally, though Washington never seemed to mind, was its leaders refusal to create continuity of democratic governments long enough to convince Pakistanis that the military would not take over again tomorrow. Across the border, India, for all its slowness of economic growth and its caste system, showed what the U.S. is supposed to want--consistent faithfulness to elected democracy. Where Pakistan failed to maintain political democracy in a one- religion nation, India has kept it in a Hindu-majority country that has four other large religions and a garden of small ones. Danger sign: The newly re-elected Hindu-led coalition will have to clamp down harder against any religious persecution of Muslims and Christians. India's real friends will never lessen pressure against that. And the new government is not likely to stay in office long if it does not fulfill its anti-persecution promises to several parties in the coalition. No, the U.S. did not itself create a militaristic Pakistan. But by showing for years that it did not care much, it encouraged Pakistan officers prowling for power, lessened the public's confidence in democratic government when Pakistan happened to have one and slighted the Indians' constancy to democratic elections. In 1961, in the U.S. Embassy in Seoul, I heard the ranking U.S. diplomat urge Washington not to recognize the military gang that had just taken over South Korea after ousting the country's first elected government in its history. But the Kennedy Administration did recognize the military government. That throttled South Koreans with military regimes for almost another two decades. The Clinton Administration is doing what America should: demand the departure of the generals. Maybe America still has enough influence to be of use to democracy some place or other in Asia. It's the least it can do for its colossal error on the subcontinent--do for Indians, but mostly for Pakistanis.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I thank the gentleman from Texas (Mr. Frost) for yielding me this time. Mr. Speaker, I do intend to support the rule and the conference report, but I wanted to express my concerns about some particular provisions concerning U.S. policy in South Asia. The conference report language that would give the President authority to waive certain sanctions against India and Pakistan, including the prohibition on U.S. military assistance to Pakistan mandated by the Pressler Amendment, as well as other arms transfer controls. While I have long supported lifting the economic sanctions against India and Pakistan, which the conference report also addresses, I am concerned the provisions in the conference report would result in a renewal of U.S. arms transfers to Pakistan. Mr. Speaker, yesterday we were reminded in a stunning and very disturbing way about the potential problems associated with renewing our military ties with Pakistan. The Pakistani Army Chief of Staff, in a nationally televised address, confirmed that a military coup has taken place. Prime Minister Sharif has been dismissed and placed under house arrest. Troops took over state-run TV and radio stations and closed the major airports. Pakistan's army has ruled the country for 25 of its 52- year history, so Army takeovers have been a relatively common occurrence. But this time, the subversion of civilian government means that Pakistan's nuclear arsenal is under direct control of the military leaders, the same hard-line forces who precipitated Pakistan's incursion into India or onto India's side of the Line of Control in Kashmir earlier this year, greatly heightened tensions in that region. I believe the provision in the Defense authorization conference report to grant waiver authority for the Pressler amendment essentially on a permanent basis is a grave mistake. Combined with expanded waiver authority on other provisions of the Arms Export Control Act, this opens the door for the administration to renew the U.S. Pakistan military relationship. Although the Arms Export Control Act waivers would theoretically apply both to India and Pakistan, with congressional notification, I am concerned that that goal is to renew military assistance to Pakistan. I hope that the administration would not help Pakistan militarily thereby putting India at risk. Likewise, I hope that any steps against Pakistan would not be matched by corresponding actions against India. The conference report also provides for extended waiver authority of the Glenn Amendment economic sanctions. I have lobbied for a suspension, if not an outright appeal, of the Glenn amendment. I am glad that the conference took action on the Glenn sanctions. Extending the waiver is a positive step, but I just think we could have gone a little further. I also want to thank the conferees for another positive provision, a sense of the Congress resolution that the broad application of export controls to nearly 300 Indian and Pakistani entities listed on the so- called Entities List, which is adopted by the Bureau of Export Administration, is inconsistent with the specific national security interest of the U.S., and that this list requires refinement. There is also language that these export controls should be applied only to those entities that make direct and material contributions to weapons of mass destruction and missile programs and only to those items that so contribute. The BXA went way too far in blacklisting entities with little or no connection to nuclear or missile programs. So, Mr. Speaker, again, I urge that we adopt the conference report and the rule, but I am very concerned about the repeal, essentially, of the Pressler Amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I want to recognize the achievements and contributions of Mr. Frank E. Fiorilli, Deputy for Business and Strategic Planning for the Army's Communications-Electronics Command (CECOM) at Fort Monmouth, NJ. Mr. Fiorilli is retiring after 34 years and a luncheon in his honor will be held on October 27. This will be a special occasion for a very special individual--one of those talented civil service managers in whom we invest our faith and trust to successfully carry out an important national security responsibility. Mr. Fiorilli began his distinguished career as a presidential intern in 1965. Born in Newark, NJ, he received a bachelors degree cum laude from Rutgers in 1965. He has been serving his country ever since. The principal function of CECOM at Fort Monmouth is to ensure that our soldiers in the field have advanced communications equipment that will protect them and contribute to the success of their battlefield mission. We have been fortunate over the years to have, at Fort Monmouth, highly skilled engineers and other professionals who develop and procure this equipment--a critical component of our military's worldwide success. Frank Fiorilli has established the foundation for the Army to adequately and properly provide advanced communications equipment for the ``Army After Next.'' He has done this with a combination of creativity and organizational skill that we should honor and encourage in all our senior Federal managers. I congratulate Mr. Fiorilli and wish him a well-deserved and fulfilling retirement.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would urge my colleagues today and tomorrow to vote only for the Norwood-Dingell managed care reform, the Patients' Bill of Rights. Every effort is being made with the rule that we will adopt today in the House to try to mess up the Patients' Bill of Rights and make sure that it is ultimately defeated and does not go on to the Senate. The Patients' Bill of Rights, the Norwood-Dingell bill, would change the way medical care is provided by guaranteeing that the doctor and the patients make the decisions about what kind of care they get rather than the insurance company and it would provide for enforcement through an external independent review process if their medical care has been denied and ultimately to the federal courts. The phony access bill that the Republican leadership will put up on the floor today does nothing for the uninsured. It does not help the uninsured at all. All it does is to make it more difficult to pass the Norwood-Dingell Patients' Bill of Rights. The substitutes that are going to be proposed tomorrow as alternatives to the Norwood-Dingell bill, all they do is basically water down their ability to get adequate patient protections and to enforce what kind of care they should get either in a court of law or through external review. Vote for Norwood-Dingell. Vote against all the substitutes tomorrow.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I heard my Republican colleagues talk about fairness. There is nothing fair about this rule. This is a killer rule. Basically, what they are doing is abusing their majority position to rig the procedure here today. And I know why. Very simply, if I am a Member and I want to support the Norwood-Dingell bill, which I certainly do, I am forced under this rule basically to vote in favor of spending Social Security money. At the same time I am also forced to vote for MSAs, medical savings accounts, health marts, and all these other poison pills that basically break the insurance pool and increase the cost for the uninsured. The Republicans say that their access bill is going to help the uninsured. Exactly the opposite; it is going to make it more difficult for people who are uninsured to buy health insurance. That is the poison pill. They are rigging this rule. They are making it impossible for those of us who want to support managed care reform and true reform to vote for it because we would have to vote for all these awful other things that will hurt the uninsured, and make it more difficult also because of the fact that we are going to be spending Social Security money. It is unfair.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I have great respect for the previous speaker, the gentleman from Pennsylvania, but I think he suggests that somehow there are not great differences between these various bills. And I do not think that is true. There are two goals in the Norwood-Dingell bill, and each of the other substitutes that we are going to vote on tomorrow takes away from those goals I think in a significant way. And that is why Members should vote for Norwood-Dingell and not any of the other three substitutes. Those two goals, which I have spoken about many times in the well, are as follows: One is the issue of medical necessity. The bottom line is the decision of what kind of care you get, whether you get a particular operation or procedure, whether you can stay in the hospital a certain number of days. That basically is defined by what is medically necessary. What the Norwood-Dingell bill says is that that decision, what kind of care you get, what is medically necessary, is going to be made by doctors and by the patients and not by the HMOs, not by the insurance companies. The second goal in the Norwood-Dingell bill is to enforce your rights. If that decision about what kind of care you make goes the wrong way, you should be able to go either through an independent review board or through the courts, if necessary, in order to enforce your right. It is an enforcement issue. The bottom line is that the Norwood-Dingell bill provides for a very good enforcement mechanism. It says that when you want to appeal a decision because of a denial of care, you are going to go to an independent review board, not under the authority, if you will, of the HMO. And they are going to define what is medically necessary, what kind of care you get, and they can overturn a denial of care. Failing that, you can go to court. All of the substitutes take away from those two goals, and that is why you should vote against the substitutes and vote for Norwood- Dingell.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, in this Republican Congress, the special interests who write the big checks get the last word. The day before the House began its debate on the Patients' Bill of Rights, the only bill that takes medical decision-making away from insurance company bureaucrats and returns it to doctors and patients, the gentleman from Illinois (Speaker Hastert) sat down with 15 health care lobbyists who paid $1,000 each for one last chance to make their case. The health care industry has cultivated the Republican leadership with strong-armed lobbying efforts and well-placed campaign contributions, over $1 million from the Health Benefits Coalition, a group of insurance groups alone. House Republicans, led by the majority whip, the gentleman from Texas (Mr. Delay) and the gentleman from Illinois (Speaker Hastert) are doing everything they can to kill reform to please their contributors in the health insurance industry. Mr. Speaker, that is why they put forward the rule today that was adopted on an almost exclusively partisan vote. Almost every or actually every Republican voted for the rule, and almost every Democrat except for one or a few voted against the rule. Mr. Speaker, I just want to talk a little bit, if I can, about this rule and why it is making the ultimate question of passage of good managed care reform difficult. The rule, instead of providing a fair and open rule for considering the Patients' Bill of Rights, basically stacks the deck by insisting on provisions that blend the managed care bill, the Patients' Bill of Rights, with a measure riddled with special interest poison pills designed to kill the Patients' Bill of Rights, the Norwood-Dingell bill, and that denies the gentleman from Michigan (Mr. Dingell) and the gentleman from Georgia (Mr. Norwood) the opportunity to offset any potential revenue losses from the measure. The Republican bill basically combines a so-called access bill, H.R. 990, and the managed care bill, the Norwood-Dingell bill, together. The measure will combine essentially a meaningful managed care bill with a special interest-laden boondoggle of a bill that masquerades as a health access bill. There is no question that this rule which was adopted today, I would say again, on almost exclusively a partisan vote, is nothing more than a cynical, desperate, last-minute attempt to stave off a bipartisan Norwood-Dingell managed care bill that was on the verge of passage. I am very fearful, Mr. Speaker, about what kind of success we are ultimately going to have here tomorrow with regard to the Norwood- Dingell bill because of the way that this rule provides for us to proceed, and because of the stark choices that many Members will have to make; had to make today on the so-called access bill, and will have to make tomorrow on some of the substitutes to Norwood-Dingell. I wanted to talk about this phony access bill that was voted on today, again, almost exclusively on a bipartisan basis. Most of the Republicans voted for the access bill and most of the Democrats voted against it. First of all, I would point out that it is designed, according to the Republican leadership, to try to improve access to health insurance for the over 40 million Americans that have no insurance, who are right now uninsured. But the phoniest aspect of this, if you will, is that the bill, this access bill, spends Federal dollars on tax breaks that do more to help the healthy and the wealthy than the uninsured. According to the General Accounting Office, nearly one-third of all uninsured Americans do not pay income taxes. These families would not be helped at all under the bill that was passed today. Instead, the greatest benefits under the bill would go to the 600,000 uninsured families that make almost $100,000 per year, because the value of shielding income from Federal tax is greater for those in the highest tax bracket. In addition to not helping the uninsured because so many of them essentially are not paying taxes, or are not paying that much to benefit from this bill, the bill expands medical savings accounts, a special tax break for the healthy and wealthy that threatens to increase health insurance premiums for everyone else. My point is, Mr. Speaker, that the so-called access bill today, which the Republican leadership claims is trying to get more people into insurance plans and out of the ranks of the uninsured, in fact will make it more difficult for those who are uninsured to buy insurance because the costs will go up. That is accomplished, first of all, by putting in the poison pill of the medical savings accounts, the SMA's, as well as new Federal regulations that would disrupt State health insurance markets. With the SMA's, and this is nothing new, this is something we have seen over and over again over the last couple years in an effort to try to defeat managed care reform, this poison pill, which was included in the 1996 bill, basically is a tax break for the wealthy. The new Federal regulations that would disrupt State health insurance markets that are in this bill, the access bill, basically are two proposals called association health plans and HealthMarts, both of which would offer cheaper, less comprehensive policies that bypass State consumer protection, insurance, and benefit requirements. Like medical savings accounts, these new plans and networks would be able to cherrypick the healthiest out of the State-regulated health insurance market, which could result in higher costs for those still in the State-regulated market. In addition, like medical savings accounts, the association health plans are supported by big contributors to Republican candidates. Mr. Speaker, my point is that this access, this so-called access bill that was adopted today, really is mucking up, if you will, the possibility of passing real managed care reform because it will travel now with whatever managed care reform bill that we adopt tomorrow and go over to the Senate together. It means that whatever managed care reform bill we pass tomorrow will now have these other provisions attached to them, attached to it, that basically are going to make it more difficult to pass in the Senate, more difficult to adopt in conference, if the Senate and the House ever get together to try to come up with a bill that both houses adopt, and undoubtedly will result in a veto by the President, because he could not possibly sign provisions like the SMA's, like the HealthMarts, that basically break the insurance pool and make the costs to buy insurance for those who do not have it even more costly than it is today. I would like to go on, though, and talk about what is going to happen tomorrow. The access bill is passed, the rule was passed. There is not much we can do about it tomorrow. But tomorrow we have more debate, which began tonight, on the Norwood-Dingell bill, and three substitutes that have been made in order under the rule which really, again, are nothing more than an effort to try to kill and water down the Norwood- Dingell bill. I have said over and over again on the floor of this House and in this well that the two major advantages and overall goals, if you will, of the Norwood-Dingell bill are fairly simple, fairly easy for the average person to understand. First of all, the first principle, the first goal of Norwood-Dingell, says that on the one hand, right now most decisions about what kind of medical care we get, what type of operation we get, or what kind of equipment we can use, or how long we stay in the hospital, or all the other things that define adequate health care, the decision as to what type of care we get is essentially now made by the HMO, by the insurance company. That is not the way it should be. What should be and the way it used to be a few years ago was that the physician, the doctor, our doctor, and us, the patients, would determine what kind of care we were going to get. We want to turn that around. In the Norwood-Dingell bill, we want to go back to the old days, essentially, when decisions about the type of care that we as Americans receive are basically decisions made by the physician, the doctor, and us, the patient. The second thing we do in the Norwood-Dingell bill is to say that if we have been denied care that we and our physician think we should have had, then we have to have some adequate way to enforce our rights and overturn that denial of care. That is essentially done in two ways with the Norwood-Dingell bill. First of all, there is an independent review, so that we do not have to go to the HMO and appeal their decision, and essentially appeal to them or someone who is within the HMO to decide the appeal. Rather, we go to an external, independent review board not controlled by the HMO, which has the ability to overturn that decision and provide us with the care that our physician and we say we need in a very quick, expedited way. Failing that, if for some reason this independent external review does not work and we are still denied care that we and the physician think we need, then we have the right to go to court and seek an action to overturn that denial of care. Or if the situation has resolved itself so that we were denied the care and we suffered damages, we were injured, we suffered, or God forbid, died, then we would be able to sue in the courts for damages as a result of that denial of care. Now, all this makes perfect sense; and, frankly, I do not know what the big deal is. Any time people have a grievance and they suffer damages, they normally can go to some kind of review and take some kind of appeal and ultimately go to the courts. What we are told by our colleagues who support the Republican leadership on the other side is that that is not acceptable. In fact, the previous speaker made the point that it is not acceptable; that the Norwood-Dingell bill goes too far in providing enforcement actions. Well, let me just say, if I could, a few things about these substitutes that are going to be considered tomorrow and why they do not establish the two goals, they do not meet the two tests that I have already mentioned; and that is, who is going to decide what kind of care one gets; and, secondly, how one is going to enforce one's rights if one was denied care. We have three substitutes that will be considered tomorrow. I just want to basically go through some of the key concerns I have with these substitutes and why I ask my colleagues to vote no against them and to let us have, instead, the Norwood-Dingell bill as the base bill that we are voting on. Let me take first the Boehner amendment in the nature of a substitute. This bill does not include many important patient protections. Now, I have not spent the time this evening going into all the patient protections, all the specific patient protections that the Norwood-Dingell bill provides, and there are many. I have talked about them many times, so I am not going to go through them all this evening. But I did want to talk about the patients' protections that are in the Norwood-Dingell bill that are not in the Boehner substitute. The Boehner substitute does not apply to all Americans in privately insured plans. It fails to extend protection to millions of Americans who purchase insurance individually. Now, my colleagues have to understand that, in the other body, a managed care bill was passed in the Senate that basically covered very few people. The tremendous advantage of the Norwood-Dingell bill is that it covers everybody, anybody who has insurance. Well, if my colleagues were to adopt the Boehner substitute tomorrow instead of the Norwood- Dingell bill, basically millions of Americans who purchase insurance individually would not be covered. The Boehner substitute also does not include a provision on accountability or liability. It, therefore, provides no meaningful remedies at all for individuals in employer plans. It takes away current remedies by placing restrictions on all health care liability claims, including those in State court. The bill also does not include access to specialists, an important aspect of the Norwood-Dingell bill, access to non-formulary drug, another important aspect in the Norwood-Dingell bill, protections for patient advocacy or limits on financial incentive arrangements that induce providers to withhold care. One of the things that is most abusive today and one of the biggest criticisms that I receive from my constituents is that, right now, HMOs provide financial incentives to physicians not to provide care. That is an awful thing. But that is the reality today in the managed care system for many people. The Boehner bill does not do anything to correct that, whereas the Norwood-Dingell bill does. The Boehner substitute's external appeals provision would require external reviews to use the plan's definition of medical necessity. When I talked before about how the Norwood-Dingell bill, one of its two major goals is to make sure that the physician and the patient decide what kind of care one gets, that is because, in the Norwood- Dingell bill, the definition of medical necessity, what is medically necessary is made by physicians. It is a standard developed in the particular specialty by the doctors in that specialty area. So that, for example, for cardiology, the Board of Cardiologist standards would hold sway. Well, the Boehner substitute basically says that, in doing an external review, the plan's definition, the HMO insurance company's definition of medical necessity holds sway. So there again, the HMO is going to decide what kind of care one gets. Reviews would only decide if the plan followed its own guidelines, essentially rubber stamping the HMOs decisions. The Boehner bill also says that plans control, HMOs control what information patients have to submit to the reviewers. The patient does not have the right to submit his or her own evidence. There is no requirement that reviews be made in accordance with the patient's medical exigencies. A review panel could take up to 30 days. Again, the problem with these substitutes to the Norwood-Dingell bill is that, if one has been denied care, one is not going to be able to have an effective appeal in a timely manner. That is one of the biggest problems with the Boehner substitute. Now, let me talk about the Coburn-Shadegg-Thomas substitute. The gentleman from Arizona (Mr. Shadegg), just a few minutes before I spoke, talked about how wonderful this substitute was. I would point out that the Coburn-Shadegg-Thomas substitute, the second substitute that will be considered tomorrow in lieu of Norwood-Dingell falls short on many important patient protections. There is a $100 threshold to get to external review. A person who is denied a simple, yet life-saving, test would never get the review. There is no ability for patients to get access to off-formulary drugs when necessary. The Coburn-Shadegg bill only requires coverage of routine costs of cancer trials, leaving patients with other devastating diseases without any protections. Emergency coverage under the Coburn-Shadegg bill for newborns is judged by a prudent health professional standard. That could mean that plans could deny payment for a larger range of neonatal emergency care. But let me also talk about the enforcement aspects of the Coburn- Shadegg bill. Again, if one is denied care, how does one enforce one's right to overturn that denial and have the care provided? Well, under the Coburn-Shadegg substitute, there is an entirely new Federal cause of action. HMOs can require an enrollee, a patient, to go to a certification panel that would decide whether the person was injured and whether this was caused by the HMO. If the panel finds for the HMO, the suit is dismissed. The bill basically caps the amount of noneconomic damages a person can receive. It also undermines existing remedies because it requires that a person go through the bill's Federal remedy before seeking any State remedies. What we are seeing here is a series of hoops. I have to be honest. I felt that the gentleman from Arizona (Mr. Shadegg) was actually being somewhat honest when he was saying that there were major limits on one's ability to sue in the substitute that he has co-authored. Well, why should that be? Why are all these limits placed on one's ability to sue if one has seriously suffered damage? I mean, this is not right. What we are trying to do here in the Norwood-Dingell bill is to basically make sure that one has a remedy, a right to enforce one's rights, and to make sure that one is not denied care. Any effort to basically water that down, to me, makes no sense and should be defeated. Mr. Speaker, let me lastly talk about the third substitute that the House will consider tomorrow, and that is the Houghton substitute or Houghton amendment. It strikes the liability provision from the Norwood-Dingell bill and replaces it with a weak Federal remedy under ERISA. The Federal remedy would preempt a long history of allowing States to provide appropriate remedies for various harms suffered by their residents. All we are doing in the Norwood-Dingell bill is saying that one has a right in State court or under State law to sue in the same way that one would for any other damage that one suffered. Well, why should we go along with the Houghton amendment which basically strikes that liability provision in Norwood-Dingell and creates another Federal remedy under ERISA? ERISA is the Federal law that preempts the State law and then makes it so that, even in States like Texas or New Jersey, where we have patient protections on the State level, that one does not have any right to those protections because one's employer may be self-insured; and, therefore, one falls under the Federal ERISA law. Well, the Houghton amendment would basically strike the provisions from Norwood-Dingell and give one another Federal ERISA remedy rather than being able to sue under State law. This Federal remedy under the Houghton amendment is full of loopholes and would allow plans, HMOs to escape liability. The Houghton amendment provides bonding arbitration in place of external review and access to courts with minimal, if any, protections for consumers against bias. Once again, Mr. Speaker, I urge my colleagues to look carefully at these substitutes tomorrow, and they will find that, in every case, they limit the ability of an American, of our constituents to be able to get quality care and to enforce their rights to make sure that they get their quality care. That is why all those substitutes should be defeated, and we should simply pass the Norwood-Dingell bill. I wanted to mention a few other things tonight about some of the attacks that we are getting and that I am sure will intensify tomorrow against the Norwood-Dingell bill, which I think have been effectively refuted by those who support the Norwood-Dingell bill, but I want to mention them again because they continue unabated. We are told, of course, the old thing, that the Norwood-Dingell bill, the Patients' Bill of Rights, is going to allow for numerous lawsuits, and that that is going to increase the costs of premiums, and ultimately employers will drop coverage for their employees because the costs will be too high. Well, I think that that has been effectively refuted by the fact for the last 2 years that the State of Texas has had on its book a patient protection act very similar to the Norwood-Dingell bill. The reality is there have been only four lawsuits filed during that 2-year period in the State of Texas, and the cost of premiums have gone up less than they have in States that do not have those same kind of patient protections. I do not think anything more needs to be said on the issue of costs or the issue of suing the HMO and liability and excessive lawsuits than to look at the Texas example. But the other attack that we are getting again was made by the gentleman from Arizona (Mr. Shadegg) earlier this evening when he said that the Norwood-Dingell bill would allow for employers to be sued; and because employers would be sued, they would drop coverage because they would not want to be the subject of lawsuits. Well, again, that is not accurate. The Norwood-Dingell bill has very specific shield language that shields the employer from liability unless they are actually involved in the decision to deny one care. I would say that even the gentleman from Arizona (Mr. Shadegg) admitted that, if they are involved in a decision to deny one care, they should be sued. The bottom line is that it is only the Norwood-Dingell bill that provides this kind of a shield to make sure that employers cannot be sued. To suggest somehow that that shield will not work again is inaccurate. I just wanted to cite a reference that has been made again by some of my colleagues today and on other occasions, the myth that is being promulgated against Norwood-Dingell on this point is to say that employers would be subject to lawsuits simply because they offer health benefits to their employees under ERISA. Well, section 302(a) of the Norwood-Dingell bill specifically precludes any cause of action against an employer or other plan sponsor unless the employer or plan sponsor exercises discretionary authority to make a decision on a claim for covered benefits that results in personal injury or wrongful death. Now, how do we define exercise and discretionary authority? The myth again being promulgated by those against the Norwood-Dingell bill is that employers' decisions to provide health insurance for employees will be considered an exercise of discretionary authority. That is simply not true. Examples of the types of decisions that health plan administrators make that directly affect the care that patients receive and could be considered medical decisions include inappropriately limiting access to physicians through restricted networks, refusing to cover or delay needed medical services, drawing treatment protocols too narrowly, offering payment incentives, or creating deterrence to discourage the provision of necessary care, and discouraging physicians from fully discussing health plan treatment options, the so-called gag rules. These are not decisions that employers make. The Norwood-Dingell bill excludes from being construed as the exercise of discretionary authority decisions to, one, include or exclude from the health plan any specific benefit; two, any decision to provide extra contractual benefits; and, three, any decision not to consider the provision of the benefit while its internal or external review is being conducted. So the bottom line is the employer is shielded from liability. That is the simple truth. That is why the Norwood-Dingell bill should be adopted tomorrow and not some of these substitutes that claim to improve on the law. Now, let me just say one thing finally if I could, Mr. Speaker. It sounds kind of crazy, but I have heard some of my colleagues say, well, why do we need to pass the Norwood-Dingell bill? Why do we need Federal legislation to address the abuses of managed care, because, after all, the States are doing this, and even the courts are doing it? I mentioned the Texas law. I mentioned the other day, and some of my colleagues have talked about it, California really recently enacting a law which was signed by Governor Davis just a few days ago. We have also heard about court cases, a recent decision by the Illinois Supreme Court that ruled last Thursday that HMOs may be sued for medical malpractice. Just last week as well, the Supreme Court assigned itself an important role in the debate over managed care, the U.S. Supreme Court, by accepting a case on whether an Illinois health maintenance organization breached a legal duty to a patient whose appendix burst during an 8-day wait for a test to diagnose her abdominal pain. So some of my colleagues are saying to me, we have some States that are passing laws, let them continue to do so. Or we have the court, this case Illinois or maybe even the Supreme Court of the United States, that will ultimately say that an individual has the right to sue the HMO, so why do we need the Norwood-Dingell bill? Well, the fact that many States have decided that they cannot wait for Federal action and have passed these measures to strengthen patient protection should not be an excuse to not have Federal action. The bottom line is, and if I could just read from an editorial that was in The New York Times the other day, it talks about why State laws are not sufficient, and it says and I quote, ``State initiatives do not replace the need for Federal legislation. For one thing, none of these State protections apply to people in self-insured plans created by large employers, which are exclusively federally regulated. More important, current Federal law has long been interpreted to bar patients covered by private employer-sponsored health plans from suing for damages caused by improper benefit denials, although the Supreme Court this week decided to hear a case that will review this issue. The California legislation tries to get around the legal hurdle by framing the new State-granted right to sue as based on the right to obtain quality care rather than the right to particular benefits. That approach will clearly be challenged in court and may well be struck down unless Congress closes the loophole in Federal law that now shields health plans from meaningful liability.'' Mr. Speaker, if I am one of the people, one of my constituents out there who has been denied care, I can assure Members that it is not going to make me feel good that I do not come under the patient protections because I happen to be in an ERISA federally-preempted plan, or that I have to wait for the courts, whether it be Federal or State courts, to find a loophole so that I can sue the HMO. Again, Mr. Speaker, I would say it has been an interesting debate today. I think it is very unfortunate that the rule passed. I think it is unfortunate that this access bill passed now, and that whatever we do pass tomorrow will have to be incorporated in this so-called access bill that I think provides a number of poison pills and will make it difficult for the Norwood-Dingell bill to move in the Senate or to be resolved in conference. But I would still urge that tomorrow is also an important day, and we want to make sure that the Norwood-Dingell bill passes and is not superceded by some of these other three substitutes that basically will water down the protection and the enforcement rights for our constituents that exist in the Norwood-Dingell bill. I urge my colleagues tomorrow to support the Norwood-Dingell bill and to vote ``no'' on all the substitutes.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, we are expecting that tomorrow we will have a debate on the Patients' Bill of Rights on HMO reform. We do not have the rule yet coming out from the Committee on Rules, and I have expressed many times on the floor of the House my concern that this rule, this procedure that may be adopted would allow the Republican leadership in the House to add poison pills, extraneous issues to the Patients' Bill of Rights in an effort to defeat it. But I do not want to dwell on that today because I am still hopeful, still optimistic that that will not be the case and we will be allowed to have a clean vote on the Patients' Bill of Rights and provide for patient protections for those Americans who have their health insurance through HMOs or managed care. But I am concerned, Madam Speaker, about the fact that, in the last few weeks and certainly the last 2 days, we have had a barrage of ads and articles that are basically put out by the HMO industry, by the insurance companies in an effort to defeat and spread erroneous information about the Patients' Bill of Rights, about the bipartisan Norwood-Dingell bill. One that I think that we have basically disputed effectively but keeps coming up is the argument that, under the Patients' Bill of Rights, there will be too many lawsuits because now patients will be able to sue their HMO if they suffer damages; and, secondly, that the cost of health insurance will skyrocket because of the fact that there will now be the ability to sue the HMO as well as the various patient protections that are in place. I think that the Texas law which has been on the books now in the State of Texas for 2 years, very similar to the Norwood-Dingell bill, effectively disputes the cost argument as well as the HMO liability or ability to sue the HMO argument. Over 2 years now in Texas, there have only been four lawsuits filed against HMOs. In addition, the costs of health insurance premiums for those in managed care have not gone up at all. In fact, Texas rates have actually been less than a lot of other States. The increases have been actually less in Texas than a lot of other States where they do not have patient protections, where they do not have the Patients' Bill of Rights. But, today, I hear another argument which I think needs to be effectively refuted as well, and that is that, somehow, employers, not the HMOs, but employers are going to be liable to suit under the Norwood-Dingell bill and that because employers will be sued, a lot of employers will drop health insurance, and the ranks of the uninsureds will increase. Well, nothing could be further from the truth. The fact of the matter is that under the Norwood-Dingell bill, under the Patients' Bill of Rights, we have specific language that shields the employer from being sued in almost every circumstance. An employer would actually have to actually be involved in the very decision about whether or not one is going to have a particular operation or be able to stay in the hospital before they could be liable for suit, which is simply not the case. In every case, the insurance company or a third party administrator handles those decisions for employers pursuant to their insurance policy. We have very effective shield language in the bill that effectively precludes the employer from being sued. Now, I want to say I thought there was a very interesting article in today's Washington Post, an op ed by Anthony Burns where he tries to say and he admits that we do have shield language in the bill that would effectively preclude an employer from being sued. But it goes on to say, essentially, in the article, and this is sort of a new twist on this theme, that even though the shield language is there, it will not matter because crafty trial lawyers will find a way to get around it. He talks about, first, that plaintiffs could argue that insurance companies or third-party administrators are merely the agents of the employer, or a crafty lawyer could argue that, by selecting one health- care provider over another, the employers' discretionary decision played a role in a decision or an outcome with regard to patient care. Well, that is totally bogus. Any trial lawyer, of course, can make any argument, and anybody can be sued and make an argument. But the bottom line is, if one has effective shield language, those arguments are not going to work. One of the things that disturb me the most is that, if one sees what is happening around the country, one will see in a recent Illinois Supreme Court decision, or even a case that is now being obtained by our own U.S. Supreme Court, that the courts increasingly are getting around the prohibition on the right to sue. But just because that is happening does not mean that we, when we pass legislation, which we are hopefully going to consider in the next few days, that if we put specific language in that says the employers cannot be sued, that should be sufficient for those who are concerned about this issue. Because any lawyer can make any argument. Any court can overturn any decision or any Federal language. But the bottom line is that we are putting that protection in the bill. I think that that should be sufficient. It is a recognition of the fact that the employers cannot be sued. Please support the Norwood-Dingell bill. Do not be persuaded by these false arguments.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise in opposition to the fiscal year 2000 foreign operations bill, but I do want to indicate support in the way this legislation affects U.S. policy towards Armenia and India. First, I want to express my appreciation to the conferees, particularly the gentleman from Alabama (Chairman Callahan) and the gentlewoman from California (Ms. Pelosi), the ranking member, for their continued attention to Armenia, Nagorno Karabagh, and the entire South Caucasus region. This year's legislation provides somewhat more assistance to Armenia than we provided in the last fiscal year, $89.67 million or 12.2 percent of the total of $735 million for the New Independent States of the former Soviet Union. The conference report also specified that 15 percent of the funds available for the South Caucasus region be used for confidence-building measures and other activities related to regional conflicts including efforts to achieve a peaceful resolution of the Nagorno Karabagh conflict. The House version of the legislation contains several report language provisions that would contribute greatly to peace and stability in the South Caucasus region. The administration should follow through on the policy directives contained in the House report which are now incorporated in the conference report. The House report specifically directs the Agency for International Development to expedite delivery of $20 million to the victims of the Nagorno Karabagh conflict. The people of Nagorno Karabagh suffered during their war of independence with Azerbaijan, and their need for help continues to be significant. They should not be discriminated against in terms of receiving humanitarian assistance simply on the basis of where they live. The administration should also heed the House report language regarding the peace process for Nagorno Karabagh, stating that assistance to the governments of the region should be proportional to their willingness to cooperate with the Minsk Group. And finally, I want to applaud the conferees from both bodies who have maintained section 907 of the Freedom Support Act. Turning to India, I want to thank the conferees and particularly the gentlewoman from California (Mrs. Pelosi), the ranking member, for not adopting a provision in the Senate version of the legislation singling out India as one of a handful of nations that would have to receive special congressional approval before the allocation of foreign aid. Section 521 of the Senate bill talked about special notification requirements for countries such as Colombia, Haiti, Liberia, Pakistan, and also included India in this list; but the House conference report does not, and I want to thank the conferees for making that change.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I wanted to spend some time tonight, because this is the week when managed care reform, HMO reform, will come to the floor for the first time. I just wanted to spend about 15 or 20 minutes talking about why the Patients' Bill of Rights, the bipartisan Norwood-Dingell bill, is the right measure, and why every effort that may be made by the Republican leadership over the next few days to try to stop the Norwood-Dingell bipartisan bill, either by substituting some other kind of HMO so-called reform or by attaching other amendments or poison pills that are unrelated and sort of mess up, if you will, the clean HMO reform that is necessary, why those things should not be passed, and why we should simply pass the Norwood- Dingell bill by the end of this week. I do not want to take away from the fact that the Republican leadership has finally allowed this legislation to come to the floor, but I am very afraid that the Committee on Rules will report out a procedure that will make it very difficult for the bill to finally pass without having poison pill or other damaging amendments added that ultimately will make it difficult for the Patients' Bill of Rights to move to the Senate, to move to conference between the two Houses, and ultimately be signed by the President. A word of warning to the Republican leadership. This is a bill, the Norwood-Dingell bill, the Patients' Bill of Rights, that almost every American supports overwhelmingly. It is at the top of any priority list for what this Congress and this House of Representatives should be doing in this session. I think it would be a tragedy if the Republican leadership persists and continues to persist in its efforts to try to stall this bill, damage this bill, and make it so this bill does not ultimately become law. I just want to say very briefly, Mr. Speaker, because I have mentioned it so many other times on the floor of the House of Representatives, the reason the Patients' Bill of Rights is a good bill and such an important bill basically can be summed up in two points; and that is that the American people are sick and tired of the fact that when they have an HMO, too many times decisions about what kind of medical care they will get is a decision that is made by the insurance company, by the HMO, and not the physician and not the patient. That is point number one. Point number two is that if an HMO denies a particular operation, a particular length of stay in the hospital, or some other care that a patient or physician feels is necessary, then that patient should be able to take an appeal to an independent outside review board that is not controlled by the HMO and, ultimately, to the courts if the patient does not have sufficient redress. Right now, under the current Federal law, that is not possible because most of the HMOs define what is medically necessary, what kind of care an individual will receive themselves. And if an individual wants to take an appeal, they limit that appeal to an internal review that is basically controlled by the HMO itself. So the individual cannot sue. If an individual is denied the proper care, they cannot take it to a higher court, to a court of law, because under the Federal law, ERISA preempts the State law and makes it impossible to go to court if an individual's employer is in a self- insured plan, which covers about 50 percent of Americans, who get their health insurance through their employer, who is self-insured, and those people cannot sue in a court of law. We want to change that. The bipartisan Norwood-Dingell bill would change that. It would say that medical decisions, what kind of care an individual gets has to be made by the physician and the patient, not by the HMO. The definition of what is medically necessary is essentially decided by the physicians, the health care professionals. And, secondly, if an individual is denied care that that individual and their physician thinks they need, under the Patients' Bill of Rights, the bipartisan bill, what happens is that that patient has the right to an external review by an independent review board not controlled by the HMO. And, failing that, they can go to court and can sue in a court of law. Now, those are the basic reasons this is a good bill. There are a lot of other reasons. We provide for emergency services, we provide access to specialty care, we provide protection for women and children. There are a lot of other specific provisions that I could talk about, but I think there is an overwhelming consensus that this is a good bill. This is a bill that almost every Democrat will support and enough Republicans on the other side of the aisle will join us against their own Republican leadership in support of this bill. But there have been a lot of falsehoods being spread by the insurance industry over the last few days and the last few weeks and will continue until Wednesday and Thursday when this bill comes to the floor, and I wanted to address two of them because I think they are particularly damaging if people believe them. And they are simply not true. One is the suggestion that the patient protection legislation, the Norwood-Dingell bill, would cause health care premiums to skyrocket. That is simply not true. If we look at last week's Washington Post, September 28, there was an article that surveyed HMO members in Texas, where there is a very good patient protection law that has been in place for the last 2 years. That survey showed dramatically that in Texas they could not find one example where the Texas patient protection law forced Texas HMOs to raise their premiums or provide unneeded and expensive medical services. The Texas law, which has been on the books for 2 years, shows that costs do not go up because good patient protections are provided. In addition, we are told by the insurance companies that costs are going to go up because there will be a lot more suits and that will cost people more money and their premiums will have to go up. Well, the 2-year Texas law that allows HMOs to be sued for their negligent medical decisions has prompted almost no litigation. Only five lawsuits out of the four million Texans in HMOs in the last 2 years, five lawsuits, which is really negligible. It is really interesting to see the arguments that the insurance companies use. The other one they are using, and they are trying to tell every Member of Congress not to vote for the Patients' Bill of Rights, not to vote for the Norwood-Dingell legislation, is this myth that employers would be subject to lawsuits simply because they offer health benefits to their employees under ERISA. What they are saying is, if we let the patient protection bill pass, employers will be sued and they will drop health insurance for their employees because they do not want to be sued. Well, that is simply not true. Senior attorneys in the employee benefits department in the health law department at some of the major law firms, and I will cite a particular one here from Gardener, Carton and Douglas, which basically did a legal analysis of the Norwood- Dingell bill, claim that this is simply not correct. Section 302 of the Norwood-Dingell bill specifically precludes any cause of action against an employer or other plan sponsor unless the employer or plan sponsor exercises discretionary authority to make a decision on a claim for covered benefits that results in personal injury or wrongful death. So the other HMO myth is that an employer's decision to provide health insurance for employees would be considered an exercise of discretionary authority. Well, again, that is simply not true. The Norwood-Dingell bill explicitly excludes from being construed as the exercise of discretionary authority decisions to, one, include or exclude from the health plan any specific benefit; two, any decision to provide extra-contractual benefits; and, three, any decision not to consider the provisions of a benefit while internal or external review is being conducted. What this means is that we precluded all these employer suits. The employer basically cannot be sued under the Norwood-Dingell bill. And I would defy anyone to say that that is the case, that an employer can be sued effectively. I wanted to mention one last thing about the poison pills, and then I would like to yield to the gentlewoman from Texas, because she is representing the State of Texas. And she knows firsthand how this law has worked so effectively in her home State of Texas, and this is a law I use over and over again as an example of why we need the Federal laws. So I would like to hear her speak on the subject. Let me just say, though, that the other thing that we are going to see over the next few days here in the House is an effort by the Republican leadership to load down the Patients' Bill of Rights, the Norwood-Dingell bill, with what I call poison pills. I say they are poison because they do not really believe that these are good things. But they think if they pass them and add them to the Patients' Bill of Rights that, ultimately, that will defeat the bill. They cannot defeat the bill on its merits because they know that that will not work, so they try to add some poison pills. Basically, what they are trying to do, and this is the same stuff we have had in previous years, a few days ago the GOP leadership announced its intention to consider a number of provisions it claims will expand access to health insurance along with managed care. Again, this is a ruse. There is no effort here to really expand access for the uninsured. It is just that they have no other way to counter the growing momentum behind the Norwood-Dingell bill. But based on the statement released by the gentleman from Illinois (Mr. Hastert), the Speaker of the House, we can expect to see the following poison pills: The worst of them are: Medical Savings Accounts, Associated Health Plans, or MEWAs, and Health Marts. All three of these measures would fragment the health care market by dividing the healthy from the sick. This fragmentation will drive up costs in the traditional market, making it more difficult for those most in need of health insurance to get it. As a result, these measures would exacerbate the problem of making insurance accessible to more people. And that is not all they do. MSAs take money out of the treasury that could be used more effectively to increase access to health insurance through tax benefits. The Health Marts and the MEWAs would weaken patient protections by exempting even more people from State consumer protection and benefit laws. There is no doubt about what is going on here with the Republican leadership. The opponents of the Norwood-Dingell bill are cloaking their fear of the bill's strength in a transparent costume. They are trying to add these poison pills to kill the bill. We should not allow it, and I do not think my colleagues will. Mr. Speaker, I yield to the gentlewoman from Texas (Ms. Jackson-Lee).

Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. Christensen). The HIV-AIDS Crisis in the African-American Community

Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman. I wanted to say one more thing, because I know we are out of time. Even though Texas and my home State of New Jersey, and now we read California, have all passed good patient protection laws, I do not want any of our colleagues to think that we do not need the Federal law. These State laws still do not apply to 50 percent of the people that are under ERISA where the corporation, their employer, is self-insured. If we do not pass a Federal law, all of the things that Texas, California, and New Jersey and other States will do are still only going to apply to a minority of the people that have health insurance. So it is crucial, even though we know that States are making progress, and even though we have seen some of the courts now intervene, Illinois last week intervened and is allowing people to sue the HMO under certain circumstances, and the Supreme Court of the United States is taking up a case, even with all that, the bottom line is that most people still do not have sufficient patient protections because of that ERISA Federal preemption. It is important to pass Federal legislation. And we are going to be watching the Republican leadership to make sure when the rule comes out tomorrow or the next day, that they do not screw this up so that we cannot pass a clean Patients' Bill of Rights. I want to thank the gentlewoman again for so many times when she has been down on the floor with me and others in our health care task force making the case for the Patients' Bill of Rights. It is coming up, but we are going to have to keep out a watchful eye.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I just wanted to mention if I could, before I move to the gentlewoman from Connecticut (Ms. DeLauro), that what we are getting from the insurance companies, from the HMOs, and the gentleman from Texas (Mr. Green) effectively refuted each of the three arguments, one, they are saying that the patient protections are going to cost too much. Clearly, the Texas experience shows that that is not true. Secondly, they are saying that there are going to be too many lawsuits, which, again, the Texas experience shows dramatically that that is not true. Four or five lawsuits in 2 years, that is incredible. The third thing I just wanted to elaborate on a little bit, and that is this latest notion, which we have been getting really in the last few weeks or last few months, this idea that the employers are going to be sued, and, therefore, they are going to drop coverage. Nothing can be further from the truth. There is specific language had the bipartisan Patients' Bill of Rights, which is the Norwood-Dingell bill, that would specifically say that employers cannot be sued. If I could just very briefly say that, the provision that is in the bipartisan bill protects employers from liability when they were not involved in the treatment decision. It goes beyond to even define that more explicitly by saying, explicitly, that discretionary authority, in other words, the situation where the employer would be somehow implicated and involved, if you will, in the decision, that discretionary authority does not include a decision about what benefits to include in the plan, a decision not to address a case while an external appeal is pending, or a decision to provide an extra contractual benefit. Now, that sounds a little like a lot of legal jargon, but the bottom line is what they are saying here is that the employer cannot be involved because they are not involved in the treatment decision, and they are not even involved in a decision about what kind of benefits to include, whether or not to avoid an external appeal, whether to provide some kind of extra contractual benefit. So I really cannot imagine any situation where an employer is liable under this provision. It has been put in there specifically to address that concern.

Mr. PALLONE. I think we have figures that say the cost over the last 2 years since this was in place in Texas was about 30 cents more per month, which a lot of states have more than that. That is one of the lowest cost increases of any state. So I want to thank you again. I yield to the gentleman from Texas (Mr. Green).