Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, during rollcall vote No. 271 on the motion to recommit H.R. 4112, I was unavoidably detained. Had I been present, I would have voted ``yes.''

Mr. PALLONE

Mr. PALLONE. Madam Speaker, yesterday the Republican Health Task Force unveiled a set of principles that fall far short of real patient protections for Americans in HMOs. More sinister was the Republicans' stated intention to combine changes in managed care with limits on medical malpractice liability and other highly controversial add-ons which will immediately kill any possibility for even limited patient protections to pass Congress this year. Earlier this week, the gentleman from Iowa (Mr. Ganske) and the gentleman from Michigan (Mr. Dingell) introduced a discharge petition to bypass the Republican leadership's opposition to real managed care reform and bring the Patients' Bill of Rights to the floor for a vote. The Patients' Bill of Rights would put control of medical decisions back where they belong, in the hands of doctors and their patients, not with the insurance industry bureaucrats. Madam Speaker, I urge all of my colleagues to sign the Ganske-Dingell discharge petition so we can have a vote on real managed care reform this year.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, the House of Representatives will soon be addressing the foreign operations appropriations bill for fiscal year 1999. Shortly after the July 4 recess members of the Subcommittee on Foreign Operations, Export Financing, and Related Programs will begin marking up this legislation, which determines to a major degree American engagement in a changing world. I would like to take this opportunity to address an area where I believe American policies, assistance, and investment can make a critical difference in promoting our values of democracy, human rights, and free markets. That is, support for the Republics of Armenia and Nagorno Karabagh. Mr. Speaker, I served as co-chairman with the gentleman from Illinois (Mr. Porter) of the Congressional Caucus on Armenian Issues. Our Caucus has 64 members from both sides of the aisle, and I visited Armenia and Nagorno Karabagh, and can tell Members that the need for help is still great, and the potential of Armenia to be a long-term friend and partner of the United States is also great. The Subcommittee on Foreign Operations, Export Financing, and Related deserves praise for many important provisions in the fiscal year 1998 foreign ops bill. That legislation provided for the first time direct U.S. humanitarian assistance to the people of Nagorno Karabagh. It also established a discretionary spending fund to restore infrastructure and promote regional integration in the Caucasus. As in previous years, the legislation also earmarked direct aid to the Republic of Armenia. It maintained the section 907 ban on direct aid to Azerbaijan, albeit with some very big exemptions, until that country lifts its blockade of Armenia and Nagorno Karabagh. In order to build on the progress made last year, I hope my colleagues who serve on the Subcommittee on Foreign Operations, Export Financing, and Related Programs will consider the following proposals. First, I urge an earmark of not less than $100 million to Armenia to promote economic development, trade, and increase U.S. investment. Because Armenia is largely cut off from the west due to the Turkish and Azerbaijani blockades, U.S. assistance has played a vital role in helping this small landlocked Nation to survive. Despite the hardships caused by the blockades, Armenia has registered strong economic growth, with the private sector accounting for a large and growing share of GDP. Furthermore, aid to Armenia is strictly monitored and effectively implemented. Earlier this year Armenia's voters had successful presidential elections, further proof of the impressive development of a multi-party democracy. I also urge the subcommittee to build upon its historic achievement in the fiscal year 1998 bill to earmark assistance to Nagorno Karabagh at $20 million. This mountainous Republic is indeed a functioning society, a fact attested to by members of the USAID team that visited Karabagh to conduct a needs assessment pursuant to the fiscal year 1998 bill. Unfortunately, our State Department has apparently interpreted the provision of aid to the victims of the Karabagh conflict, contrary to the intent of the subcommittee, as referring also to expanding existing funds for Azerbaijan's needs. I would urge the subcommittee to build on the fine precedent it established last year by increasing the earmark for Nagorno Karabagh, specifying that the funds are targeted for use within Nagorno Karabagh and further broadening the scope of assistance to Karabagh to include the reconstruction of infrastructure damaged during the war. I also believe we must maintain, without any exemptions, Section 907 of the Freedom Support Act, which became law in 1992. We must not allow any weakening or other ways of getting around the requirements of Section 907. In addition, I believe we should require the administration to report to Congress on what steps it is taking to ensure Azerbaijan's compliance with the conditions of Section 907. Finally, Mr. Speaker, in keeping with this goal of attaching tough but fair conditions to the provision of U.S. aid, we should retain the Humanitarian Aid Corridor Act. This act became law in 1996, and I believe, as most Americans, that countries that block the delivery of U.S. humanitarian assistance to other countries should not themselves receive assistance from the United States. While the Corridor Act provision does not single out any countries, it would clearly affect the Republic of Turkey, which has imposed a blockade on Armenia since April of 1993. Given Turkey's failure to abide by the requirements of the Corridor Act, I urge the subcommittee consider tightening the provisions by removing or at least strictly limiting the current broad discretion of the Presidential waiver.

Mr. PALLONE

Mr. PALLONE. Absolutely not.

Mr. PALLONE. Can I just ask you one more thing about the health marts, because I was not sure I understood. You said that your concern is that ERISA exemptions would be expanded beyond what they already are now to cover health marts? In other words, we would actually have to deal with this exemption from liability in an even broader fashion?

Mr. PALLONE. Mr. Speaker, tonight I would like to talk again about the issue of managed care reform, and I have said before on the floor that this issue, without question, has become one of the most important on the minds of Americans, not only in my district but I think throughout the country. The reason that it has become so important is because patients are being abused within managed care organizations. Patients often lack basic elementary protections from abuse, and these abuses are occurring because insurance companies and not doctors are dictating which patients can get what services under what circumstances. Within managed care organizations or HMOs, the judgment of doctors is increasingly taking a back seat to the judgment of insurance companies. Medical necessity is being shunted aside by the desire of bureaucrats to make an extra buck, and people are literally dying because they are not getting the medical attention they need and, ironically enough, are in theory paying for through their premiums. This is not an exaggeration. Myself and the gentleman from Iowa (Dr. Ganske), who will be joining me tonight, and other colleagues on both sides of the aisle have told numerous stories about people throughout the country who have been negatively impacted by managed care. As I mentioned before, because of the importance of this issue, there are a number of legislative proposals that have been introduced to give patients the protections they deserve from managed care organizations. And working with the Democratic Caucus' Health Care Task Force, which I co-chair, the gentleman from Michigan (Mr. Dingell) introduced legislation which would provide patients with a comprehensive set of protections from managed care abuses. His bill, the Patients Bill of Rights, is not an attempt to destroy managed care. It is an attempt to make it better. To emphasize that point, supporters of managed care reform want just that, reform, not a dismantling of managed care. The Patients Bill of Rights would help bring about that reform by putting medical decisions back where they belong, with doctors and their patients. I have to mention that this is also a bipartisan bill, with 7 Republican cosponsors, including my colleague the gentleman from Iowa (Dr. Ganske). Unfortunately, though, the Patients Bill of Rights does not enjoy the support of the Republican leadership. It is not clear exactly where they stand on the issue of managed care reform. There is still a task force that the Republicans have put together and has been meeting, but so far the Republican leadership has not allowed any managed care reform bill to be heard in committee or to be marked up in committee or to come to the floor, and I believe that that is because of the power of the insurance industry that that has not happened so far. Mr. Speaker, tonight I just wanted to say that there have been some recent important developments on this issue. I am going to let my colleague, the gentleman from Iowa (Dr. Ganske) go into some of this, but I just wanted to say that legislation was introduced today by the gentleman from Iowa (Dr. Ganske) and the gentleman from Michigan (Mr. Dingell), again on a bipartisan basis, to try to bring the Patients Bill of Rights and possibly other managed care reform to the floor through what we call a discharge petition. Basically a discharge petition is necessary when the House leadership will not allow a bill to come to the floor through the normal committee process. I just wanted to say how much I appreciate the efforts of my colleague from Iowa, not only in introducing this discharge petition today with the gentleman from Michigan (Mr. Dingell) but also because the gentleman from Iowa (Dr. Ganske) has been an outspoken champion and leader of the movement here in the House to bring the Patients Bill of Rights to the floor, and I think he deserves a tremendous amount of credit for that reason. The only thing I also wanted to mention today about this discharge petition is that I believe that there is a tremendous amount of support for this. As my colleague knows well, we have been working closely with over 150 groups that support the Patients Bill of Rights. I think the Patients Bill of Rights now has 192 cosponsors. Another bill on managed care reform which the gentleman from Iowa (Dr. Ganske) has supported, the PARCA bill, has even more cosponsors, from what I understand, so I do not think it is going to be difficult to get support for this discharge petition. The last thing that I did want to mention though, before yielding to the gentleman, is that we are going to push for this discharge petition over this week and during the congressional recess so that when we come back, we hopefully will get enough signatures so that we can bring the Patients Bill of Rights to the floor. I am still very concerned that the Republican leadership is going to try to produce a watered-down managed care reform bill. As we know, the Speaker has already rejected one proposal by the GOP task force because it had too many patient protections in it. There are reports now that some patient protections have crept back into the GOP plan and that the task force will come forward with a bill this week or sometime in the future. But I think we need to watch out that it is not legislation that is substantially weaker than the Patients Bill of Rights or the PARCA bill or some of the other strong legislation that we have been pushing. Obviously, we are going to keep a careful eye on that as we proceed over the next few weeks. With that. Mr. Speaker, I yield to the gentleman from Iowa (Dr. Ganske).

Mr. PALLONE. Mr. Speaker, I agree with the gentleman and thank him again.

Mr. PALLONE. And following up on your comments, and I guess I will close with this: We know that during this 2-week recess that many Members, including myself, will be having town meetings and forums at which time there will be opportunities for groups or individuals to go to those town meetings and express to their Member of Congress their support and ask them to support the Patient Bill of Rights, or actually ask them to support the discharge petition that you and the gentleman from Michigan (Mr. Dingell) have now introduced. We need to get as many Members as possible on this discharge petition because, if we can get a majority on the discharge petition by the time we come back or soon after that in the weeks that follow, we can finally bring the Patient Bill of Rights or the PARCA bill, these types of managed care reforms, to the floor. And again I just want to commend you for your effort in moving in that direction because this is the time. If we are not going to pass this now when there is so much support for it, we are never going to pass it, and we have got to try and get more and more of our colleagues on board.

Mr. PALLONE. I think there is no question that, you know, what we are really talking about here are just basic protections, common sense protections, and as the gentleman has pointed out, the not-for-profit HMOs actually from the very beginning of this year when the President first came out with his patient bill of rights in, I guess it was in his State of the Union address, and there were I think 18 points at that stage or 18 types of protections that were being discussed by the White House, and actually we had many of the not-for-profit HMOs supporting those principles because they are really a floor. They are just a floor of basic protections. And what happens is, and again I think you mentioned this at some point in the past, is that if the not-for-profit or the good HMOs, whatever their characterizations would be, adhere to these patient protections and then the other ones that are for-profit or for whatever reason do not, it basically creates a noncompetitive situation, becomes cheaper, if you will, for the ones that are not providing the protections to operate.

Mr. PALLONE. Again, if I could ask you to elaborate a little more on this, one of the concerns that I expressed earlier this evening is that the Republican Task Force would come out with patient protections that are less than what is in the Patient Bill of Rights or the PARCA bill, and that is still a concern. But I think what you are voicing now is an additional problem which is not only the possibility of not including some of these patient protections that we would like to see, but also the possibility of adding other things unrelated to patient protections that would sort of muddy the water, if you will, and maybe confuse what goes on here and take away from this issue of patient protection which we are trying to bring forward. And I know that one of the things I believe you mentioned was the medical malpractice cap, I guess, that we have discussed in the past, and that is something that would.

Mr. PALLONE. If I could recapture my time, this was done, as the gentleman pointed out, years ago when HMOs and managed care organizations were not the vehicle for most Americans to get their health insurance. Now this loophole which was there has grown into a tremendous loophole that exists actually for most Americans. I do not know what was being thought of at the time when this was voted on, but the bottom line is the circumstances have changed now, because so many more Americans are impacted by this loophole. I just wanted to say briefly, if I could, I am not sure that everyone understands when we talk about this inability to sue or this exemption, if you will, from liability, exactly what we mean. The problem is that you can only sue to recover the costs of whatever procedure was needed but denied. You cannot sue for damages. In other words, I will use an example. If you lose, say, an arm or a leg or an eye and you end up victimized for the rest of your life because your HMO denied you the care that could have saved the limb or the eye, you cannot sue for anything other than the cost of what the medical procedure to save the limb or the eye would have been. You cannot sue for losing the body part or for the deterioration of your health condition. So basically you are able to recover a very, very limited amount that does not help you to deal with the problem and the damages that you have suffered. That is really what we are talking about.

Mr. PALLONE. Again, I may be being cynical, but I think the reality is that when we put most of those patient protections in the Medicare legislation, in our own Committee on Commerce which both the gentleman and I are a Member of, the bottom line is that when those came to the floor, because of the widespread clamor, if you will, by senior citizen organizations and groups that these protections should be part of the Medicare program, and rightly so, I think the leadership, the House Republican leadership and most of the Members were unwilling to not support that because they were concerned about the power, if you will, and the clout of the senior vote, that they did not want to be denying senior citizens, who vote often and regularly, those kinds of patient protections. A thank-you is due to the seniors and the power of the senior vote and the senior organizations to make sure that that happened, but at the same time it is not fair to deny those protections to everyone else who is under 65 or who happens to not have the benefit of a Medicare program. That is really what we are about here. We are saying that those kinds of patient protections should be available to anyone who has health insurance, who is in a managed care organization or an HMO. I am glad that you brought this out. It again points out that these are not really anything radical, these are not anything unusual, we have already adopted them for the largest Federal health insurance program, Medicare. I just wanted to go back, if I can, because I know that the gentleman from Iowa has put a lot of emphasis on the ability to sue and recover costs that is denied now under ERISA, and I talked a little bit about the patient protection with regard to specialty care. I know that, at least from the reports that I have been reading in the various publications that we get on Capitol Hill that those are two areas that the House leadership seems to be reluctant to deal with. It may not actually be part of anything that the Republican leadership ultimately puts together.

Mr. PALLONE. Did not the AMA, which has been the biggest supporter of this medical malpractice reform, even say at one point that they did not want to deal with it this year in the context of the patient protections for the exact reason that you just cited, which is very amazing to me because this was always their biggest, one of their biggest, concerns.

Mr. PALLONE. I am not pronouncing it, but I thank the gentleman for the help. This is an autoimmune disease in which the body's immune system becomes overactive and attacks the protein which adheres to the top layer of skin to the body. Her parents had to battle with their HMO to insist upon appropriate diagnosis and medical care. According to Donald Tenconi, Francesca's father, her medical insurance ordeal began in December 1995 when, at the age of 11, she developed what was diagnosed as a skin rash. By March, the condition had spread and become worse. By late April, the condition was so bad she could not attend school. During this period, several requests were made for referrals to specialists outside the HMO, and these were all denied. Finally, on May 8, 1996, almost 6 months after the first appearance of symptoms, the HMO sent biopsies to out-of-network doctors and finally obtained an accurate diagnosis. The diagnosis was the disease that I mentioned and that the gentleman from Iowa (Mr. Ganske) translated for me. Even after receiving the diagnosis, the Tenconis' HMO still insisted on treating the disease primarily with its own doctors, in-network doctors. It was not until February of 1997, over 1 year after the symptoms first appeared, that the HMO finally agreed to allow Francesca to receive care at Stanford Medical Center, which possessed the doctors capable of providing the best care available in the San Francisco Bay area. Explaining the prolonged and unnecessary pain of lying down without skin on your back for over 1 year, Donald said, this is her father again, ``If you feel this pain, you will shed tears of pain, the same pain that Francesca shed night after night, week after week for many months.'' Again, I mention it because I think that it is necessary to have the patient protection that provides access to specialty care outside the network when the in-network doctors do not have the ability to take care of the individual. Under the Patients' Bill of Rights, not only is that the case that they have to allow you to go outside of the network if there is not someone inside who has that specialty ability, but also patients with serious ongoing medical conditions are able to choose a specialist to coordinate their primary and specialty care. So if you have a chronic illness that requires this kind of specialty care over a long period of time, essentially your specialist becomes something like your primary care provider so you do not have to constantly go back and get these referrals. The other example I wanted to mention, again one of the other major protections that we talk about is that decisions about provision of medical care should be based on what is medically appropriate for the patient. They should not be based on the cost considerations of an accountant or bureaucrat. The Patients' Bill of Rights prohibits health plans from arbitrarily overriding medical decisions by your physicians when these decisions are made according to generally accepted principles of medical practice. Again that refers to length of stay in the hospital, equipment, a particular type of surgery that may be required, that this is supposed to be done based on what is medically appropriate based on the decision of your doctor rather than the bureaucrats. Again, I think the gentleman from Iowa mentioned the other day an example of somebody who needed a liver transplant. I do not know if this is exactly the same example, but I would just like to mention it again if I could. This is the case I mentioned before, Judith Packevicz from Saratoga Springs, who suffered from a rare form of cancer of the liver. The HMO refused to pay for a liver transplant which was recommended by her oncologist with the support of all her treating physicians. Again, a decision that was made based on what the doctors felt was appropriate under the circumstances to have this liver transplant, but because it cost an estimated $345,000, the HMO, of course, refused to have it done and did not really give an explanation about why. I will say here it was undoubtedly the cost of it. Again they made a decision to deny her this liver transplant even though her son, Thomas Dwyer, was a willing and able donor. There were 13 other friends of Judith who volunteered to donate a part of their liver. So she had somebody willing, able, would not do it because of the cost undoubtedly, and she actually had to bring suit, again under ERISA. She cannot recover damages, only the cost of the procedure that was denied in the first place, and although it is possible that she ultimately would get the liver transplant, there was no way for her really to sue for any damages that would result because of the issue that you brought again which is that the HMO basically cannot be sued for damages.

Mr. PALLONE. I yield to the gentleman from Iowa.

Mr. PALLONE. Mr. Speaker, I appreciate the gentleman's remarks, and I think that there is no question that these patient protections are needed. We will get into more of them. Mr. Speaker, I would just like to continue along the line of what the gentleman from Iowa (Mr. Ganske) mentioned. We said over and over again the type of patient protections that we are seeking either with the patient's bill of rights legislation or the PARCA bill is really nothing more than a commonsense approach, the type of protections that I think most Americans would think that they already have with their health plan or with their health insurance but, unfortunately, they do not. I just wanted to get into two provisions of the patient's bill of rights and give two examples again similar to what the gentleman from Iowa (Mr. Ganske) did. One is the important access, if you will, to specialty care. The bill, the patient's bill of rights, establishes certain standards to ensure hassle-free access to appropriate specialty care. What it says basically is that plans must have a process for individuals to access specialty care if they need it. If the plan does not have an appropriate specialist in the network, it must provide an outside referral to such a specialist, at no additional cost to the patient. I had an example. There is a group called Consumers for Quality Care that actually put out what they call ``Casualty of the Day.'' Every week, they put out some examples of patients who suffered casualties from abuse by HMOs. This one I think applies very well to this issue of specialty care or lack of access provided by the HMO or the managed care organization to specialty care. If I could just use it as an example. This is Judith Packevicz from Saratoga Springs, New York. Actually, that is a different example I want to give for another one. I apologize. The example I want to give with regard to the specialty care is Francesca Tenconi, who is an 11-year-old girl from Oakland, California. Again, this is from Consumers for Quality Care. She suffers from, and the gentleman from Iowa (Mr. Ganske) probably will be able to help me with this better, pemphigus foliaceous.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, working families in America have been told that soon the Republican leadership of the House will unveil proposals to address the crises of teen smoking and managed care. I do not know why America and the press have to wait for some grand unveiling. If my colleagues want to know what the Republican leadership's position is on tobacco and managed care, just read the position papers of the tobacco companies and the insurance industry. If my colleagues want to see the tobacco policies of Newt Gingrich, just turn on TV and they will see $50 million worth of tobacco ads which the Speaker fully endorses. Any new legislation Republicans will lamely attempt to pass off as responsible domestic policy has the stamp of approval of big tobacco and the wealthy insurance industry, which means that it will do nothing. The gentleman from Georgia (Speaker Gingrich) and the Republican leadership are so dependent upon special-interest money, all they manage to do is ratify the status quo. Tobacco companies will still be allowed to peddle their poison to our kids, and American working families will still be trapped in inadequate health care plans.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, on June 18th, the Turkish Government sent six F-16s to Northern Cyprus and issued a warning to Greece about its military activity on Cyprus. The movement by Turkey of F-16s is cause for alarm, because in recent months Ankara has stepped up its belligerent rhetoric over the Cyprus problem. Last month, Turkey abruptly changed its position in the Cyprus peace negotiations and began insisting that three new preconditions be met before meaningful negotiations could take place. This unreasonable turnabout prompted a public rebuke of the Turks from Ambassador Richard Holbrooke, the President's Special Emissary for Cyprus. With the recent deployment of F-16s to Northern Cyprus, Ankara has edged an already volatile situation that much closer to military confrontation. What I find to be particularly abhorrent is that the Turks are using American weaponry to destabilize this region. I and many of my colleagues here in the House have pointed out time and again on the House floor, in committee proceedings, and with legislation that the Turkish presence on the island of Cyprus with 35,000 troops is illegal. Turkey is the only country in the world that has recognized northern Cyprus as an independent country. Ankara's presence in northern Cyprus, incidentally, is being bolstered by far more than American F-16s. Turkish forces are well- equipped with a laundry list of sophisticated American weaponry. The United States should not allow Ankara to use American-made weapons to enforce the illegal occupation of Cyprus. Using American weapons in this fashion may well be a violation of the Arms Export Control Act. Turkish arms transfers are not specific to Cyprus, I should point out, Mr. Speaker. There are also illegal transfers of U.S. or NATO standard weapons and other military supplies being sent to Azerbaijan by Turkey. Turkey has long sided with Azerbaijan. One of the major complications of the Nagorno-Karabagh conflict is the blockade of Armenia and Karabagh by Azerbaijan, and the Turkish blockade of Armenia in support of Azerbaijan. These blockades have made life hard for the Armenian people, stopping vitally needed relief supplies from the U.S. and other countries. Now Turkey is funneling military equipment to Azerbaijan, equipment I have seen myself in a previous visit to the front lines in Nagorno-Karabagh. Just a few weeks ago I opposed the suggestion that appeared in the media that Turkey may want to transfer American F-16 fighter planes to Azerbaijan. That country already has air superiority because it inherited a lot more airplanes from the Soviet Union than did Armenia. F-16s would give Azerbaijan overwhelming air superiority. There are now suggestions that Turkey may transfer advanced NATO howitzer or cannon artillery to Azerbaijan. Mr. Speaker, I will be asking my colleagues to join me in sending a letter to the chairman of the Committee on International Relations asking that he hold hearings on the use of American weapons by Turkey in northern Cyprus and Azerbaijan. Any use of American weaponry by Turkey that violates U.S. foreign policy and national security interests must be met with a swift and vigorous change in U.S. policy. I would also encourage all of my colleagues to join me in pressuring Turkey to be a partner in the search for a lasting peace in the region, and not a contributor to a continuing cycle of violence and tensions.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I rise today in support of H.R. 4060, which provides invaluable Federal assistance for flood control shore protection and navigation projects in my home State of New Jersey. I want to thank the gentleman from Pennsylvania (Mr. McDade), the gentleman from California (Mr. Fazio) and all the members of the Subcommittee on Energy and Water Development for their leadership in preparing this bill, including my colleague, the gentleman from New Jersey (Mr. Frelinghuysen), who has worked so hard on these projects. I wanted to say one thing: I greatly appreciate the committee's continued commitment to water infrastructure projects, and in particular the committee's continued rejection of efforts on behalf of the administration to eliminate the traditional role of the Army Corps of Engineers in shore protection projects in particular. Let me just say two things to my retiring colleagues here. For the gentleman from Pennsylvania (Mr. McDade), he has always been a person that I could go to on a bipartisan basis and ask for help. I will definitely remember that for a long time. With regard to the gentleman from California (Mr. Fazio), he is someone that I have asked for advice on a number of occasions for a number of things, and in many ways I really model myself after him in terms of my congressional career. We will have other opportunities to thank these individuals over the course of the year, but I do want to thank them today.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, let me just say about the gentleman from North Carolina (Mr. Hefner), I know a lot has been mentioned about his years of service and his sense of humor and his musical abilities, and all those are certainly true, but I just want to say, I have only been here 10 years, but I have noticed on many occasions both within our Democratic Caucus as well as on this House floor where his statements have been crucial in swaying the Members of this body to vote a certain way or to support certain legislation. In many ways he has been one of those people that is sort of the conscience of this body and particularly of our Democratic Caucus. I know that has been recognized, but I do not know if it was mentioned today. We will sorely miss him because of what he contributes to this body and to our Democratic Caucus. Mr. Chairman, I just want to thank the gentleman from North Carolina (Mr. Hefner) again and also the gentleman from California (Mr. Packard) for this legislation. I also want to thank the gentleman from New Jersey (Mr. Pappas) who cochairs our Save our Fort Committee, which is a bipartisan committee that deals with two military bases in our two districts, Fort Monmouth and Earle Naval Weapons Depot. Two projects for which funding was included in this bill are of importance to us. One is the addition to the Communication and Electronics Command Software Engineering Center at Fort Monmouth and the second is the design study for berthing pier replacements at Naval Weapons Station Earle. Expansion of Seacom's Software Engineering Center will allow Fort Monmouth to intensify its efforts to ensure American soldiers have the types of technological advantages that are the hallmark of U.S. military forces around the world. With respect to Earle, Piers 2 and 3 were constructed in 1944, and after over 40 years the time has come to replace them. Because the pier complex at Earle is one of the Navy's most important facilities on the eastern seaboard, it is extremely important that resources be provided for their upkeep. I am very pleased the committee has recognized the importance of Earle's mission and thank my colleagues for approving the first step of the DOD's long-term plan to modernize Piers 2 and 3 at Earle. I just want to thank again my colleagues on the committee, and particularly the chairman and retiring member the gentleman from North Carolina.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, Republicans continue to do everything they can to block the teen smoking and the campaign finance legislation. They want to preserve soft money and keep the obscenely large contributions from big tobacco and other special interests rolling in to fill their campaign coffers. We know on Wednesday Senate Republicans killed the comprehensive bill to help stop teen smoking, and the GOP's efforts showed where the Republicans stand: in the pocket of the big tobacco companies who want to snuff out any real efforts to prevent kids from smoking. And now we see the same thing happening with regard to managed care reform, patient protections. We have not been able to get a hearing on patient protections; we have not had any effort really to try to bring a bill to the floor that would reform managed care in the way that most Americans want to see something happen this year in Congress, to make it possible for us to have quality health care in this country. What we are seeing here on a regular basis is Republican efforts to kill every major piece of progressive legislation, whether it is the tobacco settlement, it is campaign finance reform, or it is managed care reform.

Mr. PALLONE

Mr. PALLONE. Absolutely.

Mr. PALLONE. Mr. Speaker, first of all, let me say that I am very pleased to see the gentleman here again tonight talking about the need for managed care reform or patient protections, because I believe, as I have said before, that this is the number one issue facing this Congress. It is the issue that I hear most often when I talk to my constituents and our constituents throughout this country, be they Democrat, Republican, Independent; regardless of party affiliation, regardless of State, are demanding action on these patient protections. I just wanted to make a brief comment which is that the gentleman really points out how this is nothing more than a very common sense approach to quality health care. The gentleman mentioned anecdotes, and of course they are not, they are real people and we know that they are real people, but beyond that is the notion that, and I have said this before, in my constituents' minds and I think most Americans' minds, when they hear the types of things that the gentleman is relating, they cannot believe it because they assume that their insurance company, whether it is an HMO or whatever kind of managed organization, would follow common sense precepts. In other words, they would not assume that because one is in Hawaii that one has to take a plane contrary to one's health and come back to Chicago. They would not assume, for example, that if one needs to go to an emergency room, that one would have to go to one 40 miles away rather than the one that is around the corner, because that particular hospital is not part of the network. They assume that if someone has to have access to a particular type of care, specialty care, for example, that the specialist is going to be available and that the HMO will not deny them. I think even more so, as the gentleman pointed out, is that when I talk to some of my constituents that have had problems with HMOs, they talk about the lack of an appeals process that they can really utilize, because again, if a mother has to take care of a sick child or a father has to take care of a sick child and they are working, they do not have the time to spend 9 hours a day going through some obscure way of appealing a decision. They have to have a very easy way to take an appeal to someone who is actually going to hear it in an expedited way. I have found, as the gentleman said, that a lot of these problems with HMOs, essentially what happens is that if someone does not want to accept a decision that has been made with regard to a particular type of care or access to a specialist or use of particular equipment, that people essentially give up because they do not have the time or the wherewithal to go through the appeals process, and that should not be. That is what is so egregious I think about the system that is set up. Of course, the other aspect that the gentleman points out is the inability to sue the HMO when they make a mistake or they make a decision that actually damages someone or kills someone. Again, I do not think most people would think that they have lost the right to sue because of the Federal law that is out there. So all we are really saying, all the gentleman is really saying is that we need some common sense patient protections that apply to all HMOs, to all managed care organizations, to all insurance companies, and that those basic patient protections, that ``floor,'' if you will, needs to be put in place. Otherwise, we have people dying and people getting seriously ill, and the long-term consequences of that not only are bad for the individuals, but in many cases cost the taxpayers even more money because they end up footing the bill. So I just want to thank the gentleman again for these examples, because I think that when we use examples, that is the way people will understand it. But unfortunately, we are going to have to somehow get this into the heads of some of our colleagues, because although there are a lot of people that support this, there are a lot unfortunately that make it difficult to bring up the legislation.

Mr. PALLONE. Before my colleague finishes, though, again, I assume that the cost of this care that she received was very expensive and that is another reason why they are denying it.

Mr. PALLONE. There is no question that this is nothing more than common sense. We have said it over and over again and we are simply asking for a floor for patient protections. I think, as the gentleman has well pointed out this evening, that basically it just brings the standards, if you will, of some of the worse for-profit HMOs up to the level of some of the better not-for- profit HMOs. I just want to say once again that, really, the key here is not to persuade I think the average congressman or congresswoman. Because, as my colleague has said, we have a majority of the Members of this House on one or both of these bills. What we have to do is persuade the leadership that this is something that needs to be brought up. I think tonight, with the polling that you brought out, makes a very convincing case and, hopefully, will also convince the leadership that from a political point of view this makes sense. Because the gentleman has very specifically pointed out how this is something that the public is going to be watching in terms of how they vote in November. So, hopefully, we are lighting up a fire here tonight when we continue to bring up this issue. And although there are not a lot of days left in this session, there is certainly enough to get this passed. I want to commend the gentleman again for being outspoken on this issue. Of course, as a physician, he is in the best position really to talk about these cases and analyze some of them. And I commend him, as a physician and as a Member of this body, for speaking out even though it is often at odds with his own leadership. Again, I do not want to make this a partisan issue because I believe that most Members of this body, whether Republican or Democrat, support this legislation. So I think we just have to keep at it and keep telling these stories and keep pointing out to our colleagues how important it is that this be brought of up before we end the session this fall.