Frank Pallone

Mr. PALLONE

Mr. PALLONE. It only makes sense.

Mr. PALLONE. The employers are usually covered by the same plan.

Mr. PALLONE. But, again, if the gentleman will yield, it makes sense that we get these kinds of responses because it is just common sense. Why would people think anything different? That is, I think, what we have been saying from the beginning, that these are just common-sense principles, and people are going to overwhelmingly support them. But I just wanted to mention two other things that the gentleman brought up, and I would like to stress again; and those are, the reason why people are demanding these changes and want these bills to come to the floor is because the quality of health care is suffering. We have prided ourselves in this country for so many years on having the best quality health care in the world, and I would venture to say that we still do, but that will not be the case for very long unless we start to put these kinds of common-sense protections in place, because quality is really suffering, and people realize that more and more. I think that people are used to having quality health care in this country, and they are not going to be satisfied with something less than that. The other thing that the gentleman mentioned is that the opponents not only talk about cost, but suggest that because of the exorbitant costs that they bring up falsely, that the consequence of our legislation would be that fewer people would have health insurance. In fact, there is no truth to that whatsoever. In fact, the reality is that fewer and fewer Americans have health insurance every day even with the HMOs in place. The phenomenon of more and more Americans not having health insurance is not a consequence of HMOs or any particular type of health insurance. It has to do with the fact that more and more employers simply do not provide health insurance. That is the biggest factor. So, really that is a ruse, talking about the costs. Talking about the fact that fewer Americans have health care has nothing to do with this debate, nothing to do with it whatsoever.

Mr. PALLONE. I would wonder whether or not that is even constitutional if someone ever wanted to take it up to the Supreme Court. It seems to violate the First Amendment not to be able to speak out in your profession.

Mr. PALLONE. Mr. Chairman, I think the gentleman should elaborate on that a little bit more. Most people are shocked by this gag rule. Just explain that a little more. People are shocked when they hear what kinds of restrictions are in place.

Mr. PALLONE. Could I ask the gentleman this? The bottom line is that if we have this liability provision, and the HMOs know that they could be liable, I would think the consequence would be that they would be a lot more careful about what they deny and what they do. And so, therefore, the situations where they would be liable for malpractice or making the wrong decisions would decrease and their costs probably would not be that great. So a lot of this is just preventive. A lot of the things that we are suggesting here just make for a better system in general and create prevention on the part of the HMO. And so I think that that is the reason why ultimately the cost is not really going to go up.

Mr. PALLONE. Mr. Speaker, if the gentleman would again yield, just common sense. We are not really asking for anything more. And obviously it makes sense to not switch physicians in the middle of a pregnancy or in the middle of some kind of disorder. If I could just mention too, I think that many constituents that I talk to, not only in my district but in other parts of the country, really would like to see some kind of option where patients can go outside the network for a doctor or hospital or other provider, even if it means that the patient has to pay more. I know that the Patient Bill of Rights, which is one of the bills that the gentleman mentioned, specifically says that when consumers sign up for health insurance with the employer, that the employer has to offer the option of going outside the network for a doctor, even if it means that the patient has to pay a little more. Not everybody wants to do that, but for those people who are willing to pay a little more it certainly makes sense. I find that a lot of people do not realize when they sign up for a particular HMO that they are limited by the number of doctors, or realize what doctors are in the plan or not. That is why disclosure, which is another one of the issues that is addressed in these two bills, is so important. We need to have disclosed what the patient is getting into when they sign up. Too many people now just do not know what the HMO covers and what it does not, and what doctors are in it and what hospitals are in it and what not. That is another basic right and another basic protection that those bills address which I think needs to be addressed.

Mr. PALLONE. Which is a lot less.

Mr. PALLONE. But this is obviously the reason why they are excluding it, because they do not want to incur that cost. There is no question, I would say.

Mr. PALLONE. Mr. Speaker, that is horrible. Can I ask the gentleman if he knows, what would be the cost of a liver transplant, approximately? What is the cost? Do you have any idea?

Mr. PALLONE. Mr. Speaker, if the gentleman will yield, we had a report that the gentleman mentioned the other night on the floor about the CEOs of some of these for-profit HMOs or managed care organizations, their salaries are many millions of dollars per year with all kinds of stock options that add up to additional millions of dollars. I am glad the gentleman brought out the distinction between the different types of HMOs and managed care, because in fact many of the not-for-profit HMOs or managed care organizations in the beginning, when the President first proposed patient protections, were actually supportive of the patient protections, most of which are incorporated in the two bipartisan bills that the gentleman mentioned. It is true that there are good and bad insurance companies and generally the not-for-profit HMOs and managed care organizations have not really had a problem with the kind of patient protections that we are talking about.

Mr. PALLONE. Most of what I have seen are within $5 and $10. That is most of what I have seen.

Mr. PALLONE. Mr. Speaker, if the gentleman would yield, I think it is pretty obvious. And I do not think we need to do any more than ask the average American. I am sure they would articulate and be right in saying that it is the insurance industry, of course, that is continuing to lobby in Congress to prevent this legislation from coming forward. The fact of the matter is they spend a lot of money on advertisements and other ways of trying to influence what goes on here. So I have no doubt that the reason why the leadership has been unwilling to bring this to the floor is because of the opposition from the insurance industry. We have had this so often with health care reform in general. But this, of course, hits at the very heart of the HMO and the managed care industry, because they fear that somehow by us putting these patient protections in effect, that they are going to be told what to do or that somehow their costs may be impacted. I really do not see it as a cost issue. I do not think it is going to cost anything more, or certainly a very insignificant amount extra money if anything, to implement these basic patient protections and we have to keep making that point.

Mr. PALLONE. And we would be bringing the unethical ones up to the same standards as the ethical ones in the long run. That is what the effect would be.

Mr. PALLONE. Mr. Speaker, will the gentleman yield?

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, yesterday two of my colleagues, Mr. Kennedy of Massachusetts and Mr. Kennedy of Rhode Island and I met with Deputy Secretary of State Strobe Talbot and other top State Department officials to discuss the resolution of the conflict in Nagorno Karabagh, a state in the southern Caucasus region of the former Soviet Union. Our goal was to try to develop some new ideas on how we can work to promote greater cooperation and stability in this strategically- located region. Although the State Department clearly considers Nagorno Karabagh to be of the utmost importance, my colleagues and I are concerned the U.S. diplomatic efforts have either stalled or are going in the wrong direction. We are concerned that our diplomatic priorities are being eclipsed by commercial interests in the region and that the traditional American mission of promoting democracy is being diverted by the desire to develop oil resources. Secretary Talbot and his colleagues from the Department of State who met with us were most gracious, I should say, but there are differences between the State Department and those of us in this Congress who are staunch supporters of Armenia and Nagorno Karabagh. And, Mr. Speaker, as I have mentioned in this House on several occasions, the people of Nagorno Karabagh fought and won a war of independence from Azerbaijan. A tenuous ceasefire has been in place since 1994, but a more lasting settlement has been elusive. The United States has been involved in a major way in the negotiations intended to produce a just and lasting peace. Our country is a co-chair along with France and Russia of the international negotiating group commonly known as the Minsk group formed to seek a solution to the Nagorno Karaagh conflict. Pro Armenian Members of this House welcome the high profile U.S. role in this process. As I have indicated, we have some substantive differences. Unfortunately the State Department is most reluctant to drop its support for Azerbaijan's claim of so-called territorial integrity despite the fact that Nagorno Karabagh has been inhabited by Armenians for centuries. I would say, Mr. Speaker, it is time for the U.S. and our Minsk Group partners to forget about the idea of Azerbaijan's so-called ``territorial integrity'' as the foundation for peacefully resolving this conflict. In the first place, given Nagorno Karabagh's autonomous status in the old Soviet system, there is no reason why they must be considered part of Azerbaijan. But more importantly, Mr. Speaker, the people of Nagorno Karabagh do not consider themselves to be a part of Azerbaijani society. And, considering the horrible treatment visited upon the people of Karabagh and the Armenian community in Azerbaijan proper, it is apparent to me that Azerbaijan really has no use for the people of Karabagh. The State Department officials that we met with yesterday seemed to be open to new ideas coming from the parties to the conflict, and that created a certain amount of optimism. They stressed that if Armenia, Azerbaijan and Nagorno Karabagh all agreed on a status for Nagorno Karabagh that left it free of Azeri suzerainty, the United States would go along. There was a clear understanding on the part of the State Department that the earlier Minsk Group proposal that did not address the status issue was no longer acceptable to Armenia or Nagorno Karabagh. Mr. Chairman, as we stressed at yesterday's meeting, our top priority should be to push for direct negotiations, involving Nagorno Karabagh and Azerbaijan, without preconditions. And I should add that any proposal that starts with the premise that the map of Azerbaijan must include Nagorno Karabagh is a big precondition. As a first step, Mr. Speaker, I would stress the importance of strengthening the current, shaky cease-fire as a priority for the Minsk Group. Making a priority of securing the cease-fire would help end the violence, stop the continuing casualties, and help build confidence for further agreements between the parties. I believe we should also consider the idea of ``horizontal links,'' a federation between Azerbaijan and Nagorno Karabagh among equals. This model has been used in resolving the Bosnia war and in the current negotiations aimed at resolving the Cyprus conflict. Another key is the need for security guarantees for Karabaugh. As I mentioned, Karabagh won the war and holds the strategic advantage. But it is unrealistic and unfair to except Karabagh to give up its gains on the battlefield for vague promises at the negotiating table by the United States or the other Minsk Group cochairs. Finally, let me say, Mr. Speaker, that America's role should be that of a nonbiased mediator. It is a role that we have played honorably and with great success in conflicts raging from the Middle East to Bosnia and to Northern Ireland, and there should be no difference here in the case of Karabagh.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, let me just say, because I came in at the tail end of the comments by our Republican colleagues, and I am just frustrated, as I know the gentleman from Texas is, because the Republican leadership continues to stall on this issue of campaign finance reform. There is no doubt in my mind that the Democrats have been appealing to the Republican leadership for months now to simply allow an up-or- down vote on what we consider the most significant campaign finance reform that is likely to come up this session, and that is the Meehan- Shays bill. I believe very strongly that if the Republican leadership allowed us to bring the Meehan-Shays bill to the floor today or tomorrow, any day, it would overwhelmingly pass, and we would have some significant campaign finance reform. But as the gentleman knows and mentioned, they do not want to do that. They just want to keep bringing up amendments, making it impossible for us to get to the Meehan-Shays bill. My understanding is that today they were talking about a rule, which I guess ultimately they did not bring up, that would have allowed something like between 200 and 300 amendments, what we call nongermane amendments, to the campaign finance reform. Amendments that were not even relevant to the issue in an effort to try to stall a final vote on the Meehan-Shays bill. So we are getting from the other side this constant effort by the Republican leadership to stall and stall and bring up amendments, as the gentleman mentioned, ``death by amendment'' on this issue; and I think they are going to try to let the clock run so that we never get to the Meehan-Shays bill and have some real campaign finance reform. We will have to hope that is not the case and keep at it and make it clear that we want this bill to come forward. Mr. Speaker, the same is true for the issue that I would like to address now, and that is managed care reform. We know that this issue, without question, is one of the most important issues, I would say the most important issue, on the minds of Americans today. I keep saying that when I have a town meeting or a forum, or when I see my constituents on the street, the most common concern that they have is about the quality of care or the lack of proper care that they may have because they are in an HMO or some kind of managed care system that limits their ability to receive quality care. We, as Democrats, came up with a proposal, we have had it for some time now, called the Patients' Bill of Rights, H.R. 3605, which provides a number of patient protections to deal with the problem, some of the problems that managed care organizations have presented. The problem though is that the supporters of managed care reform and the Republican leadership and the insurance industry are basically on a collision course. The Republican leadership, along with the insurance industry, is fighting tooth and nail to undermine the various managed care reform proposals that have been introduced. They basically again are trying to run the clock out, because with so few legislative days left in this Congress, those who support patient protections believe it is increasingly important that everyone come together on a bipartisan basis and allow us, demand even, that the Republican leadership allow us to bring the Patients' Bill of Rights to the floor for a vote. Mr. Speaker, I would bet again, just like campaign finance reform legislation, that if the Republican leadership allowed this managed care reform or Patients' Bill of Rights to come to the floor, it would pass overwhelmingly. That is why they do not want to let it come to the floor. There is widespread agreement in Congress for ensuring that medical decisions are made by doctors based on medical need and not by company bureaucrats whose primary concern is the company margin. We are all too familiar with the Republican leadership's preference for shortchanging the American people by cutting comprehensive health care initiatives. Mr. Speaker, we tried to bring up expanding kids' health insurance and we got opposition from the Republican leadership. Gradually, we got Republican Members to join with the Democrats and eventually we had a majority. The leadership was forced to bring the kids' health care initiative to the floor and it passed overwhelmingly. We had it with the Kennedy-Kassebaum bill. This was to deal with the problem for people who have health insurance, but have a preexisting medical condition and could not get health insurance or wanted to take their health insurance with them from job to job, the so-called portability issue. These were encompassed in the Kennedy-Kassebaum bill. These were addressed. We could not get the Republican leadership to bring the bill to the floor. We finally got some Republican colleagues to join with us and it was brought to the floor and it was voted on and it passed. This same precedent applies here today. What we are trying to do is to get more and more of our Republican colleagues to join with the Democrats to pass the Patients' Bill of Rights. Let me just, if I could, because I do not want to talk about the Patients' Bill of Rights in an abstract way or managed care reform in an abstract way, I want to give a few concrete examples of the type of patient protections that we are talking about in our Democratic bill, H.R. 3605. Let me run through some of the main points to give an idea of the kind of patient protections that we are talking about. Access to emergency services. This is very important. Because of the fear of denial of coverage, managed care patients have died in many cases, delayed seeking emergency care or been injured when driving past nearby emergency rooms to more distant network emergency rooms. What happens is a lot of times the managed care organizations require patients not to go to the hospital or emergency room close by, but to another one further away. Mr. Speaker, what our bill does is to remove these major barriers to emergency care by prohibiting prior authorization for emergency care. Coverage of emergency care, including out-of-network care, is based upon what we call a ``prudent layperson'' standard, which means that a health plan is required to cover emergency visits based on the symptoms rather than the final diagnosis. This prevents health care plans from being able to deny coverage for an emergency visit for a suspected heart attack that turns out to be severe indigestion. So if the prudent layperson, if the average person would assume that because of the condition they have to go to a local emergency room, if they go, the insurance company has to reimburse for it. Let me give another example of the types of things, the patient protections that are in our bill. Under the bill, if an employer offers only one health plan and that health plan is a closed panel HMO, that plan is required to offer their employees the opportunity to purchase a point-of-service option in addition to the basic plan offered through the employer. So that means that my employer has to give me the option of having an HMO or a managed care plan that allows me to go to a doctor outside the network and choose any doctor, if I wish, and has to give me that option when I sign up for my health insurance. I may have to pay a little more, but nonetheless I have that choice. Then I will give a third example with regard to specialty care and then I will yield to my colleague from Texas. This is access to specialty care. The bill establishes certain standards to ensure hassle-free access to appropriate specialty care. A lot of times when people want to see a specialist, they are not allowed to or they have difficulty doing it because of their managed care organization and the way that it sets forth access to specialty care. But in our bill, women are able to select their OB/GYN as their primary care provider. If the plan does not have an appropriate specialist in network, it must provide a referral to a specialist. For example, if a child needed a pediatric neurologist but the plan only had an adult neurologist, that plan would refer the child to the outside specialist at no extra cost to the family than if the care had been provided in network. Patients with serious ongoing medical conditions are able to choose a specialist to coordinate their primary and specialty care. So if the insureds have a chronic illness, their specialist can actually be, in effect, their primary care provider. Mr. Speaker, I do not think we are really talking here about anything outlandish. I think most of these patient protections are very common sense. Most people probably think that they have these kind of protections, but they do not in many cases. So we are really not asking for much. We are asking basically for a floor, that managed care organizations or HMOs have to provide certain patient protections at a minimum, regardless of the particular type of plan that an individual signs up for. There is a lot more that we can talk about, but at this point I will yield to my colleague from Texas who has been someone who has really been outspoken on this issue and is very concerned about the need for patient protections and has joined with me and others from our Committee on Commerce, which has jurisdiction over this legislation, to make the case why this bill should be brought to the floor. Mr. Speaker, I yield to the gentleman from Texas (Mr. Green).

Mr. PALLONE. Mr. Speaker, tonight, once again, I want to talk about the issue of managed care reform, and particularly the Democrats' proposal called the Patients' Bill of Rights. Before I do so, though, I would like to mention that my colleague from Texas (Mr. Green) is here to join me in this debate about managed care reform or patient protections. But I would like to yield to the gentleman at this point, because I know he would like to address some of the comments that were made by the previous speakers.

Mr. PALLONE. I appreciate my colleague's comments, and I would just like to say one more thing, too, before we close today, and that is that I believe, as the gentleman stated, that the support for these patient protections, this managed care reform, is overwhelming with the American people. And it does not matter whether you are a Democrat, a Republican, an independent, or whether you are from Texas or New Jersey or what part of the country. I know from talking to our colleagues that everyone is hearing from their constituents that we need to pass this patient bill of rights, or something like this bill we have been talking about this evening. My fear is what we may see from the Republican leadership, which so far has been stalwart in its opposition to this and its refusal to bring this up, primarily because of the insurance companies and because of the special interest money that comes from the insurance companies that is backing the Republican leadership, what I am fearful of is that as the Republican leadership keeps hearing how much support there is for this legislation, that they will try to come up with what I call a cosmetic fix; that they will try to come up with a very watered down version of our patient's bill of rights that really does not address most of the concerns that we have raised this evening. I think we have to be very careful of that. As the gentleman knows, the Republican leadership set up a task force, a Republican task force, to look into this issue. And some of our Republican colleagues who support our patient bill of rights, and have even cosponsored our patient bill of rights, are on that task force. And they were about ready, before the Memorial Day recess, to come forward with a proposal that included many of the patient protections we talked about tonight and that are in the Democratic bill. And what the Speaker did was basically pull the rug and say, no, no, go back to the drawing board and look at this some more. So, now, the second or third week has passed since that time, and still this Republican task force has not come forward with a bill. And what we are hearing is that the Speaker and the Republican leadership are putting pressure on them either to not put forward a bill or to put something forward that is basically a very watered down version of what we are talking about, a sort of cosmetic fix that does not really accomplish the goals that we set out to accomplish. So I think the worst thing that could happen, in many ways, is with all this impetus for a real managed care reform bill, if they were to just try on the other side of the aisle to bring something forward that looks like managed care reform but really is not. We have to be wary of that as well because we want to take this opportunity to pass something that really makes a difference for the average American; that really ensures quality health care. Nothing less will do. I know the gentleman shares my concern about that and my view on that. So we are going to continue to be here on a regular basis doing these special orders, constantly bringing this issue up, giving more examples, getting more of our colleagues to join with us, because we demand and we will insist that Speaker Gingrich and the Republican leadership bring the patient bill of rights up for a vote before this session ends. I want to thank my colleague again for joining me this evening.

Mr. PALLONE. Mr. Speaker, I agree with the gentleman. I am glad he brought up this issue of the discharge petition, because I think that that, in fact, is what we may have to resort to. Our colleagues, of course, are aware of it, but the American people may not be aware of the fact that the way the House works, the Speaker and the majority, which is the Republicans, have the right to decide whether or not a bill comes up for a vote in committee and whether it comes to the floor. What we are seeing with the managed care reform and our Patient's Bill of Rights is that we are not even being given the opportunity of a hearing in the committee let alone having it come up for a vote in the committee and come to the floor. So our only recourse at this point is the discharge petition, where a majority of us sign this petition, and the bill is brought to the floor in effect by getting around the Republican leadership. I think we may be forced to that over the next few days, because time is running out in this Congress. Following up on what my colleague from Texas said, I think it is important that we give examples. Over time I get up lately and do a special order like this. I try to give some examples of how the patient protections that we have in our bill would correct the situation. I just wanted to give a few this evening if I could about some of the patient protections that I mentioned and what my colleague has mentioned. With regard to access to a specialist, this is a good example that was in the New York Post in September of 1995 where a 12-year-old girl had to wait a half a year for a back operation to correct severe scoliosis. The reason was that the HMO rejected the parents' bid to have a specialist perform the procedure, insisting instead on an in-network surgeon. After taking 6 months to determine that no one in its own network was capable, the HMO eventually relented and let her go to the specialist outside the network. Of course, when we were talking before about the Patient's Bill of Rights, H.R. 3605, one of the provisions says that, if there is no specialist within the network, then the outside referral is mandated. So we would address the problem that this particular 12-year-old girl had to face a few years ago. The other example, I think, with regard to emergency care, we have a couple of examples of that, and here is one example. This is from the Los Angeles Times on August 30, 1995. A pregnant woman was rushed to a hospital emergency room in the throes of a miscarriage and bleeding profusely. After a quick exam, the ER staff put in an urgent call to her HMO with the question, ``How do you want us to treat her?'' It took nearly 3 hours for the HMO to call back and say it wouldn't cover the care because none of its doctors were available to treat the woman. After 6 hours of arguing, the HMO eventually relented. Again, under the prudent layperson patient protection in our bill, that would not happen because if the average person would expect that when you go to the emergency room with a miscarriage and bleeding, profuse bleeding, that you would immediately receive care, you would receive it, and you would not have to give prior authorization or have the HMO approve it. I mean, some of these cases that I have are really horrific cases. Here is another emergency room case, a New York man. This is from Long Island Newsday, February of 1996. A New York man slipped as he was getting out of a taxi, falling and cracking his skull. The taxi driver called 911, and the victim was rushed to an emergency room where he was given stitches, had a fracture set, and received treatment for a possible concussion. The episode was not a preauthorized emergency, so the patient's HMO refused to pay the bill. Incredible. This is another one from Long Island News Day, actually the same day. A 5-year-old boy, who fell from a balcony and hit his head on the concrete, was brought to an emergency room on a backboard. As hospital workers rushed to give him a spinal x-ray and CAT scan, the HMO requested he be put in a taxi and driven to its own medical center. In that case the emergency doctors ignored the request. Thank God they ignored the request. So the cases go on and on. But, again, sometimes I think that when I read these patient protections they sound so simplistic that people say, well, of course, we have that right. But we do not, and that is why I think it is important to raise these examples. Because people are dying. People are being seriously injured. And it is not a common sense approach that the HMOs or the managed care organizations in many cases are making. They are not looking at things rationally from a common sense point of view.

Mr. PALLONE. Mr. Speaker, if the gentleman would yield, what we do in our bill is to basically leave that up to the States. So it would be up to the State. If the State decides that they think that the HMO or the managed care organization should be liable in the circumstance, then they can. So we are not actually dictating to the States what they do in that respect, but we are leaving it up to States to make that decision. Right now, there is no liability under Federal law.

Mr. PALLONE. Mr. Speaker, if I can just interrupt the gentleman, the gag rule to me, and what you pointed out was such an excellent example of the kind of common sense approach that I think most Americans would believe they already have. I mean, I do not think most people could imagine that their doctor is not allowed to tell them something about their medical condition or possible treatment. It seems to go against the First Amendment, which it probably does if it ever went to court or ever traveled to the Supreme Court for an opinion on it. To imagine that HMOs now are allowed to gag the doctors into telling their patients what they should know, it is inconceivable to me. That is the kind of common sense approach that we are talking about that the gentleman brings up.

Mr. PALLONE

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

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise today to voice my concern over efforts to link Kashmir to the underground nuclear tests conducted by India and Pakistan. As my colleagues know, India and Pakistan conducted nuclear tests last month. The United States condemned the tests and immediately imposed economic sanctions on both countries. The United States has called for both India and Pakistan to stop further nuclear tests, not to weaponize their nuclear arsenal, sign nonproliferation treaties, and work towards easing tensions in South Asia. These are goals that I fully support. However, there seems to be a growing movement to link Kashmir to the nuclear tests, a linkage which makes no sense, in my opinion. Earlier this week, Secretary of State Madeleine Albright stated that the ``recent decisions by India and Pakistan to conduct nuclear tests reflect old thinking about national greatness and old fears stemming from a boundary dispute that goes back more than 5 decades.'' In the Senate, there has been talk of a resolution that would call for U.N. mediation in Kashmir through a U.N. Security Council resolution. The resolution would also ask the United States representative at the U.N. to hold talks with both Pakistani and Indian diplomats at the U.N. Mr. Speaker, I believe that third-party mediation with regard to Kashmir would be counterproductive. The conflict in Kashmir is 50 years old. It has plagued the 2 countries long before they developed their nuclear programs. Interference by the United Nations, the United States or any other country would not help. In fact, the 2 countries agreed to bilateral resolution of Kashmir, among other issues, through the similar accords that they signed in 1972. The State Department has a longstanding policy that India and Pakistan must resolve the Kashmir issue directly, and I do not want this to change. I was happy to read that the Indian Government earlier this week said that it would pursue efforts for a broad-based and sustained dialogue with Pakistan, and I would say that positive steps such as the resumption of talks between India and Pakistan can only help resolve this volatile issue. But as I have said previously, the nuclear tests were not a product of Kashmir. Instead, I would argue that the growing military and nuclear relationship between Pakistan and China pushed India to conduct these tests. Just one week after Pakistan conducted its nuclear tests, U.S. intelligence agencies boarded a Chinese ship carrying weapons materials and electronics destined for Pakistan. This ship was carrying arms materials that included special metals and electronics for the production of Chinese-designed anti-tank missiles made by Pakistan's A.Q. Khan Research Laboratories. Mr. Speaker, China's ballistic missile relationship with Pakistan has prompted more international concern than China's missile trade with any other country. The director of the CIA stated that ``The Chinese provided a tremendous variety of assistance to both Iran's and Pakistan's ballistic missile programs.'' It has been reported that China has been working with Pakistan in the sales of M-11 missiles and related technology and equipment since the late 1980s. Earlier this year, Pakistan successfully tested the Ghauri missile. This missile has a range of 1,500 kilometers, and it is believed that the Chinese may have had a role in its development. The Ghauri missile can be fitted with a nuclear device. Last week, President Clinton stated that China must play an important role in resolving tensions between India and Pakistan. He stated that China must help ``forge a common strategy for moving India and Pakistan back from the nuclear arms race.'' Now, I have to say that I applaud the President and the Clinton administration and my colleagues' desire to reduce tensions and bring peace to South Asia in response to the nuclear tests. However, and I stress, that asking China to play a major role as mediator in general makes no sense, given their role in Pakistan's nuclear development. I would suggest instead that the United States needs to continue a bilateral dialogue with the Indian Government and encourage the Indian Government to move away from nuclear proliferation. We, that is the United States, we are in the best position to work with the Indian Government ourselves to achieve this goal.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise this evening to share with my colleagues and the American people some new ideas on how we can work to promote greater cooperation and stability in the Caucasus region of the former Soviet Union, and specifically how we can jump-start the peace process in Nagorno Karabagh. During the Memorial Day recess, the gentleman from Rhode Island (Mr. Kennedy) and I had the opportunity to travel to the Republics of Armenia and Nagorno Karabagh to meet with government officials from both countries as well as with U.S. officials in the region. As I have mentioned in the House on several occasions, the people of Nagorno Karabagh fought and won a war of independence against Azerbaijan. A tenuous cease-fire has been in place since 1994, but a more lasting settlement has been elusive. The U.S. has been involved in a major way in the negotiations intended to produce a just and lasting peace. Our country is a cochair, along with France and Russia, of the international negotiating group, commonly known as the Minsk Group, formed to seek a solution to the Nagorno Karabagh conflict. Mr. Speaker, this so-called Minsk process, under the Organization for Security and Cooperation in Europe, OSCE, a process of shuttle diplomacy whereby the American and other negotiators travel between the various capitals seeking agreement on a resolution of the conflict, has so far not been successful in trying to resolve the Nagorno Karabagh conflict. What is needed are some new ideas and more realistic approaches that will lead to a just and lasting settlement of this conflict. Unfortunately, the U.S. position has thus far sided with Azerbaijan's claim of so-called territorial integrity, despite the fact that this land has been Armenian land for centuries, and the borders which gave the land to Azerbaijan were imposed by Soviet dictator Joseph Stalin. It is time, Mr. Speaker, for the U.S. and our Minsk Group partners to forget about the idea of territorial integrity as the foundation for peacefully resolving this conflict. In addition, we should be pushing for direct negotiations involving Nagorno Karabagh and Azerbaijan. Instead of sticking with the unworkable notion of Karabagh as an inseparable part of Azerbaijan, subordinate to the Azeri capital of Baku, I believe we should consider the idea of horizontal links, a federation among equals. This model has been used in resolving the Bosnia war and in the current negotiations aimed at resolving the Cyprus conflict. I am pleased to report, Mr. Speaker, some positive changes in the position of our State Department, including their apparent willingness to push for direct negotiations between Nagorno Karabagh and Azerbaijan. I am sensing a newfound flexibility by the State Department in terms of dropping the old adherence to the failed approaches of the Minsk Group in the past. I would stress the importance of strengthening the current, shaky cease-fire as a priority for the Minsk Group. The recent negotiations in Northern Ireland could provide a model where separate, direct negotiations were held on the issue of militia armaments. In the case of Karabagh, making a priority of securing the cease-fire would help end the violence, stop the continuing casualties and help build confidence for additional agreements between the parties. The other key is the need for ironclad security guarantees for Karabagh, with the Republic of Armenia given a central role in the process. As I mentioned, Karabagh won the war and holds the strategic advantage. It's unrealistic and unfair to expect Karabagh to give up its gains on the battlefield for vague promises at the negotiating table. Another key point on the Karabagh negotiations. It is no secret that Azerbaijan has had the support of big oil interests in its corner. Azerbaijan's territory may have significant oil reserves beneath it in the Caspian Sea area, although some new studies question just how significant these resources may be. Unfortunately, powerful and well- connected lobbyists for the oil industry have basically backed up Azerbaijan's intransigence in the negotiating process over Karabagh. I am afraid our administration's policy has tended to side with Azerbaijan because of the oil issue. I hope that Members of Congress who are involved in this issue can work with me in getting the administration to convince Azerbaijan and the oil industry that the development of those resources will continue to be complicated until the Karabagh issue is resolved. Finally, Mr. Speaker, another very troubling aspect of this issue is the indications of possible 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 conflict is the blockade of Armenia and Karabagh by Azerbaijan, and Turkey's blockade of Armenia, in support of Azerbaijan. These blockades have made life hard for the Armenian people, stopping vitally needed humanitarian relief supplies from the U.S. and other countries. Now there are growing indications that Turkey is funneling military equipment to Azerbaijan, something I have seen myself in a previous visit to the front lines in Nagorno Karabagh. As part of our efforts to resolve the conflict over Karabagh, we must restrain our NATO ally Turkey from contributing more fuel to the fire in the form of arms and other military supplies. 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 (cannon artillery) to Azerbaijan. The U.S. government cannot allow its military equipment to be used against our Armenian friends. I am currently working with some of my colleagues in this body to determine the level of Turkish support for Azerbaijan's military and in putting pressure on Turkey to be a partner in the search for a lasting peace in the region--not a contributor to a continuing cycle of violence and tensions.