Rick Santorum

Mr. SANTORUM

Mr. SANTORUM. So I would have to object.

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I thank Senator Nickles for his outstanding leadership on this task force. We would not be where we are today, passing what I believe is a very useful and precise way to respond to a very complicated problem. Senator Nickles shepherded this task force with great skill. He deserves a great amount of the credit for what is being accomplished today. With respect to the comments that this bill is dead, it is not going anywhere, the President is going to veto it, I would say this: Of all the criticism I heard about the Republican bill, most of it is it just does not go far enough. It is not that what we are doing is not right or it is not in the right direction; it just does not do enough. I do not know about you, but I have watched Congress for a long time. I have seen a lot of things happen in this institution, where sometimes it is good just to do something in the right direction, that we all agree is in the right direction. I do not think anyone is saying what you are doing is absolutely antithetical to good health care, you say internal/external--no. We need more of that, we need a tougher one, but not to say what we are doing is bad. It just is not enough. I am hopeful people will say doing something that is good should not be the enemy of what some believe is the best. So I am hopeful we can get together, the House has to act, they are going to pass a different bill, and then we can sit down with the President and our colleagues on the other side of the aisle and do something that is good. Let's do something on which we can agree. Let's do something that can move the ball forward and work together so we can go out and say: We, in fact, did protect patients. We did improve the quality of health care. Maybe not as much as some would suggest we could--I differ with that--but we did do something positive. We did improve access to health insurance. We did not blow a hole and increase costs dramatically to drive people out from health coverage. That is what we need to do, to move forward and do something good.

Mr. SANTORUM. Who will be the first person, once these employers drop their insurance as a result of this bill, to run to the Senate floor and say: These nasty employers, look at them; they are dropping their insurance; we need the Government to take over the health care system? Yes, the Senator from Massachusetts would be the first person on the Senate floor calling for a Government health care system.

Mr. SANTORUM. Madam President, I thank the Senator from New Hampshire. Many have said that you cannot sue your HMO. There are three Federal Circuit Court cases and 12 Federal District Court cases that have said ERISA does not preempt State law when you want to sue your HMO for malpractice. I ask unanimous consent to have this list printed in the Record.

Mr. SANTORUM. So the issue is not whether you can sue your HMO. That is not why we are so adamantly against the provision in the Kennedy bill. It is not to be able to sue your HMO. I do not have any problem with your being able to sue your HMO. What I do have a problem with is what this bill does; it allows you to sue your employer. It allows you to sue the employer for a decision made by an HMO, by an insurance company. What will that mean? You heard the Senator from Oregon, who is a small business owner, say--and, by the way, I have talked to dozens of employers who have said this: If you are going to open up the books of my corporation--I make widgets or I make steel or I make desks or I make pencils--you are going to open up my books for my employees to sue me for a decision my insurance company, that I hired, made. I cannot afford it. I am not in the business of health care. I am not managing these health care decisions. I hired someone to do that, but I am going to get sued for their decisions? Sorry, as much as I would love to provide group health insurance to you, I cannot allow the corporation--our corporation, our effort--to be jeopardized by a decision made by someone outside of what I do. I cannot let it happen. They will drop their insurance. I ask for 30 additional seconds.

Mr. SANTORUM

Mr. SANTORUM. If I can get through this first. It is eligible for a review. An independent reviewer, under our bill, will look at all of the facts in the case and determine whether, in fact, the pediatric cardiologist is necessary in medical judgment to, in fact, perform this procedure. They make an independent medical determination based on all of the information that is reviewed, including the recommendation of the doctor, the original pediatrician, including the recommendation by the internal reviewer. They look at all of the information, they get all of the relevant facts, and they put this together--as has been listed many times here--a laundry list of factors to consider, and they make an independent judgment as to whether a pediatric cardiologist is necessary. If it is necessary, the denial is overturned. The specialist outside of the network is selected to provide the care for this child within the HMO. That is in our bill. That is covered under our bill. So all of this talk about we are not going to have this kind of access is not carefully reading this bill. I give a lot of credit to Senator Frist and Senator Jeffords and those on the health committee. They have done an excellent job of looking through and making sure all of these kinds of situations where you have limitations--and in many cases you do have limitations, and the networks don't have a lot of specialists. But you can go outside the network if an independent reviewer determines that is what is medically necessary in that case.

Mr. SANTORUM. Yes.

Mr. SANTORUM. I thank the Chair. Mr. President, I, too, congratulate all those who have spoken. I do not want to repeat what has been said. They said it well. In the Republican bill we are not leaving 100 million people uncovered. The fact of the matter is, the States that have the authority under the law, under the Constitution, and under the McCarran-Ferguson Act, to regulate insurance do the job and do it very well. What this is all about, in my mind, is arrogance. This is about people walking around in Washington, DC, thinking: This is the center of the universe, and unless we decide what is best for all of you, you cretins out there in central Pennsylvania or in Wyoming or in Tennessee, you folks just do not understand what we, the enlightened in Washington, know what is best for you. So we are going to impose on you, State legislators, insurance commissioners, what we think you should be doing, even though you have gone through the process, an exhaustive process. Pennsylvania went through an exhaustive debate in the House and the Senate and with the Governor on what kinds of patient protections they were going to provide for the people who were covered by State insurance, those 100 million people who are ``uncovered.'' For the people in Pennsylvania, rest assured, there was a fine Patients' Bill of Rights passed by the Pennsylvania Legislature and signed by Governor Ridge. In fact, I spoke with the sponsor of that bill over the weekend. He came up to me and said: Rick, please, please, don't pass a bill that is going to wipe out what we so carefully crafted that we believe is in the best interests of Pennsylvania. Dr. Tim Murphy, the sponsor of the bill in the Pennsylvania Senate, someone who I think cares deeply about the concerns of children and concerns of the well-being of Pennsylvanians, said: Please, don't undermine what we have done. Don't put a layer of bureaucracy, the Health Care Financing Administration, overseeing the kinds of patient protections we have passed in Pennsylvania. Please, let us do what we do well, and if there are problems, we will deal with them, we will come back, and we will revisit this issue--just like the issue here is not over. But give us some credit that we know what is going on in our own States. We care about the people in Pennsylvania more than Senators from California or from Louisiana or from Massachusetts. We care about our people because they are our constituents. We see a lot of examples of arrogance in Washington, of the ``we know best'' attitude in this town. This is an amendment that says: Washington knows best. What goes on in State capitals is irrelevant because they do not really care about their constituents. If I am in Massachusetts, I care more about what goes on in Pennsylvania than the Governor or the State legislators, State senators. That is ridiculous. The fact of the matter is, the States are engaged actively. Frankly, they are much more active than we have been in the Congress. They have been actively engaged in dealing with the problems in their States, and we should let the States do what they do best, and we should do--and the Republican bill does--what only we can do, and that is to regulate ERISA plans, with patient protections and, I add, a lot more. The one thing that really sort of irks me about this whole debate is that it is not just about protecting rights with HMOs. What our bill does is much broader and deals with issues of quality and choice, giving people alternatives to HMOs, not just locking them in and trying to fix something that may or may not be broken. We say you can fire an HMO, go somewhere else, and get health care in a different way. The Democrats will not let you do that. We do. We provide tax breaks for the self-employed which, again, increases access to the system. They do not. We have not only quality assurance; we have choice; we have access. The thing we do not do--and I am very proud we do not--we do not drive up cost and drive people out of the insurance market. They do. On all four counts of what health care reform is supposed to be about--choice, quality, access, and cost--we are the winners, not the other side.

Mr. SANTORUM. Mr. President, I wanted to respond to the Senator from New Mexico. My time had run out. My understanding is that the provision in the bill says the network has to provide access to specialty care. We define in the report language clearly what access means as far as cost sharing is concerned: When the plan covers a benefit or service that is appropriately provided by a particular type of specialist not in the network, the benefit will be provided using the in- network cost-sharing schedule. In other words, no additional costs. Only in cases where it is a preference to go outside the network for a specialist, other than somebody in the network, where it has not been referred by the plan or determined by a reviewer, is that additional cost borne. As long as an independent reviewer or the plan refers out of network, the cost sharing is the same.

Mr. SANTORUM. Mr. President, the issue of access to specialty care is very important. Many of us represent, as I do, hospitals that are very intensive tertiary care facilities with lots of specialists. Those of us who have had young children have had experience at children's hospitals and have dealt with specialists and recognized the need for that. I can tell you as a father of four young children and a child who is due in September, I am not going to stand here and say we are not going to provide access to the kind of specialty care for children, or anybody else, that is needed. I am confident that the bill before us does exactly that. It does exactly that. It provides access to specialty care when it is necessary to save or help improve the life of a young child or anybody else. As an example, if you have a baby who is born with a rare heart disease and the pediatrician recommends that a pediatric cardiologist treat the baby, the claim is made and it is denied initially, and it goes through the internal review process. Specialty care is covered under the contract. Remember, we are dealing with covered benefits, so obviously if it is not a covered benefit, that is a different issue. But if it is covered--and, of course, most HMOs cover some sort of specialty care--it is covered. But in this case, say the network doesn't have a pediatric cardiologist. So you have, in a sense, what is laid out by the other side, the worst case scenario. The network doesn't have a specialist, and therefore they just won't give this specialist treatment because there isn't a pediatric cardiologist available to treat this. So a regular pediatrician would have to do so. Well, that is not the case in our bill. Our bill says that this particular denial is eligible for review by an independent external reviewer. The dispute is about who should provide the specialty care. That is an element of medical judgment. Therefore, if it is an element of medical judgment, it is eligible for review. If it is an independent review and the reviewer says yes----

Mr. SANTORUM

Mr. SANTORUM. If the Senator will yield, he is arguing that it doesn't mean anything. It means everything. Really it is sort of the opposite of that. It has such an expansive character to it that it can include inappropriate medicine, which is, I think, the point the Senator is making.

Mr. SANTORUM. Mr. President, will the Senator from Oklahoma yield for a question? As a matter of fact, we have some information just provided to us that under the Kennedy legislation, S. 6, with 1.9 million people no longer being insured, you would have 188,595 fewer breast examinations. If people had their routine breast examinations, of those 1.9 million, a certain percentage would be women, that would be the number of breast exams that would no longer take place if this legislation passed. We hear so much talk about ``in human terms,'' and they say this argument does not cut. These people are going to lose insurance. They will lose insurance. They will not get coverage so you do not have to worry about covering them for a mastectomy. They are going to find out, in many cases, unfortunately, far too late for even those kinds of treatments to be helpful. That is what we are trying to prevent in not passing a bill that drives up costs dramatically which drives people out of the insurance area.

Mr. SANTORUM. As I said, our bill is much more comprehensive. We looked at the question of access and making health insurance more affordable to cover more people, to bring them into the insurance market. Our bill, with this amendment, does that. The other thing we do is we emphasize that we do not want the Federal Government, the Health Care Financing Administration, to oversee State- regulated plans. Almost all 50 States have passed a Patients' Bill of Rights. They traditionally regulate health insurance. They are doing a very good job. We do not need to impose HCFA regulations and HCFA control over every State insurance department. It is the wrong approach. It is Washington getting its teeth into the State pie. That is unnecessary.

Mr. SANTORUM. Mr. President, I rise in strong support and encourage all my colleagues to support this amendment. The amendment does basically two things. No. 1, it establishes 100-percent deductibility for the self-employed, something for which I know many Members of both sides of the aisle have been striving. One of the things we have said about our health care proposal is that ours is much more comprehensive than the Democratic plan. It looks at the issue of access.

Mr. SANTORUM

Mr. SANTORUM. That is the obvious question. A right is a right, but it does not include the right of the Government to pay for the exercise of that right. In fact, there could be complications--there is a separation of church and state--if the Government were to get involved in enforcing those rights in this kind of way. I think we set a very dangerous precedent when we elevate a right to the point where the Government now has to pay for the access of that right or for the enforcement of that right. I think that is a dangerous standard that the Senator from Washington has posited and one I hope the Senate will reject tonight. I thank the Senator.

Mr. SANTORUM. The Senator from Washington was saying we are restricting someone's right by not paying for an abortion, which posits the interesting question that right now comes with a guarantee that the Government will pay for that right. We have freedom of speech guaranteed in the Constitution. Does the Government pay for someone who wants to speak? Do the taxpayers pay to put them on television if they want to speak?

Mr. SANTORUM. If a group of people want to assemble, does the Government pay for a room or the assembly costs? Is that part of the right of speech--that the Government must pay for the cost of assembling?

Mr. SANTORUM. Will the Senator from New York yield?

Mr. SANTORUM. If someone believes in freedom of religion, does that mean the Government should pay the church to make sure people have the freedom to worship, and make sure the freedom of religion is guaranteed?

Mr. SANTORUM. Than with taxpayer dollars. That is a specious difference? I don't think so.

Mr. SANTORUM. The answer is obvious. I retain my time.

Mr. SANTORUM. There is no prohibition in the DeWine amendment for someone taking their own wages and purchasing insurance to cover abortion. That is the analogy the Senator made, and it is invalid. I wanted to make that clear.

Mr. SANTORUM. Over 70 percent is paid for by taxpayer dollars.

Mr. SANTORUM. Whether one uses their own wages or is part of a Federal health plan, paid for, in fact by those wages----

Mr. SANTORUM

Mr. SANTORUM. Mr. President, I have sought recognition to express my support for Courthouse Construction funding for the U.S. federal courthouse in Erie, Pennsylvania. This courthouse is in dire need of repair, and the Administrative Office of the U.S. Courts has placed the Erie Federal Courthouse on its priority list, and the General Services Administration is in the final stages of completing the design for the refurbished complex, which will be ready for construction in FY2000. Specifically, this project involves the alteration of the existing Erie Federal Building, the acquisition, repair and alteration of the adjacent Erie County Library building for the bankruptcy court and court of appeals; and the construction of a new courthouse annex for the district court. The current courthouse provides inadequate space and is not consolidated in a single location, presenting logistical and security concerns for jurors, judges, attorneys, and the public. The project, which will be a major step in the revitalization of downtown Erie, will rely substantially on the rehabilitation of existing structures as opposed to more costly, new construction. I understand that the President's budget did not include funding for courthouse construction for the third consecutive year. This failure to provide funding for the needs of our judicial system is a serious oversight that should not stand in the way of the safety and security of my constituents in Erie. I look forward to working with the Chairman of the Treasury and General Government Subcommittee, Senator Campbell, and my colleague from Pennsylvania, Senator Specter, to ensure that this project receives funding as soon as possible. In the meantime, I urge the General Services Administration to take any necessary actions to rectify safety concerns or logistical problems that may result from this lapse in funding.