John Shadegg

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me time. I want to thank my colleague from New Hampshire for his hard work on the CATs budget. He has put in tremendous effort and drawn up what I believe is by far the best budget presented here tonight. But I also want to begin by addressing this notion that appears to exist in Washington, D.C., and nowhere else in the world. Every single business in America and every single business in the world understands that each year you must do more with less. They also understand that the way you can do that is through improvements in efficiency and productivity. Indeed, every single report which now analyzes productivity in America shows that we as a society are becoming more productive, year after year after year. In the last 2 years alone, we have grown more productive by 3 percent per year. That means that Ford Motor Company or General Motors or Motorola produces a better product year after year at a lower cost. Yet in government, nowhere else in all of the world do we say Oh, no, we can't do more with less, we have to do less with more. So you hear our colleagues on the other side decry the budget and say it cannot be done. I would again compliment my friend from New Hampshire for pointing out that the people who say this cannot be done, that we can never deliver more government services because of improvements in efficiency or productivity, are the same people who said we could not balance the budget, the same people who said we could not accomplish welfare reform, and the same people who say the American people do not deserve a penny of tax relief. Let us talk about what this budget does. Number one, it protects 100 percent of the Social Security surplus. Number two, as the gentleman from South Carolina (Mr. Sanford) just pointed out, it provides the reform for Medicare by providing individual retirement accounts. Let us talk about what it does for defense, since that is the number one priority of the government. It provides the strongest national defense of any of the budgets. But, most importantly, and I want to compliment my friend the gentleman from Texas (Mr. Stenholm), it does what is critically important: It contains real budget enforcement. We cannot continue to pass budgets which are a fraud.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding me this time, and I want to make it very clear that I oppose this motion to instruct, and I urge my colleagues to defeat it. I think it is important that we look at precisely what the motion to instruct does. There are two pieces to it, as my colleague, the gentleman from Michigan (Mr. Dingell), pointed out. The first one is that all necessary steps be taken to begin the meetings. On that point I think it is very important to note, and for all our colleagues to understand that, in fact, there has now been an agreement that a meeting of the conference committee will occur. It will occur either next week or the week after. It will precede the February break, which is the week after that. And so steps to begin meetings have in fact been agreed to, making the first point of the motion to instruct moot. I guess I would add on that point that I myself agree with the concern that the conferees should meet and that we should begin the process, because I wholeheartedly agree it is critically important work. But the second portion of the motion to instruct is the portion of the motion I think our colleagues should be concerned about and, quite frankly, which is the portion of the motion to instruct which makes it technically flawed. And that is that we instruct the conferees that they insist that H.R. 2723 be included in the conference report. What that means is that we insist on the House position and the House position only. Now, as a proud Member of the House, there might be occasions when I would like to insist on the House position and the House position only. But there is no one in this body, Republican or Democrat, who does not understand that in this conference committee if either the Senate or the House chooses to insist upon their position and their position only, the net effect will be tragic. My colleague, the gentleman from Arkansas (Mr. Berry), the proponent of this motion to instruct, said just a moment ago that people are suffering today and it would be tragic if we continued to delay because people will continue to suffer. Well, I think it is very important for our colleagues to understand that if either side, the House or the Senate, insists that it is their position in these negotiations or no position, then in fact what we will get is not a bill, it is not legislation, it is not relief for the American people, whom I believe are being abused, it is not legislation that will help them. If we do as this motion to instruct requires, indeed demands, if we insist that it is our bill and our bill only, the Norwood-Dingell bill, which is bipartisan, if we insist that it is that bill and that bill only, then what we are saying is we do not intend to legislate on this issue this year; we do not intend to send the President a bill that he can and will sign, and we do not intend to help the American people. Rather what we intend is to save for the election a political issue. I understand there are people in this body who want a political issue. I urge them to rethink their position. The reality is we need a compromise between the House and the Senate version, and we need legislation to help the American people. And on that point, I would note that my colleagues, the gentleman from Iowa (Mr. Ganske) and the gentleman from Georgia (Mr. Norwood), who were plowing this ground long before I, and who know it well, stood up and noted that on the critical issue of liability, we have made great strides in just the last 3 weeks. Just a few weeks ago, barely a week and a half ago, Mr. Lott indicated that any legislation which passes this year must include a reasonable liability provision holding HMOs that hurt people accountable in a court of law for their conduct; that is a tremendous stride forward. And I compliment the gentleman from Iowa (Mr. Ganske) and the gentleman from Georgia (Mr. Norwood) for acknowledging that. But if we are making progress, then why step back from that? Why insist our way or no way? I suggest that is a tragic mistake being advocated by those who do not want to help the American people on this issue, but who rather want a political issue to go forward on. And, again, the net effect of insisting our way or no way is that people will continue to suffer, the very goal this motion to instruct is designed to alleviate. There is another critical important issue to be discussed here, and that is the contents of the bill on the issue of access. My colleagues on the other side, when the bill passed the House floor, every single one of them said, we do not want to accept nor will we embrace a single provision of H.R. 2990 that addresses the problems of access to care by the uninsured. There are several pieces in H.R. 2990 that would help America's uninsured get care. While I heard some movement in the Senate side on the issue of liability, I have not heard today any movement on the House side on the issue of access to care. I think that would be a tragic mistake. This is a once-in-a-lifetime chance for this Congress to do something, not just about HMOs and their abuses, but about America's 44 million uninsured. Clearly, we need to do something about that. Indeed in his State of the Union address just last week, the President talked about access to care. He proposes three solutions. To sum it up briefly, the President in his State of the Union address proposed that we expand government-run health care from two ends, that we expand Medicaid to younger people and that we expand SCHIP. I would suggest that that is the best answer. But that the best answer is one that has a lot of bipartisan support and that is a tax credit, a refundable tax credit. And I would note that just last week, our Majority Leader Armey and Senator Breaux, a knowledgeable expert on the other side of this issue, proposed irrefundable tax credit. There are great things that can be done on health care this year. We can support a patients' bill of rights. We can enact legislation that will help the American people, but not by this motion to instruct, not by an arbitrary demand that it be our way or no way.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding, and I simply want to add a few remarks for the record. I want to thank the chairman of the committee, the ranking member of the committee, and all those involved in this effort. S. 1595 is a fitting tribute to Justice Sandra Day O'Connor, a native of Arizona and a woman who has distinguished herself. As my colleagues know, we have constructed a new United States courthouse in Phoenix, Arizona, and many of us active on this issue have been most anxious to designate this courthouse and to name it after Justice Sandra Day O'Connor. As my colleague, the gentleman from Louisiana (Mr. Cooksey), has just recited, her career has been a distinguished one. For a moment I would like to brag about the fact that Arizona has many women leaders. Five of the top elected officials in Arizona today are women, including our governor, our secretary of State, our attorney general, our superintendent of public instruction, and our State treasurer. But before they were elected as distinguished women leaders of Arizona, Justice O'Connor was a distinguished member of the Arizona bar, and my colleague, the gentleman from Louisiana (Mr. Cooksey), has read off a litany of her accomplishments. I simply want to say that as a young man growing up in Phoenix and taking the Arizona bar and some of the questions that Justice O'Connor wrote, she went on to distinguish herself and to set an example which I believe all people should follow, and to distinguish herself in the legal field. I am thrilled that Ronald Reagan appointed her to the United States Supreme Court as the first woman Justice on that court, I am thrilled that she continues to do Arizona well and to demonstrate the leadership of the women of Arizona and the women of this Nation, and I simply wanted to express my sincere appreciation and thanks to both the chairman and the ranking member of the committee for allowing this legislation to proceed through this evening.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I yield myself 30 seconds. Mr. Speaker, I have the same edition of Newsweek Magazine and noted various things in it, including the fact that it pointed out that access to specialists is denied much more frequently by HMO plans than by fee-for-service plans. But I wonder if the last speaker, who is supporting the motion to instruct, understands that that motion to instruct puts fee-for-service plans under the same regulation as HMO plans? That is, they impose the same regulatory burdens on fee-for- service, which is treating people well, according to this magazine article, as it does to HMOs. I suggest that sticking to the motion to instruct and tying our hands is not the right answer.

Mr. SHADEGG. Mr. Speaker, I yield 1 minute to the gentleman from California (Mr. Doolittle). (Mr. DOOLITTLE asked and was given permission to revise and extend his remarks.)

Mr. SHADEGG. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Louisiana (Mr. Cooksey). (Mr. COOKSEY asked and was given permission to revise and extend his remarks.)

Mr. SHADEGG. Mr. Speaker, I yield myself 3 minutes. Mr. Speaker, the essence of this motion to instruct on its substance is very clear. It would bind the House conferees to the Norwood-Dingell version of the bill. I would like to ask a series of questions of whether we really want to do that. Let me begin with this one. The substitute offered on the House, one of the substitutes offered on the House side that did not pass allowed access to ambulance services. Norwood-Dingell did not. Would the proponents of this motion to instruct say we should not allow or guarantee access to ambulance services? The substitute offered external appeal timelines that were shorter than Dingell-Norwood, getting people more care even more quickly than Dingell-Norwood. Do the proponents of this motion to instruct oppose an even shorter time period for special appeals, getting people care even more quickly? The substitute that we offered we called for binding arbitration for those who did not want to go to court. There was no similar provision in Norwood-Dingell. Did the proponents of this substitute which would bind us to Dingell- Norwood and Dingell-Norwood only say that we should not allow binding arbitration? The substitute that we offered provided access to all cancer clinical trials, as one of the earlier speakers noted. That is much broader than Dingell-Norwood for cancer patients because Dingell-Norwood does not include FDA-approved clinical trials. Two-thirds of new cancer drug tests are FDA approved. Do the proponents of this motion to instruct say that we should not have the broader provision that does more for cancer victims on clinical trials? The Norwood-Dingell bill does not guarantee either pathology or laboratory services. The substitute did. Did the proponents say we should be bound to their version and not offer pathology or laboratories services? We created a panel to ensure network adequacy, to make sure that if a plan said they had a doctor, there were enough doctors with that specialty to actually service their patient base. Norwood-Dingell has nothing to cover network adequacy. This motion to instruct would commit us to a plan that does not even require network adequacy, and that indeed is one of the problems noted in the Newsweek article discussed earlier. We prohibit plans from considering FDA-approved drugs or medical devices as experimental or investigational. Norwood-Dingell does not do that. The proponents of this motion to instruct would tie our hands and say, yes, we can take a procedure that has been approved by the FDA, a drug or a medical device; and even though it has been approved, label it experimental or investigational. The motion to instruct would tie our hands to a series of provisions that are not near as strong for patients as the substitute that was offered here on the floor. I urge my colleagues to reject the motion to instruct. Mr. Speaker, I reserve the balance of my time.

Mr. SHADEGG. Mr. Speaker, I yield 5 minutes to the gentleman from Ohio (Mr. Boehner), the distinguished chairman of the Subcommittee on Employer-Employee Relations of the Committee on Education and the Workforce.

Mr. SHADEGG. Mr. Speaker, I yield 5 minutes to the distinguished gentleman from Oklahoma (Mr. Coburn), one of the co-authors of a bill which could not be considered if this motion to instruct were adopted.

Mr. SHADEGG. Mr. Speaker, I yield to myself the balance of the time remaining. Mr. Speaker, I think this is a critically important debate. It is a debate that is reflected on thoughtful concerns across America, as pointed out in this week's edition of Newsweek, which talks about this issue about patients' rights. But we really are engaged in very much of a political discussion of what ought to occur from here forward. There is, indeed, no question but that the gentleman from Iowa (Mr. Ganske) and the gentleman from Georgia (Mr. Norwood) deserve credit for their hard work on this issue. Indeed, I would suggest quite clearly that of the two major bills before this House, they were written by four people, the gentleman from Iowa (Mr. Ganske), the gentleman from Georgia (Mr. Norwood), the gentleman from Oklahoma (Mr. Coburn), and myself. That is true of the bill on the other side, the Norwood-Dingell bill, and it is also true of the substitute which got the most votes on this side. I would also point out that there has been much made of the fact that perhaps some of the conferees will not have voted for the bill that passed the House. The bill that actually is in conference is H.R. 2990, and I believe every single one of the Republican conferees voted for H.R. 2990. Now, it is true that many of the conferees may not have voted for Dingell-Norwood, and I understand the concerns of those who have expressed that reservation, their belief that, indeed, there perhaps should be more Members on the conference committee who did vote for Dingell-Norwood. I do not know the full context of the conference committee, but I can tell my colleagues this, I for one am committed to the concept behind the major distinguishing point between Dingell-Norwood and the substitute; and that is that HMOs must be held accountable. But please make it clear that this debate is vitally important, and it is a political debate. It is a debate about whether we do something for the patients of America or whether we do nothing. The minority leader spoke about keeping the process moving forward. I urge every one in this House to work hard to keep the process moving forward, and I agree with him on that. But passing this motion to instruct, passing this set of instructions, announcing today that we are unwilling to compromise on anything but that which is in Norwood- Dingell would be a tragic mistake, because if we abide by that position, make no mistake about it, if we adopt Norwood-Dingell and Norwood-Dingell only, there will be no health care reform for this country arising out of this bill this year or next year, because that bill cannot pass and will not pass because of its extreme positions on the issue of liability. Now, its health care provisions, quite frankly, are not quite as good as ours, but they are very close. But the issue here, the fundamental question here is that we must come to a compromise. My colleagues on the other side of the aisle and the President have announced they want to do absolutely nothing about access to insurance for the uninsured and absolutely nothing about the cost of insurance and absolutely nothing about choice for those who have insurance, because their bill, Dingell-Norwood, did nothing for access, it did nothing for choice, it did nothing for cost. I say that we must move them on that issue. They must compromise, or we will not help the American people. My other colleagues on the other side who say immunity works, we should leave the HMOs absolutely immune when they injure or kill somebody, I suggest to them that if we take that stand, then, indeed, there will be no legislation this year to help the American people. This is too critical a moment in time, vastly too important for the lives of the American people for us to sit on our hands and take either an extreme position on that side in which we do nothing about access, nothing about choice, nothing about affordability, or an extreme position which says we do nothing about making health care plans accountable. This is a critically important moment in time, and the proponents of this motion to instruct would have us pass it by. They would save this issue for a political fight in the next election campaign. I believe that would be a tragic mistake. What must happen in this conference committee is that the Senate must move, because its bill is inadequate; and what must happen in the conference committee is that the House must move, because we do not get good legislation for the American people if we do not compromise. I believe that this motion to instruct, which would leave us bound to one position and one position only and would abandon the notion of compromise, would be a tragic mistake for the American people for that reason. I urge my colleagues to give the conferees the option to compromise on good legislation so we can pass and enact health care reform this year.

Mr. SHADEGG. Mr. Speaker, I understand the gentleman from Michigan (Mr. Dingell) has the right to close.

Mr. SHADEGG. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Ohio (Mr. Boehner).

Mr. SHADEGG. Mr. Speaker, I yield 1 minute to the gentleman from New York (Mr. Lazio).

Mr. SHADEGG. Mr. Speaker, I yield 3 minutes to the distinguished gentleman from Tennessee (Mr. Bryant). (Mr. BRYANT asked and was given permission to revise and extend his remarks.)

Mr. SHADEGG. Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I simply want to set the record straight on this issue. Apparently the question of whether or not State law is preempted under Coburn-Shadegg has become important, and I tried to ask the gentleman from Georgia (Mr. Norwood) about that issue. I want to point out that, in his argument, he said that it is preempted because ERISA preempts all State law. That was his premise, because ERISA preempts all State law, and our bill said not otherwise preempted. He said that is the flaw in our logic. The problem is he is wrong about that. ERISA does preempt all benefits claims, but it does not preempt quality of care claims. That is precisely what the Texas Legislature took advantage of. They wrote a law that says quality of care is not preempted. Georgia, Louisiana, and other States have followed, so his premise is simply wrong.

Mr. SHADEGG. Mr. Chairman, will the gentleman yield briefly?

Mr. SHADEGG. Mr. Chairman, I am passionate about this issue. For the last 2 years, I have done almost nothing else. I believe this is a momentous debate. But I am greatly offended by what is going on on the floor. The truth is that there are two extreme positions here, and there is a lot of misrepresentation going on. Some of the most serious misrepresentation that is going on is the allegation that Republicans do not care about patients and that the Coburn-Shadegg bill will not protect them. I am enraged by that comment. There is not a Member of this House, not one, Republican or Democrat, man or woman, not the gentleman from Georgia (Mr. Norwood), not the gentleman from Iowa (Mr. Ganske), not the gentleman from Michigan (Mr. Dingell), who is more passionate that HMOs must be held liable when they kill or maim someone. No one. No one beats me on that issue. I have written a series of ``dear colleagues,'' which you all should have read, and given them to the press, and it says, point blank, ERISA abuses people. Courts cry out for reform. It is quote after quote after quote from Federal judges describing that absolute immunity is wrong. And from my conservative friends I have been beaten up because I am not sufficiently pro-business. But let me say that the gentleman from Georgia (Mr. Norwood), whom I love and respect, is wrong, because the gentleman from Georgia (Mr. Norwood) said the only bill that can become law is a bipartisan bill, and he would be right if yours were a bipartisan bill. But it is not a bipartisan bill, because just as immunity is extreme and wrong and bad public policy, so is outright, absolute, total liability. The sad truth is that in the gentleman's to change the law, and in his decision to throw in with the other side, including the President, this issue became political, and not about patients. It needs to be about patients. The reality is no bill we pass here on the floor can, in fact, become law if it is so extreme that it results in employers being sued; and the gentleman's provision to protect employers fails. Now, I know that the gentleman from Georgia intended to write it to protect employers, but it does not do that. If they use simple discretionary authority, they can be sued. I also know that the gentleman did not want and may not have intended to throw the door open to wide open liability so that one can sue anyone, anywhere, any time, for everything. But that is the way the bill is written. The gentleman's bill will result in handing the entire process over to the trial lawyers. That will never become law. What we need is a middle ground which holds plans accountable, says you can no longer kill and maim people the way United Health Care did in United Health Care versus Corcoran, killing Mrs. Corcoran's baby. But we also need a law that says we are not going to turn the entire system over to the tort lawyers and let the tort lawyers get rich and buy Cadillacs and Lexuses and other cars out of the winnings of this system, driving people away from health care. If American businesses walk away from insuring America's workers, we have not helped the system. We need a reasonable middle ground. We do not need one extreme immunity or another extreme turning the system over to the trial lawyers. Now, I know you are well intended, but the sad truth, contrary to the description of the gentleman from Michigan (Mr. Dingell), is that your bill goes too far. It can never be law. I want a law that protects American people, that gives them health care. Employees working for American businesses need health care, and giving the system to the trial lawyers will not do that, any more than giving the system to the greed of the trial lawyers. Greed by insurance company fails. Greed by trial lawyers fails. We need a middle ground system. We need desperately to pass a bill that strikes a fair balance, that says no, you do not get immunity, you cannot injure and kill people and, no, we are not going to give the whole system over to the trial lawyers. We are going to require people to take reasonable steps, and we are not going to let the trial lawyers ring the bell and get multimillion dollar judgments and have that come out of all of our pockets and have it drive Americans away from health care. Tick through your liability provision; tick through your employer protections. You may have intended them to work, but they do not. In this debate it has been said that the truth has been lost. It is alleged that we have preempted State law. There is no one in this Congress that is more States rights than John Shadegg. We have not preempted State law. We have specifically said that Texas, Georgia, Louisiana, and any other State which passes a law to protect its patients may do so, and that law remains in effect. I implore you to pass the Coburn-Shadegg substitute.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding this time to me, and I want to begin by pointing out the bill. Would the gentleman bring me a copy of the bill? I want to point out that in this debate there is a lot of misinformation. One piece of misinformation that is going around is that this legislation does not protect existing lawsuits authorized by State law. Here is a copy of the Norwood, excuse me, of the Coburn-Shadegg substitute. If we turn to Page 91, any Member can read the language; and it plainly says for Texas, for Georgia, for Louisiana, every State action has been preserved; and it says that not only are State actions already created at State law by State legislative conduct, preserved, but those authorized by future legislation are preserved as well. Now let us turn to some of the debate that I think goes to the issue of Norwood-Dingell. I respect my friend, the gentleman from Georgia (Mr. Norwood). I know his intentions are good in this debate. I believe that he has done a great service by forcing this debate to occur here tonight. But the reality is there are two extreme positions in this debate which is going forward on the floor tonight and will continue tomorrow. Those two extreme positions are represented by the HMOs on the one side who say we must continue to have absolute immunity. On that issue I could not agree more with my friend, the gentleman from Georgia (Mr. Norwood), or my friend, the gentleman from Iowa (Mr. Ganske). A good friend of mine in Arizona said the other day why would we want people who have to get a license to practice medicine to be held liable, but people who do not have to get a license to practice medicine, not to be held liable? So on that issue, on the concept of liability I agree that we must change the system. But if immunity is one extreme, we cannot ever be held liable when we kill Mrs. Corcoran's baby. Mr. Chairman, I have to point out that absolute liability is the other extreme; and my friends on the opposite side, from the Democrat side, my friend, the gentleman from Georgia (Mr. Norwood), when he joined with them embraced the other extreme in this debate, and that is absolute liability, and let us talk about one example of that. In their enthusiasm to deal with this, they swept into their legislation fee-for-service plans. I will tell my colleagues fee-for- service plans regulated at the State level should not be brought into your legislation, but they are. They are already regulated at the State level. The State insurance commissioners cannot handle them, and they can already be sued. But my colleagues sweep them into their regulatory net. That is going too far. Let us talk about lawsuits that can be brought without exhausting the administrative review. My colleagues' bill says the minute somebody becomes dissatisfied with the plan, they can file a lawsuit. It is like simply having to allege that a marriage is irreconcilably broken. All one has to do is decide they want out, decide they want to go to court and they are in court. Well, that is no system. We ought to force patients to at least ask the plan to do the right thing. But my colleagues allow them to sue without any exhaustion of administrative remedies. They just open the door at any time. Let us go beyond that. Lawsuits over anything. Our bill says the Coburn-Shadegg substitute says we allow suits over covered benefits. If they cover this benefit, then they got to provide the benefit, and if they do not provide the benefit, we will allow an appeal; and we will probably allow a lawsuit. But my colleagues allow a lawsuit over anything, not just covered benefits; and what that means is that a panel of doctors or a court can come in after the fact and say, you may not have thought you covered this, but we are going to mandate that you should have covered it. Now think about that from the insurance policies position. They thought they insured this podium, but they have just discovered they insured the table as well, and nobody told them. That is not fair. It is the other extreme of the end of the pendulum. And what about lawsuits without limits? Nobody, nobody in this system does not understand that if we, and I implore, I implore colleagues to look at the costs that they can drive. If we allow too many lawsuits, we will produce a million more uninsured Americans. I urge my colleagues to support the Coburn-Shadegg amendment.

Mr. SHADEGG. Mr. Chairman, I rise in strong support of the Goss- Coburn-Shadegg-Greenwood alternative substitute, but I want to begin by talking about the Norwood-Dingell bill and about what it does. I want to talk about the fact that it simply goes too far. When we look at the legislation, it makes liability too available and it turns the entire system over to the lawyers. I want to focus in my remarks particularly on an issue that concerns the employers in my district. That is, can those employers be held liable when all they do is buy insurance for their employees. The reality is, the sad truth, is that my good friend, the gentleman from Georgia (Mr. Norwood) wrote language which he thought protected employers, but which does not do so. It says quite clearly that if an employer exercises discretionary authority, that employer may be sued. Discretionary authority is a very broad concept. Indeed, the decision not to do something can be construed as the exercise of discretionary authority. I want to contrast that with our efforts to protect employers. We said, no, we should not make employers liable. We ought to make health care plans liable. So how can we do that? Because we want employers to pick a health care coverage plan. So we wrote that employers cannot be sued for picking a health care coverage plan. We want employers to participate on behalf of their employees. We want them to be able to advocate on behalf of their employees. That is the exercise of their discretion. We want to them to be able to make a decision not to advocate an employee in a particular case without being suable for just that decision. Let us look at the language in our substitute. It does not say if one really exercises discretion as an employer one can be sued. It says that one may only be sued if one chooses as an employer to directly participate in the final decision to deny care to a specific participant on a claim for covered benefits. We had written an airtight provision that says one cannot sue employers. We did it precisely because we want employers to pick a plan. We want them to offer health care coverage. We want them to get involved and advocate on behalf of their employees. All of those are the exercise of discretion. Sadly, the Norwood-Dingell bill allows suits by anyone. One does not have to show actual harm or does not have to be sustained by a panel like ours does. One can sue at any time. There is no requirement that one goes through administrative remedies. One can sue over everything. Ours is limited to just covered benefits. One can sue even when the plan does everything right, that is, the plan makes the right decision that is sustained on external appeal. One still can sue under the Norwood-Dingell bill. Sadly, they put in place no limits. I know that doctors across America do not like the fact that they can be sued; and in some States, there is no tort reform. We need tort reform. We do not need lawsuit lotteries against doctors, but we also do not need them against plans driving up costs and driving patients away from the system because they cannot get coverage.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I want to begin by thanking my colleague, the gentleman from Illinois (Mr. Davis). He read a letter from a doctor, a constituent of his, who said that he supported two bills, and I think it is very important to note that of the two numbers he read off, the second number that the doctor wrote him about said he supported H.R. 2824. I think the doctor is right about that. H.R. 2824 is the Coburn- Shadegg bill, the bill that I have cosponsored, and his medical doctor constituent wrote to him to say that he favored either the Norwood- Dingell bill or the Coburn-Shadegg bill. I hope tomorrow the gentleman from Illinois (Mr. Davis) will cross the line and do exactly what that doctor said, support the Coburn-Shadegg bill, because it is a reasonable alternative. I want to talk for a moment about the two extremes in this important health care debate. One extreme says we should do nothing about the faults in the Employee Retirement Income Security Act. One of our colleagues, the gentleman from Mississippi (Mr. Pickering), his father is a district judge. He has written a number of opinions in this area. I want to quote from those. I sent around a series of dear colleagues: ``ERISA abuses people. Courts cry out for reform.'' Here is what Judge Pickering wrote: ``It is indeed an anomaly that an act passed for the security of the employees should be used almost exclusively to defeat their security, and to leave them without remedies for fraud and overreaching.'' Second in this series that I want to talk about, ``ERISA abuses people, courts cry out for reform,'' is a decision written by Judge William Young of the Federal District Court in Boston. He writes, ``It is extremely troubling that in the health insurance context, ERISA has evolved into a shield of immunity which thwarts the legitimate claims of the very people it is designed to protect.'' I want to conclude this series by again reading from another opinion by Judge Pickering in which he says, ``Every single case brought before this court has involved an insurance company using ERISA as a shield to prevent employees from having the legal redress and remedies they would have had under the longstanding State laws existing before the adoption of ERISA.'' Not amending ERISA is an extreme position that will hurt the American people. But I want to point out, there is another extreme position in this debate. That second extreme position is represented by the Norwood-Dingell bill. The Norwood-Dingell bill is extreme in several regards. First and foremost, it does not protect employers from liability. I want plans held liable. I do not want Mrs. Corcoran's baby to be killed and the plan to be able to walk away, as happened in Corcoran versus United States Health Care. But when that plan is held liable, I do not want the employer held liable. The employer just hired the plan. The employer just wanted to offer health care to his or her employees. The Coburn-Shadegg proposal, now joined by the gentleman from Florida (Mr. Goss), the gentleman from Pennsylvania (Mr. Greenwood), and the gentleman from California (Mr. Thomas) protects employers. Employers are not liable unless they directly participate in the final decision. That is the key language. That means, and here is the debate, and Members will hear this from industry, an employer is not liable, cannot be sued, for merely selecting a plan or for merely deciding what coverage ought to be, or for selecting a third party administrator. An employer cannot be held liable for selecting or continuing the maintenance of the plan. They cannot be held liable for modifying or terminating the plan. They cannot be held liable for the design of or coverage or the benefits to be included in the plan. They can only be held liable if they make the final decision to deny care. That is the way it should be. I want to go on to point out that the other extreme position represented by Norwood-Dingell is lawsuits by anyone, as my colleague, the gentleman from California (Mr. Thomas) pointed out, that let the jury decide injury. Our bill says no, you have to have a panel of doctors to decide injury. Lawsuits at any time. They do not want you to have to go through internal and external review. They do not want to have to give the plan a chance to make the right decision. They want to just go to court. Lawsuits over anything. Our legislation says it has to be a covered benefit. Their legislation says you can sue over anything, just get the lawyer and go to court. Their bill says lawsuits even when the plan does everything right. Our legislation says, no, if the plan makes the right decision, you should not be able to throw the book at them in court and drag them and blackmail them into making a settlement. Their position is lawsuits without limits. They want all kinds of unlimited damages. There are over 100 organizations, not trial lawyers, but over 100 organizations endorsing the Goss-Coburn-Shadegg-Greenwood- Thomas proposal. I urge my colleagues to join us in passing this needed legislation.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, let me begin by thanking the chairmen of the Committee on Commerce and the Subcommittee on Health, the gentleman from Virginia (Mr. Bliley) and the gentleman from Florida (Mr. Bilirakis), for making this debate possible, and for their hard work. Secondly, let me set the record straight. On two different occasions, the gentleman from Virginia (Mr. Bliley) and the gentleman from Florida (Mr. Bilirakis) offered to work with the gentleman from Michigan (Mr. Dingell) on access legislation, and their staffs made an offer to work. That offer was not taken up, so the notion that we have not attempted to work with the minority on access legislation is simply wrong. Let me address a second argument made here, which is that these two issues do not belong together. If Members do not believe these two issues belong together, they are not looking at what is happening in health care in America today. If they can say, well, we should not deal with quality of care at the same time we deal with access to care, at a point in American history when we have 44 million people who are uninsured, they do not get what is going on here. If they think we should not deal with affordability at the same time we deal with quality, they do not understand that this is all about health care. If they do not think we should give people choice at the same time that we improve quality, they do not understand markets or how this system works. We have to deal with access, affordability, and choice in order to get quality. So let me set the record straight on that point, as well. The next issue I want to deal with is the question of pay-for. The other side says these tax relief measures, attempting to give Americans who do not have health insurance now a chance to get health insurance, are not paid for, that we cannot afford this bill. Let me tell the Members, we cannot afford not to pass this bill. Thankfully, these people are getting care, but they are getting care in the most expensive form of all. They are getting it in emergency rooms. This bill lets every single American have a better chance to access affordable care. The statement that it does not help an entire group of Americans is flat false. It is wrong. Let me explain why. This bill allows small businesses to pool together through HealthMarts and association health plans and to offer coverage. That includes small businesses who today cannot provide their employees any insurance, forget the tax bracket they are in. To talk about an employee the other side has talked about who does not pay a dime in income tax, but works for an employer that cannot give that employee any health care, this bill makes it possible for that employer to give that employee health care because they can pool together and offer them more affordable coverage. So, so much for the claim that it does not help anybody at all. Then let us talk about access for the insured. This is a USA Today editorial. It appeared earlier this year. It points out that more and more Americans are losing choice. They are offered one plan and one plan only. The minority may think that is great, a single system, take it or leave it; too bad, no choice. If it does not fit you and your family, you are stuck. Too bad. Indeed, they must think it is okay because they have offered nothing to counter that. We have offered something. We have said, we ought to give all Americans, including those lucky enough to have coverage, more choices. Let us talk about how many people do not have choices. Seventy-nine percent of all employers in firms with less than 200 employees offer their employees one choice, only one choice. Almost 80 percent say, you get one choice. That is small business America. You are stuck with the plan you are offered. Our bill would let those employers offer those employees not one but five or six or eight choices. Maybe Members are against choice. I did not think so. But this legislation would help those employees just like it would help the uninsured, regardless of their tax break. By the way, it helps everybody that does pay income taxes. Let us talk about big employers. Even in firms with more than 200 employees, only 46 percent offer their employees two plans to choose from. That is, most, barely over or almost half, say you get one choice, even when you work in a fairly large company, a company with over 200 employees. This bill is about access for the uninsured. It is about affordability for the uninsured, and it is about choice for every single American. The other side says, no, we do not want access. We do not want choice. We are not worried about affordability. It is a poison pill to simply discuss this the same day we talk about quality. It is not a poison pill. The marriage of these two bills does not occur until after they leave the floor. That is the point in time when we ought to be dealing with a comprehensive fix for health care in America. I urge my colleagues to vote for this bill. It is good legislation. Regardless of the obstructionist tactics of the minority, affordability, access, and choice will help health care in America. I urge my colleagues to vote for H.R. 2990, a bill which I cosponsored with the gentleman from Missouri (Mr. Talent) and which I am proud of.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I rise in strong support of this rule; and I want to point out, as one of the original cosponsors with the gentleman from Missouri (Mr. Talent) of the access bill which provides access, affordability, and choice for the American people; that what we are hearing from the other side is that they do not like our provision, but they do not have one of their own. There is a saying around this town, one cannot beat something with nothing. Yet, in the area of access, affordability, and choice, the other side tries to beat something that we Republicans are doing for the uninsured with nothing. My colleagues will not hear them today talk about their bill to help the uninsured get access to care. Mr. Speaker, we will not hear them talk about their bill to bring down the cost of insurance and make it more affordable. We will not hear them talk about their bill to give those who are insured choice. I want to stop at this point and talk about the second issue we will hear a lot about today, which is pay-fors. We did not pay for our bill. We cannot afford this legislation. I want to point out that the opposite is true. We simply cannot afford to go on not paying for, that is, not giving care to the uninsured in America. We are already paying for them. Has everyone lost sight of that in this debate? The uninsured are getting care in emergency rooms all across America. The uninsured are getting care in hospitals all across America, and there is cost shifting to pay for that. So when we hear the argument that, oh, this is not paid for, this will bust the budget, please recognize that that is a ruse. That is not true because we are already paying for their care. Long ago, fortunately, this society decided that those who are in need should not go without care. There are 44 million uninsured Americans in this country. The vast majority of those work for small businesses who cannot afford to offer them coverage. Our legislation, the legislation that the gentleman from Missouri (Mr. Talent) and I wrote, gives those people access to care and it makes it more affordable. It gives them a deduction they do not now have. It allows small businesses to pool together. Do not let nothing beat something. I urge my colleagues to support this very fair rule.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, first, I want to thank my colleagues from Florida, Mr. Goss and Mr. McCollum for bringing this important issue before the House today. I strongly support the amendment to H.R. 1501, Consequences for Juvenile Offenders Act, to increase the number of District Court judges for Arizona, Florida, and Nevada. The need for additional judgeships for the U.S. District Court of Arizona can be best demonstrated by a letter sent from District of Arizona Chief Justice Robert C. Broomfield to the Honorable Proctor Hug, Jr., Chief Justice of the U.S. Court of Appeals for the Ninth Circuit. In this letter, Chief Justice Broomfield mentions that in the same week as the letter was dictated, one of the eight senior judges died and two more were hospitalized, leaving the District of Arizona courts literally paralyzed under an unmanageable caseload with only five justices able to hear cases. This issue is of particular interest to citizens of Arizona due to the dramatic increase in drug-related crimes in our state and the tremendous burden currently facing the sitting judges of the U.S. District Court for Arizona. Over the last several months, Arizona has been plagued with a series of massive drug seizures totaling hundreds of pounds of marijuana, methamphetamine, and cocaine, and millions of dollars in drug money. Most recently, on May 13th, federal and state law enforcement officials in Phoenix confiscated $3 million worth of drugs and seized 9 kilograms of cocaine, 11.25 kilograms of methamphetamine, 636 grams of heroin and 36 kilograms of marijuana, along with illegal firearms and stolen vehicles. All those arrested were indicted in federal district court on charges that include distribution of controlled substances, possession of controlled substances with the intent to distribute, possession of firearms, and money laundering. In February of this year, authorities seized 22 pounds of marijuana and 3 pounds of methamphetamine, and five weapons from a suspected drug dealer in Arizona. Furthermore, Border Patrol Agents assigned to the Tucson Border Sector of the U.S./Mexico border have found in recent months several intricate systems of tunnels used to smuggle illegal drugs into Arizona. The Federal Bureau of Investigation (FBI) has identified 28 drug trafficking groups believed to be major drug trafficking organizations within Arizona. Large quantities of drug money, over $2 million in 1998, have been seized by the Phoenix Police Department Commercial Interdiction Unit. Arizona law enforcement reports that powder and crack cocaine are readily available in the region's metropolitan areas. Arizona is a primary drug shipment corridor for movement of drugs from Mexico to the many areas of the United States. The more sophisticated, modern highway system of metropolitan Phoenix and the convenience of Phoenix's Sky Harbor International Airport make Phoenix an ideal drug transport city to other major cities around the country. In an effort to battle the ever-increasing presence of drugs in our community, Arizona has been designated as a High Intensity Drug Trafficking Area, or ``HIDTA''. This designation has provided law enforcement the ability to commit resources to respond to the drug trafficking problems in Arizona. Law enforcement agencies including the Phoenix and Tucson Police Departments, the Maricopa and Pinal County Sheriff's Departments, and the Arizona Department of Public Safety work in conjunction with the FBI, the Drug Enforcement Administration (DEA), and the U.S. Customs Service to coordinate interdiction efforts. These efforts have resulted in a 429% increase in methamphetamine arrests and a 52% increase in cocaine arrests in the last decade. Since 1992 alone, arrests for possession of dangerous drugs have doubled while arrests for the sale or manufacture of methamphetamine have increased 251%. As evidenced by these figures, attempts to crack down on organized drug trafficking groups have been successful. Unfortunately, the increased attention on law enforcement has not been accompanied with an increased focus on our federal court system and the judges needed to prosecute and convict these drug offenders. Arizona's justice system has continued to grow through the years while the number of judgeship appointments have remained the same. The last time the District of Arizona was granted additional permanent judgeships was 1978--twenty-one years ago! Chief Justice Broomfield has cited several factors to justify the need for an increase in permanent judgeships, including: The large increase in criminal cases filed is permanent in nature. There has been an increase of 764 permanent federal law enforcement officers in Arizona, leading to a significant increase in caseloads and filings. Since 1994 Arizona has added an additional 600 new border patrol agents which also have made a significant increase in caseloads and filings. The U.S. Attorney's Office in Arizona (which contributes a major portion of the District Court caseload) continues to expand. Since 1978 the U.S. Attorney's Office has grown from 30 attorneys to 103, an increase of 243%. That office is now the 13th largest among the 94 districts; yet with the current complement of 8 judges, the Arizona District Court ranks 29th. There has been a substantial population shift to the West and the Southwest in the last several decades. For example, the City of Phoenix is now the sixth largest city in the country, having grown from 106,818 in 1950 to 1,205,285 in 1997. The District of Arizona criminal felony filings have increased by 10 percent since 1993. Currently, Arizona is ranked third in the nation for criminal felony filings. These filings range from possession of drugs with the intent to sell to violent criminal acts such as assault with a deadly weapon, and murder. Along with the increase of criminal felony filings District of Arizona judges are burdened with a sharp increase in the number of cases. Each judge currently assigned to the District of Arizona has a caseload of roughly 834 cases, the fourth highest among the nation's 94 districts. Arizona is a state which is growing significantly and it does not have the judicial system to keep up with its growth. Without a strong judicial system we will continue to have the unbalance that our judges are currently experiencing today. For these reasons, I believe the three additional judgeships for the District of Arizona created by Mr. Goss's amendment to H.R. 1501 are desperately needed to effectively address the abundant caseload, and more importantly the high number of criminal felony filings in Arizona.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, one, I am happy to join with the gentleman on his amendment in ESEA reform which is coming later this year. Number two, I offered such an amendment in the Committee on Rules and it was rejected but, number three, I think the flaw in the gentleman's logic is the flaw in the logic of the gentleman from California (Mr. Miller) when he argued the language says ``may discipline,'' not ``must kick out.'' May discipline; not, must kick out. It does not say they must be kicked out. It says they may be disciplined.