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S. HRG. 113–361 

JUSTICE DENIED: RULES DELAYED ON AUTO 

SAFETY AND MENTAL HEALTH 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT, 

FEDERAL RIGHTS AND AGENCY ACTION 

OF THE

COMMITTEE ON THE JUDICIARY 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

NOVEMBER 7, 2013 

Serial No. J–113–38 

Printed for the use of the Committee on the Judiciary 

( 
(II) 

COMMITTEE ON THE JUDICIARY 

PATRICK J. LEAHY, Vermont, Chairman 

DIANNE FEINSTEIN, California 

CHUCK SCHUMER, New York 

DICK DURBIN, Illinois 

SHELDON WHITEHOUSE, Rhode Island 

AMY KLOBUCHAR, Minnesota 

AL FRANKEN, Minnesota 

CHRISTOPHER A. COONS, Delaware 

RICHARD BLUMENTHAL, Connecticut 

MAZIE HIRONO, Hawaii 

CHUCK GRASSLEY, Iowa, Ranking Member 

ORRIN G. HATCH, Utah 

JEFF SESSIONS, Alabama 

LINDSEY GRAHAM, South Carolina 

JOHN CORNYN, Texas 

MICHAEL S. LEE, Utah 

TED CRUZ, Texas 

JEFF FLAKE, Arizona 

BRUCE A. COHEN, Chief Counsel and Staff Director 

KOLAN DAVIS, Republican Chief Counsel and Staff Director 

SUBCOMMITTEE ON OVERSIGHT, FEDERAL RIGHTS AND AGENCY ACTION

RICHARD BLUMENTHAL, Connecticut Chairman 

PATRICK J. LEAHY, Vermont 

AMY KLOBUCHAR, Minnesota 

ORRIN G. HATCH, Utah, Ranking Member 

JEFF FLAKE, Arizona 

SAMUEL SIMON, Senior Counsel 

THOMAS JIPPING, Republican Chief Counsel 
(III) 

C O N T E N T S 

STATEMENTS OF COMMITTEE MEMBERS 

Page 

Blumenthal, Hon. Richard, a U.S. Senator from the State of Connecticut ........ 1 

prepared statement .......................................................................................... 34 

Hatch, Hon. Orrin G., a U.S. Senator from the State of Utah ............................ 7 

WITNESSES 

Witness List ............................................................................................................. 33 

Kennedy, Hon. Patrick J., a Former Representative in Congress from the 

State of Rhode Island, and Founder, The Kennedy Forum, Brigantine, 

New Jersey ........................................................................................................... 4 

prepared statement .......................................................................................... 38 

Morelli, Cathy, Southington, Connecticut ............................................................. 9 

prepared statement .......................................................................................... 51 

McGarity, Thomas O., Joe R. and Teresa Lozano Long Endowed Chair in 

Administrative Law, University of Texas School of Law, Austin, Texas ........ 20 

prepared statement .......................................................................................... 53 

Ditlow, Clarence M., Executive Director, Center for Auto Safety, Washington, 

DC .......................................................................................................................... 22

prepared statement .......................................................................................... 67 

Coglianese, Cary, Edward B. Shils Professor of Law, and Director, Penn 

Program on Regulation, University of Pennsylvania, Philadelphia, Pennsylvania ...................................................................................................................... 24 

prepared statement .......................................................................................... 71 

QUESTIONS 

Questions submitted by Senator Whitehouse for Thomas McGarity .................. 92 

QUESTIONS AND ANSWERS 

Responses of Thomas McGarity to questions submitted by Senator 

Whitehouse ........................................................................................................... 93 

MISCELLANEOUS SUBMISSIONS FOR THE RECORD 

Cohen, Edward B., Vice President, Government & Industry Relations, Honda 

North America, Inc., November 8, 2013, letter .................................................. 96 

Ellig, Jerry, Senior Research Fellow, Mercatus Center at George Mason University, ‘‘Regulatory Rush Job Deprives Many of Health Insurance Plans 

They Liked’’, October 31, 2013, The Hill, article ............................................... 97 

Gillan, Jacqueline, President, Advocates for Highway and Auto Safety; et 

al., November 6, 2013, letter ............................................................................... 99 

ADDITIONAL SUBMISSIONS FOR THE RECORD 

Submissions for the record not printed due to voluminous nature, previously 

printed by an agency of the Federal Government or other criteria determined by the Committee: 

‘‘NHTSA Vehicle Safety Priority Plan’’ Available at: http://www.nhtsa.gov/ 

Research 

(1) 

JUSTICE DENIED: RULES DELAYED ON AUTO 

SAFETY AND MENTAL HEALTH 

THURSDAY, NOVEMBER 7, 2013 

U.S. SENATE, 

SUBCOMMITTEE ON OVERSIGHT, FEDERAL

RIGHTS, AND AGENCY ACTION, 

COMMITTEE ON THE JUDICIARY, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 1:34 p.m., in Room 

SD–226, Dirksen Senate Office Building, Hon. Richard Blumenthal, 

Chairman of the Subcommittee, presiding. 

Present: Senators Blumenthal, Whitehouse, Klobuchar, Franken, 

and Hatch. 

OPENING STATEMENT OF HON. RICHARD BLUMENTHAL, A U.S. 

SENATOR FROM THE STATE OF CONNECTICUT 

Chairman BLUMENTHAL. We will be joined shortly, I am told, by 

Senator Hatch, the Ranking Member, and as sometimes happens, 

we are going to be interrupted by a vote at 1:45. That is what has 

been scheduled. Then we will take a brief break and return to this 

very, very important hearing, ‘‘Justice Denied: Rules Delayed in 

Auto Safety and Mental Health.’’ And as some of you may know, 

this hearing is a continuing effort to expose the costs and damage 

done by regulations that are delayed and thereby cause justice to 

be denied. 

When elected officials talk about regulation, the stakes can be 

tremendously high even if the public does not always understand 

and even may not be aware of what the consequences are. Regulatory agencies have authority to act through official rulemaking 

and the notice and comment process created in 1946 through the 

Rules of Administrative Procedure, but they should do so openly 

and transparently, and they should be held accountable for meeting 

deadlines for those rules. Without the rules, very often the law is 

simply dead letter. Regulations are essential to making laws enforceable, and that is really why we are here, because too many 

laws have been made essentially less effective or even unenforceable as a result of delays or non-issuance of such regulations. 

In the case of mental health parity, the cost has been clarity and 

certainty. Congress passed the Mental Health Parity and Addiction 

Equity Act in 2008. Congressman Kennedy and Senator Ted Kennedy were instrumental in its passage. They have led the Nation 

in appreciating and acting on the importance of treating as well as 

diagnosing mental health issues. 
2 

Nothing I say can really do justice to the work that they have 

done, along with others, and I want to applaud the Ranking Member, Senator Hatch, who was an original cosponsor of that legislation and is a champion in this fight. And he knows personally how 

grateful many people are to his leadership and to others who have 

worked on this issue. I have done so as a State official, as a State 

Attorney General, and very proudly with a number of my colleagues who have been State officials. 

The Act required that implementing agencies write a rule within 

a year. Pretty simple. Two years later—2 years after the Act, 1 

year after the statutory deadline—the agencies released an interim 

final rule. But the rule essentially left a lot of questions unanswered. Even worse, it left the industry wondering whether to 

change its policies or to wait until a final rule brought certainty 

and a clear path forward. And the regulators also hesitated to 

change rules, leaving the industry essentially free to delay compliance with the law. 

Five years after the Act was passed, this promise remains 

unfulfilled. I am told that issuance of final rules is imminent, 5 

years after the Act was passed, 4 years after the statutory deadline, but the costs have been tremendous. 

In mental health, uncertainty kills. If an individual poses a 

threat to himself or others, he cannot be told he will get the care 

he needs as soon as his insurance company decides the meaning of 

‘‘parity.’’ He cannot win access to needed care only after resorting 

to the courts or to a long administrative process. In a very specific, 

concrete, practical way, justice delayed is justice denied. And that 

fact is particularly true of veterans who need mental health care. 

This issue is particularly pertinent at this point in our history because of the large number of veterans who will be coming from the 

wars that they have fought, combat that has exacted a toll on their 

mental health through post-traumatic stress and traumatic brain 

injury. They need this treatment for their invisible wounds. And as 

we approach Veterans Day, we should be especially mindful about 

the searing, destructive impact of this delay on our veterans. 

In the auto safety realm, the National Highway Traffic Safety 

Administration, known as NHTSA, struggled early in its history to 

release rules in a timely fashion. The result was twofold. On the 

one hand, important NHTSA rules have been delayed even when 

Congress has expressly demanded them. One good example is the 

rear visibility rule. We held a hearing that dealt in part with it last 

time, and it was discussed at that hearing as a prime example of 

rule delay meaning justice and safety denied. 

On the other hand, NHTSA has had to do by recall what it 

should have been able to do by rule. Clarence Ditlow, one of our 

witnesses, a very distinguished safety expert, will tell the story of 

rules that were suggested to NHTSA by automobile safety advocates but went nowhere, only to arise again when defective automobiles have been removed from the road, not because they were 

bad-looking or because they were the wrong color, but because they 

were unsafe—in fact, defective. 

These are tragic situations for people who are injured or killed 

in a car that never should have been sold in the first place. And 

they are also bad for the car companies. Quite bluntly, their con-
3 

sumers, their customers, want to know exactly what they are getting, and the companies want to know what the law requires of 

them to give those customers. 

When I talk to businessmen, they tell me they make money in 

a heavily regulated industry. They need to know what the rules are 

and have certainty about what those rules will be. The great enemy 

is uncertainty. When the policy is made by adjudication because 

rulemaking is too difficult, these businessmen cannot get the certainty and clarity they need to invest, grow jobs, and grow their 

companies. 

Now, I said at the beginning the story we are telling here should 

be common ground. Both industry and consumers want clear rules. 

Everybody wants certainty. Anybody who has watched a high 

school civics class, if you have not taken one lately, knows that students learn the laws are made by the Congress, they are executed 

by the President and the executive branch, and adjudication takes 

place in the courts. But Congress cannot make laws that are effective if those laws are not accompanied by regulations necessary to 

enforce them. And representatives of both private interests and the 

public interest should want bad behavior to be prevented before it 

occurs as well as punished afterward. 

The problem that we face is to make sure the rules are promulgated and enforced, and enforced effectively, and that is why we 

are here today. 

I want to again thank everyone, particularly Ranking Member 

Hatch, who will join us shortly, if not before the vote, then afterward. And I am now going to ask for the witnesses to be sworn in 

so that we can proceed with your testimony. 

If you would please stand, raise your right hand: Do you affirm 

that the testimony you are about to give before the Committee will 

be the truth, the whole truth, and nothing but the truth, so help 

you God? 

Mr. KENNEDY. I do. 

Ms. MORELLI. I do. 

Chairman BLUMENTHAL. Thank you. Let me introduce the witnesses to the Committee. 

Representative Patrick Kennedy of Rhode Island is the co-founder of One Mind for Research. He has been an active and steadfast 

advocate of not only research but treatment of all neurological and 

psychiatric disorders, and he has been an advocate not only as a 

Member of Congress but afterward, and is the winner of numerous 

awards for the work that he has done in this area. And I know how 

busy you are. We thank you for being here today, Congressman. 

Cathy Morelli works full-time as a casualty claim adjuster. Her 

15-year-old daughter suffers from a mental illness, and she advocates for her and others who have to fight for insurance benefits 

for the treatment of mental illness. She likewise, in Southington, 

Connecticut, where she lives, as well as the State and the Nation, 

has been a very vigorous and effective advocate for treatment of 

mental health issues and better understanding of those issues. 

So we thank you both for being here today, and, Congressman 

Kennedy, if you could please begin. 
4 

STATEMENT OF THE HONORABLE PATRICK J. KENNEDY, A 

FORMER REPRESENTATIVE IN CONGRESS FROM THE STATE 

OF RHODE ISLAND, AND FOUNDER, THE KENNEDY FORUM, 

BRIGANTINE, NEW JERSEY 

Mr. KENNEDY. Thank you, Mr. Chairman, and it is an honor to 

be here with Cathy. It is good to see you again, Cathy. 

Thank you, Mr. Chairman, for your leadership on this issue and 

for calling this hearing. As you pointed out, we have been waiting 

5 years for the final rule on a piece of legislation that my late father, who sat just where you are sitting today, who sat in this 

chamber of the Senate for nearly 50 years, helped me pass. And it 

was the last major piece of legislation that my father and I worked 

on together, and I recall President George W. Bush signing it into 

law, again reaffirming the fact that these are not Republican or 

Democratic issues. Pete Domenici and Jim Ramstad were our able 

cosponsors on that piece of legislation, and it is important for us 

to reflect on that today in a very partisan environment that we live 

in. 

I think it is also important to reflect, as you have stated at the 

outset, that there are huge consequences to this lack of clarification 

and implementation of the final rule—specifically, as you mentioned, Mr. Chairman, our veterans. So when most people think 

about the Mental Health Parity and Addiction Equity Act, they do 

not often think about who those people are that are going to be impacted. Particularly they do not think about it when they think 

about our veterans, who, of course, have suffered what is known as 

the signature wound of the war: traumatic brain injury and posttraumatic stress disorder. 

Frankly, however, most of our veterans will never go to the VA 

for their care. That is because most of our veterans are State guard 

and reservists, like the Connecticut Guard, like the Rhode Island 

Guard. And they will go back to their places of employment. And 

if you cannot see the injury on the outside, then it does not exist. 

But as they go back to work and they are trying to deal with the 

confusion, with the emotional swings, with the impact and the 

symptoms of their signature wound of war, they need to be assured 

by all of us that they are not going to be left behind. 

This is not the job of just an insurance company. This is not the 

job of just the Federal Government. This is not the job of the mental health profession. It is the job of all of us. And the subject of 

this hearing, which is this delay in rulemaking and how that impacts the end result, well, as you know, Mr. Chairman, having 

been a top cop in Connecticut as Attorney General, you need clarity, you need rules in order for those to know what they are going 

to be held accountable to. 

Now, I will tell you that one of the reasons I believe we have had 

a delayed rule is not an unhappy coincidence, and that is, the passage of the ACA. Frankly, the Health Care Affordability Act has 

done more to extend parity than we ever were able to do in our 

parity bill. So I give the administration great credit for taking that 

next step and really taking parity and bringing it across our health 

care system. 

However, as you pointed out, Chairman, the notion that we have 

had to wait this long for clarity means that people have fallen 
5 

through the cracks, and specifically we have seen them fall through 

the cracks by those inscrutable insurance companies who do not always follow the best of what the intentions and what the spirit of 

the law says, but who wait for clarification before they know to do 

the right thing. 

Some insurance companies have gotten it right. Many have gotten it wrong, and the reason is because they felt they could because 

the Federal Government was not there to clarify where their actions would be in violation. 

I just want to conclude, because I know most of the good work 

that this Committee does is in the questions and answers, but let 

me conclude with this: We just had a case in New York that was 

dismissed by a judge under the Mental Health Parity and Addiction Equity Act for two reasons: 

One, the judge said that the plaintiff had to be a consumer, could 

not be someone suing on behalf of a consumer. Now, that has got 

a whole set of implications with it, particularly for our community 

of the mentally ill who have a tough time fighting for their own 

survival and health, let alone having to take a case to court, as 

Cathy did on behalf of her daughter. 

Number two, the court dismissed the case because they said the 

defendant was not the insurance company, and, Mr. Chairman, I 

would think that this would spark a lot of interest in Washington, 

particularly amongst the Chamber of Commerce. They said the defendant had to be the employer themselves; in other words, if 

United or Anthem or any of the insurance companies make a medical necessity determination, decide to impose higher treatment 

limitations or financial limitations to those seeking mental health/ 

substance abuse disorder care, then they can do so now with impunity, according to this judge and their ruling. And the right of recourse now is for employees, not someone who represents them, not 

a doctor or someone who can help them; it is up to the employees 

to bring the case against their own employer. Well, Cathy can 

speak about the role of stigma in this whole issue. You can only 

imagine what it would be like for someone to try to fight for recourse and to know that they have to do it against the person that 

is giving them a job. 

Mr. Chairman, all due respect, my message to this Committee is 

that the final rule is not the final word on this issue. And as you 

pointed out—and I think in large part due to your scheduling this 

hearing—we are going to get a final rule, and I understand it is 

going to be tomorrow. But this is not the final rule. It is the first 

step, because it is going to be the beginning whereby we begin to 

understand how we implement this thing called the Mental Health 

Parity and Addiction Equity Act, which, Mr. Chairman, you and I 

both know when we wrote the law—and Senator Hatch, Chairman 

Hatch, was a big part of this—we were crystal clear about what we 

meant. Parity, equality. If you treat diabetes, whether it is inpatient, outpatient, in-network, out-of-network, pharmacy benefits, 

emergency room services, you must do the same for a diabetic as 

you would an alcoholic as you would an asthmatic. If you treat 

someone with a stroke and you give them, you know, inpatient 

emergency room care and then you give them partial hospitalization, you have got to do that for someone who has had a psychotic 
6 

break and has psychosis, you have got to treat them the same. And 

the services must be the same. 

And what we have not had in the final rule is a description of 

what are the services. We have it in the law, Mr. Chairman. The 

law is very clear: Across all six categories of services there must 

be parity. 

But without the rule, then we have this confusion, and when 

there is a vacuum, Mr. Chairman, you know what happens in a 

vacuum. People do not always behave the way we would like them 

to behave because they do not know where the lines are drawn. 

Hopefully tomorrow the administration will draw some pretty 

bright lines outlawing discrimination, and I will conclude with this. 

Why? Not only for Cathy Morelli’s daughter, not only for people 

who are average Americans who suffer from a substance abuse disorder like I do, or a mental illness like I do, but most importantly, 

for our Nation’s heroes, our veterans, because through no fault of 

their own they came home from war, signature wound was traumatic brain injury and post-traumatic stress. And when they go to 

their insurance company, whether it be Anthem Blue Cross or 

United Optimum, or whatever, guess what? We need to make sure 

that that insurance company does not impose any higher treatment 

limitations, does not impose any of these ‘‘non-quantitative treatment limit’’ kind of barriers, like fail first, as they are doing today 

on the rest of America. I will tell you, Mr. Chairman, the day one 

of our veterans gets denied treatment for their wounds of war, I 

will tell you maybe that is going to be the day that our CEOs in 

America realize that they have a responsibility for what insurance 

company they hire to manage their benefits, and that maybe personally they might be liable, and that is really the decision of a 

judge this last week in New York. So if that is the case, I would 

hope that they are telling their legal counsels right now to get 

ready, because if Cathy has anything to say about it, just like she 

has done so persuasively in your State of Connecticut, Mr. Chairman, we are going to go around the country, and we are going to 

show up in places where there are consumers being denied. And 

just like in the rest of the civil rights movement, we are going to 

stand with others so that they do not have to do this alone and do 

not have to fight for dignity and quality of insurance coverage just 

as if they were to have any other physical health issue. 

Thank you for letting me share. 

[The prepared statement of Mr. Kennedy appears as a submission for the record.] 

Chairman BLUMENTHAL. Thank you very much, Congressman, 

for that very powerful and insightful testimony. 

I am told that a vote has been called. I do not have anyone who 

can take the gavel for me here, so I am going to be gone for just 

a few minutes, and then rush back. Hopefully I will have Senator 

Hatch with me, if I can grab him, but I just want to thank you for 

focusing on veterans who are so often, unfortunately and tragically, 

denied the treatment they deserve. Even with the supposed availability of the VA as a source of treatment, we had in Connecticut 

just within the past week a marine who came back from Afghanistan and tragically took his own life after seeking treatment for 

PTS, and with better treatment maybe he could have been saved. 
7 

Justin Eldridge was, in fact, a brave hero, and I had occasion to 

know him and to try to help him gain treatment. But, unfortunately, that treatment was not as available as it should have been, 

and as a result, the tragedy has consumed him and his family, and 

I thank you for focusing on veterans. Many of them are getting 

treatment, but parity is absolutely necessary. 

Mr. KENNEDY. Well, as you go, Mr. Chairman, let me point out 

that 72 percent of all veterans will never go to the VA in their lifetime. That is a fact most Americans do not realize. They are going 

to get their care through their employer-sponsored health plan. 

That is why this issue is more than just a consumer rights issue. 

It is an issue for our patriots. It is our veterans’ issue. 

Thank you, Mr. Chairman. 

Chairman BLUMENTHAL. That is a very, very important fact. The 

other is that 30 percent of veterans leaving the military today, or 

more, according to the armed forces themselves, suffer from PTS or 

traumatic brain injury. So we are not talking about a scattered few 

here and there. We are talking about a major part of our veteran 

population. 

So I am going to go. I apologize, Ms. Morelli, but our fellow residents of Connecticut will hold me very responsible if I miss this 

vote. Thank you. I will be right back. 

[Recess 1:57 p.m. to 2:14 p.m.] 

Chairman BLUMENTHAL. Thank you very much for your patience. 

We will now return, beginning with—Senator Hatch has an opening statement that he would like to make, and I am very glad that 

he does and that he is here. And so with your indulgence, let us 

proceed with that. Thank you. 

OPENING STATEMENT OF HON. ORRIN G. HATCH, A U.S. 

SENATOR FROM THE STATE OF UTAH 

Senator HATCH. Well, thank you, Mr. Chairman, and I apologize 

for not being here initially. I certainly welcome our witnesses here 

today, especially Patrick, whom I have known for a long time, and 

we are friends. 

I will just make a couple of points for the record so that we can 

hear from the witnesses who have come here today. 

The subject of the first panel is the regulatory delay following enactment of mental health parity legislation in 2008. Now, I cosponsored legislation addressing the issue of mental health parity in the 

107th Congress, the 108th, Congress, and the 110th Congress. 

Those bills were introduced by my friend Pete Domenici of New 

Mexico in the Senate. The Mental Health Parity Act passed the 

Senate by unanimous consent in 2008. One of the witnesses today, 

former Representative Patrick Kennedy, also a friend, introduced 

the legislation to address this issue that was enacted into law in 

October 2008. And so it concerns me greatly that the agencies required by that law to issue final regulations have still not done so. 

The best they could do was to issue interim final regulations, and 

even that was nearly 4 years ago. 

I want to make clear that I view the issue before us as separate 

from how the Affordable Care Act addresses mental health insurance coverage. The Mental Health Parity Act has bipartisan support in 2008. The Affordable Care Act did not in 2010. I do not 
8 

want the ongoing controversies about the Affordable Care Act to 

confuse or distract attention from the issue of mental health parity 

regulations that we are examining here today. 

The Affordable Care Act is, however, connected to this overall 

topic in a different way. At this Subcommittee’s previous hearing 

on August 1, I said that rushing regulations can also have serious 

costs. One of the witnesses of that hearing was from the Mercatus 

Center at George Mason University. Another of their scholars, 

Jerry Ellig, wrote an op-ed published just last week in The Hill 

about how rushing regulations contributed to the widespread and 

growing problem of insurance companies canceling health insurance policies for millions of Americans. I ask consent to put that 

op-ed into the record, Mr. Chairman. 

Chairman BLUMENTHAL. Without objection. 

[The op-ed appears as a submission for the record.] 

Senator HATCH. The second panel today is on auto safety and 

how the National Highway Traffic Safety Administration affects 

traffic accidents or fatalities. I confess that I am not entirely clear 

about how the substance of auto safety regulation fits within the 

Judiciary Committee’s purview. I think we must resist the temptation to think that federal regulators can account for and control everything around us. 

It is my understanding, for example, that more than 90 percent 

of traffic crashes involve human error; more than 10,000 annual 

traffic deaths are caused by drunk drivers; and more than half of 

all those killed in crashes are not wearing seat belts. 

At the same time, this particular agency has been very active 

with what sounds to me like positive results. Just in the last decade, NHTSA has issued hundreds of proposed and final regulatory 

actions. 

It is safe to say that automobiles are one of the most highly regulated consumer products in America today, and while the number 

of licensed drivers has more than doubled and the number of miles 

they drive has more than quadrupled since 1960, NHTSA’s estimate of the rate of traffic deaths per miles driven for the first half 

of this year happens to be the lowest in history. 

Mr. Chairman, we have before us distinguished experts on this 

subject, and I really look forward to hearing what they have to say, 

and I want to congratulate you for holding these hearings. 

Chairman BLUMENTHAL. Thank you, Senator Hatch. And you 

were not here, but I paid tribute to the leadership that you demonstrated in gaining the mental health parity law at the time 

working with Senator Ted Kennedy as well as with Congressman 

Patrick Kennedy, who is a friend of both of us, and we thank you 

for your leadership. 

Senator HATCH. I thank you. Well, Ted got me into lots of problems from time to time, but—— 

[Laughter.] 

Senator HATCH. I think it was all worth it. I will put it that way. 

We did some very, very important things together, and we were 

and still are very dear friends. 

Chairman BLUMENTHAL. And I also want to welcome Senator 

Franken, who has also been a real champion and leader on this 

issue and with this rule. 
9 

I am informed, by the way, Senator Hatch, that the mental 

health parity regulation will be issued tomorrow. Congressman 

Kennedy mentioned it in his opening statement, as did I, and this 

rule has been in the works for too long, but we are glad that it will 

be issued shortly, and it may well be, as Congressman Kennedy 

suggested, that the prospect of this hearing, which was made 

known to the administration, helped to expedite it. But whatever 

the cause, we are glad for the result. 

Ms. Morelli, you have been very, very patient and understanding, 

and please go ahead. We welcome you here, and I am particularly 

admiring and grateful for your courage and your strength as a parent as well as an advocate. Thank you for being here today. 

STATEMENT OF CATHY MORELLI, SOUTHINGTON, 

CONNECTICUT 

Ms. MORELLI. Well, thank you for giving me this opportunity to 

tell my story. 

I am here today to talk about the difficult battle I had with my 

health insurer, Anthem, in my attempt to get my teenage daughter 

the treatment she needed for her mental illness. I was completely 

blindsided by my health insurer’s constant denials for mental 

health treatment that my daughter so desperately needed. It was 

a battle I had never previously experienced whenever I sought coverage for treatment of medical conditions. Unfortunately, I discovered in a very difficult way that coverage for the treatment of a 

mental illness would not be as easily accessible as it is for a medical condition. 

Early in 2012, my then 13-year-old daughter was struggling with 

an eating disorder and began engaging in self-harming behaviors 

and suicidal attempts. Her first inpatient hospitalization began in 

March 2012 due to a suicide attempt and cutting herself. Within 

6 days of this hospitalization, our health insurer denied her continued stay in this hospital advising that they felt she could be managed on an outpatient basis and that the treatment was not medically necessary. The hospital disagreed with my insurer and filed 

an expedited appeal, but my insurer maintained their denial. 

Within a day of being released from that first hospital, she again 

attempted suicide and engaged in serious self-harming behaviors 

that involved cutting so deeply into her thigh that it required sutures to close the wound. She spent the next 14 days in the emergency department, and during her stay there she began her aggression toward people and spent most of her days in restraints and 

under heavy sedation. Within just 6 hours of being released from 

the emergency department, she again attempted suicide and struggled significantly with an eating disorder and spent the next 8 days 

medically admitted to a hospital on a feeding tube. Once she was 

stabilized, she was transferred to Vermont to yet another psychiatric hospital. 

Over the course of just 5 months, she was in and out of numerous psychiatric hospitals with each stay being cut prematurely 

short by my health insurer’s refusal to pay for the treatment that 

every doctor and therapist said she needed. 

I had applied for voluntary services through the Department of 

Children and Families through the State of Connecticut. I did this 
10 

very early on to get help in managing her illness because it was 

very clear to me that my health insurer was not going to pay for 

the treatment she really needed. Every denial was based on my 

health insurer’s contention that inpatient treatment was not medically necessary and that she could be managed on an outpatient 

basis. DCF provided us with intensive in-home psychiatric services, 

known as IICAPS, in between these hospital admissions. She was 

also being seen by an outpatient provider. 

But despite IICAPS’ and the outpatient provider’s best efforts, 

my daughter’s illness continued to spiral out of control; but without 

health insurance to cover the necessary inpatient treatment and 

the inability to pay out of my own pocket, I had no choice but to 

rely on outpatient treatment. 

Things really escalated in June 2012 when my daughter brought 

a knife to school and revealed this along with extensive fresh cuts 

on her body to the staff. She was taken to the hospital and then 

was admitted to yet another psychiatric hospital. This was the 

turning point for my daughter because, despite my health insurer’s 

denial, this hospital would not release her as she was a danger not 

only to herself but to others. 

While inpatient and under the care of professionals who treat 

mental illness, my daughter attempted and nearly succeeded at 

suicide. She was then placed on what is called ‘‘one-to-one supervision,’’ meaning staff was within arm’s reach of her at all hours 

of the day and night. I fail to see how my family could have provided this level of care that my health insurer claimed was possible. I will read an excerpt from a letter addressed personally to 

my 14-year-old daughter for her inpatient stay where she attempted and nearly succeeded at ending her life. This letter is 

dated July 16, 2012. I quote: ‘‘We cannot approve the request for 

hospital admission as of July 16, 2012. The hospital gave us information about you. This did not show that hospital care is medically 

necessary. You have recently been in the psychiatric hospital for 

about 1 month due to behavior problems and trying to hurt yourself. You have had these problems for a long time. You had to go 

into the medical hospital for a few days and now the medical hospital wants you back in the psychiatric program. You had not been 

getting better in any significant way for at least the last 30 days. 

There is no plan to do anything different. It does not seem likely 

that doing the same thing will help you get better. You need treatment that will likely help you get better . . .’’ Interestingly, my insurer paid for only 1 day of the 30 days they speak about in that 

letter. They acknowledge she needs the treatment, but they make 

it very clear they are not going to pay for it. 

So along with DCF and the Office of the Healthcare Advocate, 

who also became involved in my daughter’s case, we applied for 

Husky Health, which is the State-funded insurance plan, and coverage began at some point during her last admission. With the help 

from the State, my daughter was finally able to get the long-term 

treatment that was necessary to stabilize her condition and allow 

her to return home and be managed on an outpatient basis. 

With the help of the OHA, we began appealing the 13 denials 

issued by my health insurer in just those 5 months. At first, we 

went through the insurer’s two-step internal appeal process, but 
11 

the denials were upheld. We then filed external appeals through 

the insurance department, and every single denial issued by my 

health insurer was overturned. But it never had to get to the level 

it did considering the mental health parity laws in place. With a 

lack of regulations, these health insurers will not stop their discriminatory practices toward the treatment of mental illness. 

[The prepared statement of Ms. Morelli appears as a submission 

for the record.] 

Chairman BLUMENTHAL. Thank you, Ms. Morelli. Thank you 

very, very much for that really powerful example of the effect of the 

denial of coverage resulting from the lack of regulation. And you 

have been very objective and factual in your presentation. Let me 

ask you what the effect of those denials was on your family’s emotional state and possibly also on your daughter as she sought to recover from this life-changing illness. 

Ms. MORELLI. It was a very rough time. I often look back and 

wonder how we got through it. I am not really sure I can tell you 

how we did it. Perseverance. We had a lot of support from family, 

her school, the State, DCF, the Office of the Healthcare Advocate 

especially. I think without the resources that our State offers, I 

would never have gotten through it. But there was clearly an emotional toll for me as well as my husband and my other two daughters. At times, her sisters did not want to sleep in their own bed 

at night for fear that their sister would harm them. So it was pretty—it was a pretty rough time. 

Chairman BLUMENTHAL. Thank you. 

Congressman Kennedy, I guess this story is, again, an example 

of why you fought so hard, along with your dad, for a law which 

guarantees better parity, better insurance coverage. And we are 

not here to embarrass any particular insurer. I know the name of 

Ms. Morelli’s insurer. But this kind of intransigence and insensitivity seems all too common. 

Mr. KENNEDY. So the irony is this: This hearing is process equals 

substance. The process you have calculates the answer you are 

going to get. So if the process is not right, you are not going to get 

the right answer. In her case, as in the case with this rule, we do 

not have the right process, and that means for insurance companies, we need public disclosure requirements so that we know when 

someone like Cathy is facing a situation of discrimination. 

By the way, insurance companies need that. You know, for them 

to know when they have crossed the line, they need the same kinds 

of case law much like you would have with the IRS given certain 

situations which describe what is legal, what is illegal. Cathy 

paints the most glaring story of illegality, but, frankly, the real rub 

for the next few years is that gray area, and how do even insurance 

companies know when they are crossing the line? 

What we need from you is to help us bring transparency so that 

we have a better idea—because Cathy mentioned one of the things 

that helped her get through is the Office of Public Advocacy. Well, 

guess what? Who is out there looking at all the Cathy Morelli’s in 

the country and making sure that ERISA-insured plans are not, 

you know, subscribing to a pattern and practice of discrimination 

across State lines—like we do not know, but under the law the 

HHS Secretary has the authority to require from insurance compa-
12 

nies how they make medical necessity decisions, and they also can 

de-identify that data and make it clear who is in violation. I mean, 

this is a process, Mr. Chairman, and I would just encourage you 

to not look at this hearing as, like I said, the end of the final rule 

but really the beginning of this long process. You thought the process of getting a final rule was long. Wait until it takes us the 

time—and the sooner we get at it, Mr. Chairman, is the sooner we 

save lives, not only like Cathy Morelli’s family’s life was saved but 

the veterans that we talked about earlier, as I said, many of whom 

are going to get their insurance through their employer-sponsored 

health insurance. 

So I do not think employers will be very keen on knowing that 

their insurance carrier is denying a legitimate American hero from 

getting treatment for the signature wound of the war. But that is 

going to be the implication, Mr. Chairman, of us not doing what 

you are starting here with this hearing, and that is, implement a 

rule protecting people from discrimination against their brain illness. 

Chairman BLUMENTHAL. Thank you. I am going to defer to my 

colleagues at this point. I really agree strongly that this regulation 

will be a final rule but not the final word, and we need to pursue 

that better word or rule even as we have this one. 

I am going to, with the permission of our Ranking Member, go 

a little bit out of order just to ask Senator Whitehouse of Rhode 

Island, since a former fellow colleague is here, to do his welcome. 

And he would have been here earlier, but as I mentioned to everyone here, we had a vote, and thank you for being here. 

Senator WHITEHOUSE. Thank you, Chairman, and I also thank 

the Ranking Member for his courtesy. I just want to take a moment and welcome my colleague from Rhode Island, Representative 

Patrick Kennedy. It is terrific to have him back here, and it makes 

me very proud to see what a continuing good effect he is having. 

I know this is a passion for him. 

Patrick, we miss you around here, but clearly you are flourishing 

and doing exemplary work. So thank you so much. 

And, Mr. Chairman, let me just thank you and the Ranking 

Member for this hearing. It has been said that the oversight function of Congress is sometimes even to be preferred to its legislating 

function, and I think that without the attention that you both have 

brought to this issue with this hearing, we would not have received 

the news we did today that the rule is finally going to be announced. It was an exemplary effort in legislative oversight by Senator Blumenthal and Senator Hatch, and I am grateful to both of 

you. 

Chairman BLUMENTHAL. Thank you. Thank you, Senator 

Whitehouse. And I thanked Senator Hatch earlier, but I thank him 

again and now defer to him for his questions. 

Senator HATCH. Well, I want to thank you, Mr. Chairman. I 

think you have shown a great deal of interest in this subject matter 

and are moving in an appropriate way—in appropriate ways, I 

should say. 

I also want to thank you, Ms. Morelli, for being here today and 

for your article in the New York Times. You know, as a parent of 

a child with mental illness, you add a very, very important voice 
13 

to these problems and to our understanding of these issues and 

how they affect individuals and families. So your being here today 

is very, very important, and I concur with my dear friend and colleague from Rhode Island in his comments, and also the Chairman 

as well. 

Representative Kennedy—I am going to call you ‘‘Patrick.’’ I have 

known you since you were a little boy. 

[Laughter.] 

Senator HATCH. You have certainly grown much bigger than I 

thought—— 

[Laughter.] 

Senator HATCH. But I cannot thank you enough for the leadership of you and your family and that you continue to exercise and 

provide on this issue as well as other issues, and I am very grateful 

to you. 

In your written testimony, you described how the administration’s continuing failure to issue this final rule creates uncertainty. 

In your experience, how does this delay and the uncertainty it 

causes affect insurers and employers? You have alluded to that already, but how is the private sector responding to this lack of clarity? 

Mr. KENNEDY. Well, as was the case in other laws that were 

passed, it is left to the court system to ultimately interpret the federal law. Well, part of the problem, even with the interpretation of 

the federal law, as we saw with this notable case against an insurance carrier, dismissed last week in New York, was that they did 

not even have the terms who is a plaintiff, who is a defendant. 

Ironically, Mr. Chairman, they say that insurance carriers are not 

the defendants, employers are the defendants. 

So, Mr. Chairman, let me just say that I think for the Chamber 

of Commerce in Washington, D.C., who now represents not only insurer CEOs but every other CEO, they are going to be interested 

in this latest federal judge’s decision, because it now says they cannot just pass the buck and give the Heisman to whoever their benefit manager is in an ERISA-sponsored health plan, where an insurance company acts as the intermediary. They are going to be 

the ultimate arbiter and final person with responsibility. 

So I mention that, Mr. Chairman, because I think these decisions 

that are being made today, in lieu of a failed clarity on a final rule, 

are going to create a lot of not only confusion for families like 

Cathy Morelli’s, but it is going to create a lot of confusion for employers who may want to do the right thing, Mr. Chairman, and 

need that guidance to know when they have crossed the line and 

when they have not. And, you know, I think that is the real challenge for us now, is the oversight process. 

So the process of issuing a final rule was not very pretty. We understand what were some of the implications. Of course, the administration had health care reform to add to this mix, which is putting a lot on the table, so we give them that. But the question now 

is: As Cathy mentioned, is her situation going to be repeated in the 

future? We are going to get the rule tomorrow. The question is: Are 

we going to have it in our ability to ensure that, to the best of our 

ability—granted, it is not going to be perfect—that this situation no 

longer happens? 
14 

What I am saying to you, Mr. Chairman, what you just heard 

echoed by my good friend and colleague from Rhode Island, is that 

this is going to require constant oversight. And to the extent that 

this Committee can help inform the administration as to where 

within their existing authority they have that oversight capacity, 

to require information by insurance companies as to how they 

make medical necessity decisions, my feeling, frankly, is—and I 

know this will be music to Chairman Hatch’s views as a conservative—we do not need to mandate new rules on them. We just need 

them to be more transparent with adhering to the rules that we 

have put before them, because I think the light of day and the public at large is going to keep them honest if they know that if they 

have a deliberate discriminatory practice, they are going to be 

called out on it. 

I do not begrudge them if they make bad decisions that were 

within the margins, provided we have a way of expeditiously correcting those bad decisions. Again, all this comes back to a process, 

Mr. Chairman, and oversight is the key to that process. And that 

oversight can only take place if there is transparency of the situations that allowed for Ms. Morelli’s situation to take place. 

Senator HATCH. In many cases, when Congress enacts a law, a 

single agency or department is responsible for issuing the rules or 

regulations to implement it. Now, this complex area of insurance 

regulation involved multiple agencies and departments at the same 

time. The Department of Health and Human Services, Labor, and 

Treasury are all involved in the rulemaking that we are looking 

forward to today. 

In your opinion, has this involvement by multiple departments 

affected the development of this final rule, or has it contributed to 

its delay? 

Mr. KENNEDY. We have to think in some sense that that kind of 

multiple jurisdiction would contribute to the level of complexity. 

But here is another level of complexity. As I understand, the rules 

can indicate that States have a big responsibility in implementation, so now the question is: Where do States take their call? It 

would be a lot easier, like in civil rights, if we define the parameters on the federal level and not leave it to be squishy amongst 

the 50 States as to whether you are treated in one State versus another. That kind of harkens back to a day where, you know, justice 

depended on geography whether you had different colored skin or 

not. 

Now, in this day and age, we cannot have it where people as 

Americans, as our veterans from our country, are treated one way 

where their signature wounds of war are covered in one State but 

their signature wounds of war, TBI and post-traumatic stress, are 

not covered in another State, Mr. Chairman. 

So I think that for clarity we are going to need to make sure that 

it exists on the federal level so that these States are not having to 

kind of reinterpret what is meant by a rule that delegates a lot of 

this to the States. So I think to answer your question, there was 

complexity. I think there is going to be even more complexity if we 

are not, you know, more vigilant, if you will. 

Senator HATCH. Well, thanks to both of you. I appreciate your 

testimony. 
15 

Chairman BLUMENTHAL. Thank you, Senator Hatch. 

We are fortunate to be joined today by two of my colleagues who 

have been real leaders in this area, as I mentioned earlier, and I 

am going to call on them in the order of their arrival. Senator 

Franken, if you would please proceed. 

Senator FRANKEN. Thank you, Mr. Chairman, for convening this 

very important hearing. Paul Wellstone was a friend of mine, and 

I hold the seat that Paul once held. David Wellstone is not here 

today, but as Patrick well knows, David has been coming to D.C. 

time and time again to fight for these regs to be issued. 

I have focused, been focused from day one, on the implementation of the Mental Health Parity and Addiction Equity Act, really 

from day one, and I have led six Senate letters to the Obama administration since then requesting the timely release of the final 

rules. It is a little too late now for a timely release, but I am very 

happy that we—— 

Mr. KENNEDY. We were glad you were on our side, Senator. 

Senator FRANKEN. Believe me, I was so glad to be on your side 

on this one, and I am relieved that the final rules appear to be 

coming out tomorrow. 

Patrick—I am sorry—Congressman Kennedy, you know, we have 

been through this together. The last time I saw you was at a mental health policy conference at the White House. It was a couple 

days after my grandson was born, and I told you that I had held 

him in my arms after he was born and said, ‘‘No one expects you 

to know anything. There is no pressure on you.’’ And you said, 

‘‘That is not how it goes in my family.’’ 

[Laughter.] 

Mr. KENNEDY. That is right. 

Senator FRANKEN. And you said this, you said, ‘‘They say, ‘You 

are going to file for Congress, and then run for President.’ ’’ 

[Laughter.] 

Senator FRANKEN. So I just have to say that of all the accomplishments of all the members of the Kennedy family, you, sir, 

have been a Profile in Courage. 

Mr. KENNEDY. Thank you. 

Senator FRANKEN. And I want to thank you for that. 

Okay. So now we think these rules are going to be released tomorrow. What do you want to see in them in terms of their scope 

and transparency? 

Mr. KENNEDY. Well, the transparency is what we want to see because we have the authority to require public disclosure of the way 

an insurance company makes medical necessity determinations, 

and we have a way of reporting how Patient X with a mental illness, an eating disorder, and so forth is treated versus Patient Y 

with cardiovascular disease, with a stroke, with diabetes, with 

asthma. And if those patients with asthma and diabetes are treated inpatient and outpatient and in-network and out-of-network and 

in the pharmacy with coverage and with the ER, then guess what? 

The other chronic illness that happens to be above their neck needs 

to be covered, too, and it needs to be covered equally so you have 

a total scope of services. So we cover if diabetes means that you 

lose your sight or your legs, but we do not wait until you have to 

lose your legs to diabetes. We treat it in advance of that. But in 
16 

mental illness, we wait until you need your legs amputated. In 

mental illness, if it were like cancer, we would wait until it was 

State IV cancer before we would pay for it. So—— 

Senator FRANKEN. So what you are looking for are the transparency, the rules and regs regarding transparency. 

Mr. KENNEDY. Because I believe, Senator, that otherwise we are 

going to constantly be trying to litigate this thing to get disclosure 

about an insurance company as to why they made the decision they 

did. They may have a good reason. They just need to be up front 

about it and let the chips fall where they may, because at the end 

of the day, we are all going to have to do something in terms of 

keeping costs down. Frankly, mental health, as most economists 

recognize, is the saver of health care dollars because you think of 

someone with diabetes, if they have untreated alcoholism, you are 

in a real pickle. If you think of someone with heart disease with 

depression, guess what? Your heart disease is going to be in real 

trouble, too. You are four times more likely to have a heart attack. 

The point is that we need integration and we need transparency 

in the way we manage patients so that we can understand whether 

there is an overt discrimination. Now, we get it that the advancement of this science of mental health still needs to go a great deal 

further in its advancement. But we still know enough now to know, 

like in Cathy’s situation, where it is blatant discrimination, and we 

should at least be able to tell that and enforce that. 

Senator FRANKEN. And, Ms. Morelli, I just want to thank you for 

your testimony today. You and I know that one in five children and 

one in four adults faces mental illness, but for families that are 

going through this, they can feel pretty alone, as I imagine you did. 

And your willingness to speak out about your daughter’s experience 

and your experience is just very courageous, and I want to thank 

you. 

You know firsthand, obviously, why it is so important that behavioral health services be covered to the same extent as medical 

and surgical services by insurers. Can you just tell us how you 

think your life would have been different and how your daughter’s 

life would have been different if these regs had been issued and 

that you had gotten the proper treatment then? 

Ms. MORELLI. I can tell you that in between hospital admissions, 

when she was home and we were not able to manage her, and she 

did the extreme cutting and the behavior was so extreme, I can tell 

you my daughter will have less scars—would have less scars had 

she gotten the treatment initially and not done this back and forth 

to the hospital routine that we seemed to do, because that is where 

the significant cutting was happening, was at home, unfortunately, 

because I do not have the ability to childproof my house to a 14- 

year-old child who will even use her braces to cut herself. So—— 

Senator FRANKEN. And what was the effect of that on your other 

children, on your two other daughters? 

Ms. MORELLI. They were absolutely terrified of their sister, 

afraid to go to bed at night for fear that she would harm them, because at one point she had threatened to harm us. So they no 

longer trusted her because they saw what she was capable of. 

Senator FRANKEN. And this has an ongoing toll for your family. 

Ms. MORELLI. It does. 
17 

Senator FRANKEN. I see that I am out of time here, but I again 

want to thank you for your courageous testimony and, Congressman, thank you for yours. 

Mr. KENNEDY. Thank you, Senator Franken, for carrying on your 

late colleague’s work. Senator Paul Wellstone was a hero to all of 

us. 

Senator FRANKEN. And I want to recognize Jim Ramstad, too, 

from Minnesota, who worked with you. 

Mr. KENNEDY. Yes. Thank you. 

Chairman BLUMENTHAL. Thanks, Senator Franken. 

Senator Klobuchar. 

Senator KLOBUCHAR. Thank you very much, and thank you, Congressman Kennedy, for being here and for all your work, as Senator Franken mentioned. I know you were in Minnesota recently. 

Mr. KENNEDY. Yes. 

Senator KLOBUCHAR. And thank you for that. And I know any 

friend of Jim Ramstad’s is a friend of ours, so thank you, and you 

have an incredibly special friendship, that means a lot to everyone 

in our State, so thank you. 

Al already mentioned the work that Paul did on this bill, which 

was incredible, and thank you for helping carry on his torch over 

in the House and getting this done. I was there when that happened, and it took a lot of work on all sides. 

So my questions are more about what has been happening in 

terms of the big picture. You talked in your testimony about the 

problems of the delayed regulatory process, how it goes beyond the 

Mental Health Parity Act, and that it has stalled efforts to end discrimination in multiple other settings. Could you elaborate on that 

and what that means? 

Mr. KENNEDY. Well, if we had had a final rule earlier, we would 

have begun the process of really crystallizing the spirit of the law, 

which is that we do not want unequal treatment. But, of course, 

as you know, we have unequal treatment in a lot of other areas of 

federal insurance: in the VA, in the Department of Defense, in 

Medicare, and in Medicaid. 

So I just say that to give some insurers a little pause that I am 

not just beating up on them today, because, frankly, we are not setting a very good example as a Federal Government, because we do 

not treat mental illness equally to other physical illnesses within 

our own Federal Government. So Medicare does not reimburse it 

the same way. Medicaid does not. There are many, many examples 

of disparity in the availability of treatment and the extent of treatment available to people that is reimbursable by the Federal Government. 

So I would have said that with the final rule, there is a lot more 

work to be done. For Jim Ramstad’s work that he started and Paul 

Wellstone’s, that can continue, but we need to take that next step. 

You cannot literally jump ahead when you do not have the biggest 

step of all, which is laying the framework for equality. Because 

once we do that, now we can do the other things so that the Cathy 

Morelli’s who are senior citizens in Minnesota who are getting denied geriatric psychiatry because it is not treated the same as some 

other specialty service with Medicare, that they are not denied. 
18 

But we cannot even do that until we first get this. So what I am 

saying is this kind of held up everything until now. What I am saying is the dam is going to break tomorrow. I am glad you two are 

here carrying on the great Minnesota tradition, because there is 

going to be a lot of work to really make this a reality in the future. 

Senator KLOBUCHAR. The New York Times article many have 

talked about here quotes an insurance representative suggesting 

that the industry would welcome final rules. I think sometimes 

people do not think about it, but when there is no guidance or unclear guidance, it affects everyone, businesses and health insurers 

as well. Do you want to comment about that? 

Mr. KENNEDY. I think insurance would welcome it. Why? Because they would have clarity that they are playing on the same 

level playing field as everyone else. Even the problem of insurance 

for all was that community rating. It is so that everybody is not 

competing on who can be denied care but is competing on who can 

most effectively treat the illnesses at the most cost-effective way. 

This should not be a game of who can cherry-pick and who can 

deny. And all I would say is that is the real challenge for us going 

forward. And I think insurance companies like that clarity. They 

are in the business of clarity. They need clarity to know how they 

are going to make their decisions, and the clearer that we can be 

with them, I think the more they will welcome it, because now they 

are not going to be at a competitive disadvantage. 

Let us say one insurance company decides, well, we are just 

going to knock it out for Cathy and her family from here on out. 

They cannot be at a competitive disadvantage with their thinking 

that, well, but if my competitor does not do that, maybe I might 

be at a financial loss. 

We need to make it clear that, no, you are all in this together, 

we are all in this together, and it is important for you to do that, 

to get this final rule, be very clear, and the implementation of it 

be very clear. 

I would point to the many reviews that Cathy had to go through 

to get her claim addressed—internal review and external review. 

So, Mr. Chairman, I would also commend to you that you should 

take this up, because this is within your jurisdiction, to oversee 

how, much like the Banking Committee dealt with whether banks 

could self-deal. Right? We had 2008—the irony is that parity 

passed on the banking reform, the TARP legislation. 

Senator KLOBUCHAR. Right. 

Mr. KENNEDY. So what did we put in place to try to fix this problem of these shady investments? Well, we said you cannot behave 

in this way, you cannot self-deal; you know, you cannot have these 

rating agencies be the ones you hired tell you that you are okay. 

Right? So they are all saying, oh, keep doing it, keep doing it, keep 

doing it. Well, of course, everybody knew that it was suspect, but 

why didn’t the rating agencies say, hey, fellows, this is not kosher, 

you have got to stop this? Why? Because they were being paid by 

the banks to tell them what they wanted to hear. 

So here is the point: The insurance industry hires reviewers to 

tell them how they are doing. Now, what reviewer is going to tell 

their employer, hey, fellows, you are really not acting too well, and 

you better scale back that whole process of medical management 
19 

overtly for and oppressively against the mentally ill because it is 

just not according to law? They are going to say, good-bye, we will 

get someone else who can come in and tell us that we are not doing 

such a bad job. 

I would just say, again, Mr. Chairman, it is process equals substance. If you get a good process, you are going to have a better 

chance of getting a better outcome. 

Senator KLOBUCHAR. Ms. Morelli, have you thought through, if 

this law was properly implemented, the rules were in place, how 

that would have made you and your daughter’s life different? 

Ms. MORELLI. Yes, perhaps the first hospital I brought her to 

would have been the only hospital she had to go to and get the 

long-term treatment she needed to stabilize. It would have been a 

huge difference. I mean, it got to the point where I had to send my 

daughter from Connecticut—I had to send her down to Virginia. 

She had been to all the psychiatric hospitals, and I do not know 

why they turned her away, but I am guessing, you know, they were 

not able to help her the first time with Anthem denials, and we 

ended up having to send her down to Virginia for long-term treatment. And, fortunately, the State of Connecticut paid for it. 

Senator KLOBUCHAR. Thank you. 

Chairman BLUMENTHAL. Thank you, Senator Klobuchar. 

I want to again thank both of you for being here today. Congressman Kennedy, I assure you that these regulations will not be the 

last word. We are going to continue to be vigilant, as you have suggested we must be, and make sure that the promise of this landmark historic legislation is fulfilled. I will tell you I join in thanking you for your leadership, but also I can tell you the voice and 

spirit of your father is very much with us—— 

Mr. KENNEDY. Thank you. 

Chairman BLUMENTHAL [continuing]. On this issue, as so many 

others. In this hearing room, in the halls of the Senate, on the 

floor, I continue to hear his voice, and I think that his warrior 

fighting spirit for justice is one of the principles and the reasons 

that I and so many others feel so strongly about this issue. So 

thank you, and thank you, Ms. Morelli, again for your being here, 

but also your insistence as a parent that your child and your family 

be given what it is due. This story really is about justice, fundamentally. parity is about justice. And I very much admire your 

bravery and your strength. So thank you very much for being here, 

and we will proceed to our next panel. 

If I could ask the next panel to please stand so I can administer 

the oath. That is, as you may know, our practice here in the Committee. We are not singling you out for special treatment. Do you 

affirm that the testimony that you are about to give to this Committee is the truth, the whole truth, and nothing but the truth, so 

help you God? 

Mr. MCGARITY. I do. 

Mr. DITLOW. I do. 

Mr. COGLIANESE. I do. 

Chairman BLUMENTHAL. Let me introduce each of the witnesses 

to the Committee. 

Professor McGarity holds the Joe R. and Teresa Lozano Long Endowed Chair in Administrative Law at the University of Texas Law 
20 

School. He has taught environmental law, administrative law, and 

torts at the law school since 1980. Prior to then, prior to this job, 

he taught at the University of Kansas School of Law. Professor 

McGarity has written widely in the areas of environmental law and 

administrative law. He is the immediate past president and member of the Board of Directors of the Center for Progressive Reform, 

and we are very, very privileged to have you here today given your 

extensive knowledge of the administrative law issues that so concern us in this hearing. 

Clarence Ditlow, well known and renowned as executive director 

of the Center for Auto Safety, a consumer group founded by Consumers Union. He directs the Center for Auto Safety to improve 

auto safety, reliability, and he has played a major role in initiating 

major reforms and recalls, and he has testified more than 50 times 

before congressional committees on auto safety, warranties, air pollution, consumer protection, fuel economy, emergency conservation, 

patents, and inventions. I could go on about your abundant expertise, sir, but we appreciate your being here today as well. 

And Professor Cary Coglianese is the Edward B. Shils Professor 

of Law and Political Science at the University of Pennsylvania, 

where he currently also serves at the Penn Program on Regulation, 

and he served as the law school’s Deputy Dean for Academic Affairs. He specializes in the study of regulation and regulatory processes with an emphasis on the empirical evaluation of alternative 

regulation and regulatory strategies. I know that you bring a very, 

very valuable perspective to these hearings today, Professor, and I 

really thank you for being here today. 

I thank all of our witnesses for your patience and indulgence in 

waiting for us to begin this panel. We are a little bit behind, partly 

because of the vote and other factors, but I very much appreciate 

your being here today. 

If we could start with you, Professor McGarity. 

STATEMENT OF THOMAS O. McGARITY, JOE R. AND TERESA 

LOZANO LONG ENDOWED CHAIR IN ADMINISTRATIVE LAW, 

UNIVERSITY OF TEXAS SCHOOL OF LAW, AUSTIN, TEXAS 

Mr. MCGARITY. Thank you, Chairman Blumenthal, Ranking 

Member Hatch. I am very pleased to be here to testify on—— 

Chairman BLUMENTHAL. Are you sure your microphone is on? 

Mr. MCGARITY. Sorry. I am very pleased to be here to testify on 

a broken rulemaking system. 

The authors of the original Administrative Procedure Act envisioned rulemaking as a relatively straightforward process for making agency policy through open procedures that relied heavily on 

agency expertise and invited the public to participate in the policymaking process. 

The APA also provided for judicial review under a lenient arbitrary and capricious test. Informal rulemaking has not, however, 

evolved into the flexible and efficient policymaking tool that its 

supporters envisioned. 

During the 1980s and 1990s, the rulemaking process became increasingly rigid and burdensome as Presidents, courts, and Congress added an assortment of analytical requirements to the simple 

rulemaking model and as evolving judicial doctrines obliged agen-
21 

cies to take great pains to ensure that the technical bases for their 

rules were capable of withstanding judicial scrutiny under what is 

now called the ‘‘hard look’’ doctrine of judicial review. Professor 

Don Elliott referred to this phenomenon in the late 1980s as the 

‘‘ossification’’ of the rulemaking process. 

It is fair to say that the problem has become even worse during 

the 21st century, at least in the case—and I want to limit myself 

perhaps to the case of ‘‘high stakes’’ rulemaking where the outcome 

really matters to the stakeholders, not just to everyday rulemaking 

process of relatively non-consequential rules. 

Along with many other scholars, I am convinced that the rulemaking process is not merely ossified. It is broken. In my written 

testimony, I describe several of the causes of the broken rulemaking model, including the business community’s deregulatory 

agenda, burdensome procedural and analytical requirements imposed by courts and various executive orders, centralized White 

House review, and overly aggressive judicial review. This has had 

unfortunate side effects, including inefficiency in implementation, 

reduced incentives to revise existing rules, reduced incentives to innovate, and an overall inability of agencies to attain their statutory 

goals. 

The ossification of the rulemaking process has also yielded perverse unintended consequences. Agencies committed to fulfilling 

their statutory missions have sought out policymaking vehicles outside of the broken informal rulemaking process. These alternative 

rulemaking tools, however, often lack transparency, provide regulated industries and the public with little notice of the agency’s position on critical issues, and offer few, if any, opportunities for the 

public to participate in the rulemaking process. 

Some agencies have become so frustrated with the hurdles that 

informal rulemaking must overcome that they have attempted to 

make policy on a case-by-case basis through adjudications, directives, and recalls, that sort of thing. 

More troublesome from the standpoint of open government is the 

increasing tendency of agencies to engage in ‘‘nonrule rulemaking’’ 

through less formal policymaking tools. Informal guidance from 

technical manuals, guidance documents, guidelines in general are 

a necessary part of a complex administrative process. But these are 

typically promulgated without the benefit of comments by an interested public. These less formal policymaking vehicles render regulatory agencies much less accountable to the public and pave the 

way to arbitrary decisionmaking. They may also lack sufficient 

gravitas and permanence to allow companies to rely on them in 

making important investment decisions. 

The increase in agency use of ‘‘interim final’’ rules is especially 

worrisome. The agencies typically agree to accept public comment 

on interim final rules and prepare statements of basis and purpose 

for the final rules that are supposed to follow. One serious problem 

with this tool, though, is the fact that the agency need never promulgate a final rule. And when they do promulgate them, they are 

often greatly delayed, as we have seen earlier this afternoon. Interim final rules have a tendency to achieve a permanence that belies the agency’s expressed willingness to consider public comments. 
22 

I mention in my testimony several possible solutions, and all directed toward taking away the incentive to use rulemaking avoidance devices by relieving the agencies of many of the burdensome 

aspects of the existing informal rulemaking process. Among these 

are greater oversight by Congress, which we have talked about this 

afternoon as well; eliminating procedural and analytical mandates 

in statutes; requiring agencies to finalize interim final rules within 

a set period of time, say 3 years; cutting back on White House oversight; a softer judicial look at the substance of rules. 

This Committee is in an ideal position to begin the lengthy process of repairing this broken but extremely valuable rulemaking 

tool. I applaud the members of the Committee for holding these 

hearings, and I welcome your questions. 

[The prepared statement of Mr. McGarity appears as a submission for the record.] 

Chairman BLUMENTHAL. Thank you very much, Professor. 

Mr. Ditlow. 

STATEMENT OF CLARENCE M. DITLOW, EXECUTIVE 

DIRECTOR, CENTER FOR AUTO SAFETY, WASHINGTON, DC 

Mr. DITLOW. Mr. Chairman and members of the Subcommittee, 

thank you for the opportunity to testify on delays in rulemaking at 

NHTSA. The Center for Auto Safety has followed NHTSA for over 

40 years, and I would like to put a little flesh to some of the arguments that have been expressed from academia. 

NHTSA is a wonderful agency. It has a vital mission. If we had 

not had a NHTSA, traffic deaths in this country today would be 

200,000 versus 50,000 when the Safety Act was passed. But, unfortunately, it is woefully underfunded; it does not even have a laboratory to do its own research for rulemaking and enforcement actions. Instead, it has to rent space from Honda, a company that it 

regulates. 

During the first 5 years after its creation, NHTSA issued almost 

50 standards, and in the 40 years since then, it has issued very few 

standards. And with rare exception, the revision of the original 

standards came from congressional mandates. So Congress told 

NHTSA to upgrade the fuel tanks integrity standard, to upgrade 

the airbag standard, to set a standard for head injury, for tire 

standards, for roof crush, for pole tests. And I have put the bills 

in my written testimony where this has been done. 

But when you take a look at the defects and the lack of rules, 

whether it is the Pinto, whether it is Firestone tires, whether it is 

Jeeps today, whether it is sudden acceleration, there is a lack of 

a rule. And because of the lack of a rule, we have defects in the 

real world which lead to recalls. And recalls cost the auto companies a lot of money. They cost consumers a lot of lives. And we 

would have been much better off if we had an effective rule in 

place, and I have a number of examples in my full testimony, and 

I will just go into a couple of them. 

Take a look at tires. The original tire standard was issued in 

1970. It became quickly out of date as we had higher speed travel, 

as we had heavier vehicles. Congress in 1978, after the first Firestone recall, told NHTSA we ought to upgrade the standard. 

NHTSA did not do it, so in 2000, we had the Ford Firestone series 
23 

of recalls, and this time Congress passed the TREAD Act, and it 

mandated that the tire standard be upgraded, and today we have 

a good tire standard. 

Another real simple example is fused circuits. Two of the largest 

recalls ever are ignition switches in Fords and cruise control deactivation switches in Fords, both of which would short out and start 

fires in a vehicle, even if the vehicle was parked, turned off, and 

in the garage at night. And in some instances, a house burned 

down and people died. 

We at the Center for—the Public Interest Research Group had 

petitioned NHTSA to fuse electrical circuits, but they never issued 

that standard. There was a lot of industry opposition. It cost 

money. Well, how much did these recalls cost Ford? How many 

lives were lost? 

Another instance which we take a look at is electronics. In 1975, 

NHTSA commissioned the Department of Commerce to do some 

evaluation of electronics in cars, and Commerce said electronics are 

coming, you need to set standards for electronics in cars. Instead, 

what happened, NHTSA did not issue standards. We had acceleration with Toyota, we had acceleration in other vehicles. Today we 

have dozens of software recalls in vehicles. And what we need is 

a system validity check for software and electronics in cars. This 

is not setting a standard for what kind of electronics you used, but 

make sure that whatever you use goes through a verification test, 

a validity test that shows you have been putting good software and 

good electronics in the vehicles. 

Another, you know, just airbags, the standard—everyone likes 

this cite about NHTSA. There is one single standard that there 

have been 91 final rules in that standard, tweaking this, tweaking 

that, changing course. And today we have airbags that really work 

well, but it took us 40 years to get there, and if we had been there 

in 10 years instead of 40 years, we would have saved a lot more 

lives. 

What I would like to do is suggest that this hearing really provides a unique opportunity to examine the failings of the Motor Vehicle Safety Program at NHTSA in the rulemaking area. And if we 

have a better program, we will have fewer deaths. And we can do 

it, but we just have to decide how to do it, and I will leave the 

Committee with one final example. 

Maybe we need a performance standard with a deadline. When 

I started out in government regulation, I worked on two major 

rules: one was the Clean Air Act, which required catalysts; one was 

the Safety Act, which was going to require airbags. We got catalysts on cars in 5 years to reduce emissions and clean the air. Why 

did we do it? Because Congress set a statutory deadline to reduce 

emissions by 95 percent by 1975. The Safety Act has no performance standard. It just said go out and set standards and consider 

passive restraints. But nothing specific, and we had 30 years of additional delay, which cost us thousands of lives, and if we had had 

a better rulemaking process, we would not have had that delay, 

and we would have saved the lives. 

Thank you. 

[The prepared statement of Mr. Ditlow appears as a submission 

for the record.] 
24 

Chairman BLUMENTHAL. Thank you, Mr. Ditlow. 

Professor. 

STATEMENT OF CARY COGLIANESE, EDWARD B. SHILS PROFESSOR OF LAW, AND DIRECTOR, PENN PROGRAM ON REGULATION, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, 

PENNSYLVANIA 

Mr. COGLIANESE. Chairman Blumenthal, Ranking Member 

Hatch, I very much appreciate the invitation to testify today, and 

I want to thank you both for your valuable public service to our 

Nation. 

The idea that our regulatory system is broken is perhaps one of 

the few ideas that almost everyone agrees with today. Of course, 

that agreement runs out fairly quickly. The ways that different 

people perceive the regulatory system to be broken vary considerably. Some think the system is out of control. Others believe it provides too little control of harmful business conduct. And disagreement obviously also exists over what to do to fix the broken system. 

My testimony today focuses on one widely perceived problem 

with the regulatory system: the ossification of rulemaking. Administrative law scholars point to the National Highway Traffic Safety 

Administration as evidence for ossification, as well as to support 

their belief that its source lies with judicial review. 

Now, my testimony is that the evidentiary basis for this widespread belief disappears on closer scrutiny. This is not to say that 

every rule is adopted as swiftly as everyone would like. Today’s 

hearing obviously shows that that does not happen. Nor is my testimony that rulemaking is always easy to do. I take note of Representative Kennedy’s statement that developing a final rule is ‘‘not 

pretty,’’ in his words. 

But if we are to look at the general policy about the structure 

of our regulatory process and think about creating or modifying 

rules with respect to judicial review or other general standards of 

administrative law, then it is a general account of the rulemaking 

process that we need to focus on. And the conventional story about 

that general account is that NHTSA enjoyed no more than about 

10 good years from the standpoint of using regulations to improve 

the safety of automobiles, and that after the mid-1970s, the agency, 

in the face of some losses in the courts, retreated from rulemaking 

and shifted its efforts instead to issuing recalls on defective cars, 

which is thought to be a weaker strategy for protecting the driving 

public rather than issuing more proactive regulations. 

And the villain in the story, the conventional story, is principally 

the judiciary. A 1972 decision by the Sixth Circuit is often thought 

to be the case that led to the shock to the system and led NHTSA 

to retreat and, in the words of some administrative law scholars, 

to abandon the process of rulemaking. 

My testimony in detail is in my written comments, but let me 

briefly summarize the findings of my research. 

First, NHTSA has not abandoned rulemaking. The 2013 draft report to Congress from the Office of Information and Regulatory Affairs estimates that over the last 10 years NHTSA’s rules have imposed as much as $10 billion in annual costs on the economy as 
25 

well as delivered about $22 billion in annual benefits, or at least 

as much as that. 

Now, it may be that there is still not enough regulation from a 

normative standpoint, but it certainly is not the case that there is 

no rulemaking. Nor should one be misled to think that the number 

of rules issued in NHTSA’s first decade were all that substantial. 

In fact, a 2004 study by NHTSA showed that during the agency’s 

first decade, NHTSA’s rules imposed about $250 in costs on automobiles; whereas, in the 1990s, the rules adopted then imposed 

even greater costs, up to about $760 per car. 

Second point, NHTSA did not shift in the mid-1970s to a strategy 

of recalls. The conventional wisdom is based upon looking at data 

on total recalls, and if one looks at just the recalls initiated by 

NHTSA, you get a much different pattern. 

A third point is that the impact of judicial review in explaining 

the pattern of NHTSA’s rulemaking and recalls has been overstated. First of all, most of NHTSA’s rules are not resulting in litigated court decisions. The agency does win a substantial majority 

of its cases that do reach a decision. And the pattern of rules did 

not drop immediately after the Sixth Circuit decision in 1972. The 

pattern of recalls did not suddenly pick up either, as you would expect from the conventional story. 

Fourth, and finally, other explanations I think offer more plausible alternative accounts of the historical patterns in NHTSA’s 

rules, one being if you look at the overall budget that NHTSA has 

had for operations and research, you find that the pattern in its 

budget tracks fairly closely the pattern in its number of rules. 

Let me just conclude by saying that even though many thoughtful scholars, many of whom are my colleagues and friends who I 

respect, even though they hold fervently to the belief that, as a 

general matter, the threat of judicial review has ossified rulemaking, the well-cited account that we read in the literature is not 

very well supported on further examination. Other studies are beginning to show this with respect to other agencies as well. 

In the end, there may be many problems that lead people to conclude the U.S. regulatory system is broken. There is just no systematic evidence that the ossifying impact of judicial review is one 

of those. 

Thank you. 

[The prepared statement of Mr. Coglianese appears as a submission for the record.] 

Chairman BLUMENTHAL. Thank you. I want to thank all of our 

witnesses, and if there is no objection, I am going to make sure 

that all of your written testimony and the previous panel’s as well 

be included in the record. But thank you for keeping your remarks 

within the 5-minute time limit. 

I am going to defer to Senator Hatch for his questions at this 

point. 

Senator HATCH. Well, thank you, Mr. Chairman. This has been 

a very interesting hearing on what many would think would be a 

boring set of subjects. But they are not to me. 

Dr. Coglianese, let me just start with you and start out with a 

very basic question whether the National Highway Traffic Safety 

Administration, NHTSA, is in the regulatory game at all. In his 
26 

testimony, Professor McGarity says that NHTSA has given up on 

rulemaking and focuses instead on recalls. Do you agree with that? 

Mr. COGLIANESE. No, Senator, I would not agree with that. The 

evidence in the Federal Register is that there are rules still coming 

out of NHTSA, and one sees that both from looking at the regulatory impact analyses that are filed in these rules, that these rules 

deliver substantial benefits to society, and they also impose substantial costs to society. 

NHTSA itself did an ex post evaluation of its regulations in 2004 

and found that these regulations that NHTSA is adopting are saving a lot of lives. So there is no evidence of a systematic abandonment of rulemaking at NHTSA. 

Senator HATCH. Some scholars have written that judicial decisions in the 1970s have led NHTSA to effectively abandon rulemaking. If that were even partially true decades ago, do you think 

that this still has a paralyzing effect on NHTSA today? 

Mr. COGLIANESE. Well, when it comes to judicial review, first of 

all, with a closer look at the evidence, you do not see the dramatic 

shift away from rulemaking that is consistent with a conventional 

account. 

Second, the standard for judicial review, arbitrary and capricious 

standard that was enunciated in that Sixth Circuit decision in 

1972, was basically adopted by the U.S. Supreme Court in the case 

of State Farm in the early 1980s and has been continuing to this 

day. So if it were judicial review that was really ossifying the rulemaking process, it would be striking that NHTSA has been adopting additional rules even though it is doing so under the existing 

standard. 

Senator HATCH. Well, in my opening statement, I noted that 

NHTSA has issued literally hundreds of regulatory actions in just 

the past decade. On its face, does that not seem consistent with the 

accusations that there is so-called ossification, as you have mentioned, in NHTSA rulemaking? Do you agree with that or—— 

Mr. COGLIANESE. Right, I think the evidence is that NHTSA is 

engaging in rulemaking. It is doing so even in the face of the arbitrary capricious test and the prospect of judicial review. 

Senator HATCH. Okay. Professor McGarity, I appreciate all you 

folks testifying here today. It is very important to us. Your written 

testimony states that those being regulated are ‘‘no longer put on 

notice of the standards of conduct that the agency is applying to 

them . . .’’ Now, this makes it sound like actual rulemaking is the 

only way that an agency like NHTSA communicates such standards or regulations. But as I understand it, NHTSA issues what it 

calls a ‘‘Rulemaking and Research Priority Plan,’’ if I have that 

right. 

Now, this document, which appears in the Federal Register, addresses its anticipated rulemaking and research activities based on 

current science and data. 

Now, Mr. Chairman, I ask consent that NHTSA’s Rulemaking 

and Research Priority Plan for 2011–13 be made part of this 

record. 

Chairman BLUMENTHAL. Without objection. 
27 

[The information referred to appears as a submission for the 

record, however, due to the voluminous nature will not be included 

in the printed version of this hearing.] 

Senator HATCH. Now, I do not know how many agencies have a 

regulatory road map like this, but it seems to me this supplements 

the actual rulemaking. Now, doesn’t this prove that NHTSA is, in 

fact, communicating standards of conduct for those being regulated? 

Mr. MCGARITY. My thought on that is that, yes, other agencies 

do the same, maybe not as extensively as NHTSA does, but what 

this—if I am thinking about the document that you are mentioning 

correctly, it puts the regulatees on notice of what rules NHTSA 

plans in the future. What I was alluding to in my testimony is 

when agencies engage in alternatives to rulemaking, they do not do 

this sort of plan when they issue just a guidance document or, for 

that matter, when NHTSA issues a recall, it is not pursuant to 

some preannounced criteria that it applies to this particular thing. 

It’s done on a case-by-case basis. 

NHTSA does not use as many of the informal policy guidance, interpretative rules and that sort of thing as other agencies, and I 

would say that my testimony was aimed more at those sorts of 

things. That it is not something that NHTSA does. 

If I could have a moment, I could respond to Professor 

Coglianese’s point. 

Senator HATCH. Sure. 

Mr. MCGARITY. NHTSA does promulgate lots of rules, but most 

of these, I think, are not the major rules that stakeholders really 

care about. There are lots of minor modifications, as Mr. Ditlow 

pointed out, and I think that sometimes Professor Coglianese and 

I and other scholars talk across each other a little bit, because 

those scholars that talk about the ossification of the rulemaking 

process, we are talking about major important rules, not just dayto-day rules that get promulgated, like pesticide tolerances which 

come out by the hundreds. So that studies that focus on just total 

output are kind of missing the important impact of judicial review—and I do not limit myself just to judicial review—and Presidential review and all these regulatory analysis requirements are 

having on the agencies as they try to implement important rules 

like the ones we heard about earlier today. 

Senator HATCH. Okay. If I could ask one more question, in your 

testimony you say that NHTSA prefers recalls to rulemaking. Now, 

I noted in my opening statement that NHTSA has, in fact, issued 

hundreds of regulatory actions in the last decade; but it also seems 

to me that the increase in recalls over the last decade is at least 

as much due to Congress as it is to NHTSA. The so-called TREAD 

Act, which was enacted in 2000, requires that companies identify 

potential problems and promptly notify NHTSA. As a result, virtually all recalls are voluntary rather than initiated by NHTSA, so 

I am a little confused by your testimony that NHTSA has given up 

on rulemaking in favor of recalls. 

Could you just explain that a little bit more? 

Mr. MCGARITY. Sure. In fact, I think that you are exactly right 

that in recent years a lot of the recalls have been spawned by the 

reports that are made by the companies. In fact, I think that has 
28 

been the case for most of NHTSA’s history, and here we have to 

look a little bit behind the scenes. 

A company does not want to have NHTSA declare a recall and 

tell the world that this automobile is bad. And what they will do 

is when NHTSA has a problem with a car, they go and they talk 

to the company about it and they negotiate about it, and very often 

that results in a negotiated recall initiated by the company but, 

really, if you go beneath the surface of it, initiated by NHTSA who 

came to the company with the problem. 

In more recent years, after the TREAD Act, I think it is true that 

the companies have been coming to NHTSA and initiating the negotiations about what is going to happen to protect the public. But 

I do not exclude those company-initiated recalls from the basic pattern of NHTSA working through recalls as much as or more so 

then through rules. It has not promulgated that many important 

rules that have not been required by Congress. 

So, once again, one of the solutions I suggest is that Congress require more of these rules, as they have, with respect to NHTSA. 

Senator HATCH. Both of you gentlemen have been great. Mr. 

Ditlow, I appreciate personally the work that you do, and I just 

want to compliment you for hanging in there and doing what you 

do. 

Mr. Chairman, I am grateful you have had this hearing. I have 

got to be excused, but I appreciate all three of you being here as 

well as the prior panel. This has been a good hearing. 

Chairman BLUMENTHAL. Thank you, Senator Hatch. 

Senator HATCH. Thank you so much. 

Chairman BLUMENTHAL. Thank you. 

I have some questions, not lengthy, but I want to express my appreciation to you for being here. 

Mr. Ditlow, perhaps you could comment on the comments made 

by Professor Coglianese. I noted in your testimony toward the end 

you cited an oil industry executive telling you at one point that he 

once asked his counterparts in the automobile industry why they 

opposed virtually every NHTSA rule or regulation, no matter how 

big or small, and he told you that their strategy was to focus on 

the little things so they never got to the big things. And I suspect 

that these numbers about rules and regulations or the numbers of 

pages in the Federal Register perhaps are not fully reflective of 

what is happening with rulemaking. And maybe you could just 

comment. 

Mr. DITLOW. That is certainly true and—— 

Chairman BLUMENTHAL. And if you could turn on your microphone. 

Mr. DITLOW. That is certainly true, and what is happening is the 

industry knows that NHTSA has limited resources, and they only 

have so many lawyers to work on so many rules. So if they oppose 

every single rule, no matter how big or how small, then that is one 

less lawyer, one less rulemaking that they may be able to do that 

is important. And taking a look at what has happened recently, 

there have been two really good standards to come out of NHTSA 

in the last 5 years: one is electronic stability control, and one is 

side curtain airbags. And both of those were performance stand-
29 

ards, but they resulted in these systems, and they are saving a lot 

of lives. But it was Congress that mandated that NHTSA do this. 

And so what I would suggest is that the premise that NHTSA 

is not issuing rules is correct. I mean, what is happening is Congress is dictating to NHTSA to issue rules in the face of NHTSA’s 

inaction. And NHTSA’s inaction is in large part due to the amount 

of resistance that comes from the auto industry. 

And we can look at rules getting tied up at OMB. Well, the industry lobbyists are over at OMB opposing that and submitting information on the costs of a new regulation, and it gets delayed. And 

if there was one failing on backup cameras, it was not setting a 

hard and fast deadline. You know, give the industry—give NHTSA 

the ability to make one, maybe two extensions, but not a perpetual 

extension where all they have to do is come to the Congress and 

say we need another year. 

Chairman BLUMENTHAL. I noted particularly your reference to 

the absence of any safety standard for electronic controls and computer processing units in cars, which now have become so reliant 

on electronic devices and controls, and yet there is no safety standard. Perhaps you could talk about the implications. 

Mr. DITLOW. Yes, well, modern cars have 50 to 100 electronic 

processors in them, and there is no standard for these electronic 

processors. And organizations like IEEE have standards where you 

can validate the computer software, the electronic devices themselves, that you can determine how complex they are, what is the 

likelihood that the code will be wrong in them. And NHTSA has 

not set any standard whatsoever in that area. And to the extent 

that they have standards, what they are trying to do is apply mechanical concepts to electronic systems so that if you have a key 

fob that starts a car, their standard says inserting the code into the 

ignition via the key fob is the same as inserting a key into the 

dash. Well, it is not the same, and the code can be flawed, and 

there is no test of the code. And that is what NHTSA needs to 

focus on, and we have an agency that is under—required to do a 

study for Congress as a result of the legislation that was passed 

in MAP–21. But there is no standard that is forthcoming. We have 

not seen the study yet, and I am afraid that we are headed into 

something like was discussed in the first panel: Where is the regulation? Is the regulation going to be coming? No. We are going to 

get a study. And what is the study going to say? It is going to say 

we need more time. And it is going to be a long time coming before 

we see an electronic standard from this agency. 

Chairman BLUMENTHAL. And the absence of these regulations 

has real-world consequences in imperiling lives and perhaps causing crashes and imperiling people. 

Mr. DITLOW. Absolutely. What we are seeing with the unintended acceleration and the litigation that is arising is that the 

electronics and software experts are coming in, they are examining 

the source code in the Toyotas, and they are finding bugs and 

glitches in it that can cause and did cause sudden acceleration, and 

these cases are now being upheld by a jury. And it is just tragic. 

We should not have—one of our objectives at the Center for Auto 

Safety is to eliminate these causative accidents and eliminate the 

product liability cases, because they are failures in society. You 
30 

have a victim who has been injured, and we need to have fewer victims and better regulations. 

Chairman BLUMENTHAL. Let me ask you, Professor Coglianese, I 

am sure you are familiar with this area: What do you think about 

the need for standards relating to electronic controls and computer 

devices in cars? 

Mr. COGLIANESE. I am not an auto safety engineer so I am not— 

you know, I am not going to opine on that. So I really would like 

to, if I may, just take one moment to reply to Professor McGarity’s 

point earlier, if that would be permitted. 

Chairman BLUMENTHAL. Sure. 

Mr. COGLIANESE. Thank you very much. 

I just wanted to note that the rulemaking that I am talking 

about, that I observe at NHTSA, are not all these little technical 

amendments. Every year the Office of Information and Regulatory 

Affairs files a report to Congress on regulations, and there is a 

table in it, and OIRA puts the agencies that have the most significant rules in it. And out of hundreds and hundreds of agencies for 

the last 20 years, NHTSA has appeared in that report, and the dollar amounts for the benefits are incredible from NHTSA rules. And, 

of course, the costs are very high, too. So there is significant rulemaking that is taking place at NHTSA. 

Thank you. 

Chairman BLUMENTHAL. I am going to give Professor McGarity 

an opportunity to respond, but you would not dispute that, at least 

on its face, there seems to be a need for some regulatory effort in 

regard to the electronic devices and computers that are now more 

and more present in cars. 

Mr. COGLIANESE. Certainly to the extent that those systems are 

part of cars and they could pose safety hazard, a responsible regulator definitely should be looking at them. 

Chairman BLUMENTHAL. And is there any dispute—I would ask 

this of all the panelists—that NHTSA presently has authority to 

issue such regulations or rules? 

Mr. COGLIANESE. I do not have a dispute with that. 

Chairman BLUMENTHAL. Professor McGarity, do you wish to respond? 

Mr. MCGARITY. Just briefly, I would simply say that those huge 

benefits, although I have not looked at it in detail, my guess would 

be are coming from rules that Congress mandated by a deadline so 

as to avoid the ossification problem. So I would make that point, 

that my guess is that most of those, the benefits are attributable 

to major rules that Congress required, which is one of the solutions 

I suggest. 

Chairman BLUMENTHAL. Let me ask all three of you, you have 

been here for the earlier testimony. You heard about this delay in 

the issuance of mental health parity regulations. You have experienced with respect to NHTSA and more generally in terms of the 

regulatory governance area delays and so forth. What is the best 

way to prevent such delays? And who would have standing to challenge an agency that simply fails to comply with a deadline for 

issuance of regulation? We are not talking about disagreements 

with the regulations, challenges to their substantive merit, which 

could be, in effect, questioned by someone aggrieved by them, some-
31 

one subject to the regulations if they were harmed, but simply the 

delay, who has standing to challenge? 

Mr. MCGARITY. Well, to the extent that there is a statutory deadline—I think Professor Coglianese will agree with me—the beneficiaries of the regulation, the erstwhile beneficiaries of the regulation or groups representing those beneficiaries, should be able to 

challenge agency action not taken under the Administrative Procedure Act or sometimes under the individual statutes, to the extent 

that they have standing, which still the test is that they are aggrieved and are arguably within the zone of interest protected by 

the statute. 

Chairman BLUMENTHAL. But the statute in question may or may 

not apply to them, depending on what the regulations provide. And 

since the regulations are not final, it is kind of a Catch–22. I would 

argue that there is standing under a correct and I think legal interpretation of the standing doctrines. But I wonder how common 

those challenges are. Maybe, Professor Coglianese, you have 

some—— 

Mr. COGLIANESE. Well, in areas such as environmental law, 

where many statutes contain very specific deadlines, the deadlines 

are quite frequently not met. But they are not always subjected to 

any judicial challenge. Those who might bring the lawsuits have— 

you know, have resource constraints as well. But the remedy is 

there. 

Of course, once one gets into court after an agency has missed 

a statutory deadline, the ultimate remedy is for the court then to 

impose its own schedule or timetable. You know, obviously the 

court will not be able to grant the remedy of meeting a deadline 

that has already passed. 

I think, though, from the standpoint of overall public policy, the 

question is: Are we getting ultimately enough benefits from delay 

to justify the lost opportunities that we would gain from acting 

sooner? There may be many cases in which delay is valuable and 

needed if it means creating a regulation that will be more effective 

or that could avoid a very counterproductive result. And in the case 

of automobile safety, it seems at least, just as much as a responsible regulator needs to look into some of the problems, a responsible regulator also needs to make sure that their regulations do 

no harm and that they are not going to put in place something that 

in the complex engineering of an automobile creates an additional 

hazard that had not been anticipated. 

Mr. DITLOW. Senator Blumenthal, standing is something that 

really concerns public interest organizations. The Center for Auto 

Safety won a lawsuit against the Department of Transportation on 

fuel economy standards, but we lost it on a rehearing en banc on 

standing. So we won on the merits, but we lost on the issue of 

standing. 

And even in the area of safety, the way the courts have looked 

at standing in recent years gives us qualms about whether or not 

they will restrict the access to the courts for the citizens’ groups 

trying to even enforce a deadline. 

So we would like to see a citizen suit provision put into the Safety Act, just like we have in the Clean Water Act. I mean, that 

would help. 
32 

Chairman BLUMENTHAL. Excellent idea. Let me ask, then, perhaps all of you: How common are challenges based on delays in 

rulemaking? And do they succeed ever? Do you know of any? 

Mr. COGLIANESE. Oh, sure. I mean, there was a major one under 

the Clean Water Act that led—often these lead to settlements because the factual issue is pretty clear. One looks at the calendar 

and one looks at the Federal Register, and there is no need for a 

lot of depositions or such. So they settle out of court. Most of the 

toxic water pollutant regulations were adopted, for example, under 

a decree that was issued as a settlement of a deadline suit. 

Mr. DITLOW. Consumers Union and Public Citizen and some parents are in a challenge in the Second Circuit over the backup camera, failure to issue the backup camera rule. But there is no firm 

deadline, and so they waited 2 years to file that lawsuit. 

I would like to point out one thing in terms of recalls and standards. Some standards, like the backup camera standard, there is 

no—you will not see a recall for failure to install a backup camera. 

But you will see a recall for things like a defective cruise control 

circuit, the lack of a fuse. So I would take what Professor McGarity 

does and refine it just a little bit and say that recalls do, in fact, 

become a substitute for good rules in certain areas, but in other 

areas it is a totally ineffective tool. 

Chairman BLUMENTHAL. Did you have anything to add, Professor 

McGarity? 

Mr. MCGARITY. Only just a slight thing, and that is that Professor Coglianese is right that we have many suits in the environmental area that have resulted in settlements in which the agency 

has established its own deadline. Sometimes it goes back to court 

and asks for an extension of it, but there are many of these. 

There is, however, in the other House a movement afoot to stop 

these settlements from happening, so one needs to be aware of 

those as well. 

Chairman BLUMENTHAL. Thank you. Well, again, I really express 

my gratitude to all of you. You have greatly informed the Committee, and I hope that perhaps we will take some of your ideas 

and implement them in ways that will be helpful to agencies meeting the deadlines that are established by this Congress, but also 

enabling better compliance, swifter promulgation of these rules so 

that the public can benefit from the laws that we make. So I thank 

you very much and adjourn this hearing. 

[Whereupon, at 3:47 p.m., the Subcommittee was adjourned.] 

[Questions and answers and submissions for the record follow.] 
(33) 

A P P E N D I X 

ADDITIONAL MATERIAL SUBMITTED FOR THE RECORD
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PREPARED STATEMENT OF HON. RICHARD BLUMENTHAL
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PREPARED STATEMENT OF HON. PATRICK J. KENNEDY
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PREPARED STATEMENT OF CATHY MORELLI
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PREPARED STATEMENT OF THOMAS O. MCGARITY
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PREPARED STATEMENT OF CLARENCE M. DITLOW
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PREPARED STATEMENT OF CARY COGLIANESE
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QUESTIONS SUBMITTED BY SENATOR WHITEHOUSE FOR THOMAS O. MCGARITY
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RESPONSES OF THOMAS O. MCGARITY TO QUESTIONS SUBMITTED BY SENATOR

WHITEHOUSE
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MISCELLANEOUS SUBMISSIONS FOR THE RECORD
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