Date: 2005-07-26
Speaker: VAN HOLLEN (democrat)
Chamber: H

Mr. Speaker. I thank the gentleman from New Jersey for his leadership on this. This is a bad bill. Mr. Speaker. for many reasons. I want to focus on one of them. which is that this bill will strip away the consumer protections and the patient protections that exist under State law for our constituents today. I understand.that we have 50 States. and in those 50 States many of them have different mandates for what -has to be covered and what does not have to be covered. and there is some sense when you are talking about organizations operating across State lines that you would streamline that effort. That is exactly what the gentleman from Massachusetts and I tried to do when we took an amendment the other day to the Rules Committee. We said. let us look at six patients rights that have been agreed to on a bipartisan basis by this Congress in previous legislation and which are overwhelmingly agreed to in our States. and let us say with respect to those six rights. you cant take that right away from one of our constituents. one. of our patients. one of our consumers if you are an associated health plan. What happened to that amendment? We did not even get to hear it or vote on it in this House. What are we afraid of? What were those six provisions .that we wanted to make sure all our constituents. all our consumers. wete protected by? The right to an independent external review of coverage decisions. Fortythree States have this rule already. It says if you disagree with your insurance company as to whether or not you are covered. let us not ask the insurance company who is right and who is wrong. let us have an independent individual who can make that decision. Does that make sense? Most .of our constituents think they will have that right. If you pass this legislation and if you are in an AHP. you are not going to.get it. Second. direct access to obstetric. gynecological. or pediatric services. You do not have to wait in line before you take your child to see the pediatrician. Third. imposition of prudent layperson decisionmaking standards. If you show up at the hospital. and you have a good faith reason for thinking you are sick. and it turns out you did not have a heart attack. but you went thinking you had one and you had good reason to think -so. your insurance company cannot deny you coverage for that visit. You do not have to be the doctor. That is why we have doctors. Use of drug formularies. access to hospital emergency room treatment. 42 States have this requirement. and making sure that we do not restrict the ability of our doctors to give us their opinions. to make sure that those States where they say you cannot have a gag rule. where your physician can tell you. the patient. what he or she thinks is in your best medical interest. they cannot be punished by the insurance company for telling you the truth. These are commonsense provisions. six commonsense provisions. That is what our amendment would have done. It would have made this piece of legislation stronger and protected our constituents. What happened? We did not even allow a vote on that. I would just like to quote from 42 State attorneys general. Republicans and Democrats. who say. "Consumers rightfully expect their States to protect them from fraud and abuse. Elimination of the State role and replace-. ment with weak Federal oversight is a bad deal for small businesses and for consumers." Those are State attorneys general. Republican and Democrat. who. like us. are trying to look out for the consumer interest. Do not pass this bill. If you do. you are going to have a lot of explaining to do to your constituents when they are denied by their insurance companies coverage that they thought they rightfully had.