Providing for consideration of the bill (H.R. 5) to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system.

Mr. Speaker, pursuant to House Resolution 139, I call up the bill (H.R. 5) to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on H.R. 5, the bill under consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, our Nation is facing a health care crisis driven by uncontrolled litigation. Medical professional liability insurance rates have soared, causing major insurers to either drop coverage or to raise premiums to unaffordable levels. Doctors are being forced to abandon patients and practices or to retire early, particularly in high-risk specialties such as emergency medicine, brain surgery and obstetrics and gynecology. Women are being particularly hard hit, as are low income and rural neighborhoods.

H.R. 5, the HEALTH Act, is modeled after California's highly successful health care litigation reforms enacted in 1975 and known under the acronym MICRA. California's reforms, which are included in the HEALTH Act, include a $250,000 cap on noneconomic damages, limits on the contingency fees lawyers can charge, and authorization for defendants to introduce evidence to prevent double recoveries. The HEALTH Act also includes provisions creating a fair share rule by which damages are allocated fairly in direct proportion to fault, reasonable guidelines on the award of punitive damages, and a safe

harbor for punitive damages for products that meet applicable FDA safety requirements.

It is important to note that nothing in the HEALTH Act limits in any way the award of economic damages from anyone responsible for harm. Economic damages include anything to which a value can be attached, including lost wages, lost services provided, medical costs, the cost of pain-reducing drugs, and lifetime rehabilitation care, and anything else to which a receipt can be attached. Because of this, the reforms in the HEALTH Act still allow for very large, multi-million dollar awards to deserving victims, including homemakers and children, as the experience in California has shown.

Still, the California reforms have been successful. Information provided by the National Association of Insurance Commissioners shows that since 1975, premiums paid in California increased by 167 percent while premiums paid in the rest of the country increased by 505 percent. As Cruz Reynoso, the Democratic Vice Chairman of the U.S. Civil Rights Commission wrote recently in the Los Angeles Times, ``What is obvious about MICRA is that it works and it works well. Our California doctors and hospitals pay significantly less for liability protection today than their counterparts in States without MICRA-type reforms.''

The Congressional Budget Office has concluded that ``under the HEALTH Act, premiums for medical malpractice insurance ultimately would be an average of 25 percent to 30 percent below what they would be under current law.'' If California's legal reforms were implemented nationwide, we could spend billions of dollars more annually on patient care. Reform at the Federal level is necessary because the current crisis is national in scope.

According to a report by the Department of Health and Human Services, ``The cost of these awards for noneconomic damages is paid by all other Americans through higher health care costs, higher health insurance premiums, higher taxes, reduced access to quality care, and threats to quality of care. The system permits a few plaintiffs and their lawyers to impose what is in effect a tax on the rest of the country to reward a very small number of patients.'' Congress must act to let doctors treat patients wherever they are and to reduce health care costs for all Americans.

H.R. 5 will also save the Federal taxpayers billions of dollars. Former Democratic Senator George McGovern has written in the Wall Street Journal, ``Legal fear drives doctors to prescribe medicines and order tests, even invasive procedures, that they feel are unnecessary. Reputable studies estimate that this `defensive medicine' squanders $50 billion a year, enough to provide medical care to millions of uninsured Americans.''

According to the Department of Health and Human Services, ``If reasonable limits were placed on noneconomic damages to reduce defensive medicine, it would reduce the amount of taxpayers' money the Federal Government spends by $25.3-44.3 billion per year.''

Furthermore, despite accusations from the other side of the aisle, this is not a crisis caused by insurance companies. The President of the National Association of Insurance Commissioners wrote last month that ``To date, insurance regulators have not seen evidence that suggests medical malpractice insurers have engaged or are engaging in price fixing, bid rigging, or market allocation. The preliminary evidence points to rising loss costs and defense costs associated with litigation as the principal drivers of medical malpractice prices.''

We all recognize that injured victims should be adequately compensated for their injuries, but too often in this debate we lose sight of the larger health care picture. This country is blessed with the finest health care technology in the world. We are blessed with the finest doctors in the world. People are smuggled into this country for a chance at life and healing, the best chance they have in the world.

The Department of Health and Human Services issued a report recently that included the following amazing statistics. During the last half century, death rates of children and adults up to age 24 were cut in half and infant mortality rates have plummeted 75 percent.

Mortality among adults between the ages of 25 and 64 fell nearly as much and dropped among those 65 years and older by a third. In 2000, Americans enjoyed the longest life expectancy in American history, almost 77 years.

These amazing statistics just did not happen. They happened because America produces the best health care technology and the best doctors to use it. But now there are fewer and fewer doctors to use that miraculous technology or to use that technology where their patients are. We have the best brain-scanning and brain-operation devices in history and fewer and fewer neurosurgeons to use them. Unlimited lawsuits are driving doctors out of the healing profession. They are reversing the clock; and they are making us all less safe, all in the name of unlimited lawsuits and personal injury lawyers' lust for their cut of unlimited awards for unquantifiable damages. But when someone gets sick or is bringing a child into the world and we cannot call a doctor, who will we call, a lawyer?

As a Nation today, we have to choose. Do we want the abstract ability to sue a doctor for unlimited, unquantifiable damages when doing so means that there will be no doctors to treat ourselves and our loved ones in the first place? On behalf of all 287 million Americans, all of us who are patients, let us say yes to reasonable health care litigation management and pass the HEALTH Act.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Smith).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Pennsylvania (Ms. Hart).

Mr. Speaker, I yield 2 minutes to the gentleman from Georgia (Mr. Gingrey).

Mr. Speaker, I yield 2\2/3\ minutes to the gentleman from Virginia (Mr. Forbes).

Mr. Speaker, I yield 2 minutes to the gentleman from Iowa (Mr. King).

Mr. Speaker, I yield 2 minutes to the gentleman from Indiana (Mr. Chocola).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Tennessee (Mrs. Blackburn).

(Mrs. BLACKBURN asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I yield 1 minute to the gentleman from Pennsylvania (Mr. Gerlach).

Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Burgess).

Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Kirk).

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, the gentlewoman from Texas (Ms. Jackson-Lee) displayed a chart that indicated that 61 percent of the malpractice cases were either settled or dropped, and she insinuated that that was for free. It is not for free. It costs money to defend those suits, to go to court, to file answers, to do whatever discovery is necessary in order to convince the plaintiff that they do not have a case, and those costs get folded into the liability premiums that the physicians have to pay.

Who gets off free? It is the plaintiff that gets off free because the plaintiff is on a contingency fee and if there is no recovery then the plaintiff does not have any lawyer fees at all.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself 1 minute.

We have heard an awful lot about the impact on insurance premiums, and I just want to read from the CBO estimate, the cost of this bill. The CBO estimates that under this bill premiums for medical malpractice insurance ultimately would be an average of 25 to 30 percent lower than what they would be under the current law. However, other factors noted above may affect future premiums, possibly obscuring the anticipated effect of the legislation.

The effect of H.R. 5 would vary substantially across States, depending upon the extent to which a State already limits malpractice litigation. There would be almost no effect in malpractice premiums at about one-fifth of the States, while reductions in premiums would be substantially larger than the overall average at about one-third of the States.

What this means is that the reduction in premiums will be much greater in the States where there is a crisis, and what this bill does is that it provides access to medical care in States where high risk specialists are closing their practices because they cannot make enough money to support themselves and to pay their liability insurance premiums.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Stenholm).

(Mr. STENHOLM asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Georgia (Mr. Scott).

Mr. Speaker, I yield 2 minutes to the gentleman from Indiana (Mr. Pence).

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, I think there is a little bit of confusion around about the noneconomic damage limit. There is a specific provision in H.R. 5 that says no provision of this act shall be construed to preempt any State law whether effective before, on, or after the date of enactment of this act that specifies a particular amount of compensatory or punitive damages or the total amount of damages in a health care lawsuit, regardless of whether or not such monetary amount is greater or lesser than that that is provided under this act.

Now, every one of the 50 States is free to adjust the $250,000 limit on noneconomic damages upwards or downwards by enactment of the State legislature. My State limits it at $350,000. This is not touched by the HEALTH Act whatsoever. So if anybody thinks that this act is a straitjacket, the legislature is free to change it.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Connecticut (Mrs. Johnson).

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, I have been listening intently to this debate. Many of my friends on the other side of the aisle apparently have not been listening at all to the debate, and I just want to rebut a couple of their points.

First, they say this will not reduce insurance premiums. They were right in that it will not reduce insurance premiums by law, but the CBO says that overall insurance premiums will be reduced by 25 to 30 percent and more in States where there is a greater problem. That is the market working. That is the economics working on it. But those premiums are not going to be reduced if the current law stays where it is.

Then we have heard time and time again about $250,000 in noneconomic damages. This bill gives each State the right to adjust that amount to a greater or a lesser amount. So the State legislatures can make a determination on whether $250,000 is proper or not. If they fail to do so, then the $250,000 in the HEALTH Act is the law for that State.

Finally, we have heard ``Physician, heal thyself,'' and that a small number of physicians are responsible for the vast majority of malpractice claims. Let me say that the current tort liability system provides a huge disincentive for doctors to talk about problems

amongst themselves and to get the collective benefit of a number of doctors' opinions on how to treat a patient.

There has been a study that asked, ``Generally speaking, how much do you think the fear of liability discourages medical professionals from openly discussing and thinking about ways to reduce medical errors?'' Mr. Speaker, 59 percent of the physicians replied, ``A lot.''

If we pass this law, we will be seeing more collectively doctors' brains put together to deal with difficult cases, to talk about mistakes and make sure they do not happen again. This bill should be passed. I urge an aye vote on the bill.

Mr. Speaker, I yield myself such time as I may consume.

(Mr. HASTINGS of Florida asked and was given permission to revise and extend his remarks.)

Mr. Speaker, let me say to the gentleman from New York (Mr. Reynolds) that the gentleman and I handled this measure last fall when this bill was brought to the floor. It was a bad bill then, and it is a bad bill now. I also want to clear up something about so-called unnecessary lawsuits. There are penalties for lawyers who bring frivolous claims into any courtroom; thus, I theorize that the majority evidently does not understand that particular distinction.

Mr. Speaker, I rise today in strong opposition to this closed rule for H.R. 5. This legislation requires a full and open debate. The closed rule is abhorrent and cowardly. It denies the opportunity for free and fruitful discussion that would uncover all this legislation's deficiencies.

The current Committee on Rules chairman, the gentleman from California (Mr. Dreier), said in 1994 when a Member of the minority, and referring to the Democratic members of the Committee on Rules, ``But we should have a structure which allows Members to participate more than they do now, and that it is again underscoring Lord Acton's very famous line that power corrupts, and absolute power corrupts absolutely. The arrogance of power with which they prevent Members, rank-and-file Democrats and Republicans, from being able to offer amendments, that is what really creates the outrage here.''

That was the gentleman from California (Mr. Dreier), and outrage continues in the minority today. If the majority alleges that Democrats were wrong in utilizing the closed rule when we were in the majority, why not be the bigger party and end the practice? Why the political games, or is it simply more fun to be principled when it is convenient?

There is no question that medical liability insurance rates are out of control. Consequently, fine doctors, as well as other health care providers, often do not properly attend to patients. However, the underlying bill will not relieve doctors of high malpractice insurance premiums. I am focused on giving Americans quality health care, as all of my colleagues are, not increasing profits for the health insurance industry; and there are good proposals to correct the situation. H.R. 5 is not one of them.

Instead of protecting patients, H.R. 5 protects HMOs and big insurance companies. The so-called HEALTH Act of 2003 addresses the health of the health care industry and not that of physicians and patients. H.R. 5 is bad legislation; but like perennial flowers, its contents sprout every Congress, replenishing the coffers of its supporters. HMOs and big health insurers should not receive special treatment. They are not above the law. Nor should they be exempt from new legislation simply because they contributed millions of dollars in the last two election cycles.

H.R. 5 applies to medical malpractice, medical products, nursing homes, and health insurance claims because its supporters' true concern is not the suffering of patients or victims. Instead, H.R. 5 advocates want immunization from the consequences of irresponsible civil behavior.

The top priority in reforming America's health care system should be reducing the shameful number of preventable medical errors that kill nearly 100,000 hospital patients a year.

Wrong-doers must remain accountable. When a stay-at-home mom dies or a child dies or a senior citizen suffers irreparable harm, there is no economic loss because it is impossible to prove damages from loss of income. H.R. 5 takes away compensation for parents who lose children, husbands who lose wives, children who lose parents, and patients who lose limbs, eyesight and other very real losses that are not easily measured in terms of money.

Despite a wide consensus, skyrocketing premiums are not due to bad politics. The malpractice insurance market is having a predicament because of the insurance industry. The other side of the aisle claims that the lure of big wins prompts many to file frivolous lawsuits. But, in fact, victims are already at a disadvantage. Two-thirds of patients who file a claim do not get a dime. About 61 percent of cases are dismissed or dropped, and 32 percent are settled; and too many of them are on the courthouse steps when they could have been settled earlier. Only 7 percent of all cases go to trial.

Patients prevail in only one in five of the cases that are tried. These are pretty staggering odds against the victims.

The American people would know these truths if their Representatives could expose the selective use of data and statistics that the majority uses in supporting H.R. 5. One classic example would be the notion that in California, after 1975, premiums went down. Well, they did not go down until California reformed the insurance laws. It did not go down. It went up progressively for 12 years.

But under today's closed rule, the majority is committing the greatest form of political malpractice. When the majority has finished bullying its members into voting the party line today, the American people will not only be barred from seeking compensation when a doctor transplants an incorrect organ but they will realize that with closed rules as the order of business, they cannot even seek compensation in the People's House.

For example, if this bill were current law, no experienced trial lawyer would take the case of the young Mexican girl who lost her life at Duke University. The case would be complex, obviously, and expensive to put on, there would be no economic damages, and the maximum noneconomic award would be $250,000. H.R. 5 treats the health care insurance businesses as the victims, and that is unacceptable.

The consequences of an injury are highly subjective and affect different people in vastly different ways. Put another way, how much is my arm worth? How much is your leg worth? This one-size-fits-all solution contradicts the

promise of individualized justice and objectifies victims and the uniqueness of their suffering. Different States have different experiences with medical malpractice insurance and insurance remains a largely State-regulated industry. The $250,000 cap that must have been taken out of somebody's cap as a reason for going forward takes away juries' abilities in our States to determine the appropriate level of compensation for people who suffer grievous injuries at the hands of their health care providers. The majority does not trust the people to defend its political contributors.

Al Hunt of the Wall Street Journal quoted a Republican lawyer from Houston as asking, ``Why are juries okay to take a man's life on the criminal side but are not competent to put a dollar value on an innocent victim's life on the civil side?'' That is shameful. H.R. 5 is a health care immunity act that does not benefit physicians and victimizes patients.

When Democrats were in the majority, Republicans complained time after time that closed rules were unfair. On all of the radio infrastructure, we heard closed rules were unfair, unpatriotic and contrary to the goals of the framers. However, in more than 8 years that Republicans have been in the majority, closed rules are preferred and ruling with an iron fist is the practice. I am in strong opposition to this closed rule and the underlying bill.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself 30 seconds.

In response to my good friend and colleague regarding the fairness and openness and the 1 hour of debate, 31 amendments were offered last night in the Committee on Rules and my good friend the gentleman from New York (Mr. Reynolds) and I were there. Not one, not one, was permitted. What is fair about that?

In response to Dr. Weldon's defensive medicine argument, some people claim that billions of dollars are being wasted on so-called defensive medicine. Our own Congressional Budget Office has concluded that the idea of defensive medicine is uncertain and hypothetical. You can find that on page 74 of House Report 108-32.

Mr. Speaker, I yield such time as he may consume to the gentleman from Texas (Mr. Frost), the distinguished ranking member of the Committee on Rules.

(Mr. FROST asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself 10 seconds.

Mr. Speaker, there is a recent study reported in USA Today of medical malpractice insurance that concluded that,

on average, doctors still spend less on malpractice insurance, 3.2 percent of their revenue, than on rent. I offer that for the gentleman from Kentucky (Mr. Fletcher).

Mr. Speaker, I yield 3 minutes to my good friend, the gentleman from Maryland (Mr. Hoyer), the distinguished Democratic whip.

Mr. Speaker, I am pleased to yield 2\1/4\ minutes to my good friend, the gentlewoman from New York (Ms. Slaughter), who is an expert in this area, with a Master's of Public Health.

Mr. Speaker, would the Chair announce the remaining time on both sides, please?

Mr. Speaker, I am pleased and privileged to yield 3 minutes to my good friend, the gentleman from Michigan (Mr. Dingell), the dean of the House, who I think can speak to both substance and process.

(Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I would remind the distinguished chairman, my friend, that we did have 31 amendments last night; none of them have been allowed to come to the floor.

Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Virginia (Mr. Scott), my very good friend.

(Mr. SCOTT of Virginia asked and was given permission to revise and extend his remarks and include extraneous material.)

Mr. Speaker, how much time is remaining on both sides?

Mr. Speaker, I yield 1 minute to my good friend, the gentlewoman from Texas (Ms. Jackson-Lee).

(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Delahunt), who has studied this problem long-standing as an attorney.

Mr. Speaker, I would say to the gentleman from Nevada (Mr. Porter), the gentlewoman from Nevada (Ms. Berkley), who is married to a physician, does not find that H.R. 5 is going to remedy her husband's problem.

Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from California (Mrs. Capps), who is a registered nurse and has seen what we are talking about.

Mr. Speaker, I yield 1 minute to the gentlewoman from Nevada (Ms. Berkley), my friend, who is an attorney married to a physician, who has studied this problem actively and carefully over a period of time, coming from a State with dramatic problems.

(Ms. BERKLEY asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Edwards) and then I will be prepared to close.

Mr. Speaker, I yield myself the remaining time.

Mr. Speaker, if the previous question is defeated, I will offer an amendment to the rule. My amendment will allow the House to consider the Conyers-Dingell substitute to the medical malpractice bill. My amendment will give Members an opportunity to vote on this substitute which, unlike the majority, takes a comprehensive approach to rising medical malpractice insurance premiums. It takes steps to weed out frivolous lawsuits. It requires insurance companies to pass their savings on to health care providers, and it provides targeted assistance to the physicians and communities who need it most.

Let me make it clear that a ``no'' vote on the previous question will not stop consideration of this bill. A ``no'' vote will allow the House to consider and get a vote on the Conyers-Dingell substitute. However, a ``yes'' vote on the previous question will shut out any opportunity for a vote on the substitute. I urge a ``no'' vote on the previous question.

Mr. Speaker, I ask unanimous consent that the text of the amendment and a description be printed in the Record immediately prior to the vote on the previous question, on which I urge a ``no'' vote on the base rule.

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 139 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Florida (Mr. Hastings), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

(Mr. REYNOLDS asked and was given permission to revise and extend his remarks.)

Mr. Speaker, House Resolution 139 is a closed rule providing 2 hours of debate for consideration of H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare Act, more commonly known as the HEALTH Act. The rule waives all points of order against consideration of the bill and provides one motion to recommit with or without instructions.

Mr. Speaker, my home State of New York has been designated by the American Medical Association as one of the 18 crisis States because of the staggering number of physicians that are unable to obtain or afford liability insurance. It is not just physicians that are feeling the crunch; hospitals and other providers have also reached their breaking point.

Take, for example, family-run skilled nursing facilities in my district that have not once had a claim brought against them, yet they have seen their liability insurance rates climb over 200 percent during the past 2 years alone. That is 200 percent in the last 2 years alone.

According to a study conducted by the American Hospital Association and the American Society of Risk Management, one-third of the hospitals experienced an increase of 100 percent or more in liability insurance premiums in 2002. Meanwhile, patients are the ones losing choices, access, and care.

Mr. Speaker, last September I stood on this floor to speak in favor of the HEALTH Act. Since that time, my home community of Erie County, New York, has lost 40 actively practicing physicians. Only 3 months into the current year, they are anticipating a loss of another 20 physicians. If we do not solve the problems facing physicians in this community and so many others across America, who will provide the health care services so vital to all of our constituents?

The fact is that physicians are limiting their patients, moving to States with lower insurance rates, or closing their practices altogether. The fact is that astronomical costs and unpredictability in the legal system are causing this alarming trend.

The effect? Doctors practice defensive medicine to avoid litigation and think twice about openly discussing and reporting possible errors. A study released by the Department of Health and Human Services last week emphasizes that bolstering predictability in the legal system will dramatically reduce the incentives for unnecessary lawsuits. Those who need care will get it faster and more reliably, and those who may need proper redress will get it faster and more reliably.

The HEALTH Act will provide that predictability, while at the same time halting the exodus of providers from the health care industry, stabilizing premiums, limiting astonishing attorney fees, and above all, improving patient care.

Just as important is what HEALTH Act will not do. It will not preempt any existing State laws that limit damages at a specific amount, and it will not establish any new causes of action.

Also, it will not prevent juries from awarding unlimited economic damages. This means that quantifiable lost wages, medical costs, pain- reducing medications, therapy and lifetime rehabilitation can all be recuperated as tangible economic damages. Patients that have been wrongly injured will not be denied access to substantial amounts in economic damages.

The HEALTH Act is modeled after legislation adopted by a Democratic legislature and a Democratic Governor in the State of California nearly 30 years ago. While insurance premiums increased over 500 percent nationwide, California's have risen only a third of that much, by 167 percent.

California's insurance market has stabilized, increasing patient access to care and saving more than $1 billion per year in liability premiums. Equally important, California doctors are not leaving the State.

By following California's lead to place modest limits on unreasonable economic damage awards, an estimated $60 billion to $108 billion could be saved in health care costs each year. The Congressional Budget Office calculated that medical liability insurance premiums would be lowered an average 25 to 30 percent from what they are now under current law. And CBO also predicts that reducing the occurrence of defensive medicine would save anywhere from $25 billion to $44 billion per year of taxpayers' money.

I want to thank the leadership of the Committee on Energy and Commerce and the Committee on the Judiciary for working so expeditiously to bring this important measure back to the floor and focusing our attention on health care, particularly for coupling the HEALTH Act this week with patient safety legislation. Physicians need an environment where they can both share and learn, while at the same time practicing medicine without the fear of burgeoning liability rates and unnecessary lawsuits.

Mr. Speaker, spiraling medical liability insurance rates have hemorrhaged in recent years. Today we have an opportunity to stop the bleeding and maximize healthy patient outcomes. I urge Congress to support this rule and the underlying legislation.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, the debate has begun. We are going to have an hour on this rule. I believe after that we are going to have 2 hours of general debate. It really cuts right down through the center. As I talked about excessive court trial damage driving up the cost of patient health care, I listened to the other side say it is the insurance companies and the doctors that are the cause of so much of this. It will be a good debate. It will be a full hour here on this rule and it will be 2 hours of general debate, and then we are going to have an up or down on the HEALTH Act and we are going to find out whether it is passed and sent to the other body.

But I must say that over 60 percent of the doctors in the United States are insured by insurance companies that are owned and operated by other doctors and which operate primarily for their benefit. The idea that those companies would price-gouge the very physicians who own them, I think, is absurd.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Weldon).

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I have only served under the distinguished chairmanship of Chairman Dreier, but I am always pleased that in each rule that we make there is always a recommit. Looking back at history, one of the people that I think was a distinguished chairman of the Committee on Rules, Joe Moakley, I am not sure he always had a recommit in the legislation. I am not sure that former Speaker Tip O'Neill when he was a member of the Committee on Rules always voted that there would be a recommit. But I do believe that there has been a recommit in here. More importantly, I think it is important that this legislation was thoroughly vetted in two committees, the Committee on Energy and Commerce and the Committee on the Judiciary, and even passed by voice vote in the Committee on the Judiciary. Just weeks ago these same committees once again took testimony and the bill passed through the Committee on Energy and Commerce by voice vote.

The Committee on Rules last night took testimony for over 2 hours and reasonably provided 2 hours of general debate, in addition to the standard motion to recommit, and I believe we will have a full hour on this rule today.

Mr. Speaker, I yield 3 minutes to the gentleman from Kentucky (Mr. Fletcher). The gentleman, a doctor, is an expert in this legislation.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, we are going to continue on the debate of the issue of the day, which is medical liability. I must tell you, while I guess it is important to listen to some of the process, and half of this debate by the leadership of our House is on the process, I am hoping that we can continue to hear the debate that was at least opened by myself and my good friend from Florida who has a different view.

I look at it that we need to helm doctors and patients, and to make sure we can control the costs of malpractice insurance. I have listened to some of the debate on the other side that it is the doctors and insurance companies that are at fault.

It is an important debate. This is a debate that was heard 7 months ago in both the Committee on the Judiciary and the Committee on Energy and Commerce. The Committee on the Judiciary voted by voice vote to put the bill out. Only recently we have had those hearings again in the Committee on Energy and Commerce and the Committee on the Judiciary, and, in a bipartisan fashion, it was passed by a voice vote there.

Last night we took 2 hours of testimony. The Committee on Rules responded with a 2-hour debate, plus what will be a full hour of the resolution, now going forward here on the rule itself.

I look forward to the debate, I look forward to hearing it, and then I look forward to voting up or down on whether we are going to help patients or not.

Mr. Speaker, I yield 2 minutes to the gentlewoman from West Virginia (Mrs. Capito).

Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Keller).

(Mr. KELLER asked and was given permission to revise and extend his remarks, and include extraneous material.)

Mr. Speaker, I yield 3 minutes to the distinguished gentleman from California (Mr. Dreier), the chairman of the Committee on Rules.

(Mr. DREIER asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 2 minutes to the gentlewoman from Ohio (Ms. Pryce), a member of the Committee on Rules and Chair of the Republican Conference.

Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from Georgia (Mr. Linder), a distinguished member of the Committee on Rules.

Mr. Speaker, I yield 45 seconds to the gentleman from Nevada (Mr. Porter).

(Mr. PORTER asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 1 minute to the gentleman from Pennsylvania (Mr. Greenwood), who is an expert on the Committee on Energy and Commerce on this issue.

Mr. Speaker, I yield 30 seconds to the gentleman from California (Mr. Cox).

Mr. Speaker, I yield myself the remaining time.

I hope my colleagues have had the opportunity to read the heart- wrenching testimony presented by Leanne

Dyess earlier this month before the Committee on the Judiciary. I hope their compassion will allow them to consider how it would feel if a similar tragedy befell someone they love simply because doctors had been pushed out of the area; and I hope they can recognize that, today, we have the opportunity to prevent such tragedies from happening to others.

The HEALTH Act is about patients getting the best possible care they can when and where they need it. Dollar signs do not cure people; doctors do. Let us make sure doctors and other providers all across the country remain open for business.

I urge a ``yes'' vote on the rule and the underlying legislation. A ``yes'' vote is a vote for patients.

Mr. Speaker, I yield back the balance of my time, and I move the previous question on the resolution.

Mr. Speaker, there is one word that best describes this closed rule: cowardly. This is a Republican leadership that fears a real debate on this cold hearted proposal that would rob victims of medical malpractice. They fear that too many of their own Members would vote for a democratic bill because it makes sense and would address the problem.

They have decided to dodge a clean vote on a real bill and bury real debate in procedural doubletalk. They have decided to let their Members hide behind parliamentary tricks.

The Republican leadership has shredded any semblance of fairness or open debate. Just last year, for the first time since 1910, this Republican leadership denied the Minority party a motion to recommit. Today, the two most senior members of the House of Representatives, who are also the two Ranking Democrats on the Committees of jurisdiction, are being denied the opportunity to offer the amendment of their choosing.

The Republican leadership's bill doesn't solve the problem of medical malpractice insurance rates skyrocketing. It has no insurance reform at all. Doctors who are being price gouged by insurance companies will not see one cent of savings from this bill.

The simple fact is that draconian caps on damages do not reduce insurance premiums. In a comparison of states that enacted severe tort restrictions in the mid-1980s and those that resisted enacting any tort reform, no correlation was found between tort reform and insurance rates.

Our bill takes away the antitrust exemption for medical malpractice insurance providers that has allowed those providers to collude to jack up rates for doctors.

The Republican leadership's bill does nothing about the deadly problem of medical malpractice that costs victims literally their life and limb. Between 44,000 and 98,000 people die each year because of medical negligence in hospitals and the Republican answer is to take away the rights of surviving family members and accountability for bad apple health care providers.

H.R. 5 does nothing about the fact that 5% of all doctors are responsible for 54% of malpractice claims paid. H.R. 5 does nothing to solve the problem that medical malpractice is the fifth leading cause of death in the country.

Our bill preserves accountability in the health care system.

The Republican leadership's bill does nothing about frivolous lawsuits, only hurts victims. All this bill does is take away compensation from the most seriously injured plaintiffs. These are the victims who have a case that has so much merit that a jury of their peers decides they deserve more than $250,000 in non-economic damages.

Our bill requires an attorney to file a certificate of merit that an action is not frivolous and, if that certificate is false, that attorney can be disbarred.

The Republican bill takes a chain saw to the health care system instead of a scalpel. It is no wonder they fear a fair and honest debate and a clean vote.

I urge Members to:

(1) Vote ``no'' on the Previous Question so that we can make in order a vote on Conyers-Dingell and other worthy Democratic amendments.

(2) If we are not successful in defeating the previous question, vote ``no'' on this one sided, anti-democratic rule.

The material previously referred to by Mr. Hastings of Florida is as follows:

Previous Question for H. Res. 139--Medical Malpractice: H.R. 5--Help Efficient Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003

In the resolution strike ``and (2)'' and insert the

following:

``(2) an amendment in the nature of a substitute consisting

of the text of H.R. 1219 if offered by Representative Conyers

or a designee, which shall be in order without intervention

of any point of order, shall be considered as read, and shall

be separately debatable for 60 minutes equally divided and

controlled by the proponent and an opponent; and (3)''

Conyers/Dingell Democratic Substitute--H.R. 1219, ``The Medical

Malpractice and Insurance Reform Act of 2003''

section-by-section analysis

Scope. The legislation narrowly defines ``medical

malpractice action'' to cover ``licensed physicians and

health professionals'' for only cases involving medical

malpractice. These definitions are intended to include

doctors, hospitals, nurses, and other health professionals

who pay medical malpractice insurance premiums. See, sec.

107(8).

Title I--Reducing frivolous lawsuits

Sec. 101.--Statute of Limitations. This section limits the

amount of time during which a patient can file a medical

malpractice action to the later of three years from the date

of injury or three years from the date the patient discovers

(or through the use of reasonable diligence should have

discovered) the injury. Children under the age of 18 have the

later of three years from their eighteenth birthday or three

years from the date the patient discovers (or through the use

of reasonable diligence should have discovered) the injury.

Sec. 102.--Health Care Specialist Affidavit. This section

requires an affidavit by a qualified specialist before any

medical malpractice action may be filed. A ``Qualified

Specialist'' is a health care professional with knowledge of

the relevant facts of the case, expertise in the specific

area of practice, and board certification in a specialty

relating to the area of practice.

Sec. 103.--Mandatory Sanctions for Frivolous Actions and

Pleadings. This section requires all plaintiff attorneys who

file a medical malpractice action to certify that the case is

meritorious. Attorneys who erroneously file such a

certificate are subject to strict civil penalties. For first

time violators, the court shall require the attorney to pay

costs and attorneys fees or administer other appropriate

sanctions. For second time violators, the court shall also

require the attorney to pay a monetary fine. For third time

violators, the court shall also refer the attorney to the

appropriate State bar association for disciplinary

proceedings.

Sec. 104.--Mandatory Mediation. This section establishes an

alternative dispute resolution (ADR) system for medical

malpractice cases. Participation in mediation shall be in

lieu of any other ADR method required by law or by

contractual arrangements by the parties. A similar approach

is recommended by the Committee for Economic Development

(CED), which suggests that defendants make and victims accept

``early offers.'' The effect of the ``early offer'' program,

according to the CED, is that defendants will reduce the

likelihood of incurring litigation costs, and victims would

obtain fair compensation without the delay, expense or trauma

of litigation.

Sec. 105.--Punitive Damages. This section limits the

circumstances under which a claimant can seek punitive

damages in a medical malpractice action. It also allocates 50

percent of any punitive damages that are awarded to a Patient

Safety Fund managed by HHS. HHS will administer the

Patient Safety Fund through the Agency for Healthcare

Research and Quality. The Secretary will promulgate

regulations that will establish programs and procedures to

carry out this objective. See also, Sec. 221-223.

Sec. 106.--Reduction in Premiums. This section requires

medical malpractice insurance companies to annually project

the savings that will result from Title II of the bill.

Insurance companies must then develop and implement a plan to

annually dedicate at least 50 percent of those savings to

reduce the insurance premiums that medical professionals pay.

Insurance companies must report these activities to HHS

annually. The section provides for civil penalties for the

non-compliance of insurance companies.

Title II--Medical malpractice insurance reform

Sec. 201.--Prohibition on Anti-competitive Activities by

Medical Malpractice Insurers. This section would repeal

McCarran-Ferguson Act to ensure that insurers do not engage

in price fixing. The Act, enacted in 1945, exempts all anti-

competitive insurance industry practices, except boycotts,

from the Federal antitrust laws. Over the years, uneven

oversight of the insurance industry by the States, coupled

with no possibility of Federal antitrust enforcement, have

created an environment that fosters a wide range of anti-

competitive practices.

Sec. 202.--Medical Malpractice Insurance Price Comparison.

This section creates an internet site at which health care

providers could obtain the price charged for the type of

coverage the provider seeks from any malpractice insurer

licensed in the doctor's state. This section specifies the

availability of online forms and that all information will

remain confidential.

Title III--Enhancing patient access to care through direct

assistance

Sec. 301.--Grants and Contracts Regarding Health Provider

Shortages. This section authorizes the Secretary of Health

and Human Services (HHS) to award grants or contracts through

the Health Resources and Services Administration (HRSA) to

geographic areas that have a shortage of one or more types of

health care providers as a result of dramatic increases in

malpractice insurance premiums.

Sec. 302.--Health Professional Assignments to Trauma

Centers. This section amends the Public Health Service Act to

authorize the Secretary to send physicians from the National

Health Service Corps to trauma centers that are in danger of

closing (or losing

their trauma center status) due to dramatic increases in

malpractice premiums.

Title IV--Independent advisory commission on medical

malpractice insurance

Sec. 401-402.--Independent Advisory Commission on Medical

Malpractice Insurance. This section establishes the national

Independent Advisory Commission on Medical Malpractice

Insurance. The Commission must evaluate the causes and scope

of the recent and dramatic increases in medical malpractice

insurance premiums, formulate additional proposals to reduce

those premiums, and make recommendations to avoid any such

increases in the future. In formulating its proposals, the

Commission must, at a minimum, consider a variety of

enumerated factors.

Sec. 403.--Report. This section requires the Commission to

file an initial report with Congress within 180 days of

enactment and to file annual reports until the Commission

terminates.

Sec. 404.--Membership. This section specifically

establishes the number and type of commissioners that the

Comptroller General of the United States must appoint to the

Commission. Generally, the membership of the Commission will

include individuals with national recognition for their

expertise in health finance and economics, actuarial science,

medical malpractice insurance, insurance regulation, health

care law, health care policy, health care access, allopathic

and osteopathic physicians, other providers of health care

services, patient advocacy, and other related fields, who

provide a mix of different professionals, broad geographic

representations, and a balance between urban and rural

representatives.

Sec. 407.--Authorization of Appropriations. This section

authorizes that such sums be appropriated to the Commission

for five fiscal years.

(Prepared by the Democratic staffs of the Committee on the

Judiciary and the Committee on Energy and Commerce.)

Mr. Speaker, I ask unanimous consent to control the time of the gentleman from Michigan (Mr. Conyers).

Mr. Speaker, it is my pleasure to yield 3 minutes to the distinguished gentlewoman from California (Ms. Waters), a member of the Committee on the Judiciary and a ranking member on the Committee on Financial Services.

Mr. Speaker, it gives me great pleasure to yield 3 minutes to the distinguished gentlewoman from California (Ms. Lofgren), a senior member of the House Committee on the Judiciary and Committee on Science.

Mr. Speaker, it gives me great pleasure to yield 1 minute to the distinguished gentlewoman from the Virgin Islands (Mrs. Christensen), a physician and an advocate for good health care for all Americans. We thank her very much for her leadership.

(Mrs. CHRISTENSEN asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I yield myself 25 seconds.

I beg to differ with the gentlewoman from Tennessee. I wish her remarks were accurate, in noting from the American Insurance Association a comment that says, ``Insurers never promised that tort reform,'' which is what medical malpractice, what H.R. 5 is, ``would achieve specific premium savings.'' So in fact, the doctors will not be helped from this legislation, H.R. 5. The only persons that will be helped will be the insurance companies.

Mr. Speaker, it gives me great pleasure to yield 1 minute to the distinguished gentleman from Missouri (Mr. Clay), a fighter for the rights of many and an advocate for good health care for all Americans.

Mr. Speaker, I yield myself 15 seconds.

The playbook is being said over and over again. Victor Schwartz on tort reform says that many tort reform advocates do not contend that restricting litigation will lower insurance rates, and I have never said that in 30 years.

Mr. Speaker, I will not vote for H.R. 5, because as it is, it does nothing to decrease the premiums our Nation's physicians are burdened with. It does nothing to decrease the number of frivolous lawsuits. It does nothing to decrease the amount of malpractice being inflicted upon the American people, by bad doctors who are jeopardizing the lives of their patients, and driving up the insurance costs of their colleagues. And it does nothing to protect the rights of those suffering in the wake of an act of medical negligence.

I have doctors in my district, who are struggling with high malpractice insurance premiums. In some regions, for some specialties, those premiums can be outrageous. If this bill becomes law, the caps on claims from injured patients will put a lot of money into the coffers of insurance companies. I offered an amendment yesterday in the Rules Committee that would have forced insurance companies to pass at least half of that money down to physicians in the form of reduced premiums. That just makes sense, if this bill is really intended to decrease premiums. But that amendment will not receive a vote today. That fact lays bare the claim that this bill is anything more than a gift to the insurance industry.

This bill has many troubling aspects and omissions. For example, noneconomic and punitive damages are capped at $250,000 and there is no provision to have this arbitrary number rise over time with inflation. So, we know that the value of the dollar will go down over time. Do we also feel the value of a human life, or of a child's pain and suffering will also go down over time? I surely do not. This could have easily been changed, but it was not.

Another aspect of this bill that I feel is morally repugnant, is in its valuing of rich people's lives more than poor people's, or children's, or stay-at-home mothers'. In the case of truly heinous acts of negligence, a judge and jury can award a damaged person with punitive damages. Punitive damages, as the name implies, are meant to punish egregious wrong-doers. This bill caps punitive damages at $250,000 or twice the economic damages, whichever is higher. So if a CEO with a high salary is injured and can't go back to work, his economic damages could be in the millions, and therefore through punitive damages--the perpetrator would be punished severely. On the other hand, if the injured is a child or a stay-at-home mother, the economic damages would be low, and the punitive damages would be capped at $250,000. Why would the U.S. Government, dedicated to the idea that every person should be treated as equal, say that doctors who hurt rich people should be punished more than those who hurt poor people--that the value of a poor person's life is less--that it is OK to take bigger risks in treating poor people? This is absolutely morally bankrupt.

And the bill does nothing to stem the tide of frivolous lawsuits. This bill, by definition, cuts awards to those people who a jury decided were not frivolous. This is short-circuiting our judicial process.

What in the name of God and country are we doing giving a gift to insurance companies, while people are suffering and access to medical care is threatened? I will vote against H.R. 5 and urge my colleagues to do the same.

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Berman), a distinguished senior member of the Committee on the Judiciary who knows about California medical malpractice law firsthand.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from New Jersey (Mr. Pascrell), one who has been a fighter for physicians and first responders.

Mr. Speaker, I yield the gentleman from New Jersey (Mr. Pascrell) 10 seconds to respond.

Mr. Speaker, I yield 3 minutes to myself.

(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I want to answer and I thank the distinguished speaker.

Mr. Speaker, I am going to ask the young lady just to come closer. We have the personal touch here this afternoon.

I want to answer the question that has been raised. This is over and over again about whose problems we are solving. Can I give my friends the real facts?

Sixty-one percent of the cases are dropped. That means as you go into the courthouse, and those of you who have been injured, you have your cases dismissed 61 percent. Plaintiffs only get 1 percent of the verdicts across the Nation. Defense verdicts. That means they rule on behalf of the HMOs, the doctors, the hospitals, 6 percent, and settlements are 32 percent.

H.R. 5 is a bill that does not harm the doctors and the physicians, which we do not want to harm, but it literally destroys the victims. What it does is when the verdicts come it injures the victims because you tell them that they cannot get a recovery.

There is no crisis in medical malpractice insurance. What the crisis is is the insurance companies who refuse to reduce the payments.

So let me show you who will be hurt by H.R. 5. Nathaniel will be hurt by H.R. 5. This is the face of H.R. 5. Why? Because Nathaniel was 6 weeks old when Nathaniel became brain damaged because he was not diagnosed with jaundice. In the Democratic substitute we eliminate cutting off Nathaniel's damages. We take the caps off the noneconomic damages. Is it not interesting that physicians who want to have their rates reduced do not get any relief directly from the insurance payoff because this is not access to medical care. This is insurance payoff day.

What we do for Nathaniel in the Democratic substitute is we say to the doctors, if you are good doctors, we want the savings that have been given to those to be reduced. I had an amendment that said reduce it by 50 percent. Put 50 percent of the savings and reduce the premiums of the doctors. This is real medical malpractice response. This puts the doctors in the rural communities in New Jersey, in Mississippi, in Texas and New York in the innercity. This helps the babies like Nathaniel.

And then to my dear friends, what about the States rights? What about the States that want to make their own determinations to protect their own citizens, to ensure that Nathaniel does not lay languishing with brain damage, and because he was only 6 weeks old, the noneconomic damages that would provide for him for the rest of his life were cut off, the pain and suffering damages were cut off at $250,000 in today's time? So besides cutting us off from having amendments, besides denying us a substitute--a legitimate way to discuss a reasonable response-- this is what we have today: A false bill that addresses a false issue and Nathaniel languishing in brain damage. Our bill would have provided Nathaniel for getting his day in court, providing for his mother and father the pain and suffering they are experiencing while he languishes without hope.

Payoff day for insurance companies. I stand against it. Vote against

Mr. Speaker, I yield myself 25 seconds to respond.

The Republicans have represented that H.R. 5 is to reduce the premiums of physicians. Let it be perfectly clear, and I stand by my document, 61 percent are dismissed, but let it be perfectly clear that nowhere will the physicians have premiums reduced and more doctors be able to practice because we pass H.R. 5, which is a payout to the insurance companies. I maintain that position and it is accurate.

Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman from Pennsylvania (Mr. Hoeffel), who experiences firsthand what happens with a

crisis in his State. He is a leader on these issues.

Mr. Speaker, I yield myself 10 seconds.

The real point is that the insurance companies have specifically said they will not reduce premiums with the passage of H.R. 5.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Illinois (Mr. Davis), who knows hospitals because they are in his district, an advocate for good health care for all Americans.

(Mr. DAVIS of Illinois asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Rhode Island (Mr. Langevin), who has faced many issues that deal with the needs of hospitals and his own constituents and good health care, and I thank him for his leadership.

(Mr. LANGEVIN asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Tierney), an individual who has stood firm on the rights of patients, the rights of victims.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Washington (Mr. Inslee), who knows what it is like to have victims denied economic damages under this legislation.

(Mr. INSLEE asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I wish this bill would help cure that problem.

Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Linda T. Sanchez), one of our newest Members, and a new member on the Committee on the Judiciary, who we are very proud to have because she has been a real fighter for patients' rights.

Mr. Speaker, I ask unanimous consent that the gentleman from Massachusetts (Mr. Delahunt) be allowed to manage the balance of the time on the minority size.