E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 104 CONGRESS, FIRST SESSION

Vol. 141 WASHINGTON, THURSDAY, OCTOBER 19, 1995 No. 162 House of Representatives

The House met at 9 a.m. and was Mr. GUTIERREZ led the Pledge of Well the schoolchildren are not called to order by the Speaker pro tem- Allegiance as follows: starving, and the hospitals will not pore [Mr. LAHOOD]. I pledge allegiance to the Flag of the close. f United States of America, and to the Repub- I urge my colleagues to preserve and lic for which it stands, one nation under God, protect Medicare. Live long and pros- DESIGNATION OF SPEAKER PRO indivisible, with liberty and justice for all. per. TEMPORE f f The SPEAKER pro tempore laid be- WITH MALICE TOWARD NONE, fore the House the following commu- ANNOUNCEMENT BY THE SPEAKER WITH CHARITY FOR ALL nication from the Speaker: PRO TEMPORE WASHINGTON, DC, The SPEAKER pro tempore. There (Mr. GUTIERREZ asked and was October 19, 1995. will be fifteen 1-minutes on each side. given permission to address the House I hereby designate the Honorable RAY for 1 minute.) f LAHOOD to act as Speaker pro tempore on Mr. GUTIERREZ. Mr. Speaker, today this day. IT IS TIME TO UPDATE MEDICARE is a historic day. A day that House Re- NEWT GINGRICH, publicans, to fulfill their unsatiable de- Speaker of the House of Representatives. (Mr. TIAHRT asked and was given sire to give a tax cut to their wealthi- f permission to address the House for 1 est contributors, will try to slash Medi- minute and to revise and extend his re- care by $300 billion. PRAYER marks.) We Democrats remember historic The Chaplain, Rev. James David Mr. TIAHRT. Mr. Speaker, today is a days. We remember when 30 years ago Ford, D.D., offered the following pray- historic day. Today, the House will Lyndon Johnson and Harry Truman er: move to preserve and protect Medicare. stood together and said, ‘‘the time has We pray, O God, that peace will reign Thirty years ago, on a closed rule, come to guarantee health care for all in our world and we specially pray that Congress passed a 1960’s Blue Cross- of our seniors.’’ peace will reign in our hearts. We are Blue Shield health care plan called We feel as much pride in that day as grateful that even in lives that know Medicare. Health care has progressed 30 Republicans should feel shame on this the tension between the ideals of the years. It has improved. Now it is time day. So maybe it is time for them to mind and the reality of an imperfect to bring Medicare up to date. remember their history too. In 1865, world there can be a sense of calm, and If we do not, it is going to go broke. facing a challenge far greater than ris- even with great responsibilities that The only way to sustain the cum- ing Medicare costs, our greatest Presi- seem to overwhelm there can be seren- bersome system is to raise payroll dent—a Republican President—stated ity. Grant to all Your people, O God, taxes $123 billion. that we would heal our Nation’s the gift of peace and calm and serenity, The Republican plan will preserve wounds ‘‘with malice toward none, this day and every day, we pray. Amen. and protect Medicare and offer some with charity for all.’’ f options. If seniors do nothing, they will I say to my colleagues in the major- stay on Medicare. They can also select ity—slashing $300 billion from seniors’ THE JOURNAL Medicare Plus to expand their coverage health care for a tax giveaway to your The SPEAKER pro tempore. The through a health managed care plan. rich friends is malice, pure and simple. Chair has examined the Journal of the They can select a medical savings plan With malice toward none, with charity last day’s proceedings and announces to reward them for having a healthy for all. How empty and distant those to the House his approval thereof. lifestyle, or they can select the health words seem to the party of Abraham Pursuant to clause 1, rule I, the Jour- care plan they had while working Lincoln today. nal stands approved. under an employer if he chooses to f f offer it. Those who oppose updating Medicare REFORMING MEDICARE FOR THE PLEDGE OF ALLEGIANCE are the same folks who said school- BETTER The SPEAKER pro tempore. The children would be starving this year. It (Mr. HAYWORTH asked and was Pledge of Allegiance will be led by the was reported last night they said if we given permission to address the House gentleman from Illinois [Mr. passed this plan, one-fourth of the hos- for 1 minute and to revise and extend GUTIERREZ]. pitals in America will close. his remarks.)

b This symbol represents the time of day during the House proceedings, e.g., b 1407 is 2:07 p.m. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor.

H 10309 H 10310 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Mr. HAYWORTH. Mr. Speaker, I lis- show the seniors that we care about The point is we are going to make tened with great interest to my good them and their future. Medicare better for senior citizens. friend from Illinois who preceded me The Medicare Preservation Act is an f here in the well. He quoted Abraham honest, realistic, up-front bill, that Lincoln accurately. But he misapplied provides real reform for our current A FALSE CHOICE the quote, for rather being malicious Medicare system. It will ensure that (Mr. DEUTSCH asked and was given and mean-spirited, the only mantra the seniors have the right to stay in their permission to address the House for 1 guardians of the old order can offer, in- present Medicare plan, but will also minute and to revise and extend his re- stead what we are doing today is em- offer choices to those looking for a marks.) bodying the spirit of America. change. Mr. DEUTSCH. Mr. Speaker, we are Because we are saying to America’s The Medicare Preservation Act at- here today because my Republican col- seniors, you deserve to have a choice in tacks waste, fraud, and abuse in order leagues want to destroy Medicare, and health care. You do not need to be cut to provide real accountability for the their premise is that Medicare will be off magically at age 65 to a one-size- taxpayers dollars. bankrupt in 7 years. fits-all plan. We believe you have the Yes, Mr. Speaker, today is the day we What I have here is a chart that right to determine the health care you vote to save Medicare for the next gen- points out a fact, which is that in the should have, and if you want to keep eration. I urge all my colleagues to 30 years of Medicare’s existence, the Medicare as it exists now, then you vote ‘‘yes’’ on the Medicare Preserva- actuarial life of Medicare was less than have the right to keep that as well. tion Act. 7 years. This is not unprecedented. It is But the senseless mantra that we are f a flatout lie that my Republican col- making changes in Medicare for tax TROOPS TO BOSNIA WITHOUT leagues have been stating about the breaks for the wealthy is patently false CONGRESSIONAL CONSENT? unprecedented nature of the 7-year ac- and, Mr. Speaker, even malicious. tuarial life. How sad it is; it is symptomatic of (Mr. TRAFICANT asked and was The $270 billion in cuts, as my Repub- the new minority, folks who have no given permission to address the House lican colleagues have been talking vision for the future, would only apply for 1 minute and to revise and extend about, is also a flatout lie. The trustee a Band-Aid and only came up with a his remarks.) report calls for a far less number in Mr. TRAFICANT. Mr. Speaker, once plan in the final nanosecond of the 11th terms of what would make actuarial again, a President says he can send hour, instead of dealing responsibly. sense for the Medicare system. troops into a war zone without the con- Friends, join us. Let us reform Medi- The choice that my Republican col- care for the better. sent of the Congress. What is the surprise here? Think leagues have been talking about is a f about it. The Congress of the United false choice. Everyone in this Chamber, everyone in America knows what the MEDICARE AND MANAGED CARE States has time after time allowed the Presidents of the United States to agenda is. The agenda is to force people (Mr. KENNEDY of Rhode Island usurp the constitutional power of the into substandard HMO’s because the re- asked and was given permission to ad- people. Turn the other cheek, and now imbursement level in a traditional dress the House for 1 minute and to re- the President is just simply going Medicare will be so low. vise and extend his remarks.) ahead and servicing all the cheeks he Just because people are old in this Mr. KENNEDY of Rhode Island. Mr. can in Congress. country does not mean they are stupid. Speaker, today is the day, today is the The bottom line is this: I do not The American people will not believe day that the Republican majority will know how you feel about Bosnia, Mem- what the Republicans are doing. pass historic cuts to the Medicare Pro- bers, but I say not one American sol- f gram. Today is the day that they will dier shall be sent to Bosnia without a HEALTH CARE CHOICES FOR OUR cut $270 billion out of the Medicare vote of the Congress. That is not the SENIOR CITIZENS Program. Today is the day that they old-fashioned way. That is the con- will begin to raise premiums and stitutional way. (Mr. LONGLEY asked and was given deductibles for people, like Herb If we continue to let Presidents take permission to address the House for 1 McCulloch, who lives on $240 a month the Constitution and mold it like clay minute.) and they are going to ask him to come in their hands, we are gong to find our- Mr. LONGLEY. Mr. Speaker, I am up with an additional $100 a month in selves in one hell of a bloody war. tired of the nonsense we have been lis- out-of-pocket expenses. f tening to. Why are they doing this? Because There are three very simple truths they want to pass a $245 billion tax cut. WE ARE IMPROVING MEDICARE about what the House is going to act Better than 52 percent of that tax cut (Mr. GILCHREST asked and was on today, and, first, as the minority is going to go to individuals and fami- given permission to address the House party appears to forget, this is a pro- lies earning $100,000 or more. for 1 minute and to revise and extend gram, Medicare is a program that is Mr. Speaker, ladies and gentlemen of his remarks.) paid for by taxes on the wages of work- the House, their solution is to put el- Mr. GILCHREST. Mr. Speaker, all ing people and by seniors through their derly into managed care programs, those who are listening in the House premiums. managed care. You know what it Chamber this morning, and if there are We owe it to them to see that this means. It means managed to deny care any people over the age of 65 listening money is used wisely and effectively, to the very senior citizens they propose on their televisions at home, the vote No. 1. to protect. that we will take today will not take No. 2, any senior who is currently in It is not fair. It is not right. As any benefits to Medicare away. the Medicare Program is going to be Democrats, we are going to say ‘‘no.’’ The existing program of Medicare, if guaranteed the right to stay in the Today Republicans should be it is not reformed, is not sustainable. Medicare Program as it is if that is ashamed of themselves. We are going to take a vote that will what they choose to do. There will be f reform Medicare in a manner that, if no increase in copayment, no increase any senior citizen wants to keep the in deductible, and the premium rate TODAY WE VOTE TO SAVE existing program the way it is, they will be maintained at the 70 percent MEDICARE can choose to do so. If any senior citi- paid for by the Government rate, 30 (Mr. JONES asked and was given per- zen wants to choose another form of percent paid for by seniors. mission to address the House for 1 health care or another health care car- Third, we are going to allow those minute and to revise and extend his re- rier, the amount of money that they seniors who wish to make choices marks.) put in and the Federal Government about their health care. What a radical Mr. JONES. Mr. Speaker, today is puts into their Medicare Program as an idea, that we would allow people to the day we vote to save, protect, and individual can be transferred to that choose the health care program that preserve Medicare. Today is the day we contracting health care carrier. might be best for them. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10311 Shame on the minority for failing to But what are Democrats’ sons and Mr. HANCOCK. Mr. Speaker, I have understand these principles. daughters telling them? It is a nostal- been hearing a lot of conversations the f gic piece of Chicken Little, ‘‘The Sky past several years, but I am 66 years Is Falling.’’ Yes, with creativity of Ste- old. Here is my Medicare card. I am MEDICARE AND MEDICAID ven Spielberg, they are story-telling. voluntarily leaving the Congress at the (Ms. VELA´ ZQUEZ asked and was They should remember this one: Two end of this term, and I frankly have a given permission to address the House mothers, two women were fighting over very vested interest in the preservation for 1 minute and to revise and extend the same baby. The wise King Solomon of Medicare. I want the choice for my her remarks and include extraneous pulled out a sword and said, ‘‘Cut the future medical care given to me in this material.) child in half.’’ One would-be mother Medicare bill. Ms. VELA´ ZQUEZ. Mr. Speaker, said, ‘‘Fine.’’ The other one said, ‘‘No, This bill is good for senior citizens, it today I rise to take strong exception to never.’’ Love is stronger. Love of a par- is good for the working people who are the right wing attack on Medicare. The ent deserves love of a child. paying the payroll taxes to guarantee drastic and mean spirited cuts Repub- b 0915 the Medicare, to pay for Medicare. It licans propose will devastate the preserves, protects, and it saves Medi- What a different bill we would have health care system and severely jeop- care. Within a year from now, I guess I today if the Democrats would follow ardize access to health care for the el- will be full-time on the Medicare bill, the example of love. The love of a derly in my district and around the Na- after I leave the Congress. Mother Theresa rather than the terror tion. f Lets be clear about what is going on of a Stephen King. If the Democrats criticism energy were spent coming to here. Republicans want to cut Medicare SYMBOLISM SPEAKS LOUDER the table rather than launching gre- not to save the trust fund but to fi- THAN RHETORIC nades at those who sit at the table, nance back door deals with wealthy what a better bill we would have. It is (Mr. KLINK asked and was given per- doctors, special interest groups and time to put love of parents and love of mission to address the House for 1 rich corporations. seniors above love of politics and par- minute and to revise and extend his re- The issue of whether we should slash tisanship. marks.) Medicare is simply a question of val- Mr. Speaker, let us do the right Mr. KLINK. Mr. Speaker, as we head ues. Are we going to bankrupt the el- think to do: Reform, protect, and pre- down a road as historical as the one derly? Are we going to kick seniors out serve Medicare. that we are encountering today, sym- of nursing homes in order to finance a bolism becomes very important. It is tax break for the rich? f an important symbol as we note that I believe that to do so would be im- PAY MORE, GET LESS PLAN exactly the same moment that we are moral, unfair, and just plain cruel. (Mr. DOGGETT asked and was given Mr. Speaker, here is a letter that a debating and voting on a $270 billion permission to address the House for 1 Republican constituent wrote to me. cut in Medicare in the other Chamber, minute and to revise and extend his re- She said: the House Committee on Banking and marks.) Financial Services is debating and vot- Cuts in Medicare will be devastating and Mr. DOGGETT. Mr. Speaker, let me ing out a $245 billion tax giveaway by these cuts are unacceptable. We the people, take the gentleman to a little different put the Republicans where they are today the Republicans. and we will be sure to take them out if we part of his Bible. There is a part called Our Republicans say one has nothing are not represented. honor thy father and thy mother, and I to do with the other. But the symbol- do not find anything honorable about I include the entire letter for the ism of the moment is they take place this Republican pay more, get less RECORD. at exactly the same time in both plan. That is what it is. OCTOBER 17, 1995. houses of this great Congress. There is Of course, not everybody is unhappy no quid pro quo, no tit for tat. I think Re Republican Medicare Bill. with it. You see, while it gives a swift DEAR CONGRESSMAN: I cannot even begin to the symbolism speaks otherwise. put into words the seriousness of the reper- kick to seniors, those who bought into It is also important to note that an- cussions of this proposal. the plan get a mighty big kickback. other new version of this bill came out The effect of this bill will be devastating Even the Republicans’ own staffers say of the Committee on Rules last night to my local hospital and nursing home. yes, taxpayers are going to have to that no Member of the House has had The projected loss of future revenues for fork over an extra $1 billion because of my local facility and nursing home seems in- an opportunity to read the 900-plus the repeal and weakening of pages. By the way, we started a few comprehensible to me: $14.2 million over 7 antikickback provisions in this bill. years! In addition, the projected loss of jobs days ago with a bill that was 421 pages, The pharmaceutical companies settled in this area being at 3,500 is not tolerable. it grew and grew until finally now 10 for only $100 billion by the Republican This program will shift enormous funding days later it is almost 1,000 pages, and plan to repeal the discount for pharma- to me a property owner in Wyoming County not one hearing has been held on any ceuticals at public hospitals. because the hospital is county-owned. The version of this legislation. tax burden will increase an estimated 28 per- Yes, it is very difficult for the Repub- cent. This is not acceptable. licans to talk about being antifraud Ladies and gentlemen, symbolism This legislation threatens the survival of when there is so much fraud in this speaks louder than the Republican my hospital and the future jobs of my neigh- plan. We only need to turn to this rhetoric. bors. I understand the Speaker of the House morning’s newspaper to see that they f needs to retain his parties support but we, are saying House Republicans today the people, put the Republicans where they FACT OVER FICTION are today and will be sure to take them out open literally a vote trading bazaar. if we, the voters, are not represented. Speaker NEWT GINGRICH cheerfully de- (Mr. HEFLEY asked and was given CYNTHIA TINKER, scribed the bargaining as ‘‘a little bit permission to address the House for 1 Warsaw, NY. like Christmas shopping.’’ Well, there minute and to revise and extend his re- f are a lot of mothers and fathers in marks.) America who have nothing to be Mr. HEFLEY. Mr. Speaker, they PRESERVE AND PROTECT cheered about and much to worry shall not bear false witness—that is MEDICARE about when it comes Christmas shop- what the Democrats have been doing (Mr. KINGSTON asked and was given ping time. on this Medicare issue. Republicans permission to address the House for 1 f have a plan to save Medicare. Repub- minute and to revise and extend his re- licans have a good plan to save Medi- marks.) H.R. 2425 PROTECTS MEDICARE care. We want America to see our plan. Mr. KINGSTON. Mr. Speaker, not (Mr. HANCOCK asked and was given We aren’t afraid to show the American since Mother’s Day have Democrat permission to address the House for 1 people what we’re trying to do, because mommas across America gotten so minute and to revise and extend his re- what we are doing is saving the single much attention. marks.) most important entitlement program H 10312 CONGRESSIONAL RECORD — HOUSE October 19, 1995 in society today. Let’s look at the Now, any senior knows if their insur- Rubin, Donna Shalala, and the other facts. ance company told them ‘‘We are going members of the board of trustees from Premiums are going up. They are to increase your rates by $1,900, and this administration signed that report going up $7 so that we can increase that is a cut, a slashing of your rates,’’ saying that within 7 years the system spending per beneficiary by $1,900. the senior would say, ‘‘You are crazy.’’ will be bankrupt, we had to do some- The tax cuts that Democrats say If you want to know a special inter- thing. We Republicans are stepping up we’re giving to the rich to fund these est group that is driving this Member, to the plate and doing it. Let us ad- reforms were passed last spring. They my seniors from AARP, 20 members dress this in a bipartisan way. have nothing to do with preserving have been advising me on this item. f Medicare. Their advice is why do we allow more If you don’t want to switch plans or than the rate of inflation? We are pro- MEDICARE CUTS WILL HURT service you do not have to. The Repub- posing twice the rate of inflation, Mr. SENIORS lican plan does not require you to Speaker. Twice the rate of inflation is (Mr. GENE GREEN of Texas asked change anything unless you want to. what our projections are. Finally, for Democrats to decry that and was given permission to address some kind of a backroom deal was f the House for 1 minute and to revise and extend his remarks and include ex- made by Republicans to satisfy certain AN OUTRAGEOUS PIECE OF traneous material.) interest groups is absolutely absurd. LEGISLATION What’s happening is people are finally Mr. GENE GREEN of Texas. Mr. (Mr. GIBBONS asked and was given starting to really look at our plan and Speaker, Congress will vote today on permission to address the House for 1 they’re starting to realize that it’s a the Republican plan to cut the $270 bil- minute and to revise and extend his re- good plan and that scares the heck out lion in Medicare to pay for that $245 marks.) of Democrats. billion, and my colleague from Califor- Mr. GIBBONS. Mr. Speaker, this is f nia, they are stepping up to the plate, the most outrageous thing I have seen but they are being greedy. Even though A DAY OF INFAMY in my 33 years here in the House. Yes, the Medicare trustees, as the gen- I am talking to you. Nobody has ever (Ms. JACKSON-LEE asked and was tleman said, said we need to deal with seen the bill that we will be voting on given permission to address the House Medicare, they only said we needed to in 3 hours. Nobody has ever seen the for 1 minute and to revise and extend deal with it for $89 billion and not $270 bill we will be voting on in 3 hours. her remarks.) billion. The bill we will be voting on is not Ms. JACKSON-LEE. Days of infamy. Speaker GINGRICH’s Medicare plan October 12, we lock up seniors in Amer- the bill that came from the Committee takes three times as much to pay for ica. October 19, today, Republicans on Ways and Means, not the bill that that tax cut of $245 billion. The simple have 900 pages to trash Medicare. Pre- came out of the Committee on Com- truth is that they do not need the $270 miums for all seniors will rise at least merce. It is some bill adopted some- billion from Medicare to make the pro- $87 by 2002; hospitals will close; Medi- where in this Congress by a group of gram healthy. They are cutting Medi- care benefits for beneficiaries will go people whose faces and names are un- care to pay for the tax breaks. up $1,700; and, yes, you will get your known. Nobody knows what is in that Do not be fooled. Seniors will be hurt $270 billion for a tax cut. bill. by Speaker GINGRICH’s plan. Number What a day of infamy. How sad. And I know why it is being adopted. It is one, premiums will double, forcing when we want to talk about scriptures, being adopted for one simple reason: many seniors to choose between their let me tell you about a scripture. The GOP, get old people, and use the money choice of health care and other living story goes in the New Testament that you get from them to pay for a tax cut essentials. The choice of doctors will the Lord asked a question, and the law- for your wealthy contributors. be limited. This is an outrage. yer responded as he asked the question, Earlier this year my Republican col- ‘‘Lord, when did I deny you?’’ And he f leagues talked about the Washington did not realize that he denied him when MEDAGOGUERY Post editorial. Before they vote today, he ignored seniors in America, the sen- I hope they would read today’s edi- ior from Houston, TX, that says ‘‘I do (Mr. DREIER asked and was given torial, where it talks about what they not believe the drastic cuts in Medicaid permission to address the House for 1 say, ‘‘Who Pays if Medicare Is Cut?’’ and Medicare should take place for the minute and to revise and extend his re- I include that editorial for the marks.) tax breaks for the privileged. I can’t RECORD. Mr. DREIER. Mr. Speaker, I have en- hardly write, my finger is so sore, and [From the Washington Post, Oct. 19, 1995] my husband has 2 ulcers on his leg.’’ joyed the Biblical quotations through- WHO PAYS IF MEDICARE IS CUT? These are the letters, time and time out the morning, but there have also again, that I have gotten from my sen- been a number of quotations from the The great question—you could say gam- ble—with regard to the Republican plan to iors who say stop trashing Medicare media. My friend from Texas focused on an article that appeared in today’s reform Medicare is whether it will it succeed and let us make something happen for in fostering competition that will drive down all Americans. paper, and, frankly, while we do not on the cost of care, or will simply shift some f this side regularly champion the Wash- large part of the cost from the government ington Post, I believe that the Wash- back to recipients, thereby creating a much ONLY IN WASHINGTON IS AN ington Post described so much of what more limited program—a half-Medicare. No INCREASE A CUT we have heard over the past few min- one knows the answer. What the House and (Mr. BILBRAY asked and was given utes on the other side of the aisle, be- Senate are being asked to do in considering permission to address the House for 1 cause they have observed the debate their respective versions of the plan in the over the past several months. They next two weeks is to choose between risks. minute and to revise and extend his re- One is the risk of not acting to curb the marks.) said the rhetoric which has come from enormous projected cost of the program, Mr. BILBRAY. Mr. Speaker, it is the Democrats is nothing but which threatens over time to break the really sad that we have try to reinforce medugoguery. That is the Washington bank—and which the Republicans are right the public’s perception of lack of trust Post editorialization of what we have to have taken seriously and sought to ad- in Washington with the MediScare tac- been hearing. dress. The other is the risk of shifting too tics. Only in Washington could a 42- to We as Republicans have stepped up to much cost to lower-income elderly and dis- 45-percent increase be called a cut. the plate. Another article that ap- abled people who can’t bear it and who may Now, my colleagues on the other side peared, Adam Clymer in yesterday’s therefore be left without the care that they of the aisle may say that may be work- both need and currently have. New York Times acknowledged that in The Republicans have argued that the cuts ing with words and may be working the past the Democrats have tried to they propose would fall mainly on hospitals, with numbers. Per person we are talk- avoid tough votes. doctors and other providers, and only to a ing about going from $4,800 to $6,700, a We as Republicans have acknowl- lesser degree on Medicare recipients them- $1,900 increase. edged that when Robert Reich, Bob selves. But it isn’t certain that this is how it October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10313 would work out. The government itself better bill. Please join us in solving iors from $4,800 per year today to $6,700 would pay the providers less. But the plan this problem for senior citizens. per year in 2002. then also makes it possible for the providers Mr. Speaker, I think it is morally Fact: By law, Medicare savings can to recover if they want by charging the re- reprehensible to frighten senior citi- be used only to save Medicare. cipients more. The insurers and providers with whom the recipients would deal would zens for political agendas. Fact: The Medicare debate has be- not be required to absorb the cuts. Rather, to f come a game of who are you going to the extent that competitive pressures per- believe: Those across the aisle who mitted, they would be free in various ways to VOTE ‘‘NO’’ ON MEDICARE BILL knew about the impending bankruptcy pass them on; the recipients then would have (Mr. BENTSEN asked and was given for years and did nothing? Or those to absorb them. permission to address the House for 1 who have taken the challenge and Our own sense is that, as the bills are writ- made the promise to save Medicare ten, this risk is too great. That’s particu- minute and to revise and extend his re- larly the case because the Republicans would marks.) from an untimely death. These are just decimate Medicaid, the backstop program Mr. BENTSEN. Mr. Speaker, I rise in the facts. for the needy elderly and disabled. The house strong opposition to the Medicare Pil- f the Republicans are building has plenty of fering Act of 1995 that the Republicans roof over cost but not enough floor under are bringing to the floor today. b 0930 care. Much has been made in recent days of The Republicans think they can fool the deals that House Speaker Newt Gingrich DO NOT TRADE HEALTH CARE FOR the American people by dressing this TAX CUTS is said to have struck with the American bill up in Orwellian language and call- Medical Association and other provider (Mr. MILLER of California asked and groups to ensure their support for the plan. ing it the Medicare Preservation Act of 1995. was given permission to address the The assorted deals are small potatoes com- House for 1 minute and to revise and pared with this structural defect in the plan. But the American people have caught It has to be fixed to make the plan worth on that they really are pilfering Medi- extend his remarks.) passing. care to pay for a tax cut for the rich. Mr. MILLER of California. Mr. The plan has, while we’re at it, one other Under the Republican plan, you re- Speaker, today is the day that the Re- provision that would cost billions of dollars duce Medicare spending by $270 billion publicans trade the health care of our while serving no good purpose and ought to and you only extend the life of the seniors for tax cuts for the wealthy. be killed outright. We have in mind the med- Today is the day that the Republicans ical savings accounts the proposal would per- Medicare hospitalization trust fund to the year 2006. Under the Democratic al- take on the best health care system in mit. Instead of paying a recipient’s bills or the world, the least expensive health giving the recipient a fixed amount to help ternative, you reduce Medicare spend- buy an insurance policy or enroll in a man- ing by $90 billion and you also extend care system in the world, in terms of aged care plan, the government would put the trust fund to the year 2006. Even overhead, and the most comprehensive that amount in a savings account in the per- the Republican staff of the Ways and health care system in the world for son’s name, partly to buy a high-deductible, Means Committee admit that the two senior citizens, and today they trade so-called catastrophic insurance policy, the bills achieve the very same goal. that in for tax cuts to the wealthy. rest to be used for other purposes. After a Mr. Speaker, they do so by taking certain amount had accumulated, if the re- So what is going on here? If cutting $90 billion and cutting $270 billion away benefits that seniors have. They cipient didn’t need or want to use the money do so by making sure that seniors will for health care he could use it to take a va- achieve the same goal, why do the Re- cation, buy a boat—you name it. publicans insist on cutting Medicare by not be able to pay and to purchase the Healthy and better-off people who could af- $270 billion and what happens to the same health care levels and benefits ford the risk would be drawn to this. The $180 billion difference? that they have today 5 years from government would be putting more in their The answer is that it is being used to today. They will not be able to arrange accounts per year than they currently take pay for those $245 billion in tax cuts for the same level of health care. And from Medicare, thus adding to costs and that we do not need and cannot afford. so we leave our seniors stranded so leaving less to care for the sick and less well- that we can provide tax cuts and cap- off. It’s a skimming operation, and it ought No matter how the Republicans dis- to be dropped without a second thought. guise it, there is no escaping the fact ital gains cuts to the wealthiest indi- viduals in this country. f that they are cutting Medicare to pay for tax cuts. One of my seniors from Pittsburg, CA SOLVE MEDICARE PROBLEMS IN A That is irresponsible. That is wrong. wrote and said, ‘‘Congress must under- BIPARTISAN WAY That is unfair to America’s senior citi- stand we seniors built this country and (Mr. BARTLETT of Maryland asked zens. Vote ‘‘no’’ on the Medicare Pilfer- we deserve better. You should not do and was given permission to address ing Act of 1995. this to us.’’ the House for 1 minute and to revise f f and extend his remarks.) Mr. BARTLETT of Maryland. Mr. JUST THE FACTS ON MEDICARE MANAGED CARE WORKS IN MEDICARE Speaker, the Medicare trustees have (Mrs. VUCANOVICH asked and was told us that Medicare is going bank- given permission to address the House (Mr. BLUTE asked and was given per- rupt. Let me quote from their own for 1 minute and to revise and extend mission to address the House for 1 words: ‘‘We strongly recommend that her remarks.) minute and to revise and extend his re- the crisis presented by the financial Mrs. VUCANOVICH. Mr. Speaker, marks.) condition of the Medicare trust funds Sergeant Joe Friday used to say ‘‘Just Mr. BLUTE. Mr. Speaker, perhaps we be urgently addressed on a comprehen- the facts, ma’am.’’ Well, here are just will have to wait a year or two until sive basis.’’ the facts on Medicare. our friends on the other side of the This is a quote from the Medicare Fact: According to Clinton trustees, aisle come over to our way of thinking. trustees. Six of them, four of them ap- Medicare is going bankrupt in 7 years Similarly, we are now hearing that pointed by President Clinton, three of and Congress should do something this President Clinton is saying that the them Cabinet-level positions. We be- year to avert this disaster. 1993 tax increase was wrong and not the lieve that their recommendation Fact: The Medicare Preservation Act right thing to do and perhaps too large. should be followed, and we are doing will save the Medicare system, while Yet we heard from Members on the that. giving choice to seniors that they have other side how important that was, and We really need to address the Medi- asked for time and time again. now President Clinton has come over care crisis. Please join us in addressing Fact: No senior will be forced into an to our way of thinking. that crisis. Please stop medagoguery. HMO. HMO’s are simply an option for I think our colleagues on the other Please join in the discussion which is seniors, as is traditional Medicare, side will come over to our way of now just beginning. The passage of this medical savings accounts, and provider thinking on Medicare because we need bill today is just one of a number of sponsored networks. to save this important program. Under steps in which this bill can be modified Fact: The Medicare Preservation Act the Republican plan Medicare will so that it becomes ever a better and increases individual benefits for sen- grow by $86 billion over the next 7 H 10314 CONGRESSIONAL RECORD — HOUSE October 19, 1995 years and we will institute reforms shameless depths to which the dema- times the rate of inflation. We cannot that are already working in the private goguery and the rhetoric has gone to in sustain that, our seniors do not want sector. this debate, last night I was on the to try to sustain that, we need to fix it. In my home district of Worcester floor and the bill was compared by the f County, MA, 60 percent of my constitu- gentleman from New York to the at- ents are already in managed care. It tack by the Japanese on Pearl Harbor. PROPOSED CUTS IN MEDICARE works, it provides quality care for sen- Our bringing forward this bill was com- WILL HURT SENIORS iors under Medicare right now, and it pared to the Japanese attack on Pearl (Mr. SANDERS asked and was given can be used to reform our health care Harbor. How does the gentleman from permission to address the House for 1 system and reduce the devastating rate Florida feel about that? minute and to revise and extend his re- of increase we are now seeing. f marks.) Mr. Speaker, pass this bill. It is the Mr. SANDERS. Mr. Speaker, there is right thing to do for America. WOLVES IN SHEEP’S CLOTHING no excuse for a $270-billion cut in Medi- f (Mrs. SCHROEDER asked and was care when the Republican leadership is given permission to address the House simultaneously providing huge tax A LITTLE EARLY CHRISTMAS for 1 minute and to revise and extend breaks for the rich, is building more B– SHOPPING her remarks.) 2 bombers, and is maintaining $125 bil- (Mr. SCHUMER asked and was given Mrs. SCHROEDER. Mr. Speaker, we lion in corporate welfare. permission to address the House for 1 have heard of wolves in sheep’s cloth- In my State, these cuts will result in minute and to revise and extend his re- ing, and today that is what we see. over 80,000 elderly and disabled Ver- marks.) Today we see all sorts of people from monters paying higher premiums for a Mr. SCHUMER. Mr. Speaker, it was the other side of the aisle parade down weakened Medicare system. As a result like a carnival yesterday here in the here and say trust the party that of the Republican plan, Medicare part House. Step right up, step right up, fought tooth and nail not to have Medi- B premiums will rise by $312 in the called Barker NEWT GINGRICH as he care 30 years ago, but trust them now. year 2002. called in the special interests for their Trust the party who had seniors ar- Mr. Speaker, not only will seniors be cut of the pie in an effort to save this rested last week in this body when paying more for a weakened system, devastating Medicare program. they tried to ask questions. Trust the but throughout our country and in In fact, the Speaker said it was ‘‘a party who has this 961 harmless page rural States like Vermont our rural little like Christmas shopping’’, as the bill that none of them could pass a test hospitals will be endangered. Fifty-five GOP started selling off parts of the on and they have had no hearings on, percent of the revenue that comes into Medicare package to special interests. but trust them. our hospitals come from Medicare and For everyone else Christmas shop- There is nothing harmful in here. Medicaid, and many of them will not be ping starts the day after Thanksgiving, Trust the party whose leader, Speaker able to sustain these cuts. but for the AMA, the pharmaceutical GINGRICH says the main thing coming f companies, the nursing home opera- out of the session will be the tax cut tors, Christmas shopping started this for the rich. That is the crown jewel of PERMISSION FOR SUNDRY COM- week. They got their goodies while the this whole session and the seniors are MITTEES AND THEIR SUB- average senior paid: No reimbursement going to get the gruel that is what we COMMITTEES TO SIT TODAY for nausea medicine after chemo- are doing today. The rich get the jewel, DURING THE 5-MINUTE RULE therapy. Increases in copayments for they get the gruel, but they keep say- Mr. LINDER. Mr. Speaker, I ask loved ones in nursing homes. ing trust their party and listen to the unanimous consent that the following How is that going to devastate fami- trustees. That is wrong. committees and their subcommittees lies throughout America? f be permitted to sit today while the Well, the GOP should know some- House is meeting in the Committee of thing. Yes, they can make a lot of MEDICARE NEEDS INTELLIGENT the Whole House under the 5-minute deals and do a lot of trading to save a CHANGE rule: bad package. They will win the vote, (Mr. LINDER asked and was given Committee on Agriculture, Commit- but they will lose the war. permission to address the House for 1 tee on Commerce, Committee on Gov- f minute and to revise and extend his re- ernment Reform and Oversight, Com- marks.) mittee on International Relations, SENIORS WILL HAVE CHOICES Mr. LINDER. Mr. Speaker, I believe Committee on the Judiciary, Commit- (Mr. HOKE asked and was given per- it was G.K. Chesterton who said, ‘‘I tee on Resources, Committee on mission to address the House for 1 still believe in liberalism, but, oh, Science, Committee on Small Business, minute and to revise and extend his re- there was a time when I believed in lib- and Committee on Transportation and marks.) erals.’’ Infrastructure. Mr. HOKE. Mr. Speaker, the dema- The liberals today are losing their It is my understanding that the mi- goguery that has developed over this mind over losing control over the peo- nority has been consulted and that issue is truly shameless. Let us get a ple’s health care. It is not so much how there is no objection to these requests. couple of facts straight first. much we spend, it is who decides. The The SPEAKER pro tempore (Mr. No. 1, one of the things that each and Republicans want to give that decision LAHOOD). Is there objection to the re- every Medicare beneficiary has the to the people who use the health care. quest of the gentleman from Georgia? right to choose is to stay in the pro- Let them have the same choices that There was no objection. gram exactly as it is today, precisely we have in health care. Do you want to f as it is today, with no increases in opt out of the 1965 style Blue Cross pro- copayments, my friend, the gentleman gram? Even Blue Cross does not pro- PROVIDING FOR CONSIDERATION from New York [Mr. SCHUMER], with no vide that kind of health care delivery OF H.R. 2425, MEDICARE PRESER- increases in deductibles, with the same system anymore, but we have locked VATION ACT OF 1995 program, 311⁄2 percent, no increase in our seniors into a 30-year-old system Mr. LINDER. Mr. Speaker, by direc- the percentage of the part B premium. from which they cannot escape. tion of the Committee on Rules, I call They will have the right to choose Do we want seniors to have the up House Resolution 238 and ask for its that. choices that we have? High deductible immediate consideration. They will also have the right to other medical savings accounts, a managed The Clerk read the resolution as fol- choices, the same kind of choices that care system, to stay with their current lows: we have in this U.S. Congress, that health care system? The old 30-year-old H. RES. 238 every Federal employee has, and that program does not allow any choices Resolved, That at any time after the adop- people in the private sector have got. and it gives us a health care system tion of this resolution the Speaker may, pur- But if we want to see the depths, the that is increasing in cost at three suant to clause 1(b) of rule XXIII, declare the October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10315 House resolved into the Committee of the ation of this historic legislation. The While many have stood on the side- Whole House on the state of the Union for rule allows for 3 hours of general de- lines of the debate and pointed fingers consideration of the bill (H.R. 2425) to amend bate to be equally divided between the of blame, we have accepted the trust- title XVIII of the Social Security Act to pre- ee’s challenge to rescue Medicare. The serve and reform the Medicare Program. The chairmen and ranking minority mem- first reading of the bill shall be dispensed bers of the Committees on Ways and resolution crafted by the Rules Com- with. All points of order against consider- Means and Commerce. Following the 3 mittees will bring to the House floor ation of the bill are waived. General debate hours of general debate, the rule makes the Medicare Preservation Act—a bill shall be confined to the bill and amendments in order as an original bill for the pur- that I believe is bold enough to pre- specified in this resolution and shall not ex- pose of amendment, the amendment in serve Medicare for another generation. ceed three hours equally divided among and the nature of a substitute consisting of As I previously stated, House Resolu- controlled by the chairmen and ranking mi- the text of H.R. 2485, as modified by the tion 238 is a narrow rule allowing both nority members of the Committee on Ways sides of the aisle an opportunity to and Means and the Committee on Commerce. amendment printed in the Rules Com- After general debate the bill shall be consid- mittee report. present the case that their proposal ered for amendment under the five-minute The bill, as amended, shall be consid- will protect Medicare for a generation rule. An amendment in the nature of a sub- ered as the original bill for the purpose of Americans. Ours is a carefully bal- stitute consisting of the text of H.R. 2485, of further amendment under the 5- anced bill that is the result of thou- modified by the amendment printed in the minute rule, and the bill shall be con- sands of hours of work by Members of report of the Committee on Rules accom- sidered as read. All points of order this House. This rule will preserve that panying this resolution, shall be considered against the provisions of the bill, as delicate balance, and it is common as adopted in the House and in the Commit- amended, are waived. practice for most bills coming out of tee of the Whole. The bill, as amended, shall be considered as the original bill for the pur- The rule provides for consideration of the Ways and Means Committee to be pose of further amendment under the five- an amendment in the nature of a sub- considered under closed or modified minute rule. The bill, as amended, shall be stitute numbered 2 printed in the CON- closed rules. It is important to note considered as read. All points of order GRESSIONAL RECORD, if offered by the that the original legislation creating against provisions in the bill, as amended, minority leader or his designee. All the Medicare program for millions of are waived. No further amendment shall be points of order are waived against this Americans was considered under a in order except the amendment in the nature amendment. The amendment is consid- closed rule in 1965. of a substitute printed in the Congressional ered as read, is not subject to amend- Before I lay out some of the general Record and number 2 pursuant to clause 6 of provisions of the act, I want to discuss rule XXIII, which may be offered only by the ment, and is debatable for 1 hour di- minority leader or his designee, shall be con- vided between a proponent and an op- two specific provisions included in this sidered as read, shall be debatable for one ponent of the amendment. rule. First, the rule provides language hour equally divided and controlled by the The rule provides that after a motion to ensure that all areas of the country proponent and an opponent, and shall not be to rise has been rejected on any day, receive equitable funding through subject to amendment. All points of order another motion to rise may only be of- amendments to the capitation rate for- against that amendment in the nature of a fered by the chairman of the Commit- mula. While funding will be distributed substitute are waived. After a motion that tees on Ways and Means or Commerce, based upon historical costs and chang- the Committee rise has been rejected on a or by the majority leader, or a designee ing populations, the rule provides that day, the Chair may entertain another such motion on that day only if offered by the of either one of them. It also provides certain minimum funding levels will be chairman of the Committee on Ways and that the provisions of clause 5(c) of maintained. The formula guarantees Means, the chairman of the Committee on rule XXI shall not apply to votes on that historically low-cost areas will Commerce, or the majority leader, or a des- this bill, amendments, or the con- not be penalized because of their cost ignee of any of them. At the conclusion of ference report for this bill. I expect effectiveness. consideration of the bill for amendment the that we will witness many eloquent Second, the rule adds additional lan- Committee shall rise and report the bill, as speeches—pro and con—during today’s guage to attack fraud and abuse in amended, to the House with such further debate, and these two provisions are Medicare. The current Medicare sys- amendment as may have been adopted. The tem is so infected with fraud, abuse, previous question shall be considered as or- simply designed to limit some common dered on the bill, as amended, and any dilatory motions that may unneces- and misuse that it wastes billions of amendment thereto to final passage without sarily delay the consideration of this dollars each year. I doubt that any intervening motion except one motion to re- bill. Member of Congress has not had at commit with or without instructions. The Finally, this resolution provides one least one constituent at a town hall motion to recommit may include instruc- motion to recommit, with or without meeting or other event to show the tions only if offered by the minority leader instructions, as is the right of the mi- Member an example of a fraudulent or or his designee. The yeas and nays shall be nority. If the motion to recommit does erroneous Medicare billing. My own considered as ordered on the question of pas- contain instructions, the rule provides mother has received three such billings sage of the bill and on any conference report thereon. Clause 5(c) of rule XXI shall not that the motion may only be offered by in the last couple of years, and I am apply to the bill, amendments thereto, or the minority leader or his designee. convinced that she is not the only one conference reports thereon. Mr. Speaker, in about an hour, we who has encountered this problem. The SPEAKER pro tempore. The gen- will all participate in a historic event Therefore, in addition to the antifraud tleman from Georgia [Mr. LINDER] is that will lead us to consider a bill that provisions in the base text of this bill, recognized for 1 hour. will almost immediately benefit mil- this rule defines several new Federal Mr. LINDER. Mr. Speaker, for the lions of seniors, and eventually, mil- health care crimes and defines pen- purpose of debate only, I yield the cus- lions of Americans who will one day alties of up to 20 years in prison for tomary 30 minutes to the gentleman look to Medicare for health care serv- violations of these laws, laws focusing from Massachusetts [Mr. MOAKLEY], ice. I am honored to carry to the House on fraud, bribery, theft, embezzlement, pending which I yield myself such time floor a rule that presents our monu- and kickbacks. This provision covering as I may consume. mental proposal to save Medicare. doctors and hospitals engaging in this During consideration of this resolu- The fight to save Medicare began in deceit deserves to be part of the bill, tion, all time yielded is for the purpose earnest on April 3 of this year when the and this rule provides for its inclusion of debate only. Medicare Board of Trustees that over- in the reform package. (Mr. LINDER asked and was given sees the Medicare trust fund reported In addition to fighting fraud, this bill permission to revise and extend his re- to Congress that the Medicare trust will reduce reimbursement rates for marks and include extraneous mate- fund would begin to decline next year doctors and hospitals and provide sen- rial.) and would be completely bankrupt by iors with more choices for health care Mr. LINDER. Mr. Speaker, House the year 2002. The alarm to take dras- delivery. To achieve these goals, the Resolution 238 is a modified closed rule tic and immediate action to save the Medicare Preservation Act adds two that waives all points of order against program has created an atmosphere new programs to the current Medicare H.R. 2425, the Medicare Preservation that is both exciting and anxious for program—MedicarePlus and Medisave. Act of 1995 and provides for consider- Medicare beneficiaries. Through MedicarePlus, some citizens H 10316 CONGRESSIONAL RECORD — HOUSE October 19, 1995 will decide to choose a plan that offers these new programs in the first few in the power and potential of the mar- fixed rates, and covers prescription years. Over and over again, Americans ketplace. Market forces have modern- drugs, and even eyeglasses. Increas- have shown that they make wise ized every other segment of our soci- ingly, Americans have stated that they choices, and this plan gives our seniors ety, and I am certain that they will appreciate their managed care pro- that opportunity. have the effect of improving quality gram, and would stay in it. This bill af- Medicare is a 1965 Blue Cross/Blue and decreasing costs when applied to fords them the opportunity to choose Shield program in which costs have government health care. Without a managed care. Those who opt for medi- simply grown out of control. For exam- doubt, H.R. 2425 will provide seniors cal savings accounts through Medisave ple, when the program began, the Gov- with more choices and result in tre- would be completely in control of their ernment subsidized 50 percent of the mendous benefits to future generations own health spending. All of these part B premium. Yet today, the sub- of American seniors. We fulfill our changes will assure that we secure the sidy that our children and grand- promise to our citizens with this bill. children must pay has grown to 68.5 Medicare promise we made to our sen- The resolution that was favorably re- percent. Only the greediest of the el- iors. ported out of the Rules Committee is a We have to be clear: No benefit will derly, none of whom I know, would ask fair rule that will allow for careful con- be cut. You can keep your doctor and their grandchildren to shoulder more of sideration of the Republican proposal you have the option to choose any this burden. Therefore, we freeze the to save Medicare and a minority sub- other doctor. There will be no coercion subsidy at this level. Despite cries from stitute bill. I urge my colleagues to into any specific program. In fact, if a the other side that we are doubling pre- support the rule so that we may pro- senior chooses a MedicarePlus program miums, the fact is that this proposal ceed with consideration of the merits or chooses Medisave and then becomes will simply raise the part B premium of this extraordinarily important legis- dissatisfied, the bill states that the about $7 a month by year 7 of this plan. lation. senior can always move back to the The $7 is a small price to pay to pre- current Medicare system. We expect a serve both the future of Medicare and b 0945 very high degree of satisfaction, how- the future of our grandchildren. ever, as the Congressional Budget Of- As I have stated before, the most ex- Mr. Speaker, I submit the following fice has concluded that about 25 per- traordinary development has come in for inclusion in the CONGRESSIONAL cent of seniors will take advantage of those nations that have put their trust RECORD. THE AMENDMENT PROCESS UNDER SPECIAL RULES REPORTED BY THE RULES COMMITTEE,1 103D CONGRESS V. 104TH CONGRESS [As of October 18, 1995]

103d Congress 104th Congress Rule type Number of rules Percent of total Number of rules Percent of total

Open/Modified-open 2 ...... 46 44 51 72 Modified Closed 3 ...... 49 47 17 24 Closed 4 ...... 9 9 3 4 Total ...... 104 100 71 100 1 This table applies only to rules which provide for the original consideration of bills, joint resolutions or budget resolutions and which provide for an amendment process. It does not apply to special rules which only waive points of order against appropriations bills which are already privileged and are considered under an open amendment process under House rules. 2 An open rule is one under which any Member may offer a germane amendment under the five-minute rule. A modified open rule is one under which any Member may offer a germane amendment under the five-minute rule subject only to an overall time limit on the amendment process and/or a requirement that the amendment be preprinted in the Congressional Record. 3 A modified closed rule is one under which the Rules Committee limits the amendments that may be offered only to those amendments designated in the special rule or the Rules Committee report to accompany it, or which preclude amendments to a particular portion of a bill, even though the rest of the bill may be completely open to amendment. 4 A closed rule is one under which no amendments may be offered (other than amendments recommended by the committee in reporting the bill).

SPECIAL RULES REPORTED BY THE RULES COMMITTEE, 104TH CONGRESS [As of October 18, 1995]

H. Res. No. (Date rept.) Rule type Bill No. Subject Disposition of rule

H. Res. 38 (1/18/95) ...... O ...... H.R. 5 ...... Unfunded Mandate Reform ...... A: 350–71 (1/19/95). H. Res. 44 (1/24/95) ...... MC ...... H. Con. Res. 17 ...... Social Security ...... A: 255–172 (1/25/95). H.J. Res. 1 ...... Balanced Budget Amdt ...... H. Res. 51 (1/31/95) ...... O ...... H.R. 101 ...... Land Transfer, Taos Pueblo Indians ...... A: voice vote (2/1/95). H. Res. 52 (1/31/95) ...... O ...... H.R. 400 ...... Land Exchange, Arctic Nat’l. Park and Preserve ...... A: voice vote (2/1/95). H. Res. 53 (1/31/95) ...... O ...... H.R. 440 ...... Land Conveyance, Butte County, Calif ...... A: voice vote (2/1/95). H. Res. 55 (2/1/95) ...... O ...... H.R. 2 ...... Line Item Veto ...... A: voice vote (2/2/95). H. Res. 60 (2/6/95) ...... O ...... H.R. 665 ...... Victim Restitution ...... A: voice vote (2/7/95). H. Res. 61 (2/6/95) ...... O ...... H.R. 666 ...... Exclusionary Rule Reform ...... A: voice vote (2/7/95). H. Res. 63 (2/8/95) ...... MO ...... H.R. 667 ...... Violent Criminal Incarceration ...... A: voice vote (2/9/95). H. Res. 69 (2/9/95) ...... O ...... H.R. 668 ...... Criminal Alien Deportation ...... A: voice vote (2/10/95). H. Res. 79 (2/10/95) ...... MO ...... H.R. 728 ...... Law Enforcement Block Grants ...... A: voice vote (2/13/95). H. Res. 83 (2/13/95) ...... MO ...... H.R. 7 ...... National Security Revitalization ...... PQ: 229–100; A: 227–127 (2/15/95). H. Res. 88 (2/16/95) ...... MC ...... H.R. 831 ...... Health Insurance Deductibility ...... PQ: 230–191; A: 229–188 (2/21/95). H. Res. 91 (2/21/95) ...... O ...... H.R. 830 ...... Paperwork Reduction Act ...... A: voice vote (2/22/95). H. Res. 92 (2/21/95) ...... MC ...... H.R. 889 ...... Defense Supplemental ...... A: 282–144 (2/22/95). H. Res. 93 (2/22/95) ...... MO ...... H.R. 450 ...... Regulatory Transition Act ...... A: 252–175 (2/23/95). H. Res. 96 (2/24/95) ...... MO ...... H.R. 1022 ...... Risk Assessment ...... A: 253–165 (2/27/95). H. Res. 100 (2/27/95) ...... O ...... H.R. 926 ...... Regulatory Reform and Relief Act ...... A: voice vote (2/28/95). H. Res. 101 (2/28/95) ...... MO ...... H.R. 925 ...... Private Property Protection Act ...... A: 271–151 (3/2/95). H. Res. 103 (3/3/95) ...... MO ...... H.R. 1058 ...... Securities Litigation Reform ...... H. Res. 104 (3/3/95) ...... MO ...... H.R. 988 ...... Attorney Accountability Act ...... A: voice vote (3/6/95). H. Res. 105 (3/6/95) ...... MO ...... A: 257–155 (3/7/95). H. Res. 108 (3/7/95) ...... Debate ...... H.R. 956 ...... Product Liability Reform ...... A: voice vote (3/8/95). H. Res. 109 (3/8/95) ...... MC ...... PQ: 234–191 A: 247–181 (3/9/95). H. Res. 115 (3/14/95) ...... MO ...... H.R. 1159 ...... Making Emergency Supp. Approps ...... A: 242–190 (3/15/95). H. Res. 116 (3/15/95) ...... MC ...... H.J. Res. 73 ...... Term Limits Const. Amdt ...... A: voice vote (3/28/95). H. Res. 117 (3/16/95) ...... Debate ...... H.R. 4 ...... Personal Responsibility Act of 1995 ...... A: voice vote (3/21/95). H. Res. 119 (3/21/95) ...... MC ...... A: 217–211 (3/22/95). H. Res. 125 (4/3/95) ...... O ...... H.R. 1271 ...... Family Privacy Protection Act ...... A: 423–1 (4/4/95). H. Res. 126 (4/3/95) ...... O ...... H.R. 660 ...... Older Persons Housing Act ...... A: voice vote (4/6/95). H. Res. 128 (4/4/95) ...... MC ...... H.R. 1215 ...... Contract With America Tax Relief Act of 1995 ...... A: 228–204 (4/5/95). H. Res. 130 (4/5/95) ...... MC ...... H.R. 483 ...... Medicare Select Expansion ...... A: 253–172 (4/6/95). H. Res. 136 (5/1/95) ...... O ...... H.R. 655 ...... Hydrogen Future Act of 1995 ...... A: voice vote (5/2/95). H. Res. 139 (5/3/95) ...... O ...... H.R. 1361 ...... Coast Guard Auth. FY 1996 ...... A: voice vote (5/9/95). H. Res. 140 (5/9/95) ...... O ...... H.R. 961 ...... Clean Water Amendments ...... A: 414–4 (5/10/95). H. Res. 144 (5/11/95) ...... O ...... H.R. 535 ...... Fish Hatchery—Arkansas ...... A: voice vote (5/15/95). H. Res. 145 (5/11/95) ...... O ...... H.R. 584 ...... Fish Hatchery—Iowa ...... A: voice vote (5/15/95). H. Res. 146 (5/11/95) ...... O ...... H.R. 614 ...... Fish Hatchery—Minnesota ...... A: voice vote (5/15/95). H. Res. 149 (5/16/95) ...... MC ...... H. Con. Res. 67 ...... Budget Resolution FY 1996 ...... PQ: 252–170 A: 255–168 (5/17/95). H. Res. 155 (5/22/95) ...... MO ...... H.R. 1561 ...... American Overseas Interests Act ...... A: 233–176 (5/23/95). H. Res. 164 (6/8/95) ...... MC ...... H.R. 1530 ...... Nat. Defense Auth. FY 1996 ...... PQ: 225–191 A: 233–183 (6/13/95). H. Res. 167 (6/15/95) ...... O ...... H.R. 1817 ...... MilCon Appropriations FY 1996 ...... PQ: 223–180 A: 245–155 (6/16/95). H. Res. 169 (6/19/95) ...... MC ...... H.R. 1854 ...... Leg. Branch Approps. FY 1996 ...... PQ: 232–196 A: 236–191 (6/20/95). H. Res. 170 (6/20/95) ...... O ...... H.R. 1868 ...... For. Ops. Approps. FY 1996 ...... PQ: 221–178 A: 217–175 (6/22/95). October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10317 SPECIAL RULES REPORTED BY THE RULES COMMITTEE, 104TH CONGRESS—Continued [As of October 18, 1995]

H. Res. No. (Date rept.) Rule type Bill No. Subject Disposition of rule

H. Res. 171 (6/22/95) ...... O ...... H.R. 1905 ...... Energy & Water Approps. FY 1996 ...... A: voice vote (7/12/95). H. Res. 173 (6/27/95) ...... C ...... H.J. Res. 79 ...... Flag Constitutional Amendment ...... PQ: 258–170 A: 271–152 (6/28/95). H. Res. 176 (6/28/95) ...... MC ...... H.R. 1944 ...... Emer. Supp. Approps ...... PQ: 236–194 A: 234–192 (6/29/95). H. Res. 185 (7/11/95) ...... O ...... H.R. 1977 ...... Interior Approps. FY 1996 ...... PQ: 235–193 D: 192–238 (7/12/95). H. Res. 187 (7/12/95) ...... O ...... H.R. 1977 ...... Interior Approps. FY 1996 #2 ...... PQ: 230–194 A: 229–195 (7/13/95). H. Res. 188 (7/12/95) ...... O ...... H.R. 1976 ...... Agriculture Approps. FY 1996 ...... PQ: 242–185 A: voice vote (7/18/95). H. Res. 190 (7/17/95) ...... O ...... H.R. 2020 ...... Treasury/Postal Approps. FY 1996 ...... PQ: 232–192 A: voice vote (7/18/95). H. Res. 193 (7/19/95) ...... C ...... H.J. Res. 96 ...... Disapproval of MFN to China ...... A: voice vote (7/20/95). H. Res. 194 (7/19/95) ...... O ...... H.R. 2002 ...... Transportation Approps. FY 1996 ...... PQ: 217–202 (7/21/95). H. Res. 197 (7/21/95) ...... O ...... H.R. 70 ...... Exports of Alaskan Crude Oil ...... A: voice vote (7/24/95). H. Res. 198 (7/21/95) ...... O ...... H.R. 2076 ...... Commerce, State Approps. FY 1996 ...... A: voice vote (7/25/95). H. Res. 201 (7/25/95) ...... O ...... H.R. 2099 ...... VA/HUD Approps. FY 1996 ...... A: 230–189 (7/25/95). H. Res. 204 (7/28/95) ...... MC ...... S. 21 ...... Terminating U.S. Arms Embargo on Bosnia ...... A: voice vote (8/1/95). H. Res. 205 (7/28/95) ...... O ...... H.R. 2126 ...... Defense Approps. FY 1996 ...... A: 409–1 (7/31/95). H. Res. 207 (8/1/95) ...... MC ...... H.R. 1555 ...... Communications Act of 1995 ...... A: 255–156 (8/2/95). H. Res. 208 (8/1/95) ...... O ...... H.R. 2127 ...... Labor, HHS Approps. FY 1996 ...... A: 323–104 (8/2/95). H. Res. 215 (9/7/95) ...... O ...... H.R. 1594 ...... Economically Targeted Investments ...... A: voice vote (9/12/95). H. Res. 216 (9/7/95) ...... MO ...... H.R. 1655 ...... Intelligence Authorization FY 1996 ...... A: voice vote (9/12/95). H. Res. 218 (9/12/95) ...... O ...... H.R. 1162 ...... Deficit Reduction Lockbox ...... A: voice vote (9/13/95). H. Res. 219 (9/12/95) ...... O ...... H.R. 1670 ...... Federal Acquisition Reform Act ...... A: 414–0 (9/13/95). H. Res. 222 (9/18/95) ...... O ...... H.R. 1617 ...... CAREERS Act ...... A: 388–2 (9/19/95). H. Res. 224 (9/19/95) ...... O ...... H.R. 2274 ...... Natl. Highway System ...... PQ: 241–173 A: 375–39–1 (9/20/95). H. Res. 225 (9/19/95) ...... MC ...... H.R. 927 ...... Cuban Liberty & Dem. Solidarity ...... A: 304–118 (9/20/95). H. Res. 226 (9/21/95) ...... O ...... H.R. 743 ...... Team Act ...... A: 344–66–1 (9/27/95). H. Res. 227 (9/21/95) ...... O ...... H.R. 1170 ...... 3-Judge Court ...... A: voice vote (9/28/95). H. Res. 228 (9/21/95) ...... O ...... H.R. 1601 ...... Internatl. Space Station ...... A: voice vote (9/27/95). H. Res. 230 (9/27/95) ...... C ...... H.J. Res. 108 ...... Continuing Resolution FY 1996 ...... A: voice vote (9/28/95). H. Res. 234 (9/29/95) ...... O ...... H.R. 2405 ...... Omnibus Science Auth ...... A: voice vote (10/11/95). H. Res. 237 (10/17/95) ...... MC ...... H.R. 2259 ...... Disapprove Sentencing Guidelines ...... A: voice vote (10/18/95). H. Res. 238 (10/18/95) ...... MC ...... H.R. 2425 ...... Medicare Preservation Act ...... Codes: O-open rule; MO-modified open rule; MC-modified closed rule; C-closed rule; A-adoption vote; D-defeated; PQ-previous question vote. Source: Notices of Action Taken, Committee on Rules, 104th Congress.

CORRECTION OF VOTES IN COMMITTEE Vote by Member Yea Nay Present from Massachusetts [Mr. MOAKLEY], REPORT—OCTOBER 19, 1995 the distinguished ranking member of MOAKLEY ...... X ...... The Rules Committee’s report, House Re- BEILENSON ...... X ...... the Committee on Rules. The gen- port 104–282 on House Resolution 238, the rule FROST ...... X ...... tleman from Massachusetts is recog- for the consideration of H.R. 2425, the Medi- HALL ...... X ...... SOLOMON ...... X ...... nized for 30 minutes. care Preservation Act of 1995, contains four Mr. MOAKLEY. Mr. Speaker, I thank erroneous rollcall votes. RULES COMMITTEE ROLLCALL NO. 202 Below is a correct version of those votes. the gentleman from Georgia [Mr. The corrected votes for Rollcall Nos. 178, 189, Date: October 18, 1995. LINDER], my dear friend, for yielding 202, and 203 are as follows: Measure: H.R. 2425, the Medicare Preserva- me the customary half-hour, and I tion Act of 1995. COMMITTEE VOTES yield myself such time as I may Motion By: Mr. Solomon. consume. Pursuant to clause 2(l)(2)(B) of House rule Summary of Motion: Add provision to rule XI the results of each rollcall vote on an ordering yeas and nays on passage of bill and Mr. Speaker, I am very honored to be amendment or motion to report, together suspending application of clause 5(c) of rule back at the leadership table today with the names of those voting for and XXI to votes on passage of bill, amendments doing my part on behalf of every Amer- against, are printed below. For a summary of thereto, and conference reports thereon. ican who does not want their Medicare the amendments moved to be made in order, Results: Adopted, 9 to 3. benefits cut to pay for the tax cuts for see section following the rollcall votes. the very, very rich. Vote by Member Yea Nay Present RULES COMMITTEE ROLLCALL NO. 178 Mr. Speaker, I heard 7 hours of testi- Date: October 18, 1995. QUILLEN ...... X ...... mony in the Committee on Rules yes- Measure: H.R. 2425, the Medicare Preserva- DREIER ...... X ...... GOSS ...... X ...... terday and I still cannot understand tion Act of 1995. LINDER ...... X ...... why anyone on Earth would propose Motion By: Mr. Moakley. PRYCE ...... X ...... Summary of Motion: Make in order amend- DIAZ-BALART ...... X ...... such a horrible, horrible idea. McINNIS ...... X ...... Mr. Speaker, 40 million elderly ment by Representative Rangel. WALDHOLTZ ...... X ...... Results: Rejected, 4 to 9. MOAKLEY ...... X ...... Americans rely on Medicare, but my BEILENSON ...... X ...... Republican colleagues still insist on Vote by Member Yea Nay Present FROST ...... HALL ...... X ...... using Medicare as a slush fund for tax QUILLEN ...... X ...... SOLOMON ...... X ...... breaks. I can tell my colleagues that I DREIER ...... X ...... was not sent to Congress to do that. GOSS ...... X ...... RULES COMMITTEE ROLLCALL NO. 203 LINDER ...... X ...... Mr. Speaker, I want to make some- PRYCE ...... X ...... Date: October 18, 1995. thing very clear. This bill will hurt. DIAZ-BALART ...... X ...... Measure: H.R. 2425, the Medicare Preserva- This bill will hurt and it means that McINNIS ...... X ...... tion Act of 1995. WALDHOLTZ ...... X ...... senior citizens’ premiums increase MOAKLEY ...... X ...... Motion By: Mr. Quillen. BEILENSON ...... X ...... Summary of Motion: Order rule reported. about $400, but they will have to give FROST ...... X ...... Results: Adopted, 9 to 3. up their own private doctors. HALL ...... X ...... SOLOMON ...... X ...... Where I come from, if you pay more, Vote by Member Yea Nay Present you should get more. But not today, RULES COMMITTEE ROLLCALL NO. 189 QUILLEN ...... X ...... Mr. Speaker. This bill takes health Date: October 18, 1995. DREIER ...... X ...... benefits from Grandma, from Grandpa, GOSS ...... X ...... Measure: H.R. 2425, the Medicare Preserva- LINDER ...... X ...... and hands them over to the richest tion Act of 1995. PRYCE ...... X ...... Americans in the forms of a nice, big, Motion By: Mr. Beilenson. DIAZ-BALART ...... X ...... McINNIS ...... X ...... juicy, fat tax break. Summary of Motion: Make in order amend- WALDHOLTZ ...... X ...... Republicans are not cutting Medicare ment by Representative Ganske. MOAKLEY ...... X ...... Results: Rejected, 4 to 9. BEILENSON ...... X ...... to save it. Republicans are not cutting FROST ...... Medicare to protect senior citizens. Re- HALL ...... X ...... Vote by Member Yea Nay Present SOLOMON ...... X ...... publicans are cutting Medicare to fill QUILLEN ...... X ...... that big, big hole left in our Nation’s DREIER ...... X ...... Mr. LINDER. Mr. Speaker, I reserve wallet after their tax break for the GOSS ...... X ...... the balance of my time. LINDER ...... X ...... very rich. PRYCE ...... X ...... The SPEAKER pro tempore (Mr. Mr. Speaker, at a time when we DIAZ-BALART ...... X ...... LAHOOD). It is the prerogative of the McINNIS ...... X ...... should be immunizing more of our chil- WALDHOLTZ ...... X ...... Chair to welcome back the gentleman dren, at a time when we should be H 10318 CONGRESSIONAL RECORD — HOUSE October 19, 1995 training more of our health workers, at care Program, or they can choose a pri- b 1000 a time when we should be working to- vate health plan and Medicare will give A bazaar, a trading session, simply to gether to make this country as com- them $4,800 to pay for it. be able to find enough votes to put petitive and caring as it can be, this Then there is a group, and I think through this plan, to cut Medicare by bill leaves thousands and thousands of this is a group that I represent back $270 billion. senior citizens out in the cold. home because they are working Ameri- PARLIAMENTARY INQUIRY Mr. Speaker, this will cripple our fine cans. They work for firms like GE and Mr. MCDERMOTT. Mr. Speaker, I medical schools, our outstanding IBM, International Paper Co. or the have a parliamentary inquiry. teaching hospitals, our research facili- State of New York or local govern- The SPEAKER pro tempore (Mr. ties, and the health of the entire coun- ment. They have health coverage LAHOOD). The gentleman will state his try will ultimately suffer. through their employer. parliamentary inquiry. Mr. Speaker, senior citizens need Under this new plan, they can retire Mr. MCDERMOTT. Since we had no their health care a lot more than the tomorrow, either join the current Med- hearings in the Committee on Ways very, very rich need another tax break. icare Program or they can continue the and Means, I want to clarify what doc- Take it from me, Mr. Speaker, senior policy they have now with their cur- ument we are dealing with. citizens need their health care a lot rent employer and Medicare will con- Mr. LINDER. Mr. Speaker, that is more than the very, very rich need tribute up to $4,800 to help pay for it. not that parliamentary inquiry. other things. That gives great relief to those people. Mr. MCDERMOTT. Wait and listen to Mr. Speaker, this bill is wrong. It is Last, there is a group of small busi- my parliamentary inquiry. wrong. It is wrong. So, I ask my col- We had a bill introduced, H.R. 2425, in nessmen, like farmers, and I represent league to defeat the previous question the committee. Then we had a sub- maybe the 20th largest dairy producing and oppose this rule. stitute of 435 pages that was dropped on district in America, who currently buy Mr. Speaker, I reserve the balance of us the day of the first meeting. a Blue Cross-Blue Shield plan or a pri- my time. Mr. LINDER. Point of order. vate plan, but when they retire tomor- Mr. LINDER. Mr. Speaker, for the Mr. MCDERMOTT. Then we have a purpose of debate only, I yield 4 min- row their income goes down and they bill identified as Union Calendar 145, utes to the gentleman from New York no longer can afford the same policy. H.R. 2425, which is 900 pages—— [Mr. SOLOMON], chairman of the Com- Mr. Speaker, under this plan they can Mr. LINDER. Point of order. mittee on Rules. either: Mr. MCDERMOTT. Which is 900 Mr. SOLOMON. Mr. Speaker, let me One, join the existing Medicare Pro- pages, which has never had a hearing, take a moment to welcome back my gram as it is today or, two, continue to and now we have H.R. 2485. Are there colleague, the gentleman from Massa- buy the health policy they have today any other—— chusetts [Mr. MOAKLEY]. Mr. Speaker, I and Medicare will contribute up to The SPEAKER pro tempore. The gen- would say to the gentleman that he has $4,800 toward the cost of that policy. tleman from Washington will suspend. not changed a bit, and it is a pleasure Mr. Speaker, last weekend I sat home Mr. MCDERMOTT. Are there any to have him back here. and I randomly called over 100 con- other changes before us—— Mr. Speaker, let me also take a mo- stituents from all of these categories I The SPEAKER pro tempore. The gen- ment to thank the gentleman from mentioned above and you know what? tleman from Washington will suspend. Georgia [Mr. LINDER], who is managing After I explained this new program, The gentleman from Georgia will this rule, and the other members of the without using terms like Medisave, state his point of order. Committee on Rules, for supporting Medigap, or MedicarePlus, when I ex- POINT OF ORDER this rule. Because, by voting for this plained it to them in layman’s lan- Mr. LINDER. Point of order. Is that a rule, my colleagues are voting to give guage, almost every one of them said parliamentary inquiry or a speech? greater equity to the rural hospitals in they were relieved and they thanked Mr. MCDERMOTT. I think asking the America. That means more money to me for what we are doing to save Medi- Chair what we are considering is basi- rural hospitals because they are so care today. cally a parliamentary inquiry. We are out here as a parliament to deal with pressed right now for financial assist- So, on behalf of my constituents, I law. The question is, What we are deal- ance: This rule will go a long way to- want to thank the two committees for ing with? ward helping them. So, I thank the the great job that they have done. Committee on Rules for supporting it. The SPEAKER pro tempore. The They really are saving this system for Chair will read from the rule: Mr. Speaker, last month I turned 65 the elderly for years to come. years of age and am now a contributing An amendment in the nature of a sub- Mr. MOAKLEY. Mr. Speaker, I yield member of the Medicare system. On be- stitute consisting of the text of H.R. 2485, 1 minute to the gentleman from Texas half of myself and my constituents, I modified by the amendment printed in the [Mr. FROST], an outstanding member of report of the committee on Rules accom- want to thank the gentleman from the Committee on Rules. panying this resolution, shall be considered Texas [Mr. ARCHER], the gentleman Mr. FROST. Mr. Speaker, at 10 as adopted in the House and in the commit- from Virginia [Mr. BLILEY], and other tee of the whole. The bill, as amended, shall members of their committees for this o’clock last night the Committee on be considered as the original bill for the pur- bill, which not only saves the existing Rules was called back into session to pose of further amendment under the 5- system from bankruptcy, but guaran- rewrite this rule. Now, what was going minute rule. tees there will be Medicare protection on? The Republicans are desperate to Mr. MCDERMOTT. Can the Chair tell for the elderly for many years to come find votes to promote their $245 billion us, are there any changes between the with no ‘‘Band-Aid fix’’ as is usually tax cut for the wealthy. H.R. 2425, which came out of the com- the case, here in Congress. Look in today’s New York Times. mittees, and H.R. 2485, which was used Mr. Speaker, I have been hearing ‘‘For Republicans in the House, a Fran- in the Committee on Rules last night? from several different groups of people tic Vote Trading Bazaar,’’ and I want The SPEAKER pro tempore. The who are legitimately concerned about to quote from this. Chair cannot further respond. how this reform affects them. First, Today the office of Speaker Newt Gingrich PARLIAMENTARY INQUIRY there is a group already retired on became a kind of bazaar as lawmakers Mr. DINGELL. Mr. Speaker, I have a Medicare. They can stay in the system trouped in seeking concessions and Mr. Ging- further parliamentary inquiry. exactly as they are or they can buy an- rich tried to please them. The bargaining The SPEAKER pro tempore. The gen- other private health policy and Medi- was a little like Christmas shopping, as Re- tleman will state his parliamentary in- care will give them up to $4,800 to help publican lawmakers searched for gifts. To quiry. help pay for the sweeteners for the rural law- Mr. DINGELL. Could the Chair tell pay for it. That is important for those makers, this is what they did. They decided people on Medicare today to know. not to expand Medicare coverage of chiro- us which of the documents that have Second, there is a group ready to re- practor services and not to pay for drugs been coming forth so profusely is to be tire that has no current insurance. needed to combat nausea caused by certain used today for consideration of the leg- They can retire, join the existing Medi- anticancer drugs. islation? October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10319 The SPEAKER pro tempore. The re- and the bill it makes in order, we are either one of those committees, but yet sponse from the Chair is that the Chair keeping our promise to the American it was reported by the Committee on has just ruled on that. people to put Medicare on a sound fi- Rules. It is 471 pages long. The other The gentleman from Georgia is rec- nancial footing. one is 900 pages long. ognized. Mr. Speaker, let us save Medicare. I Then we are adopting a rule here Mr. LINDER. Mr. Speaker, for pur- urge my colleagues to support this fair today that makes two more changes. poses of debate only, I yield 3 minutes rule and to bring this country Medicare Now I am told by staff that there are 17 to the gentlewoman from Ohio [Ms. that is guaranteed to survive. changes in this bill that have never PRYCE], our colleague on the Commit- POINT OF ORDER been considered by any committee in tee on Rules. Mr. GIBBONS. Mr. Speaker, I make a this Congress. Nobody has ever seen Ms. PRYCE. Mr. Speaker, this is a point of order that a quorum is not them. This is Newt’s bargaining pack- historic day in the House of Represent- present. age. This is what he bought his Repub- atives, and I am pleased to rise in The SPEAKER pro tempore. The lican votes on. strong support of this rule for the Med- Chair does not need to entertain that Then, to add insult to injury, there icare Preservation Act. at this point. are two more amendments to this bill, Throughout the past year, we have Mr. GIBBONS. When will the Chair that has never been read by anybody, made every effort to alert the Amer- entertain such a motion? There is obvi- in this rule that we are adopting today. ican people, and seniors in particular, ously not a quorum present, Mr. I have seen a lot of razzle dazzle, I that we are facing a serious crisis. Speaker. say to the gentleman from New York Medicare is growing at an Mr. Speaker, you know, you are the [Mr. SOLOMON] in this Congress in 33 unsustainable rate, and retirement of Speaker pro tempore. The Speaker is years, but you and your Committee on the baby boomers is just around the off selling books somewhere today. Rules and NEWT GINGRICH top it all. corner. Unless decisive action is taken There is obviously a quorum not For what purpose? For one purpose now, the Medicare system will col- present. Any camera can see a quorum only: To get old people to take $270 bil- lapse. With the health of 34 million is not present. Why can I not make a lion out of their pockets and give it to senior citizens at stake, we can’t delay point of order if a quorum is not your rich contributors. any longer. The time has come for Con- present? Mr. SOLOMON. Mr. Speaker, will the gress to act responsibly and coura- The SPEAKER pro tempore. Under gentleman yield? geously, in the face of all the rhetoric rule XV, clause 6(e) the Chair cannot Mr. GIBBONS. No. You cut us off. and politics as usual. entertain such a point of order during You did not give us any time. NEWT After months of congressional hear- debate. GINGRICH did not give us any time to ings and meetings with senior citizens, The gentleman from Massachusetts debate here. Why should I yield to you? doctors, hospitals, and health care ex- [Mr. MOAKLEY] has 26 minutes remain- Mr. SOLOMON. Well, you are still perts, Congress has crafted a plan that ing and is recognized. my friend. will prevent Medicare’s bankruptcy Mr. MOAKLEY. Mr. Speaker, I yield Mr. MOAKLEY. Mr. Speaker, I yield and give seniors the peace of mind they 3 minutes to the gentleman from Flor- 1 minute to the outstanding gentleman deserve as they look forward to their ida [Mr. GIBBONS], the ranking minor- from Michigan [Mr. DINGELL], the retirement years. ity member of the Committee on Ways ranking minority member of the Com- Our committees have developed a se- and Means, who has done an outstand- mittee on Commerce. rious response to the Medicare crisis, ing job trying to keep the priorities of (Mr. DINGELL asked and was given one which not only promises solvency the Congress going in the right direc- permission to revise and extend his re- of the program, but offers seniors the tion. marks.) right to choose their health care plan, Mr. GIBBONS. Mr. Speaker, I have Mr. DINGELL. Mr. Speaker, this is a including the right to stay in the tradi- seen a lot of outrages in my 33 years, bad rule and a bad bill. I urge my col- tional Medicare system. but this tops it all. I will not compare leagues to defeat the previous question, What this plan is about is change, it to the attack on Pearl Harbor. I was to defeat the rule and defeat the bill. and change long overdue. The current in the Army in the attack on Pearl The process here has been an abomi- Medicare program is a 1965 Blue Cross/ Harbor. It was not a joke. I lost a lot of nation. It has been an insult to the Blue Shield health care plan codified friends and a lot of colleagues. But this American people. There have been no into law. But just like stereos, comput- is a stealth attack of terrible propor- hearings on this bill. There have been ers, or cars, health care plans have tions. constant changes in its language. seen a lot of innovation in the last 30 Mr. Speaker, there is only one reason There have been constant backroom years. that we are having this gag rule today. deals cut to benefit special interests. Here and now in 1995, you can still Yesterday, the Republicans spent 4 Committee amendments have been drive a 1965 Chevy, but there are a lot hours on shrimp, 4 hours on shrimp. disappearing from the final text, and of new models out there with cruise Today we are spending 3 hours on 40 now a gag rule is before us permitting control, air bags, and automatic locks. million people’s benefits, $270 billion. only one amendment. For the first time in 30 years, this pro- Now, that is the Republican priority in Republicans say we need this bill to posal gives seniors the opportunity to this Congress: 4 hours on shrimp, 3 save Medicare. Do not believe it. There choose a newer model, but we’re also hours on Medicare. is only one reason that this bill is re- saying, if you want to keep your 1965 There is obviously not a quorum quired, and that is to provide tax cuts plan, if you want to keep on driving present. I do not know where the Mem- for the rich, financed at the expense of your favorite 1965 Chevy, that’s all bers are. I wish they were here because senior citizens and Medicare recipients. right—it’s now your decision, not the what we have to say is important. The committee never had a minute’s Government’s. I want to try to follow up what was hearings on this legislation. No com- This plan is honest and sincere. just said here about the razzle dazzle mittee did. There is no hidden agenda. It’s all that is going on about these bills. This The bill has undergone constant there, up front, in black and white for is the bill that was finally reported by changes. We have Democratic sub- the American people to see—no fine the Committee on Ways and Means stitutes here which will not have an print, nothing between the lines. after two or three substitutes by the opportunity to be considered. There are Our plan will simplify and strengthen chairman. It is not worth a hoot. It is proposals in this bill that have been Medicare, while finally giving seniors 900-and-some pages long and had al- sneaked in in the dark of night, and no the same choices we all have. ready been discarded. This is the bill Member knows what they might con- Saving Medicare is not just a slogan that was adopted by the Committee on tain. or a political strategy. Rather, it is a Rules last night. It was referred to the I urge rejection of this gag rule. moral obligation to our seniors and to Committee on Ways and Means. It was PARLIAMENTARY INQUIRY future generations. We are committed referred to the Committee on Com- Mr. DOGGETT. Mr. Speaker, par- to this challenge, and with this rule merce. It never saw the light of day in liamentary inquiry. H 10320 CONGRESSIONAL RECORD — HOUSE October 19, 1995 The SPEAKER pro tempore. The gen- meaningful public debateÐwe all know the the American dream, those that tleman will state his parliamentary in- only place this bill can be debated is behind thought if they took care of their’s, quiry. closed doors with the AMA and other special that our country would take care of Mr. DOGGETT. Under this rule, as it interests. The Republicans are in such a rush them. is proposed, is the new rule of the to go home to explain this sellout to their con- I know, Republicans have fought House requiring a three-fifths’ vote on stituents, they didn't have time to allow for a Medicare from the inception. Every tax increases before any tax increase meaningful debate on the actual legislation. time it comes up, you have always been can go into effect, is that rule being The issues which fall within the jurisdiction there, always been there, to vote it suspended under this rule so that this of the Judiciary Committee rank among the down. And here you come again, where will be a tax increase that does not most important economic matters we will see hospitals that service the poorest of comply with the new rules of the this Congress: Massive new antitrust exemp- the poor, in the rural areas, in the House? tions that will allow doctors to fix prices inhibit inner-cities, where they have no sup- I realize it is to provide tax cuts, but their competitors; radical medical malpractice port system, there you are reducing does it not have a tax increase? and product liability changes that will for the the benefits. The SPEAKER pro tempore. The first time ever intrude on the States' rights to People get up here time and time Chair would refer the gentleman from protect their citizens against negligence; and again saying that is just not so. Well, Texas to the last sentence of the rule. wholesale rewrites of our antifraud laws that why do you not go to the hospital peo- Mr. DOGGETT. Does that permit a will make it almost impossible to prosecute ple and ask them why they believe you suspension of the three-fifths rule to Medicare fraud committed by doctors. are destroying them? Why do you not allow a tax increase to go into effect Amazingly, we in the Congress will go go to those in the nursing homes and without a three-fifths’ vote? through this process having had no debate ask why they are so frightened? And The SPEAKER pro tempore. That is whatsoever on the merits of these broad-rang- why are we not able to say that there the rule being waived relating to in- ing proposals. When the antitrust and mal- is nothing wrong with that trust fund come tax rate increases. practice issues were raised in the Ways and that $90 billion would not take care of? Mr. DOGGETT. I thank the Chair Means Committee, Chairman ARCHER cut off If you are so concerned about the very much. debate by saying that the Judiciary Committee Medicare bill, and this will be new to Mr. MOAKLEY. Mr. Speaker, I yield would resolve them. Yet Chairman HYDE re- my Republican majority friends, it 1 minute to the gentleman from Michi- fused to hold a hearing or a markup, Speaker would be brand new, it would be mak- gan [Mr. CONYERS], who has worked GINGRICH discharged the committee from con- ing history, that you were concerned very diligently on this matter. sideration, and the Rules Committee ruled all about the Medicare bill, all you have to (Mr. CONYERS asked and was given of our amendments out of order. We've held do is cut your tax bill by $90 billion, permission to revise and extent his re- 10 days of hearings on Waco, 8 days of mark- throw it over there and fix the trust marks.) up on immigration, and no hearings or markup fund, and set up a commission to do Mr. CONYERS. Mr. Speaker, we come on the antitrust, medical malpractice, and anti- the rest. here on a rule that handles the issues fraud provisions in the Medicare bill. Mr. MOAKLEY. Mr. Speaker, I yield that fall within the jurisdiction of the So we have the absurd situation where the 1 minute to the gentleman from Ohio Committee on the Judiciary that are only group which is permitted to write and de- [Mr. TRAFICANT] the friend of labor, the the most important economic matters bate important changes to the antitrust, medi- friend of the elderly. in this Congress, massive antitrust ex- cal malpractice, and antifraud laws are the Mr. TRAFICANT. Mr. Speaker, I op- emptions that will allow doctors to fix special interestsÐnot the Congress. Now I pose the rule; another choice should and inhibit the prices of their competi- know why the majority keeps putting off gift have been put in order. I will oppose tors, radical medical malpractice and and lobby reform. Obviously they needed to the bill; it is simply not the best. But product liability changes for the first finish this billÐthe largest legislative giveaway I do not agree with the politics being time that will intrude on the States’ of all timeÐbefore they can even consider lob- played here today, the spin to win, re- rights to protect their citizens against bying reform. gardless of the consequences. Depicting negligence, wholesale rewrites of the I urge the Members to defeat this rule and NEWT GINGRICH as Darth Vader and Re- antifraud laws that will make it al- restore a level of sanity and reasonableness publicans as two-headed monsters may most impossible to prosecute Medicare back into the legislative process. seem to be good democratic politics, fraud committee by doctors, and yet but it is bad public policy for America. b we have had no debate on any of these 1015 Congress spends too much time on matters. Mr. MOAKLEY. Mr. Speaker, I yield motive and not enough time on sub- The chairman of the Committee on 2 minutes to the gentleman from New stance. The important issue today is Ways and Means, the gentleman from York [Mr. RANGEL], a real fine Member not whether Republicans win or the Texas [Mr. ARCHER], cut off debate in who has lived firsthand with this very, Democrats win. Medicare should be that committee, saying the Committee very terrible situation that we see in fixed. Medicare is in trouble, and I be- on the Judiciary would resolve them. some of the nursing homes in the State lieve that we should address that issue. The chairman of the Committee on the of New York. I oppose the bill. It is simply not the Judiciary has never held hearings on (Mr. RANGEL asked and was given best we could fashion. this, and Speaker GINGRICH discharged permission to revise and extend his re- PARLIAMENTARY INQUIRY the Committee on the Judiciary from marks.) Mr. SKAGGS. Mr. Speaker, I have a consideration. Mr. RANGEL. Mr. Speaker, there parliamentary inquiry. Ten days on Waco in Committee on comes a point where shame has to be The SPEAKER pro tempore (Mr. the Judiciary, 8 days on immigration, an issue that has to be discussed. No LAHOOD). The gentleman will state it. no days on Medicare fraud. one knows better than I how important Mr. SKAGGS. Mr. Speaker, looking I rise in strong opposition to this outrageous a campaign promise is, and I recognize at the last sentence on page 3 of the rule. when you promise $245 billion to those rule, the waiver of clause 5 of rule XXI, Later today this House will be considering who support the goals and aims of the am I correct that this is the provision one of the most far-reaching and punitive Republican Party, that you must keep that requires three-fifths of the Mem- pieces of legislation in the history of this Na- that promise. bers to approve any tax increase on tion. The bill has been negotiated behind The question is, have you no shame final passage? closed doors directly with special interests and in how far you go to raise the money? The SPEAKER pro tempore. The gen- only peeks its head above water occasionally, Student loans, school lunches, housing tleman is correct about an income tax only to be changed and revised through mas- for the poor. And now we are talking rate increase. sive and complex substitutes further tailored to about the crown jewel. The crown jewel Mr. SKAGGS. Mr. Speaker, what is suit the needs of powerful special interests. is not $245 billion in tax cuts. The the reason that this provision is in the And today our right to debate the merits of crown jewel is aged Americans, those resume, if the Chair could respond? this legislation has been all but eliminated. who raised their families and their The SPEAKER pro tempore. The Why should we expect to have any sort of grandchildren, those that believed in Chair cannot speculate on that. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10321 Mr. SKAGGS. Mr. Speaker, presum- terday in the Rules Committee under- tlement Reform. We grappled with the ably it must be because there is a tax scores the importance of the Medicare fact that doing nothing means disaster rate increase in the bill. Otherwise, Program and the high level of interest for Medicare and all entitlements. there would be no point in having this it holds for all Members. This rule is Today we step up to our responsibility waiver. fair and reasonable. By way of com- and offer positive action to avert that The SPEAKER pro tempore. The parison, when the Medicare Program crisis. I hope my colleagues will join Chair will point out again that the pro- was first created 30 years ago, there me in doing the right thing for Medi- vision is in the rule, as has been read. were no amendments allowed, other care, for America. Mr. MOAKLEY. Mr. Speaker, I yield than technical changes proposed by the Mr. MOAKLEY. Mr. Speaker, I yield 2 minutes to the gentleman from Vir- Ways and Means Committee. Today’s 1 minute to the gentleman from Texas ginia [Mr. PAYNE]. rule allows the minority two opportu- [Mr. DOGGETT] who has a presentation. Mr. PAYNE of Virginia. Mr. Speaker, nities to present alternative reform Mr. DOGGETT. Mr. Speaker, I thank I rise in strong opposition to this rule, plans—so let’s cut out this nonsense the gentleman for yielding me time. because all year long, every time that about process. Mr. Speaker, you know, unless you someone from this side of the aisle has Mr. Speaker, the history of this mo- are a special interest with a swarm of come down to criticize or even talk ment should not be lost on us. We have lobbyists, you have very little to smile about the Republican plan, we were a bedrock program that affects the about with reference to this Repub- met with the same response: ‘‘Where is most personal aspect of the lives of lican pay-more, get-less plan. But I your Medicare plan,’’ they said, ‘‘and tens of millions of Americans—but we think I have found something to give what will you do to save Medicare?’’ all know Medicare part A is a health you a smile with. It is a painting that Well, Mr. Speaker, those of us from care program that is headed over the I think captures it all. It captures the the Democratic Conservative Coalition cliff to oblivion of bankruptcy in a few raw truth of this Republican plan, a came up with a plan to protect Medi- short years. The Republican majority, painting by a great American artist, care and the 37 million people it serves. well aware of the risks of losing the William Harnett, known for the re- What was the response of the Repub- rhetorical war to the scaremongers, markable precision of his painting, who lican majority? They gagged us. The nonetheless has stepped up to our com- gave in this particular painting a me- Committee on Rules will not even per- mitment to preserve, protect, and im- ticulous examination of the physical mit our plan to be heard on this floor prove Medicare. We offer opportunity reality of a lowly object. It is called today. for more choice, more access, less cost. ‘‘Plucked Clean,’’ and that is what is Let me tell my colleagues what they Repeatedly newspapers like the Wash- happening to American seniors. A are missing. We put together a Medi- ington Post and the New York Times chicken carcass against the wall, care reform plan that is not driven by have commended us for taking on this plucked clean. a promise to cut taxes, but by the need tough challenge. As yesterday’s New I do not suggest that the Republicans to create efficiency, choice, and per- York Times made clear, we are not were chicken about hiding this plan. If sonal responsibility. The coalition’s ducking our responsibility of govern- you has a plan this sorry, you would plan is a solid, middle-ground plan. It ance. We are not employing an oft-used hide it too. What I am concerned about combines long-term structural reforms technique of the Democrates in pack- and why I think ‘‘Plucked Clean’’ sum- with reasonable cost savings to ensure aging this vote within a larger bill to marizes this plan is that seniors are Medicare’s long-term solvency. Our shield Members from the so-called being plucked clean, a feather today, a Medicare reform plan provides $100 bil- tough votes. We are going to pass this feather here, really all about destroy- lion more for Medicare than does the bill because our constituents want us ing the Medicare system. Republican plan in the next 7 years. to save the Medicare program, not just Mr. LINDER. Mr. Speaker, for the There are four other good reasons for today’s seniors, but for their chil- purpose of debate only, I yield 1 minute why we should hear this plan today. dren and their grandchildren. That’s to the gentleman from New Mexico The coalition’s plan contains sub- the moral imperative we have before [Mr. SCHIFF]. stantive Medicare reforms designed to Mr. SCHIFF. Mr. Speaker, I rise in us. And I think, as Americans listen promote efficiency and fairness. It con- support of this rule. I want to thank carefully to the details of what this tains provisions to protect bene- and acknowledge the Committee on legislation does they’ll like what they ficiaries. It does more to protect our Rules for making as a part of this rule hear. That’s what polls show. They’ll rural hospitals than does the Repub- my proposed amendment to strengthen find that the scare tactics have been lican plan. Finally, we meet our obliga- the prosecution of health care fraud as overblown and misleading—‘‘medabo- tion to ensure the solvency of the Med- part of the rule that will be enacted bury’’ as the Washington Post calls it. icare Program. with the adoption of the rule. For 30 years, Medicare has served the Choose our plan. Under our plan sen- The language that I offered in my elderly and disabled of this country. iors who are happy with the current amendment is not new language. It can Because of Medicare, many fewer older system can keep what they have now. be found as part of H.R. 2326, a bill I de- Americans live in poverty today than Those who think they can get a better veloped with the gentleman from Con- 30 years ago, and all have a better qual- program from a health maintenance or- necticut [Mr. SHAYS], chairman of the ity of life because of Medicare. ganization or a medical savings ac- Subcommittee on Human Resources of We need to be thoughtful and delib- count, will have those options to the Committee on Government Reform erative in our approach to Medicare re- choose from. Despite some claims to and Oversight. form, and that is what our coalition the contrary, we are tackling the This bill, which deals with health bill does. It is a travesty that this bill major problems of fraud and abuse, care fraud, has bipartisan cosponsor- will not be heard on this floor today, which, by the way, are among the big- ship. This provision builds on the pro- and I urge a no vote on this rule. gest complaints seniors have about the visions already included by the gen- Mr. LINDER. Mr. Speaker, I am Medicare program. This bill provides tleman from California, Chairman pleased to yield for the purpose of de- incentives for seniors to report fraud THOMAS, in the first draft of the Medi- bate only 3 minutes to the gentleman and it doubles the penalties on those care bill, which includes provisions from Florida [Mr. GOSS], a member of who cheat the system. And we have such as a trust fund to help support ad- the Committee on Rules. seen to it that this rule takes us even ditional investigations and prosecu- (Mr. GOSS asked and was given per- further, incorporating critical anti- tions of health care providers. mission to revise and extend his re- fraud and abuse proposals drafted by My amendment in particular would marks.) our colleague, former prosecutor STEVE first make health care fraud a crime, Mr. GOSS. Mr. Speaker, I thank my SCHIFF. The Schiff language beefs up regardless of whether through fraud, friend from Georgia [Mr. LINDER], for enforcement, increases civil penalties embezzlement, false statements, or yielding and congratulate him for a and fines, and, most importantly, es- bribery and kickbacks. marvelous job in managing this rule. tablishes health care fraud as a Federal Mr. MOAKLEY. Mr. Speaker, I yield Mr. Speaker, the quality and the felony. Mr. Speaker, I served as a mem- 2 minutes to the gentlewoman from Ar- quantity of debate we had all day yes- ber of the Kerrey Commission on Enti- kansas [Mrs. LINCOLN]. H 10322 CONGRESSIONAL RECORD — HOUSE October 19, 1995 (Mrs. LINCOLN asked and was given saw a bill that was 430 some pages, cause the political parties in Washing- permission to revise and extend her re- then we were given a bill that was 470 ton are not listening. They are, once marks.) some pages, when we arrived here this again, putting bills on the floor to Mrs. LINCOLN. Mr. Speaker, I thank week we got a bill that was over 900 achieve their partisan political ends. the gentleman for yielding me time. pages, and now we have a bill that is, The coalition has a bill that is going to Mr. Speaker, my voice may be lost again, almost a thousand pages and on fix the Medicare System and do it in here in the roaring sea of petty, par- none of these bills did we have a chance the right way, and we are not even tisan politics, but I think the Amer- to have a hearing. No hearings on this. going to be allowed to have a vote on ican people need to know that in this No Members know what it is they are that bill on the floor of the House discussion and in this argument, they going to be voting on today because today, and I think it is an outrage. are the ones that are being forgotten. they have not had a chance to read it. I give credit to my Democratic col- It has been said, ‘‘Be careful what This rule and the strict limit of debate leagues. They put a bill together that you ask for, for you may get it.’’ The are designed simply to push through a fixes the part A problem with Medi- Republicans asked us to give them an hysterical bill, not historic but care. The problem is they have ignored alternative to their plan to cut $270 bil- hysterical bill, that will not stand up the problem in the part B part of the lion from Medicare. The Conservative to the light of day, that will not stand system. Frankly, we think it needs to Democratic Coalition delivered. We up to public debate, that will not stand be fixed if we are to have a sustainable gave them a plan that will guarantee up to scrutiny, that will not stand up situation here that will not come back Medicare solvency and balance the to an open amendment process. to haunt us within our hospital system budget by 2002. Our plan will reduce Mr. Speaker, this process is very sim- and within the senior citizens. Medicare by $100 billion less than the ply designed to pass a horrendous piece On the other side, the Republicans Republican plan. of legislation in time to make the 6 have put together a bill that goes fur- Now that we have given them what o’clock news tonight. ther than we think they can sustain. they have asked for, they will not give I think the symbolism of this was not We do not think what they have in this House Members the chance to vote on lost when last week as 15 senior citi- bill is achievable, and, frankly, they our plan. The coalition’s plan is more zens came into our committee and have this hundred billion dollars extra reasonable and fair to strengthen Medi- tried to inquire as to why there were in this bill so they can pay for the tax care than the two plans that will be no hearings they were led away. They cut which Members of the coalition, by voted on here today. were handcuffed and the lights were the way, support. We just think it I like the way my colleague from turned off. Indeed, this whole system should be put off until after we get the Minnesota, Mr. SABO, explained it. It has been done in the dark. budget balanced, and we think this is bears repeating. If our plan was ruled Mr. LINDER. Mr. Speaker, may I in- where the American people are as well. in order, House members would have quire as to how much time remains? Mr. Speaker, our bill, as I said, picks three choices. No. 1, vote for $90 billion The SPEAKER pro tempore (Mr. up the fixes to part A, but we also do in cuts to ensure solvency until 2006, LAHOOD). The gentleman from Georgia the fixes that need to be made in part but do nothing to balance the budget. [Mr. LINDER] has 91⁄2 minutes remain- B, and we also do the things that need No. 2, vote for the coalition’s plan to ing, and the gentleman from Massachu- to be done to make the rural health ensure solvency of Medicare for future setts [Mr. MOAKLEY] has 12 minutes re- part of the system work. Yesterday the generations, while balancing the budg- maining. Republicans made an attempt to fix et by 2002. That will reduce Medicare Mr. MOAKLEY. Mr. Speaker, I yield the rural health part of the bill and by $100 billion less than the Republican 1 minute to the gentlewoman from what they found out happened, as some plan. Or, No. 3, vote for the Republican Connecticut [Ms. DELAURO]. of their Members are telling me, is plan to cut $270 billion from Medicare, Ms. DELAURO. Mr. Speaker, I rise in they will have hospitals in their dis- paying for a tax cut, while balancing strong opposition to this rule and in trict that will have money taken away the budget by 2002. strong opposition to this bill which from them to pay for other hospitals in The first option does not cut enough will cut $270 billion from Medicare to their district. One of those Members to really take care of the problem. The pay for a tax cut to the wealthy. This said 25 of his counties will lose, 22 are third option cuts too much, digging bill is a bad deal for seniors. It means going to gain. into the pockets of senior citizens and seniors will see their premiums in- Mr. Speaker, that is no kind of fix. rural health care providers and hos- crease and their benefits decrease. For The reason they are in this problem is pitals. seniors this plan should be called the they have rates of growth in their bill The second option, however, the coa- pay-more-get-less plan. that are too low, that is not realistic, lition’s plan, is the solution between It is a good deal for the special inter- and that is why they cannot make this the two extremes, what the American ests. Last week NEWT GINGRICH bought work. We think it is really an outrage, people are looking for. Republicans off the doctors’ lobby with a $3 billion one more time, that we have two ex- leaders asked us not to criticize unless back-room deal. Under this plan, sen- treme positions, that are not the right we could offer a better plan, and we iors, on fixed incomes, will pay more positions, and we will not have the op- did. while doctors with a 6-figure incomes portunity to vote on the right position will make more. until next week. We urge the defeat of b 1030 Mr. Speaker, 30 years ago another this rule. Now they will not allow us to bring Congress made a pact with our seniors, Mr. LINDER. Mr. Speaker, for the our plan to the floor for a vote, and I it said never again would they have to purposes of debate only, I yield 2 min- suspect that might be because ours is worry that one accident or one illness utes to the gentleman from Florida the most reasonable plan and it would will wipe out their life’s savings. This [Mr. MILLER]. probably get the most votes. But the Congress has no right to break that sa- Mr. MILLER of Florida. Mr. Speaker, senior citizens in the first district of cred pact. Vote no on a $270 billion today we are going to have a historic Arkansas and the young people who Medicare cut to pay for a $245 billion debate and vote on one of the most im- will be on Medicare in the future have tax break. portant issues facing senior citizens asked us to quit playing petty politics Mr. MOAKLEY. Mr. Speaker, I yield and that is Medicare. We have been de- and do the right thing. I hope we can. 2 minutes to the gentleman from Min- bating the issue for 3 years and now we Mr. MOAKLEY. Mr. Speaker, I yield nesota [Mr. PETERSON]. are finally going to have a chance to 1 minute to the gentleman from Penn- (Mr. PETERSON of Minnesota asked really make good reforms in the pro- sylvania [Mr. KLINK]. and was given permission to revise and gram. Mr. KLINK. Mr. Speaker, I urge my extend his remarks.) We have a good program. I am proud colleagues to vote no against this rule. Mr. PETERSON of Minnesota. Mr. of this program. It is a good program First of all, in the Committee on Com- Speaker, I hope that the American peo- for our senior citizens. We agree with merce we were given a bill that was 420 ple are listening to what the Members so many things that our colleagues on some pages, and then the next day we of the coalition are saying today be- the other side are talking about. We October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10323 agree Medicare is going bankrupt and They say Medicare cuts are not fund- Mr. LINDER. Mr. Speaker, for the we need to save it. Where we disagree ing the tax cut, we ask, What is? purpose of debate only, I yield 2 min- is we do not want to have just a Band- Mr. Speaker, the voice of the Amer- utes to the gentleman from Connecti- Aid to fix it for a year or so, we want ican people was not heard before the cut [Mr. SHAYS]. to fix it before the baby bommers re- committees of Congress when they Mr. SHAYS. Mr. Speaker, I thank the tire in the year 2010. briefly considered these radical gentleman for yielding me time, and I We want to give choices. And it is changes in the Medicare Program. just wanted to say that I oppose the amazing why the people on the other The majority conducted a 1-day hear- Medicare bill described by the Demo- side are opposed to choices. We have ing on their proposal to cut the Medi- crats. It is an outrageous bill as de- choice as a Member of Congress. Every care Program by $270 billion. scribed by the Democrats, but that is year we get to have a choice of plans, And, when those most directly af- not our bill. just like all other Federal employees. fected by these cuts came to Congress Democrats are saying, regretfully, we We are in the same plan with the De- to raise their voices of appeal—they want copayments. We do not want partment of Agriculture employees and were not heard—they were forced to copayments. There are no copayments. Department of Commerce and such. We raise their hands so that they could be They say we want deductibles. There get to choose. What is wrong with handcuffed and arrested. are no increases in deductibles. They choice? What is wrong with giving peo- Perhaps that is because they want us say we increased the premium, and the ple the right to choose? to ignore the impact of this $270 billion premium stays at 311⁄2 percent. The Mr. Speaker, we are going to give cut upon the heart and soul of our Na- taxpayer will continue to pay 681⁄2 per- people the right to stay in the plan tion—rural America. cent. now. My 86-year-old mother will not This bill makes the most sweeping change, and there is no reason to make changes in the Medicare Program since Mr. Speaker, we have three main her change. People can stay in the cur- it was first created more than 30 years goals as this Republican majority. We rent plan. Those that want to choose a ago. want to get the financial house in medical savings account, great, let Citizens of rural America have in- order and balance our budget. We want them choose it. Those that want to go comes that are 33 percent—yes, one- to save our trust funds. We want to in managed care, great, let them third—lower than their urban counter- protect, preserve, and strengthen them. choose it. parts. And we want to transform this social Why not let local doctors and local The elderly who live in rural areas corporate farming welfare state into an hospitals who deliver the care to their are 60 percent more likely to live in opportunity society. We are going to do local communities offer their own pro- poverty—60 percent. that, but we must save our trust fund, gram? What is wrong with that? Why Through this Medicare Preservation it is going bankrupt, and we will. deny choice? Why is this one-size-fits- Act, Medicare funds for rural Ameri- How do we do it? No new taxes. We do all in Washington the rule that has to cans will be cut by at least $58 billion. not affect beneficiaries. We affect pro- be kept? Why not give choice? The $270 billion cut translates into at viders and we change the system. We We are increasing spending every least $45 billion less for the health care are transforming the system, allowing year. We talk about $270 billion in cuts. for impoverished, disabled, or elderly people to keep what they have or we Let us look at how much we are in- Americans in rural areas—and trans- are allowing them to get into private creasing it. Whether the glass is half lates into $70 billion less for hospitals. care. We are giving them choice. We full or half empty, we are increasing For Pitt County Memorial Hospital, are allowing them to have the same spending on Medicare by $354 billion one of the finest university medical kind of health care that we as Federal over 7 years compared to the last 7 centers in rural areas, this cut trans- employees have. We are giving them years. That goes from $4,800 to $6,700. lates into a $621 million loss—$621 mil- the choice they asked for. That is an increase. lion less for needed medical care. Mr. Speaker, we are doing it without Mr. Speaker, we have a good bill that For Nash General Hospital, $234 bil- cutting the program. We are increasing is going to make Medicare a better pro- lion less in the same time period. it. We are going to spend $600 billion gram for our seniors. For the Craven Regional Medical more of new money. Not $300 billion, Mr. MOAKLEY. Mr. Speaker, I yield Center, $211 billion less—and I could go $600 billion more. It will go from $4800 1 minute to the gentlewoman from on and on and on. per beneficiary to $6700 per beneficiary. North Carolina [Mrs. CLAYTON]. The bill cuts $54.5 billion from pay- Only in Washington when we spend 50 (Mrs. CLAYTON asked and was given ments to health care providers. percent more do people call it a cut. permission to revise and extend her re- Twenty-five percent of rural hos- Mr. MOAKLEY. Mr. Speaker, I yield marks.) pitals already operate at a loss, and 1 minute to the gentleman from Illi- that is because Medicare alone ac- Mrs. CLAYTON. Mr. Speaker, Amer- nois [Mr. DURBIN], a distinguished ica has reason to be concerned. They counts for almost 40 percent of the av- member of the Committee on Appro- call it Mediscare, we call it Medicare. erage hospital’s net patient revenue. priations. They want to cut corners, we want to This bill, that is thicker than Web- Mr. DURBIN. Mr. Speaker, for those cut sickness. ster’s dictionary, cuts funding for who cannot stay tuned to this expen- They believe Government should not teaching hospitals, reduces payments sive debate today, because of the Re- carry the disabled, we believe the dis- for nursing homes—and, fails to dedi- publican rule we have 3 hours to debate abled can carry themselves—if given a cate most of the cuts to the Medicare a $270 billion cut in Medicare. That is a chance. trust fund. They want those with money to get Can you imagine the devastation billion and a half a minute. If people more wealth, we want those without that these cuts will cause to rural cannot stay tuned, I will tell them money to have an equal chance—at areas? what will happen. health. Hospitals are certain to close—doc- The Democrats who created Medicare They refuse to hear those who dis- tors will become scarce—rural Ameri- will lose today. The Republicans, under agree with them, we want decisions to cans will go without health care. the gentleman from Georgia [Mr. GING- be made with all the facts. And, we We call it Medicare, they call it RICH], will ram through a $270 billion want to know what’s in that 1,000-page Mediscare. Mr. Speaker, America has cut that will increase premiums for bill. reason to fear. seniors to the tune of $400 a year and it They want to tighten the belt and Mr. LINDER. Mr. Speaker, may I in- will end up giving the wealthiest 1 per- strangle our senior citizens and their quire as to the time remaining on each cent in America a $19,000 annual tax families, we want enough room to in- side? break. clude everyone, especially those in The SPEAKER pro tempore. The gen- But do not lose heart. Seniors may be need. tleman from Georgia [Mr. LINDER] has glum tonight, the special interests will For themselves, they want hospitals 71⁄2 minutes remaining, and the gen- be dancing in Washington, but we are just moments away, for many in rural tleman from Massachusetts [Mr. MOAK- counting on the President of the Unit- America, we simply want hospitals. LEY] has 8 minutes remaining. ed States to veto this monstrosity, to H 10324 CONGRESSIONAL RECORD — HOUSE October 19, 1995 bring us back to the table for a biparti- the Congress, never bothered to read Mr. BEILENSON. Mr. Speaker, I san, common sense approach to really the report. yield 30 seconds to the gentleman from save Medicare. Mr. Speaker, we are going to move Michigan [Mr. LEVIN]. Mr. Speaker, the real winners not forward to save Medicare on our own, if (Mr. LEVIN asked and was given per- only have to be seniors and their fami- the other side refuses to be construc- mission to revise and extend his re- lies, we have to tell the special inter- tive. marks.) ests to get out of the business of Mr. BEILENSON. Mr. Speaker, I Mr. LEVIN. Mr. Speaker, part of the wrecking Medicare, get out of the busi- yield 1 minute to the gentlewoman October assault of the Republicans on ness of tax breaks for the wealthy. Let from California [Ms. PELOSI]. Medicare is on Medicare fraud and us make Medicare a solid system. Let Ms. PELOSI. Mr. Speaker, I rise in abuse. Last night, they put into the us not make it a piggy bank for the opposition to the rule because I object bill, last night, five or six pages. I want wealthy. to the limitation it places on debate. my colleagues to know it is a smoke Mr. LINDER. Mr. Speaker, for the Mr. Speaker, in order to keep the screen. purpose of debate only, I yield 2 min- American people in the dark, the Re- Mr. Speaker, the conduct that is cov- utes to the gentleman from Ohio [Mr. publican leadership has demanded a ered in this bill is already covered HOKE]. closed process which stifles debate and under Federal law. They are weakening Mr. HOKE. Mr. Speaker, I thank the shuts out the voices of those affected Federal law. The inspector general gentleman for yielding me time, and I by this legislation. says, ‘‘Crippling.’’ Justice Department rise in strong support of this rule and Mr. Speaker, I oppose the rule be- says, ‘‘Seriously undercutting.’’ They the Medicare Preservation Act to save cause of the process, but also because cannot cover up this assault on our Medicare from bankruptcy, preserve it of the substance of the legislation. The battle against fraud and abuse in Medi- for the current retirees and protect it Republican proposal assaults the qual- care. Mr. Speaker, to my colleagues on the for the future. ity, security, affordability, and acces- Now we have heard so much dema- sibility of health care to our seniors. other side of the aisle I say, Shame on goguery medigoguery from the other This legislation is not legitimate, be- you. Mr. BEILENSON. Mr. Speaker, I side of the aisle on this bill for the past cause it has not been subject to a pe- yield myself such time as I may 6 months, and it would take weeks to riod of public comment. It is not re- sponsible, because it imposes higher consume. answer every erroneous charge and ac- (Mr. BEILENSON asked and was cost and benefit cuts for America’s sen- cusation. I would like to focus on one given permission to revise and extend iors to give a $270 billion tax break to particularly disingenuous argument we his remarks.) have heard constantly and it is that America’s wealthiest. This is a sad day Mr. BEILENSON. Mr. Speaker, I oppose this the Medicare trustees have said that in America, because the Republican rule and the bill representing the Medicare saving Medicare will require only $89 leadership is undermining the dignity portion of the 1995 budget reconciliation legis- billion in savings. of our seniors, undermining the quality lation that it makes in order. First, the Medicare trustees in their of our health care, and undermining The modified closed rule we are considering report did not recommend a specific the greatness of our country. today is totally inadequate for the consider- savings level necessary to prevent Med- Mr. Speaker, I urge our colleagues to ation of one of the most important bills we will icare from becoming insolvent. Their vote ‘‘no’’ on the rule, to vote ‘‘no’’ on be asked to vote on this year. If enacted, the only conclusion was that the plan was the bill. I urge our colleagues to sup- Medicare portion of the reconciliation legisla- going bankrupt and that swift and de- port Medicare, yes; tax cuts no. tion will have a profound impact on the lives cisive action should be taken to save Mr. LINDER. Mr. Speaker, may I in- of nearly 40 million elderly and disabled citi- it. quire as to the time? zensÐAmericans who are among the most The SPEAKER pro tempore (Mr. Second, the $89 billion the Democrats vulnerable members of our society. talk about would amount to nothing LAHOOD). The gentleman from Georgia This major and complicated piece of legisla- more than another in a long line of [Mr. LINDER] has 4 minutes remaining tion deserves, if not an entirely open rule, cer- band-aid solutions that would only get and the gentleman from California [Mr. tainly one that allows far more time for debate us through the next election, when we BEILENSON] has 6 minutes remaining. and that makes many more amendments in should be worried about getting us Mr. BEILENSON. Mr. Speaker, I order than the rule before us permits. through well into the next century. Re- yield 1 minute to the gentleman from We urged in the strongest possible terms member, the baby boomers begin retir- Kentucky [Mr. WARD]. that the majority on the Rules Committee ap- ing in about 2008–2010. If we don’t take Mr. WARD. Mr. Speaker, I have a prove a more open rule for H.R. 2425, so that strong and decisive measures now, chart here that I think is very impor- the fullest possible debate could be held on its Medicare would be seriously jeopard- tant for the American people to see as provisions and on their enormously serious ized by then. this debate begins. Remember, we all consequences. Third, the $89 billion figure was pro- want to make sure that Medicare stays Unfortunately, we were unsuccessful, and posed by one Medicare trustee, Robert safe and sound, just as we have done al- we are faced now with a rule that severely lim- Rubin, the Secretary of the Treasury. most every year since 1970. its debate and shuts a great many members My question is this. If $89 billion in Mr. Speaker, we are seeing a study out of the amendment process entirely. savings is all that is needed to save that says Medicare going to need some Mr. Speaker, the Rules Committee heard Medicare, why didn’t Rubin tell Presi- help, but it does not need $270 billion of yesterday from at least 40 membersÐRepub- dent Clinton, whose proposal called for help. The reason they have to do $270 lican, Democratic, and independentÐof the $190 billion in savings? Clinton is billion on this side of the aisle is to House, most of whom came before us to ask Rubin’s boss, isn’t he? He’s also one of keep the promises they have made for that their proposed amendments to H.R. 2425 Clinton’s Medicare trustees. So why tax cuts, half of which go to the top be made in order. didn’t he just walk across the street one-eighth of income earners in this At least some of those amendments de- and tell the President? country. serve to be debated and voted on by the full The reason is politics. The $89 billion Mr. Speaker, this chart shows that House. They are reasonable proposals; they being bandied about by the medigogues people who are making more than were offered by sensible and thoughtful Mem- on the other side of the aisle is a politi- $100,000 a year are going to get 52 per- bers of this body who obviously have given cal calculation, not an actuarial one. It cent. Over half of the tax breaks that their suggestions a great deal of thought. is rooted in Presidential politics, not they are instituting this year will go to Instead, the rule we are considering denied economic reality. people earning over $100,000. Today, the 14 members of the Democratic caucus and 5 Wall Street Journal said, ‘‘Tax analy- Republican members the right to offer their b 1045 sis shows GOP package would mean in- amendments today. At the very least, we felt I guess nobody expected anybody in creases for half of taxpayers.’’ They are that the majority on the Rules Committee this Congress to read the report that increasing taxes on the poor, and the would have made in order the very reasonable was prepared for the Congress. I guess working poor, and lowering them on and thoughtful amendments proposed by sev- the Democrats, while they controlled the wealthy. It is not right. eral Republicans. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10325 This is a list of the Republican amendments These are only a few of the very serious is- trustees asked us to do; would allow that we will be unable to vote on today, and sues that Members should have been allowed military retirees to take their Medic- which certainly deserve consideration: to vote on today. aid money to military hospitals and The gentleman from Iowa [Mr. GANSKE] re- Mr. Speaker, H.R. 2425 is the single largest have the much needed care. quested that three amendments be made in part of the massive budget reconciliation plan; Mr. Speaker, I also want to say order. Two of them are aimed at curbing po- it cuts Medicare far beyond what is necessary shame on the Democratic leadership tential abuses by HMO's, an issue that was to safeguard the Medicare trust fund. for not allowing the coalition to offer central to last year's debate on health care re- It would not only impose new and heavy fi- their plan as the Democratic alter- form and should be of as much concern to our nancial burdens on the elderly, but it would native in the motion to recommit. This Republican colleagues this year. also irresponsibly relax Federal regulation of body is about finding fairness for the The first amendment would require that phy- doctors and the operations of their practices. American people. It is not about cater- sicians, rather than nonmedical personnel, re- The concessions that loosen or repeal Federal ing to the Republicans’ special inter- view denials of care. The second would make regulations that are in the bill to win the sup- ests or the Democrats; special inter- it more difficult for HMO's to retroactively deny port of the American Medical Association are ests. It is doing what is right for the payment for care in emergency situations. far too extreme; no one argues that Federal American people. The Republicans promised open rules, These two were approved by the Commerce regulation that is too complex and burden- and yet they are depriving us of the op- Committee but were not included in the Ar- some should not be rectified, but the legisla- portunity to offer a very good plan cher-Bliley compromise that is being made in tion before us uses reported excesses as an that was put together. They claim to order as the original text. excuse to do away with Federal oversight al- be for fairness, and yet the fairest plan The third Ganske amendment would provide most entirely. The provisions that severely weaken Fed- of all, one that would solve the prob- a minimum floor in the adjusted average per lem, will not see the light of day be- capita cost of 85 percent of the national aver- eral laws prohibiting kickbacks and fraud and abuse and that allow doctors to refer patients cause they do not want a better alter- age and then provide for differential updates native to come to the floor, because to close the gap. to companies in which they have a financial interestÐa practice now forbiddenÐwould un- both groups are afraid it would pass. The gentleman from Connecticut [Mr. Mr. Speaker, I would like to point SHAYS] requested that his amendment dealing dermine consumer protections and could harm public health, especially when combined with out that several members of the Com- with Medicare fraud and abuse be made in mittee on Rules that voted to deny the other provisions in the bill that end Federal order. That amendment would add important coalition the plan to bring Medicare standards for nursing homes and make it antifraud prevention measures to H.R. 2425 subvention to the floor, the gentleman more difficult for victims of malpractice to col- by improving coordination between Federal from New York [Mr. SOLOMON], the lect large judgments. and State antifraud efforts; improving Federal gentleman from Georgia [Mr. LINDER], Mr. Speaker, we should be concerned that criminal law to better address health care the gentlewoman from Ohio [Ms. this complex bill relaxes or repeals many laws fraud; and improving administrative proce- PRYCE], the gentleman from Florida that were originally adopted in response to dures, especially those to keep providers pre- [Mr. DIAZ-BALART], the gentleman from abuses that prompted public outrage. And viously barred from participating in Medicare. Colorado [Mr. MCINNIS], the gentleman even though the bill is promoted as being writ- There is obviously a good deal of support for from Texas [Mr. FROST], and the gen- ten to control the costs of Medicare, many of strengthening the provisions in the bill to com- tleman from Ohio [Mr. HALL], are all its proposalsÐincluding those weakening bat waste, fraud and abuse; this comprehen- cosponsors of the bill to fix Medicare fraud sanctionsÐwould actually increase the sive amendment should have been made in subvention. Yet those seven Members, costs. order so that Members could decide if its pro- a majority of the Committee on Rules, There are many other worrisome provisions visions are necessary to protect and strength- would not let this important measure in this bill. For example, in a little noticed pro- en the Medicare Program. as a part of the coalition budget, come vision, the bill would reimburse private hos- The gentleman from Massachusetts [Mr. to the floor. pitals for some local taxes, a provision that in TORKILDSEN] asked that his amendment be in Mr. Speaker, I say to these col- effect takes money from hospitals that serve order allowing all States to see their Medicare leagues, ‘‘Shame on all of you all.’’ disproportionate numbers of the poor and un- funding increase at the national average, in- Mr. LINDER. Mr. Speaker, I yield 2 insured and gives it to hospitals whose main stead of the proposal in the bill that has dif- minutes to the gentleman from Califor- purpose is to make a profit. ferent growth rates for different States. He ar- nia [Mr. DREIER], a colleague on the Mr. Speaker, this bill makes the most pro- gued that a uniform rate of increase is essen- Committee on Rules. found changes in the Medicare Program since tial so that some States do not have to bear (Mr. DREIER asked and was given its inception. It is a shame that the majority is far more of the national burden in cuts than permission to revise and extend his re- allowing this bill to be rushed through without other States. marks.) adequate time or amendment and without a Mr. DREIER. Mr. Speaker, the world The gentleman from Michigan [Mr. CAMP] complete understanding by Members of the has changed since 1965. Back in 1965, we asked that the House be allowed to vote on House or the public of the seriousness and saw the automobile industry in a great his amendment exempting from the medical complexity of the changes this bill is propos- deal of difficulty. It was world com- malpractice liability cap those instances in ing. petition which played a role in bring- which medical treatment was intentionally This rule should be defeated so that we can ing about the changes that we have withheld. consider a wider range of amendments to this seen. The companies that produced Mr. Speaker, the Democratic amendments major bill. If it is not, the bill itself should be those automobiles back in 1965 have should also have been in order. defeatedÐin its present form it will severely gone through tremendous managerial They sought to allow Members to vote on damage a system on which 40 million elderly changes. cuts in Medicare that would have ensured its and disabled Americans rely. It does not de- We need to recognize that it is a new solvency, but would not have been so great as serve our support. day. And thank heavens, this new ma- the Republican plan that uses cuts in Medi- Mr. BEILENSON. Mr. Speaker, I jority has stepped up to the plate and care to help pay for tax Increases for the yield 2 minutes to the gentleman from decided to bring this very important wealthiest Americans. Mississippi [Mr. TAYLOR]. system into the 21st century. They sought to strengthen fraud and abuse Mr. TAYLOR of Mississippi. Mr. We are doing it under a very unique provisions that the bill weakens unacceptably. Speaker, I come to the floor today to process. Thirty years ago, April 7, 1965, They sought to add new preventative bene- ask my colleagues to vote against this when this measure came to the floor, it fits such as mammography, colorectal screen- rule. came under a completely closed rule. A ing, and diabetes screening. Mr. Speaker, I want to begin by say- completely closed rule which did not They sought to reinstate the clinical labora- ing shame on the Republican leader- allow any amendments, any substitute, tory regulations, the nursing home reform ship who control the Committee on any motion to recommit. standards, the ban on physician self-referral, Rules for not allowing the coalition to Today, as we look and seek to pro- and to remove the serious exemptions from offer their $170 billion plan to save tect, strengthen, and preserve Medi- antitrust laws for physicians forming managed Medicaid; and dollar-for-dollar plan care, what are we doing? We are provid- care groups. that would save Medicaid, as their ing the opportunity for alternatives to H 10326 CONGRESSIONAL RECORD — HOUSE October 19, 1995 be met. We are doing it in a bipartisan Speaker, this is a bad bill. It should go spite that old adage that some people way. In a bipartisan way we came to down. will pay attention to the debate and the conclusion that we should deal Mr. Speaker, I have two words to describe have a change of mind. with this language that addresses the this ruleÐbate and switch. Mr. Speaker, I urge a no on the pre- issue of fraud. We have done it very ef- Three times I have received a copy of this vious question. If the previous question fectively. We did it last night up in the bill only to walk into a committee meeting the is defeated, I will offer an amendment Committee on Rules. next day and find a new bill. to the rule. I also believe that we need to recog- In fact, yesterday afternoon at 4 p.m., we Mr. Speaker, I will insert in the nize that the rhetoric that we have saw for the first time the bill we are now de- RECORD the text of my amendment. heard from so many of my very good bating. The amendment would do two things. friends on the other side of the aisle Cuts in Medicare will directly affect 37 mil- First, it would strike the provision and has been correctly described by the lion Americans. waive the three-fifths vote requirement Washington Post as nothing more than For an issue so important to AmericaÐthis on any measure with a Federal income Medigoguery. rule allows only 4 hours of debate. tax rate increase; and, second, Mr. Mr. GIBBONS. Mr. Speaker, will the This rule is about a bill which cuts $270 bil- Speaker, will make in order the Rangel gentleman yield? lion to provide for a tax cut for the wealthy. amendment to make Medicare solvent Mr. DREIER. Mr. Speaker, I have Yet, the latest polls show that 83 percent of by an across-the-board limit on tax only a limited amount of time. Americans do not want to cut Medicare to pro- cuts for the wealthy. Mr. GIBBONS. Mr. Speaker, the gen- vide for a tax break for the wealthy. Mr. Speaker, I submit the following tleman is the one who imposed the We are also told that this bill is about giving for inclusion in the RECORD. time limit by this rule. seniors a choice. But, as far as I can tell the AMENDMENT TO H. RES. 238 Mr. LINDER. Regular order. only choice seniors will have is to pay more or On page 3, lines 18–20, strike ‘‘Clause 5(c) of Mr. DREIER. Mr. Speaker, I yield to give up their doctor. rule XXI shall not apply to the bill, amend- the gentleman from Florida. ments thereto, or conference reports there- Yesterday, I asked to offer two amendments on.’’ Mr. GIBBONS. Mr. Speaker, I want that would have strengthened this bill and cost On page 2, line 25, strike ‘‘.’’ and add ‘‘and to correct what the gentleman from Medicare nothing. the amendment in the nature of a substitute California said. The Republicans got a The House will not even have the chance to printed in the Congressional Record and motion to recommit in 1965. The mo- consider my amendments under this rule. numbered 3 pursuant to clause 6 of rule tion to recommit gutted Social Secu- It is not just unfair to run the peoples House XXIII, which may be considered any rule of rity, and every Republican but 10 voted this wayÐit is undemocratic. the House to the contrary notwithstanding, for it. to be offered only by Representative Rangel I urge my colleagues to vote ``no'' on the of New York or his designee, which shall be Mr. DREIER. Mr. Speaker, reclaim- previous question and vote ``no'' on this rule. considered as read, shall be debatable for one ing my time, as my friend has made it Mr. LINDER. Mr. Speaker, I reserve hour equally divided and controlled by the very clear, I was not here. The gen- the right to close. proponent and an opponent, and shall not be tleman from Florida was here then, but The SPEAKER pro tempore (Mr. subject to amendment.’’ there was not a substitute that was of- LAHOOD). The gentleman from Massa- On page 3, line 1, strike ‘‘that amendment in the nature of a substitute’’ and insert fered. chusetts has 11⁄2 minutes remaining, Mr. Speaker, this rule is much more and the gentleman from Georgia re- ‘‘the amendments in the nature of a sub- stitute made in order under this resolution’’. open than the rule that considered serves the balance of his time to close. Mr. Speaker, I urge a ‘‘no’’ vote on Medicare in 1965. I urge an aye vote on Mr. MOAKLEY. Mr. Speaker, I yield the previous question. this very fair rule, and recognition 1 minute to the gentleman from Oregon that stepping up to the plate and deal- [Mr. DEFAZIO]. b 1100 ing with a serious problem that Presi- Mr. DEFAZIO. Mr. Speaker, what Mr. LINDER. Mr. Speaker, I yield dent Clinton has acknowledged is strange version of democracy is this? myself the balance of my time. something that the majority of this We have a program that affects the Mr. Speaker, in closing, I would like Congress is willing to do. lives, directly, of 40 million Americans, to emphasize again the quote or the Mr. MOAKLEY. Mr. Speaker, I yield affects the lives of their children or comment made on this floor by the 1 minute to the gentleman from New their parents or their grandparents, a gentleman from Illinois [Mr. DURBIN]. Mexico [Mr. RICHARDSON], a Nobel tremendously important program, and Mr. DURBIN said Democrats are going Prize candidate. without any hearings on the final ver- to lose today. They are indeed. They (Mr. RICHARDSON asked and was sion of this legislation, this House is are going to lose control of a program given permission to revise and extend going to be forced to move forward that they began and have held control his remarks.) with 3 hours of debate. over and has grown entirely out of con- Mr. RICHARDSON. Mr. Speaker, 30 Mr. Speaker, we spent about 10 times trol. They are going to lose control years ago, the Congress covered itself as much on the Waco hearings as we over the lives and choices of seniors in with glory by passing the Medicare are going to spend on Medicare for health care, and they are going to lose Program, which provided health cov- every American. control over money of future genera- erage for millions of Americans. Medicare has problems. Yes. Does tions to pay for it. Mr. Speaker, today in this Chamber this bill address those problems? No. Is We have heard a lot of florid prose we are presiding over the decimating of it a thoughtful approach? No. Is it today, not to say lurid prose. The gen- Medicare. If this monstrosity becomes something that will stabilize Medicare tleman from New Mexico said, we are law, Medicare will end as we know it into the next century and anticipate decimating Medicare. To decimate today, America, is this what you voted the retirement of the baby boom? Ab- means to reduce by one-tenth. We are for last November? solutely not. actually increasing Medicare spending Maybe my colleagues on the other Mr. Speaker, it is purely budget- and over the next 7 years to $1.6 trillion. It side will win the vote today, and politics-driven. Medicare does have a was $924 billion over the last 7 years. maybe they will win the vote in the problem. It has a $90 billion shortfall That is hardly to decimate to reduce corridors of the AMA and other Gucci over a 7-year period. They are taking by one-tenth. lobbyists on K Street, but they will $273 billion to fix a $90 billion problem. Much reference has been made to the lose the vote in the hearts and minds of Mr. MOAKLEY. Mr. Speaker, I yield rule regarding a 60 percent vote for in- ordinary Americans. myself such time as I may consume. creases in tax rates. There is no in- Mr. Speaker, we are ramming (Mr. MOAKLEY asked and was given crease in tax rates in this bill. There through this bill at 100 miles an hour permission to revise and extend his re- are no increases in taxes in this bill. with no hearings, 3 hours of debate, for marks.) But those of us in the majority won- a drastic overhaul of the system that Mr. Speaker, I think that Members dered if some on the minority would affects 40 million Americans. have heard the debate. They say a per- call the part B premium a tax and call Does the Republican leadership think son convinced against his will is of the it an increase. It has been called a pre- that nobody is going to notice? Mr. same opinion still, but I hope that de- mium for 30 years. But it is no doubt October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10327 that somebody would begin to call it a Fox LaTourette Ros-Lehtinen Orton Sabo Thurman tax in the debate today and take up an- Franks (CT) Laughlin Roth Owens Sanders Torres Franks (NJ) Lazio Roukema Pallone Sawyer Torricelli other hour of time defending it. Frelinghuysen Leach Royce Pastor Schroeder Towns We have heard that Republicans have Frisa Lewis (CA) Salmon Payne (NJ) Schumer Traficant never supported Medicare. Yet when it Funderburk Lewis (KY) Sanford Payne (VA) Scott Velazquez Pelosi Serrano passed 30 years ago, it passed 313 to 115 Gallegly Lightfoot Saxton Vento Ganske Linder Scarborough Peterson (FL) Sisisky Visclosky Peterson (MN) Skaggs with nearly half of the Republicans in Gekas Livingston Schaefer Volkmer Pickett Skelton this House voting yes. Gilchrest LoBiondo Schiff Ward Gillmor Longley Seastrand Pomeroy Slaughter We heard in the Committee on Rules Waters Gilman Lucas Sensenbrenner Poshard Spratt Watt (NC) yesterday by the gentleman from Cali- Goodlatte Manzullo Shadegg Rahall Stark Waxman fornia [Mr. STARK], that in 8 of the last Goodling Martini Shaw Rangel Stenholm Williams 9 years or 9 of the last 10 years, I forget Goss McCollum Shays Reed Stokes Graham McCrery Shuster Richardson Studds Wilson which number he gave us, that biparti- Greenwood McDade Skeen Rivers Stupak Wise san bills have been introduced, Repub- Gunderson McHugh Smith (MI) Roemer Tanner Woolsey licans and Democrats, to change reim- Gutknecht McInnis Smith (NJ) Rose Taylor (MS) Wyden bursement rates to attempt to Hancock McIntosh Smith (TX) Roybal-Allard Thompson Wynn Hansen McKeon Smith (WA) Rush Thornton Yates strengthen Medicare. It has not Hastert Metcalf Solomon NOT VOTING—7 worked. It is growing out of control. Hastings (WA) Meyers Souder In closing, let me give Members one Hayworth Mica Spence Cox Flake Tucker Hefley Miller (FL) Stearns Crane Martinez more quote that I support from a Dem- Heineman Molinari Stockman Fields (LA) Tejeda ocrat. Just 2 years ago it was said, Herger Moorhead Stump ‘‘Today Medicaid and Medicare are Hilleary Morella Talent b 1123 Hobson Myers Tate going up at three times the rate of in- Hoekstra Myrick Tauzin Mr. TOWNS changed his vote from flation. We propose to let it go up an- Hoke Nethercutt Taylor (NC) ‘‘yea’’ to ‘‘nay.’’ other two times the rate of inflation. Horn Neumann Thomas Mr. SHUSTER and Mrs. MORELLA This is not a Medicare or Medicaid Hostettler Ney Thornberry Houghton Norwood Tiahrt changed their vote from ‘‘nay’’ to cut.’’ Hunter Nussle Torkildsen ‘‘yea.’’ That Democrat was Mr. Clinton on Hutchinson Oxley Upton So the previous question was ordered. October 5, 1993. Hyde Packard Vucanovich The result of the vote was announced Inglis Parker Waldholtz Mr. Speaker, I move the previous Istook Paxon Walker as above recorded. question on the resolution. Johnson (CT) Petri Walsh The SPEAKER pro tempore (Mr. The previous question was ordered. Johnson, Sam Pombo Wamp LAHOOD). The question is on the resolu- The SPEAKER pro tempore (Mr. Jones Porter Watts (OK) Kasich Portman Weldon (FL) tion. LAHOOD). The question is on ordering Kelly Pryce Weldon (PA) The question was taken; and the the previous question. Kim Quillen Weller Speaker pro tempore announced that The question was taken; and the King Quinn White the ayes appeared to have it. Kingston Radanovich Whitfield Speaker pro tempore announced that Klug Ramstad Wicker RECORDED VOTE the ayes appeared to have it. Knollenberg Regula Wolf Mr. MOAKLEY. Mr. Speaker, I de- Mr. MOAKLEY. Mr. Speaker, I object Kolbe Riggs Young (AK) LaHood Roberts Young (FL) mand a recorded vote. to the vote on the ground a quorum is Largent Rogers Zeliff A recorded vote was ordered. not present and make the point of Latham Rohrabacher Zimmer The SPEAKER pro tempore. This order that a quorum is not present. will be a 5-minute vote. The SPEAKER pro tempore. Evi- NAYS—194 The vote was taken by electronic de- dently a quorum is not present. Abercrombie Dixon Kaptur vice, and there were—ayes 227, noes 192, The Sergeant at Arms will notify ab- Ackerman Doggett Kennedy (MA) Andrews Dooley Kennedy (RI) not voting 13, as follows: sent Members. Baesler Doyle Kennelly [Roll No. 727] Baldacci Durbin Kildee Pursuant to the provisions of clause 5 AYES—227 of rule XV, the Chair announces that Barcia Edwards Kleczka Barrett (WI) Engel Klink Allard Chrysler Frelinghuysen he will reduce to a minimum of 5 min- Becerra Eshoo LaFalce Archer Clinger Frisa utes the period of time within which a Beilenson Evans Lantos Armey Coble Funderburk vote by electronic device, if ordered, Bentsen Farr Levin Bachus Coburn Gallegly will be taken on the question of adop- Berman Fattah Lewis (GA) Baker (CA) Collins (GA) Ganske Bevill Fazio Lincoln Baker (LA) Combest Gekas tion of the resolution. Bishop Filner Lipinski Ballenger Cooley Gilchrest The vote was taken by electronic de- Bonior Foglietta Lofgren Barr Cox Gillmor vice, and there were—yeas 231, nays Borski Ford Lowey Barrett (NE) Crapo Gilman Boucher Frank (MA) Luther Bartlett Cremeans Goodlatte 194, not voting 7 as follows: Brewster Frost Maloney Barton Cubin Goodling [Roll No. 726] Browder Furse Manton Bass Cunningham Goss Brown (CA) Gejdenson Markey Bateman Davis Graham YEAS—231 Brown (FL) Gephardt Mascara Bereuter Deal Greenwood Allard Bunn Cunningham Brown (OH) Geren Matsui Bilbray DeLay Gunderson Archer Bunning Davis Bryant (TX) Gibbons McCarthy Bilirakis Diaz-Balart Gutknecht Armey Burr Deal Cardin Gonzalez McDermott Bliley Dickey Hancock Bachus Burton DeLay Chapman Gordon McHale Blute Doolittle Hansen Baker (CA) Buyer Diaz-Balart Clay Green McKinney Boehlert Dornan Hastert Baker (LA) Callahan Dickey Clayton Gutierrez McNulty Boehner Dreier Hastings (WA) Ballenger Calvert Doolittle Clement Hall (OH) Meehan Bonilla Duncan Hayworth Barr Camp Dornan Clyburn Hall (TX) Meek Bono Dunn Hefley Barrett (NE) Canady Dreier Coleman Hamilton Menendez Brownback Ehlers Heineman Bartlett Castle Duncan Collins (IL) Harman Mfume Bryant (TN) Ehrlich Herger Barton Chabot Dunn Collins (MI) Hastings (FL) Miller (CA) Bunn Emerson Hilleary Bass Chambliss Ehlers Condit Hayes Minge Bunning English Hobson Bateman Chenoweth Ehrlich Conyers Hefner Mink Burr Ensign Hoekstra Bereuter Christensen Emerson Costello Hilliard Moakley Burton Everett Hoke Bilbray Chrysler English Coyne Hinchey Mollohan Buyer Ewing Horn Bilirakis Clinger Ensign Cramer Holden Montgomery Callahan Fawell Hostettler Bliley Coble Everett Danner Hoyer Moran Calvert Fields (TX) Houghton Blute Coburn Ewing de la Garza Jackson-Lee Murtha Camp Flanagan Hunter Boehlert Collins (GA) Fawell DeFazio Jacobs Nadler Canady Foley Hutchinson Boehner Combest Fields (TX) DeLauro Jefferson Neal Castle Forbes Hyde Bonilla Cooley Flanagan Dellums Johnson (SD) Oberstar Chabot Fowler Inglis Bono Crapo Foley Deutsch Johnson, E. B. Obey Chambliss Fox Istook Brownback Cremeans Forbes Dicks Johnston Olver Chenoweth Franks (CT) Johnson, Sam Bryant (TN) Cubin Fowler Dingell Kanjorski Ortiz Christensen Franks (NJ) Jones H 10328 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Kasich Myrick Shuster Towns Volkmer Wise for 45 minutes, the gentleman from Kelly Nethercutt Skeen Traficant Ward Woolsey Florida [Mr. GIBBONS] will be recog- Kim Neumann Smith (MI) Velazquez Watt (NC) Wyden King Ney Smith (NJ) Vento Waxman Wynn nized for 45 minutes, the gentleman Kingston Norwood Smith (TX) Visclosky Wilson Yates from Virginia [Mr. BLILEY] will be rec- Klug Nussle Smith (WA) ognized for 45 minutes, and the gen- Knollenberg Oxley NOT VOTING—13 Solomon tleman from Michigan [Mr. DINGELL] Kolbe Packard Souder Crane Martinez Tucker LaHood Parker Spence Fields (LA) Morella Waters will be recognized for 45 minutes. Largent Paxon Stearns Flake Payne (VA) Williams The Chair recognizes the gentleman Latham Petri Stockman Johnson (CT) Roth from Texas [Mr. ARCHER]. LaTourette Pombo Stump Lazio Tejeda Laughlin Porter Mr. ARCHER. Mr. Chairman, I yield Talent b Leach Portman Tate 1131 myself such time as I may consume. Lewis (CA) Pryce Tauzin So the resolution was agreed to. Mr. Chairman, today marks a great Lewis (KY) Quillen Taylor (NC) and historic occasion. With the action Lightfoot Quinn The result of the vote was announced Thomas Linder Radanovich we are about to take, we will perform Thornberry as above recorded. Livingston Ramstad Tiahrt A motion to reconsider was laid on lifesaving legislative surgery on our LoBiondo Regula Upton Nation’s vital Medicare Program. Longley Riggs the table. Vucanovich In just 74 days, for the first time in Lucas Roberts f Manzullo Rogers Waldholtz the 30-year history of Medicare, the Martini Rohrabacher Walker Government will begin a year in which Walsh PERSONAL EXPLANATION McCollum Ros-Lehtinen it spends more Medicare money than it McCrery Roukema Wamp Mr. PAYNE of Virginia. Mr. Speaker, during Watts (OK) takes in. I repeat, this has never hap- McDade Royce rollcall vote No. 727 on House Resolution 238 McHugh Salmon Weldon (FL) pened before. I was unavoidably detained. Had I been McInnis Sanford Weldon (PA) That is why the action we are taking Weller present I would have voted ``no.'' McIntosh Saxton today is so very important. McKeon Scarborough White f Metcalf Schaefer Whitfield This bill saves Medicare for seniors. Meyers Schiff Wicker PERSONAL EXPLANATION It preserves Medicare for 50-year-olds, Mica Seastrand Wolf and it tells young voters to have faith Young (AK) Miller (FL) Sensenbrenner Mr. ROTH. Mr. Speaker, on rollcall in their Government. We Republicans Molinari Shadegg Young (FL) No. 727 I was in a meeting on the agri- Moorhead Shaw Zeliff have long-term solutions, and we are Myers Shays Zimmer culture trade provisions, but had I been determined to protect Medicare for present, I would have voted ‘‘yea.’’ them, too, without raising their taxes. NOES—192 f Our bill is innovative, bold, and vi- Abercrombie Frank (MA) Miller (CA) sionary. It is long term. When it comes Ackerman Frost Minge PERSONAL EXPLANATION Andrews Furse Mink to a program as important as Medicare, Baesler Gejdenson Moakley Mrs. JOHNSON of Connecticut. Mr. nothing else is acceptable. Baldacci Gephardt Mollohan Speaker, on rollcall No. 727 I was inad- Under our bill, seniors will have the Barcia Geren Montgomery vertently detained, but had I been right to freely choose the Medicare Barrett (WI) Gibbons Moran Becerra Gonzalez Murtha present, I would have voted ‘‘yes.’’ plan that best suits their needs, includ- Beilenson Gordon Nadler f ing staying in the present fee for serv- Bentsen Green Neal ice system, and to keep their own doc- Berman Gutierrez Oberstar GENERAL LEAVE Bevill Hall (OH) Obey tor, keep their own hospital, and keep Bishop Hall (TX) Olver Mr. ARCHER. Mr. Speaker, I ask their own plan, if that is their pref- Bonior Hamilton Ortiz unanimous consent that all Members erence. It is their choice to make, and Borski Harman Orton may have 5 legislative days within no one in government will force that Boucher Hastings (FL) Owens Brewster Hayes Pallone which to revise and extend their re- choice. Browder Hefner Pastor marks and include extraneous material For the first time, Medicare will give Brown (CA) Hilliard Payne (NJ) on H.R. 2425. seniors access to the same kind of Brown (FL) Hinchey Pelosi The SPEAKER pro tempore (Mr. Brown (OH) Holden Peterson (FL) health care plans that are available in Bryant (TX) Hoyer Peterson (MN) LAHOOD). Is there objection to the re- the private sector, many of which in- Cardin Jackson-Lee Pickett quest of the gentleman from Texas? clude benefits that are not currently Chapman Jacobs Pomeroy There was no objection. available under Medicare. Clay Jefferson Poshard Clayton Johnson (SD) Rahall f We also have to ask, why should not Clement Johnson, E. B. Rangel seniors have the same choices like Con- Clyburn Johnston Reed MEDICARE PRESERVATION ACT OF gressman do? Under Medicare-plus, Coleman Kanjorski Richardson 1995 Collins (IL) Kaptur Rivers they will. And to make certain our so- Collins (MI) Kennedy (MA) Roemer The SPEAKER pro tempore. Pursu- lution is long term, we protect the sav- Condit Kennedy (RI) Rose ant to House Resolution 238 and rule ings, thanks to a proposal of the gen- Conyers Kennelly Roybal-Allard XXIII, the Chair declares the House in tleman from Pennsylvania [Mr. ENG- Costello Kildee Rush Coyne Kleczka Sabo the Committee of the Whole House on LISH], language in this bill guarantees Cramer Klink Sanders the State of the Union for the consider- that the savings cannot be used for tax Danner LaFalce Sawyer ation of the bill, H.R. 2425. cuts. de la Garza Lantos Schroeder The Democrats know that we paid for DeFazio Levin Schumer b 1132 DeLauro Lewis (GA) Scott our tax cuts, more than paid for them, Dellums Lincoln Serrano IN THE COMMITTEE OF THE WHOLE last spring, before we ever got into Deutsch Lipinski Sisisky Accordingly the House resolved itself Medicare. This bill is about saving Dicks Lofgren Skaggs Dingell Lowey Skelton into the Committee of the Whole House Medicare for Medicare’s sake. Dixon Luther Slaughter on the State of the Union for the con- Our bill powerfully and effectively Doggett Maloney Spratt sideration of the bill (H.R. 2425) to cracks down on fraud and abuse. It re- Dooley Manton Stark amend title XVIII of the Social Secu- wards seniors who discover fraudulent Doyle Markey Stenholm Durbin Mascara Stokes rity Act to preserve and reform the practices. It doubles civil penalties and Edwards Matsui Studds Medicare Program, with Mr. LINDER in creates new criminal penalties against Engel McCarthy Stupak the chair. those who commit fraud. Eshoo McDermott Tanner Evans McHale Taylor (MS) The Clerk read the title of the bill. As I mentioned earlier, our solution Farr McKinney Thompson The CHAIRMAN. Pursuant to the is long term. It saves Medicare for the Fattah McNulty Thornton rule, the bill is considered as having next generation. This contrasts with Fazio Meehan Thurman been read the first time. the Democrats’ quick fix approach, a Filner Meek Torkildsen Foglietta Menendez Torres Under the rule, the gentleman from Band-Aid approach, designed to save Ford Mfume Torricelli Texas [Mr. ARCHER] will be recognized themselves for the next election. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10329 Mr. Chairman, I believe that not only Who pays for them? The seniors, by enough to sustain that system is sim- will this bill be historic, so, too, will having their part B premiums doubled. ply wrong. We can do better than that this Congress. We are the first group of Seniors are denied the free choice in this debate. under the Republican bill of doctors lawmakers to directly challenge the b 1145 convention political wisdom that it is and are forced to join managed care not politically possible to fix Ameri- plans run by the likes of Prudential In- The second principle I would like to ca’s explosive entitlement programs, surance Co., a company convicted of lay down is, we all agree the Medicare which threaten to bankrupt our Nation defrauding its customers of over $3 bil- trust fund will begin running out of and the future of our children. lion. Why should we vote to have our money next year and run out of money The Democrats who ran Congress for parents’ health care entrusted to in 7 years unless we do as the trustees 40 years refused to confront the Na- crooks like Prudential Insurance Co., suggest; fundamentally change the sys- tion’s long-term problems, other than just so the same rich executives who tem to keep it out of bankruptcy, to by raising taxes. Republicans are prov- run that company can share in $245 bil- preserve it for my mother and your ing today that we can and will solve lion in tax cuts? It is immoral, it is un- parents and grandparents. Now, we differ on how to accomplish our Nation’s most difficult problems, American. that. We should debate those dif- and I predict the American people will It is what the Republicans are doing, ferences and not challenge each other’s be thankful that we did. unknowingly, at the direction of one Mr. Chairman, long-term programs person. Not a person on that side of the motives here. Our differences are sim- ple. We believe, as President Clinton must be fair for all generations. I am aisle knows what is in this bill. No sub- believes, and as he has said, ‘‘Medicare proud to author this bill, not just as a committee ever met to consider the and Medicaid are going up at three Member of Congress, but as a Medicare bill. It was written by one person in times the rate of inflation’’. We pro- beneficiary myself and as a parent and the bowels of this Capital to destroy pose to let it go up at two times the a grandparent. What we do today in Medicare, and that is what they are rate of inflation. That is not a Medi- historic. It is wise, it is just, and, most doing. This same leader destroys any care or Medicaid cut. importantly, it saves, preserves, and protection from fraud and abuse and Mr. Chairman, when we hear all this protects Medicare. shoddy care in nursing homes, all in business about cuts, let me caution Mr. Chairman, I reserve the balance the name of less government. Members that that is not what is going Every congressional district in this of my time. on. We are talking about increases in Mr. GIBBONS. Mr. Chairman, I yield country under this Republican plan Medicare and a reduction in the rate of myself such time as I may consume. will see hospital payments cut by an growth. Mr. Chairman, this is, I agree with average of $300 million. Go home and We believe as the President does, the gentleman from Texas [Mr. AR- tell your hospital administrator that that we have to substantially cut back CHER], truly an historic day. Unfortu- for the next 7 years they get $300 mil- the waste, the fraud, and the ineffi- nately, it is another day in infamy for lion less. Ask they which emergency cient spending in Medicare to save it. 40 million Americans who depend upon room they are gong to close, which sen- Second, we believe seniors should Medicare for their health care. These 40 ior citizen they are going to deny care. have the choice to stay in Medicare, million Americans will in a few years, Unfortunately, nothing is so likely to and our plan lets them stay. To choose if this bill becomes law, be herded into sway the Republicans as honesty and Medicare, to choose their own doctor, managed care, where instead of getting decency. But these cuts they propose choose their own hospital, or, if they a doctor when they need help, they will will hurt, and hurt badly, real people. want to, like my mother, remain in the get a gatekeeper, and the money saved Hard-working Americans, who paid system. Our plan allows that. We also by all of that will be used to pay for an into Medicare for years will not get believe seniors should have the same unconscionable tax cut. That is the community health care centers, they choices we Members have, other op- simple issue that we are deciding here will not get safety net systems to pro- tions, and that is what our plan pro- today. vide them Medicare. vides. Mr. Chairman, I yield such time as he For 30 years we have working suc- Mr. Chairman, I urge a ‘‘yes’’ vote on may consume to the gentleman from cessfully to uphold the one true Con- this good bill. California [Mr. STARK], the ranking tract with America, and that is Medi- Mr. DINGELL. Mr. Chairman, I yield member on the Subcommittee on care. We have not and will not agree to myself 2 minutes. Health of the Committee Ways and breaking that contract in order to fi- Thirty years ago this year I had the Means. nance Republican tax cuts for the privilege of sitting in the Chair and Mr. STARK. Mr. Chairman, I thank wealthiest Americans. We must do ev- presiding over the House when we the gentleman for yielding me this erything to defeat this reckless Repub- passed Medicare into law. This is the time. lican plan. I urge a ‘‘no’’ vote. gavel I used. Before that time better Mr. Chairman, Medicare is one of the Mr. BLILEY. Mr. Chairman, I yield 2 than half of Americans had no health finest achievements of the U.S. Gov- minutes to the gentleman from Louisi- insurance if they were senior citizens. ernment, and for 30 years, hundreds of ana [Mr. TAUZIN]. Today, 991⁄2 percent of American senior millions of seniors have been provided Mr. TAUZIN. Mr. Chairman, I thank citizens are covered by health insur- quality health care at a reasonable the gentleman for yielding me this ance. cost, in an efficient manner, under the time. What is going to happen today is that guidance of the Federal Government. Mr. Chairman, as we begin this his- this body, under a gag rule, is going to Now one Republican, in a messianic toric debate on the Medicare Preserva- vote to cut the benefits of senior citi- grab for power, seeks to destroy Medi- tion Act, I would like to lay a few prin- zens, to reduce their choice of doctors, care. With reckless disregard for the ciples on the table: The first is that no to cut money for fraud enforcement, seniors, these leaders on the Repub- one in this Chamber should dare sug- and to weaken the laws against fraud. lican side bribed the American Medical gest that they love their parent or And the Justice Department and the Association with a $300 million pay grandparent any more than anybody inspector general of the Department of raise. The seniors are paying for that else in this Chamber. As I speak today, Health and Human Services say so. It $300 million bribe to the doctors by my mother, 77 years old last week, is going to force people into HMO’s. We being denied cancer treatment in mam- twice a cancer survivor, is laying in a will close hospitals today, especially mograms and colorectal screening. hospital bed in room 219 of Thibodaux rural hospitals. The same Republicans, on the same General Hospital in my hometown. She Mr. Chairman, this is because the day the bribe was given, voted to cut is doing fine. My sisters are with her, House is preparing to honor a Repub- cancer screening for seniors, to repay and I speak to her every hour. She is on lican commitment to cut $245 billion in political contributors of over $1 million Medicare, one of the prime bene- taxes for the rich and to cut Medicare by the Golden Rule Insurance Co. ficiaries in this country of a great sys- $270 billion. Without that cut of $270 alone. Medical savings accounts have tem. To suggest that anyone in this billion in Medicare, the tax cut is not been delivered. They cost $3 billion. room does not love their parents possible. H 10330 CONGRESSIONAL RECORD — HOUSE October 19, 1995

This bill will reduce protection for BUNNING], a respected member of the Mr. Chairman, I speak today as a nursing home patients. It was crafted committee. woman who has served on the Ways and by an abundance of sneaky, unre- (Mr. BUNNING of Kentucky asked Means Committee for over a decade. ported, backroom deals. The bill is over and was give permission to revise and During that time, I have taken a num- 300 pages long. It has grown like fun- extend his remarks.) ber of tough votes to protect Medi- gus, and each of those growths rep- Mr. BUNNING of Kentucky. Mr. care’s solvency—and today, I am again resents a significant benefit to special Chairman, I rise in support of the Med- willing to vote to protect Medicare and interests. Last night the bill was icare Preservation Act. It’s a good bill. its future. However, my experience changed after the House adjourned. It preserves Medicare—it strengthens tells me that a $90 billion problem does Mr. Chairman, no one knows what is Medicare. not demand a $270 billion solution—so I in this bill because no hearings have It keeps Medicare from going Bank- know the reductions in the majority’s been held upon it. I urge my colleagues rupt. And best of all it gives senior bill are too deep and too damaging to to reject the bill. citizens more options—more choices. Medicare. Mr. Chairman, I include for the I think you will all agree that Mem- Let me raise two specific reasons RECORD my full statement. bers of the U.S. Congress have a good why this legislation would hurt senior Mr. Chairman, many years ago, a clever health care system. citizens. songwriter offered advice this House would do We get a booklet every year that First, the bill would limit the well to heed: ``Fools rush in where wise men lists the options available to us—insur- amount Medicare pays for bene- fear to go.'' ance plans or PPOS and HMOS. We get ficiaries. The bill’s hard cap on pay- The process by which we have reached this a wide range of choices. We can pick a ments would not keep pace with medi- point is foolish in every sense. Without a sin- plan that suits our needs and our fami- cal inflation, and would therefore cre- gle hearing devoted to the contents of this bill, ly’s needs. It’s a good deal. ate a growing disparity between what I have enrolled in a PPO. I still get to Republicans ask America's seniors to stand health services cost and what Medicare see my family doctor—my gatekeeper. like deer in the headlights, transfixed by the would pay. This disparity would cer- I show him this card—and my office notion of fixing the Medicare program. They tainly undercut the quality of care visit only costs me $10. And I have this expect senior citizens to accept without ques- under Medicare and force seniors into a other card that I can take to the drug tion or complaint the absurd declaration that terrible choice: Either pay more to unless we destroy the Medicare program now, store and pick up my prescription med- make up the difference or settle for it will destroy itself. icine and no matter how much it costs, second-rate health care. Seniors should Nothing could be further from the truth. I say I only pay $10. to my Republican colleagues that it's this sim- It’s a good deal. not be discriminated against in this ple: Drop your tax cut for the rich, and none This Medicare reform bill that we are way. Second, proponents of the bill claim of these Medicare cuts will be necessary. considering today gives the senior citi- This debate occurs, appropriately, in Octo- zens of our country the same kind of that people on Medicare will have new ber, the month of Halloween. This is the time options that Members of Congress now choices while retaining their right to for walking around in costumes and masks. have. It will give them the same kind stay in traditional Medicare. I support This Medicare bill has been costumed by the of choices we have. providing additional choices, but Republicans in the cloak of Medicare preser- That’s the beauty of this bill. We choice for some should not ruin the vation. But after today's trick or treat is over, save Medicare. We strengthen Medicare only choice for others—traditional after the mask comes off, Medicare bene- and on top of it all, we make Medicare Medicare. ficiaries will understand that the only reason better. Under the majority’s bill, some sen- the Republicans have to cut $270 billion from We are going to hear a lot of out- iors would pay the price for the choices the Medicare program is to provide for a tax rageous rhetoric about how we are made by others. This puts a new spin break for their rich friends who don't need it. slashing benefits—that’s hogwash. It’s on the carrot-and-stick approach: This Republican bill will cost seniors more political hogwash. And I, for one, think Under this bill, when healthier seniors money. It will reduce their choice of doctors. It that this program is too important to choose the carrot, sicker seniors get will jeopardize the quality of the health care play political games with. the stick. system. It will compound, not correct, the This bill is a good bill—it gives sen- For example, when younger, problems waste, fraud, and abuse. And if this ior citizens the same kind of health healthier seniors leave traditional bill passes, my friends, the AMA's members care that Members of Congress enjoy Medicare by selecting a medical sav- will need that tax cut to shelter all their addi- now. That’s a good deal. ings account, that will leave older, tional income from the extra money stuck in Mr. GIBBONS. Mr. Chairman, I yield sicker seniors behind in traditional this bill for them in some backroom deal for myself such time as I may consume to Medicare to face rising costs. As a re- which they sold their support. answer the gentleman from Texas’ sult, these higher costs would trigger This is the same AMA, I remind the seniors challenge. the so-called failsafe cuts, further re- out there, that opposed the creation of Medi- I am sure the gentleman is familiar ducing payments to doctors and hos- care in the first place. Socialized medicine, with his bill. He knows there is a fail- pitals in traditional Medicare. The ob- they called it. But now that they have their safe device in there. The impact of the vious consequence would be fewer and snouts in the public trough, they just want fail-safe device is to require the Sec- fewer quality providers for seniors re- more and more and more. For seniors, that retary of Health and Human Services maining in traditional fee-for-service means less and less and less. to make cuts only in the fee-for-service Medicare. Mr. Chairman, the American people will program an undesignated amount of Some might reply that a well-de- hear more throughout the day about the de- money in order to balance the Federal signed risk adjuster would address this fects in this legislation. I urge my colleagues budget. There is no way that the Sec- problem of adverse selection. But the to oppose this bill. It took 30 years for us to retary of Health and Human Services simple truth is: We do not currently create and build the Medicare system; let's not can make that kind of cut and preserve have, nor does this bill propose, such a take just a few hours to destroy it. fee-for-service type service for people risk adjuster—and anyone who under- Mr. ARCHER. Mr. Chairman, I yield who elect it. stands this issue, which is always myself such time as I may consume. Mr. Chairman, that is the fraud in present in insurance decisions, knows Mr. Chairman, we are going to hear a the gentleman’s bill. One of the many how hard it would be and has been to lot of misinformation presented in this frauds in his bill. And it will drive all design one. debate, and I would challenge my Dem- seniors into a gatekeeper operation If we are going to tell seniors they ocrat friends to begin to list the bene- under managed care. can stay in traditional Medicare, then fit cuts that are made in this package Mr. Chairman, I yield 4 minutes to we have an obligation to ensure that it from what are currently available the gentlewoman from Connecticut is a real option, and not just a false under Medicare, because there are [Mrs. KENNELLY]. promise. This bill fails that test. none. Mrs. KENNELLY. Mr. Chairman, I The majority often implies that sen- Mr. Chairman, I yield 2 minutes to thank the gentleman for yielding me iors will barely notice the reductions, the gentleman from Kentucky [Mr. time. since so much of their bill’s savings October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10331 would be achieved by cutting fraud and and consume 21 percent of their dispos- Mr. Chairman, this is a bad bill. It by providing seniors more health care able income. has not been thought through and we options. But the truth is that almost Mr. Chairman, when I joined with ought not take a chance with a pro- all of the bill’s savings come from cut- Members of the 104th Congress in a gram that is so important to so many ting payments to providers and in- genuine effort to reform Medicare and Americans. creasing beneficiaries’ premiums. In preserve it for the next generation, I Mr. ARCHER. Mr. Chairman, I yield fact, the Congressional Budget Office made a deal with myself. I pledged that 30 seconds to the gentleman from Cali- [CBO] has said that only 1 percent of I would not support a plan that I could fornia [Mr. THOMAS] chairman of the the bill’s savings come from reducing not sit down with my parents and ex- Health Subcommittee of the Commit- fraud, and that only 2 or 3 percent of plain. tee on Ways and Means, a gentleman the bill’s savings come from providing who has contributed so much in the de- b 1200 seniors new choices. More than 95 per- velopment of this plan. cent of the savings will come in ways Well, I have explained it, and, Mr. Mr. THOMAS. Mr. Chairman, we are that will be all too evident to Ameri- Chairman, I am here today to say that going to respond every time someone ca’s seniors. The Medicare they know we owe it to the American seniors to makes a misstatement, and the will be no more. pass this preservation act. misstatement was that we are cutting Mr. Chairman, the American people Mr. DINGELL. Mr. Chairman, I yield the hospital updates. We are not cut- want to keep Medicare solvent. I do 15 seconds to the gentleman from ting; we are slowing the growth. too. That is why I am voting for $90 bil- Michigan [Mr. STUPAK]. Mr. Chairman, the gentleman from lion to save Medicare. But $270 billion Mr. STUPAK. Mr. Chairman, the gen- Louisiana talked about ‘‘slowing the in Medicare reductions is ludicrous. It tlewoman from Connecticut said there growth’’ in a statement from the Presi- should not happen, and it will wreck are no cuts in this bill. I would direct dent. Here are the updates according to Medicare as we know it. the attention of the gentlewoman to the CBO numbers. As any Member can Mr. ARCHER. Mr. Chairman, I yield page 275 in PPS hospitals, which shows see, every year the hospital reimburse- 30 seconds to the gentlewoman from that for 1996, which started 18 days ago, ment goes up. That is slowing the Connecticut [Mrs. JOHNSON]. fiscal year 1996, there is a 15-percent growth. That is not a cut. Mrs. JOHNSON of Connecticut. Mr. cut for hospitals. That 15 percent will Mr. ARCHER. Mr. Chairman, I yield 2 Chairman, I want to point out for the not only affect seniors, but the whole minutes to the gentleman from Geor- RECORD that no speaker has pointed to population that is served by those hos- gia [Mr. COLLINS], a member of the any benefit cuts. In fact, our bill guar- pitals. Committee on Ways and Means. antees all Medicare benefits, for future Mr. DINGELL. Mr. Chairman, I yield Mr. COLLINS of Georgia. Mr. Chair- retirees as well as for current retirees, 2 minutes to the distinguished gen- man, there is an old saying: Tempta- an increase of spending per retiree of tleman from California [Mr. WAXMAN]. tion will beat your door down, but op- $2,000 over the 7 years, which is just as (Mr. WAXMAN asked and was given portunity will knock only once. much as we increased spending over permission to revise and extend his re- Today the Democrats offer tempta- the last 7 years. Thus, absolutely guar- marks.) tion: To extend Medicare until 2006. anteeing the benefits will be there for Mr. WAXMAN. Mr. Chairman, what But the Republicans offer an oppor- America’s seniors. we are going to do today, if the Repub- tunity to extend Medicare to 2012 and Mr. GREENWOOD. Mr. Chairman, I licans get their way, is a travesty, it is beyond. yield 11⁄2 minutes to the gentleman irresponsible, and it is wrong. Thirty- The real difference between tempta- from North Carolina [Mr. BURR], a fine seven million Americans depend on tion and opportunity is that the Demo- new freshman Member of the House Medicare. They want a program that crat temptation sets the stage for an- who has contributed significantly to let them see their own doctor and pro- other tax increase by the year 2006. the bill. tects them from financial ruin when Their plan will leave the Medicare (Mr. BURR asked and was given per- they get sick. trust fund underfunded by $309 billion— mission to revise and extend his re- Mr. Chairman, they do not want us to just when those Medicare funds will be marks.) gamble with Medicare. They do not needed by the World War II generation. Mr. BURR. Mr. Chairman, I came to want us to go along with what some But Mr. Chairman, this is nothing Congress because I believed that there health-care theorist thinks might new—this has been the pattern of Con- were many things in this country that make them more cost-conscious con- gress over the last 31 years, since Medi- just did not work like they were de- sumers. They already watch their dol- care was created. signed. Medicare is one of them. For lars. They pay enough in premiums and Congress has either increased the once, it is time for us to stand up to coinsurance, and most Medicare recipi- rate or changed the income base 23 the Federal Government bureaucrats ents live on less than $25,000 a year. times in 31 years in order to keep the who believe that they can do no wrong. Most of all, they do not want us to Medicare program running. In my opinion, Medicare is a perfect balance the budget on the backs of The temptation the Democrats offer example of good intentions choked by a Medicare recipients. They do not want today continues that history and en- bureaucracy unable to address the us to cut Medicare so we can cut taxes. sures that taxes will again have to be changing needs of a vital program. It is The supporters of this bill are not raised in order to continue Medicare. long past time that we inject the wis- telling us some facts. First of all, not Mr. Chairman, what happens when dom of the private sector, which has only will Medicare beneficiaries pay payroll taxes are increased? created products that work, into a higher premiums to hold on to part B, Seniors know. Seniors know their health care blueprint for seniors in but the bill will allow doctors and hos- children and grandchildren will have America. pitals to charge the patients more less income for their families; the cost It is time to offer choice to Medicare money directly over and above what of consumer goods and services will in- beneficiaries which allow and encour- they get now paid from the Medicare crease; and we are less competitive in age them to spend their health-care fund. That is something they cannot do the world market. dollars in a way that best fits their at the present time. Mr. Chairman, when our Medicare health needs. Second, this will take away the seniors, who are on a fixed income, go It is time we allow our parents the choice of doctors and will herd people to the doctor, the grocery store, or pay ability to choose their coverage while into managed care plans. That is not a utilities, the cost of each of these serv- maintaining the security of the current bad choice if you want an HMO, but ices will reflect the increase in payroll system for those who need it. that should not be your only choice. taxes. Call me crazy, Mr. Chairman, but for Third, this bill is going to jeopardize The Democrat temptation to Medi- decades we have delayed, ignored, and the quality of care for everyone, when care reform repeats the mistakes of the tinkered with Medicare while my par- hospitals and emergency rooms are past. ents and 36 million other Americans forced to close, when medical research The Medicare Preservation Act is the have seen their health care costs rise hospitals are starved of funding. best of the two options. H 10332 CONGRESSIONAL RECORD — HOUSE October 19, 1995 It addresses concerns about excessive Mr. Chairman, the GOP bill makes it night was a provision that does not charges for health care, addresses harder to detect fraud; makes it harder touch their weakening of the fraud and waste, fraud, and abuse of precious to prosecute fraud; makes it harder to abuse provisions. They have weakened Medicare dollars, and ensures that recover. Even CBO, that the gentleman them, and they have told Members Medicare will be solvent until 2012 and from California [Mr. THOMAS] has maybe they will fix them later. beyond. quoted from, says the fraud provisions Why did they do this? And nothing The Medicare Preservation Act re- will only get us $2 billion over 7 years. they did last night can cover it up. quires that we look ahead and antici- Mr. Chairman, they do not even find What they did last night may be a pate the World War II generation; and any fraud in this bill until 1998. They small step forward in some areas, but we will study the changes to make sure cannot find any. I can tell my col- it is five steps backward in terms of it is working like it’s supposed to. leagues that with oxygen concentrates, fighting fraud and abuse against Medi- It does all this by changing the Medi- we can recover $4.2 billion in 5 years care. That is what they have done and care process, without a tax increase. just by using the same formula the it is shameful. Mr. BLILEY. Mr. Chairman, I yield Veterans Administration uses. But my Mr. BLILEY. Mr. Chairman, I yield 1 1 ⁄2 minutes to the gentleman from colleagues on the other side do not ac- 11⁄2 minutes to the gentleman from Wis- Texas [Mr. BARTON]. cept those things. consin [Mr. KLUG]. (Mr. BARTON of Texas asked and Mr. Chairman, there is no fraud- Mr. KLUG. Mr. Chairman, this is was given permission to revise and ex- fighting elements in this bill. The De- quite simply a choice about two dif- tend his remarks.) partment of Justice is against it. The ferent headlines. Mr. BARTON of Texas. Mr. Chair- Office of Inspector General is against January 1, 2002. ‘‘Medicare Bankrupt. man, Medicare is going to lose $18 bil- it. They have all come out against Seniors Devastated. Hospitals to close. lion this year from waste, fraud, and these so-called fraud and abuse sec- Safety net Destroyed.’’ abuse. That is $50 million a day, $2 mil- Or October 20, 1995. ‘‘Medicare Saved. lion an hour, $3,000 dollars a minute. tions. Take the charts from CBO and take the time line that has been cre- Federal government delivers on its Since the debate began at 9 o’clock this promise to seniors.’’ morning, Medicare has lost $6 million ated. Mr. Chairman, $2 billion is all they recover. Which headlines would you prefer to due to waste, fraud, and abuse. see. Now which headline do you think I Mr. Chairman, the bill before us has Mr. ARCHER. Mr. Chairman, I yield 1 minute to the gentleman from Califor- want my mom to see who’s now living the toughest penalties ever presented in Wisconsin who’s 78 years old? nia [Mr. THOMAS], chairman of the Sub- to the Congress on waste, fraud, and If we do not save Medicare today the committee on Health. abuse. For the first time we have a def- President’s own Medicare trustees say inition of Federal health care fraud. Mr. THOMAS. Mr. Chairman, we are talking about fraud and abuse. What the Medicare trust fund will be tapped Mr. Chairman, I want to read that out in 7 years. There will be nothing very quickly: my colleagues should do is look at the bill. left. Zero. Zippo. Whoever, having devised or intending to Oh sure there is another way to fix it. Mr. Chairman, this bill, as the gen- devise a scheme or artifice, commits or at- To raise taxes. To pump more into a tleman from Texas [Mr. BARTON] cor- tempts to commit an act in furtherance of or bureaucratic, Washington system for the purpose of executing such scheme or rectly pointed out, does more than any whose losses are twice the private sec- artifice to defraud any health care benefit other provision ever in the history of tor. The President admitted the other program; or to obtain, by means of fault or Medicare. day he made a mistake raising taxes fraudulent pretenses, representations, or Fraud: We find it. We utilize 37 mil- promises, any of the money or property last year. No fooling. lion Americans with not only a toll- owned by, or under the custody or control of, What kind of tax increases will it free number, but a whistleblower re- any health care benefit program. take to save Medicare—how about an- ward structure by the Secretary. We That is the definition. They can be other 1.3 percent payroll tax—$585 a require, it is not required now, an ex- fined and imprisoned for up to 10 years. year for someone making $45,000 a planation of what goes on, so recipients If the fraud results in bodily harm, year. Now that is just in the next few will know what has been done to them. they can be imprisoned for up to 20 years. years. If the fraud results in death, Mr. Chairman, we have a Medicare But as the shortfall gets worse we they can be imprisoned for life. Integrity Program. We utilize the new- would have to raise the taxes again— Mr. Chairman, that is tough. If they est technology to go after fraud. We nearly double the current rate—mean- make a false statement, they can be have a corporate whistleblower pro- ing an increase of $1,584 a year for that imprisoned for 5 years. That is cur- gram. We double the civil penalties. We worker making $45,000. rently a misdemeanor. If they try to have criminal penalties. We have ex- The impact on small businesses is ab- embezzle or steal money, they can be pulsion from all Federal programs if solutely devastating—the Chamber of in prison for up to 10 years. If they try providers are found to be violators. Commerce says a small business with to bribe or engage in graft, they can be Mr. Chairman, we increase the en- 25 workers—mail in another $13,000 in in prison for up to 15 years. forcement with bucks put in by the tax payments. How do most businesses Mr. Chairman, I could go on and on, Shaw-Gibbons amendment for more en- react to tax increases, they cut jobs, but this bill has the toughest waste, forcement officials. Lastly, and most raise prices—and that means 3 million fraud, and abuse penalties ever pre- importantly, we define in a way so that jobs vanish. sented to this Congress. I urge my col- people will know what they can or can- Fix Medicare today—give seniors op- leagues to vote for it. not do. It is clear. It is responsible. tions, live up to the promise. Listen to Mr. DINGELL. Mr. Chairman, I yield Fraud: we find it, we fight it, and we the President’s own death bed con- 90 seconds to the gentleman from fix it. versation about raising taxes. Which Michigan [Mr. STUPAK]. Mr. GIBBONS. Mr. Chairman, I yield headline do you prefer? Medicare Mr. STUPAK. Mr. Chairman, the last 1 minute to the gentleman from Michi- thrives, or Medicare dies. Not too gentleman spoke about fraud in this gan [Mr. LEVIN]. tough a choice is it? bill. I agree with the gentleman. It is a Mr. LEVIN. Mr. Chairman, clearly Mr. Chairman, the choice is easy. fraud to have this bill. the issue of fraud and abuse is a sen- One headline or the other: ‘‘Medicare Mr. Chairman, if you take a look at sitive nerve on the majority side, and Thrives’’ or ‘‘Medicare Dies’’. it, this GOP bill, what the Republicans it should be. have done, they have legalized fraud in Mr. Chairman, the Inspector General b 1215 this bill. They have raised the legal and the Justice Department have said Mr. DINGELL. Mr. Chairman, I yield standard that is required of law en- my colleagues on the other side are 2 minutes to the distinguished gen- forcement to crack down on fraud, going to cripple efforts under Medicare, tleman from New Jersey [Mr. waste, and abuse. They have raised the and they are. PALLONE], chairman of the Democratic legal standard in which HCFA and OIG The Republican side called these ef- Health Care Task Force. can recover proceeds, money stolen forts to weaken the fraud statute sala- Mr. PALLONE. Mr. Chairman, I want from the trust fund. cious. It is. What they inserted last to make a plea to my colleagues on the October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10333 other side of the aisle to oppose this Our 9th District Delegation, which rep- unsustainable trend and one that nei- ill-conceived Medicare plan. The Re- resents the largest Senior Citizen population ther seniors nor younger Americans publican leadership proposal, as we in New Jersey in Ocean, Burlington and At- working to support themselves and know, will cut $270 billion out of Medi- lantic counties, issued a letter on September their families can be asked to under- 22, 1995 to House Speaker Newt Gingrich and care to pay for $245 billion in tax cuts Senate Majority Leader Bob Dole, urging write. mostly for the wealthy. them to scrap this plan. The financial crisis in the Medicare It is not necessary to make these Copies of our correspondence to Speaker program is not a short-term cash flow cuts in order to keep Medicare solvent. Gingrich and Senator Dole were conveyed to problem, as the Democrats would like The Medicare trustees have told us New Jersey’s Congressional Delegation. For the American people to believe. The that Speaker GINGRICH’s cuts had three your convenience, a second copy of this ap- trustees of the Medicare trust fund, times any estimate of what is needed peal is enclosed. three of whom are President Clinton’s Please allow our Delegation this oppor- to make Medicare solvent. Mr. Chair- own Cabinet members, said in their re- tunity to reiterate our profound concerns port on the HI, or part A, trust fund, man, seniors are going to be forced to about these cuts in Medicare services for our pay more to get less under the Ging- elderly. ‘‘The trust fund fails to meet the trust- rich proposal. Part B premiums will As you are aware, alternative proposals ee’s test of long range close actuarial double without a penny of that in- have been offered that would maintain the balance by an extremely wide margin.’’ crease going back into the part A Medi- solvency of the Part A and Part B trust Further, the same trustees said in care hospital trust fund. funds until 2006. This $90 billion compromise their report on the SMI trust fund, the package would provide a decade for Congress part B trust fund, ‘‘while in balance on Seniors will ultimately be forced into and the While House to achieve a well- HMO’s and have to give up their own an annual basis, shows a rate of growth planned and balanced proposal to resolve of costs which is clearly doctors because the Republican pro- Medicare’s financial problems. This com- posal puts money into HMO’s at the ex- promise would also provide the opportunity unsustainable.’’ pense of the traditional Medicare sys- for a bipartisan consensus. The public trustees of the Medicare tem. Our Delegation is genuinely sensitive to program were very clear when they My colleagues, the Republican plan the difficult decision you face and have had said, ‘‘The Medicare Program is clearly will destroy America’s high quality our own feet roasted by the hot coals of unsustainable in its present form.’’ Leadership. We feel very strongly that a rush The Democrats in the past have ig- health care system because hospitals to judgment on this issue is bad public pol- nored the long-range spending problem and other health care providers will be icy. America must never turn its back on our of the Medicare Program. Their solu- so squeezed for Medicare dollars that parents and grandparents. tion has been to continually raise taxes they will be forced to close or signifi- We, respectfully, urge New Jersey’s House Members to oppose this $270 billion Medicare on working Americans, and that is still cantly cut back on their services. their solution. None of this would be necessary if cut. Your leadership, in targeting Medicare fraud, the staggering costs of health care and In the years since the enactment of Speaker GINGRICH were not insisting on in building a bridge to the future with the al- Medicare, the maximum taxable a big tax break for the wealthy. I know ternative proposals set forth by Reps Sam amount has been raised 23 times. Two that at least half of my Republican col- Gibbons that will provide the chance for years ago, the Congress, then con- leagues from the State of New Jersey Congress to seek a consensus solution to pre- trolled by Democrats, raised taxes, have already indicated that they are serve Medicare for our parents and grand- Medicare taxes again. All that did was voting no on this terrible bill. I would parents. just put another financial burden on ask all of my colleagues on the other Thank you for your thoughtful attention the taxpayers and put off the financial to this appeal on behalf of the Senior Citi- side to heed the words of three Repub- crisis in the trust fund for just a few lican State legislators from the Jersey zens of Ocean, Burlington and Atlantic coun- ties. months. Clearly, raising taxes yet Shore who wrote to my New Jersey col- Sincerely, again on the American people is not leagues in the House this week and LEONARD T. CONNORS, JR., the answer. urged support for the Gibbons-Dingell Senator—9th District. The Medicare Preservation Act, on substitute. JEFFREY W. MORAN, the other hand, addresses the out-of- They said, and I quote: Assemblyman—9th District. control spending in the Medicare Pro- Alternative proposals have been offered CHRISTOPHER J. CONNORS, gram by opening up the private health that would maintain the solvency of the part Assemblyman—9th District. care market to the senior population. A and part B trust funds until the year 2006. f By harnessing some of the innovative This $90 billion compromise package would cost effective and high quality private provide a decade for Congress and the White ANNOUNCEMENT BY THE CHAIRMAN sector health care delivery options, House to achieve a well-planned and bal- Medicare beneficiaries will not only anced proposal to resolve Medicare’s finan- The CHAIRMAN. The Chair would have a choice in their health care cov- cial problems. like to take the time to remind Mem- We feel very strongly that a rush to judg- erage for the first time, but the Gov- ment on this issue is bad public policy. bers that it is not appropriate to wear ernment will also be able to rein in America should not turn its back on our par- or display badges while engaging in de- out-of-control Medicare spending. It is ents and grandparents. bate. a win/win situation. Mr. Chairman, I include for the Mr. ARCHER. Mr. Chairman, I yield 3 The Republican plan provides secu- minutes to the gentleman from Louisi- RECORD this letter from my fellow Re- rity for not only today’s seniors but publican State legislators in New Jer- ana [Mr. MCCRERY], a valuable member also lays the groundwork for the re- sey urging opposition to this. of the Subcommittee on Health. tirement of my generation, and it does Mr. MCCRERY. Mr. Chairman, as this it without increasing the tax burden on STATE OF NEW JERSEY, chart shows, spending on the Medicare 9TH DISTRICT LEGISLATIVE OFFICES, working people. Forked River, NJ, October 13, 1995. system has skyrocketed since 1970. Mr. DINGELL. Mr. Chairman, I yield Re Medicare. Here we are today and Members can 1 minute to the distinguished gen- To: Hon. Christopher H. Smith, Hon. Robert see, if nothing is done, it goes off the tleman from Pennsylvania [Mr. KLINK]. E. Andrews, Hon. Marge Roukema, Hon. chart. Mr. KLINK. Mr. Chairman, I thank Robert D. Franks, Hon. Robert G. In 1970, Medicare spent about $8 bil- the gentleman for yielding time to me. Torricelli, Hon. Rodney P. lion; in 1994, Medicare spending was I would like to begin by yielding to Frelinghuysen, Hon. Robert Menendez, about $165 billion. That is an increase the gentleman from Ohio [Mr. BROWN]. Hon. H. James Saxton, Hon. Frank A. of almost 2,100 percent in just 14 years. Mr. BROWN of Ohio. Mr. Chairman, LoBiondo, Hon. Frank Pallone, Jr., Hon. In the part B side alone, growth rates the previous speaker, under the Ging- William J. Martini, Hon. Donald M. have been so rapid that outlays of the rich Medicare plan, the hospitals in Payne, and Hon. Richard A. Zimmer. program have increased 40 percent per and around the district of the gen- DEAR HOUSE MEMBERS: It is our under- standing the House Ways and Means Com- enrollee just in the past 5 years. More tleman from Louisiana [Mr. MCCRERY], mittee has voted 22–14 to send the Medicare alarming is that Medicare spending is will lose $158 million over the next 7 reform package to the House floor next projected to explode to over $350 billion years under the Gingrich Medicare cut week. in 2002. Clearly, this is an plan. H 10334 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Mr. KLINK. Mr. Chairman, I thank They voted against Medicare 30 years us that under all sets of assumptions the gentleman for that input. Here is ago, and they are voting against it the fund goes bankrupt, and it goes the chart which actually shows the re- again today. My colleagues, actions bankrupt in 7 years. Taking our re- duction in Medicare spending per bene- speak louder than words, and the Re- sponsibility very seriously, we Repub- ficiary under the House Republican publican actions are loud and clear. licans went to work. plan. I have to get this straight. When The Republicans did not want Medi- We gathered with senior citizens, is a cut not a cut? care 30 years ago and they want to dis- with experts from around the country, Last year when we were trying to do mantle it now. and we said, what can we do? Is there health care, every Republican on the I do not believe that we must destroy any good news? Can we fix the situa- Committee on Ways and Means signed Medicare to save it. Democrats do not tion? We found good news. We found a letter which said, ‘‘the additional raise premiums for seniors. Democrats that health insurance costs for work- massive cuts in reimbursement to pro- ensure that Medicare is there for our ing people, not retired people, were viders proposed in this bill’’—the Clin- families, for our children, for our going down. Inflation rates at 10.5 per- ton bill—‘‘will reduce the quality of grandchildren, and their children. cent in Medicare are killing it. care for the Nation’s elderly.’’ That Under their plan, the Republicans b 1230 was $168 billion versus $70 billion now. eliminate nursing home standards. The current chairman of the Com- Poor seniors lose help for copayments The private sector using intelligent mittee on Ways and Means made the and deductibles. new programs have brought the infla- statement, ‘‘I just don’t believe that Under the Republican plan, the rich tion rate down below to virtually zero. the quality of care and availability of get tax cuts, and our Nation’s elderly We said the good news is this. We can care can survive these additional and hard-working families get higher preserve Medicare, we can preserve fee- cuts.’’ Now they are saying that these Medicare bills. It’s a scam, a sham, and for-service options for everyone who are not cuts. It is cuts in the rate of a shame. I know it. You know it. Now wants to stay that way, but we have growth. Were you lying to us now or the American people know it. new and exciting options. are you lying to us then? Mr. Chairman, on this day, October Mr. Chairman, my mother and father Mr. ARCHER. Mr. Chairman, I yield 19, let the word go forth from this place have chosen the managed-care option. myself such time as I may consume. into every State, every city, every They love it. They save $1,000 a year I resent the fact that the gentleman town, every village, every hamlet that each because they no longer buy implied that I have lied. No. 1, that it was the Republicans who voted to MediGap insurance. They have new does not belong on this floor. But the cut Medicare—they voted to cut Medi- prescription drug benefits. They get all gentleman, as usual, has not given the care by $270 billion in order to give a of the referrals they want. They are de- factual information. $245 billion tax break to the wealthy. lighted. The plan that I made those com- The Republican plan is too much, too This plan is very straightforward. We ments on cut $490 billion out of Medi- radical, too extreme. preserve fee-for-service, we increase care and Medicaid. Without transform- We have more than a legislative re- the per beneficiary expenditure from ing Medicare, without giving other op- sponsibility to oppose this Republican $4,800 a year to $6,700 a year, and for tions, without including true savings plan. We have a mandate, a mission, those seniors who want new choices, we in the cost drivers. That was a totally and a moral obligation to protect Med- have excellent new choices in managed different time, a totally different pro- icare. care. This is a spectacular bill. Ameri- gram. But it cuts $490 billion out of This vote—this debate is about some- cans will be proud of it. Senior citizens Medicare and Medicaid. thing much bigger than one vote. It is love it. Vote ‘‘yes.’’ Mr. Chairman, I reserve the balance bigger than one bill. It is about two Mr. DINGELL. Mr. Chairman, I yield of my time. contracts, the Republican contact with 2 minutes to the distinguished gen- Mr. GIBBONS. Mr. Chairman, I yield the rich, and the Democratic contract tleman from Oregon [Mr. WYDEN]. such time as he may consume to the with the American people—Medicare. (Mr. WYDEN asked and was given gentleman from Georgia [Mr. LEWIS]. Medicare is a contract—a sacred trust permission to revise and extend his re- Mr. LEWIS of Georgia. Mr. Chair- with our Nation’s seniors and our Na- marks.) man, I thank the gentleman for yield- tion’s hard-working families. Mr. WYDEN. Mr. Chairman, our Na- ing time to me. My fellow Americans, remember—it tion needs—— Mr. Chairman, I rise today in strong was the Democrats who found the cour- Mr. STARK. Mr. Chairman, will the opposition to the Republican Medicare age and the strength to provide health gentleman yield? plan. I rise to tell you there is another care to our seniors, and it is the Demo- Mr. WYDEN. I yield to the gentleman way, a better way. We Democrats have crats who will preserve it for unborn from California. a plan. We save the Medicare trust generations. Mr. STARK. Mr. Chairman, I wish to fund, and we do it without hurting the We must not and will not break the inform the gentleman that in the dis- poor, the sick, and the elderly. contract with America’s seniors and trict of the gentleman from Pennsylva- How can we do it? We can do it be- families. I urge my colleagues to sup- nia [Mr. GREENWOOD] there will be $128 cause we do not pay for tax breaks for port the Democratic alternative and cut from hospitals over the next 7 the rich. There is only so much oppose the Republican plan to cut Med- years. money—you can either use it to help icare. Mr. WYDEN. Mr. Chairman, our Na- the sick and the elderly or you can give Mr. ARCHER. Mr. Chairman, I yield tion needs bipartisan reform of Medi- it to the rich. My Republican col- myself such time as I may consume. care, but instead today’s bill will de- leagues may say whatever they wish, Mr. Chairman, the facts have already liver a nationwide Medicare migraine. but the truth is that these very large— been presented to this committee. Med- Instead of listening to our seniors, and these huge Medicare cuts are needed to icare increases per beneficiary go from our families, and to the inspector gen- pay for their tax breaks for the rich. $4,800 to $6,700 per year. The total ag- eral, this is a cut first, ask questions The Republicans say they want to gregate increase in medical expendi- later Medicare initiative, and the fraud help Medicare. But what they do is dif- tures increases $1.4 trillion under our section is a metaphor for the whole ferent. Thirty years ago, the Demo- plan over the next 7 years. But only in bill. Instead of legislation to protect crats created Medicare and the Repub- Washington can an increase be called a seniors and taxpayers, it protects the licans voted against it. cut. crooks and the thieves. Instead of im- Two years ago, Democrats passed a Mr. BLILEY. Mr. Chairman, I yield proving access to health care, it pro- bill that helped the Medicare trust 11⁄2 minutes to the gentleman from vides a freeway to fraud, and, my col- fund. Every Republican voted no. Pennsylvania [Mr. GREENWOOD]. leagues, think of the words of the non- Earlier this year. the Republicans Mr. GREENWOOD. Mr. Chairman, partisan fraud-buster at the Office of took $87 billion from the Medicare earlier this year we got some very bad the Inspector General who said that trust fund. Today, they want to cut an news for Americans and senior citizens. this bill will cripple, it will cripple, ef- additional $270 billion. The trustees of the Medicare funds told forts to bring justice. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10335 Let me tell my colleagues it is pos- Mr. Chairman, I yield 2 minutes to Mr. WAXMAN. Mr. Chairman, I just sible to develop 21st century Medicare the gentleman from Florida [Mr. BILI- want to comment on the statement that works for seniors and taxpayers. RAKIS]. made by the previous gentleman. He Reject this bill and come with me to (Mr. BILIRAKIS asked and was given claimed we are not cutting benefits, we Oregon because I will show each of you permission to revise and extend his re- are not going to make people pay for programs that protect seniors, hold marks.) benefits for their health care. How are down costs, and insure that we have a Mr. BILIRAKIS. Mr. Chairman, I will we getting $270 billion in Medicare cuts path to the 21st century. We can do use the word ‘‘shame.’’ Shame on those and the AMA supports the bill? Some- this job right. We can do it in a biparti- politicians who over the years, not just thing just does not add up. san way. But let us listen to our sen- now, use scare tactics and misinforma- Mr. BRYANT of Texas. Mr. Chair- iors and our taxpayers. tion to frighten our senior citizens all man, the gentleman’s logic is impec- Mr. DINGELL. Mr. Chairman, I yield in the interests of getting votes cable. I would point out that the losses 1 minute to the distinguished gentle- through fear. These actions are uncon- to hospitals in and around the district woman from Oregon [Ms. FURSE]. scionable. of the gentleman from Florida [Mr. Only the most affluent retirees are Ms. FURSE. Mr. Chairman, I thank BILIRAKIS] are going to be $210 million having their part B premiums raised the gentleman for yielding this time to over the next 7 years, and my colleague substantially. We are not raising Medi- me. says there are no cuts. His folks are care copayments or deductibles. We I have here a list of words that I am going to feel them. will not be reducing services or bene- The fact of the matter is, Mr. BILI- told the Republicans were asked to use fits—our legislation ensures that the in this debate, words like historic, suc- RAKIS, as chairman of the Subcommit- core services in the current Medicare tee on Health, my colleague and his cessful, saves. Well, there was a his- Program will be retained and must be toric event 30 years ago. The Demo- Republican friends ought to be working offered to all beneficiaries. on the fact that health care costs are crats in this House passed Medicare. I also want to make it clear that no rising. Instead my colleague is working Not one Republican voted for it. one will be forced into HMO’s. If Medi- on cutting health care insurance that Successful? Well, yes. This bill suc- care beneficiaries wish to keep the cur- elderly people use to cope with health cessfully guts Medicare. rent fee-for-service benefit where they care costs. That is the problem. Saves? Well, yes. This bill saves the have complete choice of their doctor, The fact of the matter is it is not a promised tax breaks for the rich. they will be permitted to do so. If bene- secret that my colleague’s party philo- Mr. Chairman, also on this list it ficiaries want to enroll in an HMO sophically does not believe Medicare is says we should say the Democrats are which might include additional health the appropriate role of government, scaring 85-year-olds. Mr. Chairman, as benefits, or some other Medicare-plus and yet he comes in here and tells us a member of the committee, I know plan, they can do so. It will be their they are not cutting it. Mr. Chairman, that it was the Republicans who or- choice. Under our proposal, coverage dered the arrest of 85-year-olds who will be assured to all senior citizens, my colleague has gotten power, and came to the committee. They came regardless of prior health history or now he is cutting it. He boasts there. They came to ask the committee age. throughout the land he is cutting gov- what is going to happen to our Medi- From the beginning of this effort, I ernment, but today, as he takes $270 care protection. They were Americans. have insisted that protecting bene- billion out of the program that insures It is a disgrace that they were arrested. ficiaries was an essential part of any the health needs of seniors, he says he I think there is a word that is not on Medicare report effort. I represent a is not cutting it. Only in Washington would anybody this list, Mr. Chairman, and that word congressional district that has one of believe that, Mr. ARCHER. is shame. the highest percentages of senior citi- zens in the country. I also worked for I would point out that with regard to Mr. BLILEY. Mr. Chairman, I yield these cuts, Mr. Chairman, the gen- myself 30 seconds to respond. years as an attorney and a community volunteer with many retirees. Re- tleman from Texas [Mr. ARCHER] and I Mr. Chairman, the rules of this House are pretty much both in the same situ- are explicit. The chairman of any com- cently, I myself, reached Medicare age. This bill is the product of listening ation. In Harris County, TX, we are mittee is required to preserve order, talking about $2.4 billion in cuts be- and when citizens of any persuasion, and learning. It is a product of many discussions with people who had real tween 1996 and the year 2002 according any age, come in, refuse to obey the or- to the Health Care Finance Adminis- ders of this House, the chairman has no life, day to day experiences with the Medicare Program. It protects our cur- tration. choice but to have them escorted out of Now my colleagues asked for facts, the room. rent beneficiaries while ensuring that Medicare will exist for future bene- There is facts. Dallas County, $1.6 bil- Mr. Chairman, that is exactly what ficiaries. lion in cuts between 1996 and the year happened in the Committee on Com- In a recent Washington Post article, 2002. Why? To pay for tax cuts for merce, and that is what we had to do Robert Samuelson said it well when he wealthy people out of the hides of el- regrettably, but that is the truth. stated that ‘‘Republicans occupy the derly people who are not going to be Mr. DINGELL. Mr. Chairman, I yield high moral ground and the low politi- able to pay their medical bills because myself 15 seconds. cal ground. They have raised critical they have cut their insurance. Mr. Chairman, I love my dear friend questions at the risk of political sui- Mr. ARCHER. Mr. Chairman, I yield from Virginia, but I notice he did noth- cide.’’ myself such times as I may consume ing when a bunch of people came in and And, knowing that, Republicans still very simply to say that once again we dumped bags of mail from dead men, believe it is our responsibility to show are back into the same rhetoric. There from people who were not supporting pure guts and courage to save Medicare will be increases for hospitals across the legislation in question, and some of for our seniors, their children, and this country. Those increases have al- which were addressed ‘‘contributor.’’ grandchildren. We have taken on the ready been demonstrated by the facts. Our Republican colleagues have a great task of protecting and preserving Medi- Only in Washington can a Member of sensitivity about the senior citizens, care because it is our moral respon- Congress stand up and call increases a but none whatsoever about rascality by sibility, not because of political neces- cut. high-paid lobbyists. sity. We have taken the higher ground Mr. Chairman, I yield 2 minutes to Mr. BLILEY. Mr. Chairman, I yield and this is ground that I am proud to the gentleman from Michigan [Mr. myself such time as I may consume. stand on. CAMP], a respected member of the com- Mr. Chairman, the organization that Mr. WAXMAN. Mr. Chairman, I yield mittee. disrupted that meeting, I would like 2 minutes to the gentleman from Texas (Mr. CAMP asked and was given per- the RECORD to show, 96 percent of those [Mr. BRYANT] and I ask him if he would mission to revise and extend his re- funds come from the public treasury. yield back to me 15 seconds. marks.) The person who was the ringleader was Mr. BRYANT of Texas. I yield to the Mr. CAMP. Mr. Chairman, I thank a paid staff person. gentleman from California. the distinguished gentleman from H 10336 CONGRESSIONAL RECORD — HOUSE October 19, 1995

Texas [Mr. ARCHER] for yielding this b 1245 growing rapidly because you know how time to me, and I rise today in support So what happens, she does not go to seniors will get together and talk and of the Medicare Preservation Act be- take care of herself. Now, what would compare notes, and when one learns cause it officially ends the policy of we have under this program with our from the other that they have a new just raise taxes. HMO’s and PPO’s and the PSN’s? I prescription drug program benefit, Mr. Chairman, some who oppose our mean, even a $5 doctor bill is some- they say, ‘‘How do I get that,’’ and program have called it extreme. What thing that she would be concerned they make the choice. is extreme is that year after year the about. You might want to amplify on One of the things about this debate Democrat’s answer to the Medicare cri- that. that has been interesting to me is you sis has been to raise taxes. Almost Mr. GREENWOOD. If the gentleman and I and Members of this side of the every year, Democrats dug deeper into will yield, the option that would be aisle know our friends on the other side the pockets of working Americans just very attractive for the constituent in of the aisle will spend all day, as they to get through the next election. And your district that you just have de- have spent the last 6 or 7 months, scar- in 1993, they even raised taxes on sen- scribed would be a managed care op- ing senior citizens that all of these ter- iors citizens. tion. Most of the managed care compa- rible things are going to befall them. Nine times, since 1965, the Medicare nies have told us that, and they are al- The fact of the matter is that we are Board of Trustees has stated that Med- ready doing this in many areas of the confident today, we are confident be- icare was in severe financial trouble country, that they will offer managed cause we know when the political dust and needed reform. What was the care plans in which there is no require- settles, when this plan is finally signed Democrats answer? Raise taxes. Just ment whatsoever to pay Medigap insur- into law, that the senior citizens will throw more money at it to get through ance. So that $1,000 a year that she then, beginning in January, have these the next election. may be paying now toward her Medigap new options. They will see, my good- Since 1965, Democrats raised the pay- insurance would disappear. Suddenly ness, their copays did not go up, roll tax on working Americans eight she would gain new benefits. She would deductibles did not go up, their Social times, over 450 percent. They raised the probably gain a prescription drug bene- Security check, even with part B de- earnings subject to tax for Medicare 10 fit. She may get an improved dental or duction, is bigger than it was this year. times, an increase of over 2000 percent. vision benefit. She would no longer They will then thank us. Once this de- Then they raised taxes on Federal and have that out-of-pocket cost at all and bate is over, we think we will be able State employees, and, when they still still be able to go to her doctors within to say we told you so. needed more, in 1993, they raised taxes her network whenever she chooses. She Mr. STEARNS. Is it not also true, if on American seniors who had already would, I think, would welcome this they want to remain in Medicare as it paid their fair share into the program. change very much and be far better off is right now, they can still do that? Now, a senior earning just $34,000 pays and have more money left over in her They still have that choice? not half of their Social Security in budget at the end of each month. Mr. GREENWOOD. Absolutely. That taxes but 85 percent. And now even the Mr. STEARNS. Is it not a point of is the beauty part. We have made cer- President admits taxes were raised too fact that all the people in this room tain from day one there is the fee-for- much in 1993. have the Federal employee health ben- service option will always be available Mr. Chairman, that is extreme. efit program, and is it not a point of Could we put the Medicare crisis off a to every single senior citizen in Amer- few years if we raise taxes again? Sure fact that people on this side are in ica that wants to keep it. Those that we could. HMO’s, in fact, there are Members of may be a little too old for change, do Could we avoid the vicious attacks Congress who have retired who are in not like to change, can keep their fee- by special interest groups if we didn’t health management organizations and for-service and enjoy the kind of Medi- reform the system? Sure. they are not picketing and screaming care that they have grown to enjoy But we are not going to do that. We and worried? Because actually what we these past years. are going to preserve, protect and are trying to do is develop a program Mr. GIBBONS. Mr. Chairman, I yield strengthen Medicare not to get for Medicare that is much like the myself 30 seconds. through the next election, but for the First Lady and the President has and I know the two gentlemen who just next generation. We will ensure the all of us have, which basically says had this colloquy on the floor are sin- solvency of this program. We will in- that health management organizations cere. But last year I checked all of the crease benefits. We will maintain the might work for some people. It should Medicare policies of every Member in current premium rate and for the first be a choice, and surely if it is good Congress here. Ninety-nine percent of time in the history of Medicare, we will enough for Members of Congress, these us have fee-for-service. Ninety-nine give seniors the right to choose the same choices should be available for percent of us have fee-for-service, and health care plan that best suits their the seniors. So I think that is what you all of those, all of those that have fee- health needs. are saying for this particular woman in for-service have abortion benefits in Mr. BLILEY. Mr. Chairman, I yield 5 Florida who is on a very small pension our medical care policies. You know, minutes to the gentleman from Florida every month. This would be a possible those are in the records of the House. [Mr. STEARNS]. choice for her. You might want to just Go check them. Mr. STEARNS. Mr. Chairman, I amplify on that, because I know you PARLIAMENTARY INQUIRY would like to have a colloquy, if I have toured, like I have, many health Mr. THOMAS. Mr. Chairman, I have could, with the gentleman from Penn- maintenance organizations, talked to a parliamentary inquiry. sylvania. Both he and I have worked the seniors, and for some of them they The CHAIRMAN. The gentleman will hard in our districts getting the mes- are very happy. state his parliamentary inquiry. sage out how important it is to look at There are people that have high Mr. THOMAS. Mr. Chairman, is it this program because it is going bank- monthly drug costs, and the HMO is against the rules to wear slogans, but- rupt, and we want to offer them paying for that, and it is paying for tons, while addressing the Committee choices, much like the choices that the their deductible. So that surely that is of the Whole, and did the Chairman not gentleman and I have. Perhaps many an approach we should not rule out by already indicate what the rules are? Members do not know that a large keeping the one warehouse, one-size- The CHAIRMAN. The gentleman is number of the Federal employees are fits-all program we now have. Surely correct. retired and they have choices, HMO’s, moving it to what we have in the Fed- Mr. STUPAK. Mr. Chairman, I yield PPO’s, and all these other things. Let eral employee health benefits program 90 seconds to the gentleman from New us talk, for example, about a widow is a step forward. York [Mr. MANTON]. whose $600-a-month pension is too low Mr. GREENWOOD. The fact of the Mr. MANTON. Mr. Chairman, at the to pay for this expensive part C matter is 9 percent of seniors in this outset, I yield to the gentleman from medigap insurance and whose biggest country already have chosen the option Michigan [Mr. STUPAK]. problem is that she cannot afford the of receiving their Medicare benefits Mr. STUPAK. Mr. Chairman, I just deductible portion of her doctor’s bill. through managed care. That number is wanted to point out the last speaker in October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10337 the well down here, the gentleman the senior gets to use what is left in I thank the gentleman for explaining from Florida [Mr. STEARNS], his dis- the account for his or her medical ben- that and making it clear to the Amer- trict will lose $154 million over the efits, go to whatever doctor or hospital ican people and, most importantly, to next 7 years if this Republican plan he or she wants. Once the deductible is our senior citizens that the Repub- goes through, just to give a tax break reached, then in a year in which that licans, by providing a $2,000-per-bene- to the rich. particular individual has high costs, ficiary increase is what is going to save I am more concerned about the State then the medical, the catastrophic, Medicare for our seniors so they can of Michigan where the gentleman from coverage would kick in and they would feel that it is safe and sound and better Michigan [Mr. CAMP] spoke in which in have no more out-of-pocket costs what- for them. his district the hospitals will lose $125 soever. Mr. DINGELL. Mr. Chairman, I yield million between now and 2002 just to In a year in which she was particu- 1 minute to the distinguished gen- pay for this tax break for the rich. larly healthy, managed her costs and tleman from Florida [Mr. DEUTSCH]. Being from Michigan, I am very con- did not go to a doctor very often, she Mr. DEUTSCH. Mr. Chairman, you cerned about that. would be able to keep the balance in know, sometimes we can make com- Mr. MANTON. Mr. Chairman, I rise the medical savings account. It is a plicated issues simple. If we are saving in strong opposition to this draconian good opportunity for savings for those $270 billion and there are 37.6 million plan to slash $270 billion from Medi- seniors. beneficiaries, this is what it is going to care. This so-called Medicare preserva- Mr. PAXON. I would make a com- cost each Medicare beneficiary in tion plan will seriously threaten the ment. My parents are both retired. America, whether in terms of direct integrity of the program and inflict Both have had catastrophic health care out-of-pocket expenses or not. undue pain on America’s elderly. concerns. Of course, this would be very There is another chart which I think Under this bill, the elderly will suffer important to them. is probably the best chart and the an increase in their premiums and a de- I also want to make the point Medi- clearest and most factual, and if we crease in the quality of their health care is important to them today, too. can focus in on this so people watching care services. Quite simply, you are They want to see Medicare protected can see, my Republican colleagues asking seniors to pay a lot more, but and strengthened. It is their health have said we have to do something, expect a lot less. care needs. It concerns me deeply. If there is this incredible crisis, the trust And last night, Mr. Chairman, in one their Medicare is not safe and secure, fund is gong to go bankrupt in 7 years. final act of cruelty, the majority in- they have to turn to the family to help. Well, the Medicare Program has ex- cluded a provision to deny anti-nausea We want to make certain for them and isted for 30 years. Twelve of those thir- drugs for chemotherapy patients. How all of the constituents this plan is pre- ty years there was a shorter life ex- can you possibly justify denying basic served and protected for the coming pectancy than 7 years that exists dignity and comfort to those in the years. today, and we did incremental changes. twilight of their life, who are fighting Mr. FRISA. Mr. Chairman, will the We fixed it. for that very life. gentleman yield? It is a flat-out lie that this is unprec- Speaking out against this outrageous Mr. GREENWOOD. I yield to the gen- edented. It is a flat-out lie that $270 proposal is not a matter of dema- tleman from New York. billion needs to be cut. It is a flat-out goguery, its a matter of duty. Duty to Mr. FRISA. Mr. Chairman, I just lie that choice will be available for the senior citizens we represent. wanted to, if we could, because this is Medicare beneficiaries. Oppose this legislation. such a serious issue, it is an important Mr. GIBBONS. Mr. Chairman, I yield Mr. ARCHER. Mr. Chairman, I yield one for our senior citizens. My folks such time as he may consume to the 30 seconds to the gentleman from Lou- are both retired and are counting on gentleman from Tennessee [Mr. CLEM- isiana [Mr. MCCRERY]. Medicare being there throughout their ENT]. Mr. MCCRERY. Mr. Chairman, the retirement, and they are happy that we (Mr. CLEMENT asked and was given gentleman stated something that is are taking the opportunity to make permission to revise and extend his re- just incorrect, and it has been stated in Medicare safe and sound and better for marks.) the media some. We are not denying all of us. Mr. CLEMENT. Mr. Chairman, I rise payments for anti-nausea drugs for So I would like to ask the gentleman, in opposition to the Republican Medi- cancer patients. The fact is that we are there going to be increased funds care reform plan and ask my colleagues will continue to pay for the intra- for seniors under the Republican plan? to support the Dingell-Gibbons sub- venous drug that people, the cancer pa- Mr. GREENWOOD. Well, of course, stitute. tients, use to fight nausea. there are. Despite all of the rhetoric to Mr. Chairman, when President Lyndon Mr. BLILEY. Mr. Chairman, I yield 4 the contrary, we are actually taking, Johnson began the Medicare Program in minutes to the gentleman from Penn- right now, we are spending on average 1965, less than half of all seniors had health sylvania [Mr. GREENWOOD]. $4,800 per each beneficiary in the Medi- insurance. It was understood that the elderly Mr. GREENWOOD. Mr. Chairman, I care Program. Our plan increases that had declining resources, costly health care yield to the gentleman from New York about 5 percent each year for a 40-per- needs, and few insurers willing to sell them [Mr. PAXON] for a question. cent increase over the next 7 years. So coverage. Since its creation, the Medicare Mr. PAXON. Mr. Chairman, I have 7 years from now we will be spending Program has been a great success. Today, 99 many constituents back in western $6,700 for beneficiaries. It is a huge in- percent of senior citizens and a substantial New York, in the Buffalo and Roch- crease. proportion of the disabled are covered by ester, Finger Lakes areas, that are con- What we are doing is bringing down Medicare. It has contributed to reducing pov- cerned about catastrophic costs in the unsustainable inflation rate which erty among the elderly and causing the life ex- health care. How would medical sav- is bankrupting the system. pectancy rate in America to exceed that of ings accounts help those with recurring Mr. FRISA. In other words, and I every country in the world except Japan. Med- health problems pay for these cata- think this is very important, despite icare is fulfilling its mission. strophic expenses? the rhetoric, it is really not truthful. Let me review briefly the two areas of the Mr. GREENWOOD. The medical sav- We are saying the average senior citi- Medicare Program. Part A of Medicare is fi- ings account is a new component of zen will be getting an extra 100 $20-bills nanced by the hospital insurance trust fund, Medicare that we have included in this spent on their medical behalf. So there which comes primarily from the hospital insur- reform. Those seniors who choose it is more money being spent for senior ance or Medicare payroll tax contributions paid would have deposited into their medi- citizens under the Republican plan. by employers, employees, and self-employed cal savings account a number of dollars It is absolutely incredible, I think individuals. Medicare part A will pay for inpa- that would average about $5,000 across you would agree, that my colleagues on tient hospital care, skilled nursing facilities, the Nation; the first portion of that de- the other side of the aisle are trying to home health care, and hospice services. It is posit would be used to buy catastrophic say that 100 additional $20-bills for our the trust fund of part A which the Medicare or major medical insurance that would senior citizens is a cut. It is absolutely trustees say is ``severely out of financial bal- cover them above he deductible. Then incredible. ance'' and must receive ``prompt, effective, H 10338 CONGRESSIONAL RECORD — HOUSE October 19, 1995 and decisive action'' from Congress to restore Second, making the trust fund sound for the ing cost of part B by keeping the part B pre- the stability of the program. short term and the long term; mium at 31.5 percent of total cost rather than The second aspect of the Medicare Pro- Third, protecting beneficiaries from dramati- at 25 percent as now planned. This means a gram is part B, the supplementary medical in- cally increased costs and reduced access to doubling of Medicare part B premiums by surance trust fund. Part B is optional, and pri- care; 2002, increasing from $46.10 now to approxi- marily finances physician and hospital out- Fourth, improving patient choice without co- mately $104 in 2002. While I do not oppose a patient services. Part B is financed by pre- ercion or compromising the quality of care; sensible increase in premiums, I believe this mium payments from enrollees and by general Fifth, reasonable sacrifice by all while ensur- increase is out of reach for many low-income revenue funds from the Federal Government. ing the quality and viability of provider services seniors. I support the Democratic plan which The part B premium is currently $46.10 for all Americans. would permanently maintain premiums at 25 monthly or 31.5 percent of total costs of Medi- Let us now turn to a quick overview of the percent of total cost. care, and the budget of 1993 would bring the two major proposals now before the Congress, As you can see, many of the aims and premium down to 25 percent of total costs one from each party. First, let's look at the Re- methods are the same in the two plans. But from 1996 to 1998. Beneficiaries are respon- publican plan to reform Medicare. the details differ at significant points, particu- sible for an annual deductible of $100 and co- The Republicans, in their noble effort to bal- larly with regard to how much of the burden insurance, usually a 20-percent copayment. ance the Federal budget and reduce the defi- seniors are asked to bear. cit, agreed to a fiscal year 1996 budget resolu- The part B trust fund is not in financial crisis, I would like to sum up the Medicare debate tion which would reduce the rate of increase though only because it is financed partially by as I see it. First, I support many of the reforms in Medicare spending by $270 billion by the the general fund which is experiencing run- both sides support including incentives for en- year 2002, bringing its rate of growth down away health care costs and driving up the def- tering managed care, slowing the increase in from its current 10 percent a year to about 6 icit of the U.S. Government. provider payments, and eliminating fraud and percent a year. Let me be clear that I do not believe Medi- abuse. These are all contained in the Demo- The most important innovation in the Re- care is out of control or too generous as some cratic substitute which I am supporting. have stated. In truth, Medicare pays only 45 publican proposal is a feature which would allow Medicare beneficiaries to opt for a wide Let me share with you my disagreements percent of the Nation's health care bill for the with both plans, Democratic and Republican. elderly, and it is less generous than 85 per- range of privately run health plans, with the Government paying the premium. The plan Too often Democrats have sat on the sidelines cent of private health insurance plans. this year while the Super Bowl is being played The problems we are facing with Medicare would provide an incentive for beneficiaries to on the fieldÐwe have offered more critique today are primarily external, not internal. choose an option that is less costly, such as than solutions. While this may be a good polit- Though some problems do exist internally managed care or preferred provider groups, ical stunt, it is not responsible nor respectful of such as fraud and abuse, most of the factors while allowing those who want to stay in the our Nation's senior citizens or our children which bring us to the present crisis are exter- traditional fee-for-service style Medicare Pro- who will bear the cost of the Medicare Pro- nal. Let me share a few with you. gram to do so. However, the Republican plan gram if we do nothing. But I have not been First, the primary threat to Medicare is its would force many low-income seniors out of content to sit on the sidelines. Before this de- rising costs which are consequently driving up the traditional program because of the high bate even began, I stepped out in support of the Federal deficit at alarming rates. The abil- cost of staying in the fee-for-service as com- health care reform bill this year that would ity of any reform proposal must be measured pared to other options. The Dingell-Gibbons have made many of the adjustments we are by the following yardstick if we are to balance substitute, which I will support today, allows now discussing. Even today, I would have pre- the budget and get our financial house in seniors to move into managed care and re- ferred to have voted for the coalition substitute order: Does the reform measure control the wards this cost-saving sacrifice without pun- which would have dealt with part A and part costs of Medicare? Over the past 20 years the ishing those who wish to stay in traditional B. But the Republicans in the Rules Commit- cost of the Medicare Program has increased fee-for-service programs. tee would not allow this bill to come to the an average of 15 percent a year. In this year Another set of cost-saving provisions in the House floor for a vote. So, today I will choose alone, Medicare will account for 11.6 percent Republican plan would reduce the growth of between the better of two evils and support of all Federal spending. This will rise to 18.5 fees paid to hospitals, doctors, and other care the Democratic substitute. percent by 2005 if costs are not controlled. providers by an estimated $110 billion over 7 Another factor which threatens the future of years. The Democratic and Republican plans I sharply disagree with Republicans at one Medicare is the growing number of senior citi- both rely heavily on reductions in the increase major point. Earlier this year, the Republicans zens in America. The Baby Boomers will begin of payments to providers, but the Republican voted for a $245 billion tax cut which gives retiring shortly after 2010, and recent years plan also contains a look back provision which over 50 percent of the cut to those who make have seen a dramatic increase in life expect- I oppose that would balance the budget on the over $100,000 a year. It is any wonder then ancy. During the 30-year period from 1990 to backs of providers if the projected cost sav- that Republicans now need to save $270 bil- 2020, the growth rate of the senior citizen ings are not realized. This will only mean that lion from the Medicare Program to pay for population will be double the growth rate of doctors and hospitals will begin turning down these tax cuts. I believe a tax cut of this mag- the total U.S. population. This means that Medicare patients, leading to a national health nitude at this time is irresponsible, especially those receiving Medicare benefits will out- care travesty. when the majority of the tax cut goes to number those employees and employers pay- Both Democratic and Republican plans also wealthy Americans. This translates into the ing into Medicare. contain provisions to eliminate excessive fraud outrageous premium and deductible increases Among other contributors to the rising cost and abuse within the Medicare Program. The Republicans now propose. of Medicare are the high cost of advanced Congressional Budget Office estimates that at The seniors in my district are telling me, medical technologies, the rapid increase in least $20 billion could be saved over 7 years ``Congressman, I don't mind sacrificing some procedures by doctors after a fee schedule by reducing fraud and abuse in the Medicare benefits and bearing some of the financial bur- was imposed by Medicare, the fee-for-service Program. I believe it is wrong to raise pre- den of the Medicare Program to ensure the vi- arrangement which gives no cost-saving in- miums for seniors until the cheats and ripoff ability of the trust fund. But it seems to me centives to providers or patients, and the rise artists are weeded out of Medicare. The that the Republicans are asking us to bear of Medicare fraud and abuse. All these fac- Democratic plan makes significant headway most of the burden for this reform, and it is not tors, some of which I applaud such as life ex- toward reducing fraud, but the Republican fair.'' I've been hearing a lot of people at home pectancy and miraculous technology, have plan will repeal existing statutes that keep saying that they are beginning to think that brought us to this present moment of crisis. doctors from preying on their patients for their GOP stands for Get the Old People party. I Before looking at the specific proposals to own financial self-interests. am not so sure they are wrong. reform Medicare, I wish to suggest the values These measures, and others, are slated to The Greek word for crisis is krisis. The which I believe should drive any attempt at re- ensure the viability of the Medicare part A Greeks used this word to point to a critical form. I believe you will agree with me. These trust fund. Let us turn to part B for a moment. moment in time when the road ahead would values are: I remind you that the primary reason to reform either mean a time of devastation or a time of First, ensuring that every dollar saved from part B is to reduce the growth in the Federal great opportunity. This is a time of krisis. The Medicare goes directly toward strengthening deficit, not to build up the part A trust fund decisions Congress make at this time will the part A trust fund and eliminating the Fed- which receives its revenues from elsewhere. mean a future of prosperity and health security eral deficit; The Republicans choose to deal with the ris- for all Americans, or it will mean a bleak future October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10339 of prosperity and health care for only the privi- Mr. BROWN of Ohio. Mr. Chairman, Mr. HOUGHTON. Mr. Chairman, leged few. I believe this is the time of great under the Gingrich Medicare plan, the there is a lot of emotion in this issue, opportunity, and together we will forge out a hospitals in and around the district of and I can understand it. It is a very im- Medicare Program that will provide the best the gentleman from New York [Mr. portant issue. I always think of what health care for our Nation's elderly for dec- PAXON] will lose $64 million over the Wilbur Mills said, that there are prob- ades to come. next several years to give tax breaks to ably more votes changed in the House Mr. GIBBONS. Mr. Chairman, I yield the wealthy. Under the Gingrich Medi- Chapel than there are on the House 30 seconds to the gentleman from Wis- care plan, the district of the gentleman floor. consin [Mr. KLECZKA]. from New York [Mr. FRISA] will lose I am not going to try to convince Mr. KLECZKA. Mr. Chairman, the $262 million, again to give tax breaks anybody, but I am just going to tell previous speaker indicated we are to the wealthiest people in this coun- you where I am coming from. The gen- going to be giving all of this cash to try that do not need it. tleman from Ohio [Mr. BROWN] has senior citizens under the Republican Mr. RICHARDSON. Mr. Chairman, thrown around a lot of numbers is plan. reclaiming my time, I want to talk terms of how many cuts will be in peo- What he did not tell the seniors that about the effect of this plan on rural ple’s hospitals. I would question those are watching today is we are going to hospitals. That is what I represent. On numbers. I have seen those numbers double your premiums in part B; all Indian reservations throughout the myself as far as my own district is con- right. The Senate provisions provides State of New Mexico and many States cerned and I question the authenticity more copays, more out-of-pocket-ex- in this country, rural health care will of them. penses. be devastated. Rural hospitals will Seniors, this is what you are getting: close under this plan. In no way are Second, I think the issue is are we Nothing. they going to get more funds and re- going to face up to this thing or not? Mr. GIBBONS. Mr. Chairman, I yield sources. Everybody agrees we should. The Presi- 2 minutes to the gentleman from Mas- Now, this is according to the Amer- dent agrees, the Democrats agree, the sachusetts [Mr. NEAL]. ican Hospital Association. The typical Republicans agree. How are we going to Mr. NEAL of Massachusetts. Mr. rural hospital will lose $5 million in do it? It is a matter in terms of timing Chairman, the Massachusetts Hospital Medicare funding over 7 years, and that and numbers. Association and the gentleman from means many of them are going to Also, there always is a better way. I Massachusetts [Mr. TORKILDSEN] have close. In my own district, the average can devise a better way. I am not sure rejected the Republican Medicare bill. senior lives on $800 a month, and pay- this plan is exactly the way I want, but The MHA says the spending reductions ing $92 a month in premiums and un- it is a good plan. in these proposals are too fast, too limited out-of-pocket expenses is going The next point is that there are no deep, and would jeopardize the ability to be devastating. eternal fixes for the Medicare problem. of Massachusetts hospitals to provide Rural Medicare patients are going to We never can go asleep. We are always quality health care to patients and lose access to doctors. America’s rural going to have to be on top of this communities. areas are going to need at least 5,000 thing. The question is are we going to Health care in Massachusetts is more primary care physicians to have have a short-term or longer term ap- world-class. When Raisa Gorbachev and the same access to those that accept proach to this thing. Elizabeth Dole, and as I learned yester- Medicare. The American Medical Asso- Let me talk a little bit about cuts. If day, when Chairman SOLOMON, of the ciation says cuts in Medicare are so se- I spend $1 today and I spend 90 cents 7 Committee on Rules, all were ill, they vere they will unquestionably cause years from now, that is a cut. If I spend came to Massachusetts. some rural physicians to leave Medi- $1 today and I spend $1.45 7 years from b care. now, that is not a cut. Those are the 1300 Mr. DINGELL. Mr. Chairman, I yield relationships we are talking about. If the Medicare bill was a good bill, 1 minute to the distinguished gen- would not the Massachusetts teaching tleman from Ohio [Mr. BROWN]. Let me talk a little bit about taxes. hospitals, with the renowned reputa- Mr. BROWN of Ohio. Mr. Chairman, I I did not vote for a tax cut. I did not tion that they have earned over many appreciate the gentleman yielding think it was appropriate, I did not years, take the lead and endorse the time. think it was the right timing. However, bill? We trust these hospitals with our Mr. Chairman, we have listened to the Republican Party has felt that is lives. We should also trust their assess- the Republicans talk over and over important, the President has felt that ment of the Republican Medicare bill. about what a great plan this is, how it is important, the gentleman from Mis- The Gingrich Medicare cuts are sim- expands choice. The fact is senior citi- souri [Mr. GEPHARDT], the minority ply too large for hospitals to absorb. zens in this country now have full leader, has felt that is important. It is Cuts of this magnitude will damage the choice with Medicare. Yes, under the a fact we deal with everyday. Why can quality of health care in America, es- Gingrich plan seniors will have their we not get together; why can we not, if pecially for senior citizens and future choice of a plan, but they lose their our philosophy is the same, do some- generations. We should be investing, choice of doctor. thing which is important as far as this and not cutting research and edu- The Gingrich plan gives physicians overall Medicare issue is concerned? cation. financial incentives, the New York Mr. GIBBONS. Mr. Chairman, I yield These outlandish cuts to hospitals Times calls it ‘‘bribes for doctors,’’ to 11⁄2 minutes to the gentleman from In- will cause massive job loss across this move out of traditional fee-for-service diana [Mr. JACOBS]. country. The people hurt most by these into HMO’s. Medicare beneficiaries Mr. BROWN of Ohio. Mr. Chairman, cuts will be the hard working men and therefore will be pushed out of tradi- will the gentleman yield? tional fee-for-service and forced into women of America, all so that a tax Mr. JACOBS. I yield to the gen- HMO’s, forced into managed care. cut can be given to wealthy Americans tleman from Ohio. who have not even asked for it. It is This is purely and simply a political Mr. BROWN of Ohio. Mr. Chairman, just not right. payoff to big insurance companies. We Mr. DINGELL. Mr. Chairman, I yield know it, NEWT GINGRICH knows it, the the gentleman from New York [Mr. HOUGHTON] mentioned he has other fig- 11⁄2 minutes to the distinguished gen- Republicans know it, and the American ures and he did not believe these fig- tleman from New Mexico [Mr. RICHARD- people know it. ures. Under the Gingrich Medicare SON]. Mr. ARCHER. Mr. Chairman, I yield 2 (Mr. RICHARDSON asked and was minutes to the gentleman from New plan, the hospitals in and around the given permission to revise and extend York [Mr. HOUGHTON], a respected gentleman’s district, my friend from his remarks.) member of the Committee on Ways and New York, will lose $167 million over Mr. BROWN of Ohio. Mr. Chairman, Means. the next 7 years. will the gentleman yield? (Mr. HOUGHTON asked and was I would ask if he would come back in Mr. RICHARDSON. I yield to the given permission to revise and extend the well and perhaps tell us what the gentleman from Ohio. his remarks.) numbers he has that are different from H 10340 CONGRESSIONAL RECORD — HOUSE October 19, 1995 the numbers that we have been re- or $270 billion, but the real issue here is cent every year, you can be sure that it counting, because we have heard no de- what is happening to the health secu- will, because people who are buying bate or no questioning of those num- rity of senior citizens. health care or selling health care to bers. Right now, senior citizens in this the Government are going to spend Mr. JACOBS. Mr. Chairman, reclaim- country get enough money to buy a every nickel their customer tells them ing my time, speaking of numbers, the program that covers what they need. they are going to spend the next year. proponents of this measure cite approv- And the Republicans are saying that in The fact is we have to exercise some ingly the trustees’ report that there the first year, 1996, in the dark bar, we control at the Federal Government will be a shortfall in the next 7 years in are going to give them enough to buy level to control these costs. Otherwise, Medicare part A, and that is the truth. exactly what they have today. By the they will be out of control forever and But it is not all the truth. year 2000, you can see that the dark bar that is the reason we find ourselves in The rest of the trustees’ report states does not go as high as the CBO says an this situation. We have to fix this pro- how much that shortfall is, $90 billion. equivalent health plan is going to cost. gram. Otherwise, it is going to go So if you accept approvingly the one The difference is $1,100. That is the na- bankrupt. tional average. part, you should accept approvingly b 1315 the other; $90 billion is considerably Now, if you are from California and less than $270 billion. I wonder anyone watching this, you are going to need I want to say one other word about remembers the city of Bentre in Viet- another $1,200. If you are from New the Seattle area because it is very im- nam. That is the one that was wiped York, you are going to need another portant. Seattle is an urban commu- nity and yet it is one of the healthiest out, every lock, stock, horse carriage, $1,100. If you are from Texas, you are communities in the Nation. It is also human being, and building, the Army only going to need $994. Ask yourself one where we have one of the most effi- major declaring it became necessary to where those senior citizens are going to cient health care systems in the Na- destroy it in order to save it. come up with that extra $1,100 to buy tion. My father used to say that in politics the same thing they have today. Why is that, Mr. Chairman? It is be- you can get people to eat the pudding, Every time the Republicans use the word, ‘‘choice,’’ listen to that and say cause in Seattle we essentially in- but you cannot get them to read the vented the managed care program. recipe. Today we are talking the rec- to yourself ‘‘voucher.’’ They are put- ting my father and my mother, my fa- Under managed care individuals get to ipe. We will see how the pudding tastes. sign up in a program that looks out for Mr. DINGELL. Mr. Chairman, I yield ther 90, my mother 86, and everybody your health over the long-term basis. 2 minutes to the distinguished gentle- else’s grandparents and parents, out on the street with a voucher. They call it Instead of trying to cure diseases as woman from California [Ms. ESHOO]. they come up, it actually prevents in- Ms. ESHOO. Mr. Chairman, today the choice. We are going to let you choose dividuals from getting sick in the first Gingrich Republicans are being encour- anything you want. But if you do not place. A lot of people in the Seattle aged to use certain words, probably put have the money, if that voucher only area have found that to be a good idea. together by some PR agency or PR per- buys 75 percent of what it buys today, who will make it up? The kids will One of the great things about this son, to describe their Medicare plan, bill is that it tries to do for the rest of words like ‘‘historic, serious, and long- make it up. This is the hidden agenda here. They the Nation what we have done very term.’’ are shoving that $1,000, they will not successfully in Seattle by having the Well, in some ways, I could not agree say it is cuts and I will not say it is option to take managed care instead of with them more. Their plan is historic cuts, they are shoving that additional the fee-for-service program. We have because it marks the end of a 30-year $1,000 into their kids. been able to keep the costs down across commitment to provide our seniors If you happen to be out there watch- the board, and that is what this bill with health care. It is serious. It is rad- ing this or if Members are on this floor will do for the entire country. ical surgery, because it places the lives and happen to have a kid in college, Mr. ARCHER. Mr. Chairman, I yield 2 and well-being of 37 million Americans you know what tuition does to you. To minutes and 30 seconds to the gen- at risk. And it is long-term because it have your parents show up at the same tleman from Ohio [Mr. PORTMAN], an- will tear holes in our social safety net time and say, ‘‘well, I cannot afford it. other respected member of the Com- that will remain for many years to It is not paid for by my health insur- mittee on Ways and Means. come. ance,’’ for the first time in 30 years, Mr. PORTMAN. Mr. Chairman, I It ‘‘saves, preserves, and protects,’’ people my age, 58 and down, are going thank the gentleman for yielding time not Medicare, but $245 billion in tax to have to think about how they make to me. breaks that no one is asking for. It up that difference for their parents. We have heard a lot today from the ‘‘protects the right to stay with your One can talk about $90 billion and other side of the aisle about how the doctor,’’ but only if you are able to pay actuarials and all the rest of this stuff. increases in spending in our Medicare more for the privilege. It ‘‘protects the There is 96 pages of things where they plan will not keep up with the private right to choose,’’ only if your choices give away to doctors. As a doctor, I am sector growth. We just heard from the are slim and none. It is ‘‘responsible,’’ ashamed by the kind of deal they came gentleman from Washington [Mr. but only if you are a member of the in and cut. When we are cutting money MCDERMOTT]. I wish his chart were AMA. It is ‘‘innovative and bold,’’ inas- from senior citizens and putting them still up. Maybe it can be put up again. much as it breaks new ground for being at risk like this, for doctors to come in It might be useful to have it. It is just cruel to seniors. It is ‘‘the right thing and negotiate for another $500 million, not accurate. It is not accurate. to do,’’ but only if your parents did not is a shame. There is no reason to do The charts we just saw from the gen- raise you to know any better. that. tleman compares apples to oranges. It Mr. Chairman, the Republican Medi- Mr. BLILEY. Mr. Chairman, I yield is full of unknowns. It is full of false care plan is all these words and one 11⁄2 minutes to the gentleman from assumptions. Let me give Members a more, disgraceful, and I urge my col- Washington [Mr. WHITE]. couple. leagues to defeat it so that we can go Mr. WHITE. Mr. Chairman, I would First of all, the Medicare figures are on and make America a stronger, bet- like to say, first of all, that the expla- per beneficiary. The private sector fig- ter, and more gentle Nation. nation we just heard from my col- ures are not per beneficiary. How can Mr. GIBBONS. Mr. Chairman, I yield league from the Seattle area, who I we compare those two? The private sec- 3 minutes to the gentleman from Wash- have a great deal of affection and re- tor figures are, thus, inflated. ington [Mr. MCDERMOTT]. spect for, is exactly the kind of think- Second, the Medicare figures the Mr. MCDERMOTT. Mr. Chairman, ing that got us in this mess in the first Democrats use do not include a lot of like the gentleman from New York place. We have been doing this for 30 other costs, including administrative [Mr. HOUGHTON], I wish that this debate years, and the fact is it is a self-fulfill- costs. It is comparing apples to or- would be about substance and we could ing prophecy. anges. actually talk about what is going to If the Government tells you the cost Here is a better chart that illustrates happen. We can argue about $90 billion of medical care is going to go up 10 per- clearly what the gentleman from New October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10341 York [Mr. HOUGHTON] and others have point of service arrangement. That trembling in the hearts of every senior citizen been trying to explain, which is that means if my father, who lives in Illi- in the United States for decades to come. under this bill before us Medicare nois, wants to see a cataract specialist Mr. Chairman, 380,239 of Americans on spending actually goes up. Guess what? at the Mayo Clinic, he would be able to Medicare live in the State of West VirginiaÐ It actually keeps pace with the private do that and still receive his health care my State. How many of them will be sector. It will be higher than the pri- coverage. disenfranchised, when they lose $1.5 billion vate sector 7 years from now as it is All I want to emphasize is one impor- and more in Medicare payments under this today. tant point; that under the Republican bill? How many will become more seriously ill, This chart compares apples to apples. plan PPO’s are required to take any or even die, as a result of denied health serv- It compares what employers will pay senior who wants to sign up. If an indi- ices under Medicare? The Republicans say: per employee for health care in the pri- vidual happens to be diagnosed with They don't know, and they don't careÐall they vate sector to what the government cancer and wants to enroll in a PPO of- know is they need to find $245 billion in a will pay per beneficiary under the Med- fered in their area, they have that op- hurry, and Medicare is one of the biggest icare Preservation Act. It clearly tion under this bill. Nobody can keep piggy banks around. shows that, even when we assume a them out. They have to accept all Mostly, what we don't understand is why it growth rate of 7 percent, as the gen- comers. is necessary to take these drastic actions in a tleman from Washington did, Medicare Under the current Medicare system, program that is not insolvent, and according to will still pay more in each year PPO’s are not available. Under the the trustees report, wasn't in danger of be- through the year 2002 than we pay in Medicare reform plan, PPO’s are an op- coming insolvent for another 7 years? This 7- the private sector. In fact, that 7 per- tion under this plan. year window gives us plenty of time to work cent private sector health care figure is Mr. GIBBONS. Mr. Chairman, I yield out ways in which to keep the program solvent inflated. 30 seconds to the gentleman from as we have done since 1970 when the first I will give Members a couple of rea- Maryland [Mr. CARDIN]. trustees report came outÐgiving us only a 2- sons it is. First, the private health care Mr. CARDIN. Mr. Chairman, we seem year window in which to bring solvency back cost increases have been far lower over to have a debate over what is a cut. My to Medicare. For every year since, Congress recent years than 7 percent. The ad- constituents define it this way. If they has responded to the trustees report, and has ministration’s own Department of are asked to pay more to get the same never failed to assure continued solvency for Labor tells us last year health care benefits, it is a cut. If they are receiv- Medicare. costs were nationally at about 4.5 per- ing moneys that will not buy the same The Medicare actuaries have stated, over cent. amount of service 7 years from now, and over again, that in order to bring solvency Mr. Chairman, we have seen reports and they are expected to put more back to the Medicare Program now, we need recently, including a story in the money in their pocket in order to pay only cut $89 billion from the Program. Why Washington Post of just a couple weeks for those services, it is a cut. then the unprecedented, frightening cut of ago, which indicates that recent sur- The chart shown by the gentleman three times that amount? H.R. 2425 calls for a cut of $270 billion in veys, comprehensive surveys have from Ohio [Mr. PORTMAN] shows what the program, supposedly in order to save it. shown us that for the first time in 10 the per cost is per person. Yes, it costs Save it for whom? We believe, based on the years health care costs nationally are less to provide for people under 65 than evidence before us, that this $270 billion is below inflation. over 65, because people over 65 use necessary so that Republicans can award tax All this, incidentally, was included in more health care. This bill is a cut. cuts for those who don't need itÐand most a recent CBO report that I would en- Mr. DINGELL. Mr. Chairman, I yield wouldn't even want it if it disenfranchised the courage everyone to read. The point is 30 seconds to the distinguished gen- elderly. that the private sector numbers are no- tleman from Ohio [Mr. BROWN]. This bill, if allowed to pass, will increase where near that 7 percent. But even Mr. BROWN of Ohio. Mr. Chairman, I senior's Medicare premiums from today's $46 when we include the 7 percent num- thank my friend for yielding me time, a month to more than $90 a month by 2002. bers, the Medicare spending continues and I offer my condolences to my It will force seniors off their current fee for to be higher than the private sector friend from Washington State about service plan into managed care plans, where spending. the Seattle Mariners. they will have no choice of physician or hos- This is a generous program, folks. More importantly, Mr. Chairman, I pital. Under managed care, seniors will be un- What we have come up with is a very offer my condolences to the elderly in able to call 911 for an ambulance in an emer- generous plan. It is a responsible ap- his district who will suffer some $31 gencyÐnot unless someone somewhere in a proach to a very real problem. I would million in cuts in services to them; and new managed care bureaucracy preapproves encourage all Members to support the to the gentleman from Ohio [Mr. the emergency. Republican plan. PORTMAN], in his district, $67 million in Emergencies don't often happen during of- Mr. BLILEY. Mr. Chairman, I yield the next 7 years will be taken from the fice hours where the preapproval comes 11⁄2 minutes to the gentleman from Illi- elderly in the Cincinnati area; and the fromÐand in my experience, when a person nois [Mr. HASTERT]. gentleman from Illinois [Mr. HASTERT], has an emergency, they are not inclined to (Mr. HASTERT asked and was given in his district, some $143 million will be call a business office for preapprovalÐthey permission to revise and extend his re- taken from the elderly in that area. are more than prone to calling 911. Not al- marks.) Mr. DINGELL. Mr. Chairman, I yield lowed under this Medicare reform proposal. If Mr. HASTERT. Mr. Chairman, the such time as he may consume to the a senior goes to the emergency room or calls question before us today is simple. Do gentleman from West Virginia [Mr. RA- an ambulance without managed care we give seniors more choices or do we HALL]. preapprovalÐeven if it turns out to be a costly choose, do we choose, to let Medicare (Mr. RAHALL asked and was given heart attackÐthat senior will be presented a go bankrupt without any choices for permission to revise and extend his re- bill for those costsÐand required to pay them anybody at all? marks.) out of their own pockets. Under the Republican plan to save Mr. RAHALL. Mr. Chairman, I rise in If a senior needs home care which, today, Medicare, seniors get more choices. opposition to the so-called Republican costs seniors nothing in copayments under One new choice, for instance, that is Medicare plan. Medicare, that senior will in the future be not offered today is preferred provider Mr. Chairman, I rise today in total opposition forced to pay 20 percent of home care costs. organizations. Many Americans are fa- to the so-called Medicare Reform bill before Pretty tough on seniors on low, fixed incomes miliar with this option. In fact, it is the House. who are already struggling with decisions available under the congressional med- Mr. Chairman, H.R. 2425 is a little bit like about whether to heat, or eatÐor whether ical insurance plan. topsyÐit grows, and grows and grows. The they can pay for their prescription drugs and Mr. Chairman, under a preferred pro- bill before us is nearly 1,000 pages longÐand still buy groceries. vider organization or PPO, seniors are few of us have had a chance to read it, much And for those seniors not yet old enough for part of a managed care plan but they less understand it. But from what we've heard Medicare coverageÐnot yet 65 years of ageÐ can see any doctor they want, even a since the secrecy on details of the Republican it gets worseÐfor in future they will have to doctor outside the network through a plan was lifted, it's enough to put fear and wait a little longerÐuntil they are age 67. H 10342 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Mr. Chairman, let me repeat that, the Medi- with overall negative margins. They could just as well call this legislation care cuts for my State of West Virginia will be have physical plants which average the End of Medicare as We Know It more than $1.5 billion. Currently, West Vir- more than 25 years in asset age as com- Act. ginia's 380,239 seniors who are enrolled in pared to 7 years for other hospitals. One of my favorite stories about Jo- Medicare live predominantly in rural areasÐ54 Mr. Chairman, cutting these hos- seph Stalin relates to his manipulative percent of them. By living in rural areas, they pitals is the last place we should con- use of labels. He designated the Soviet are already limited with respect to access to sider rather than the first place we satellites of Eastern Europe ‘‘People’s health care providers of facilities. Cuts in Med- should consider. Democracies.’’ The label did not make icare reimbursement to hospitals located in Mr. ARCHER. Mr. Chairman, I yield 2 these enslaved countries either demo- rural areas is expected to cause many of them minutes to the gentlewoman from the cratic or popular. to closeÐfurther limiting rural West Virginia State of Washington [Ms. DUNN], a re- When the Soviet-dominated inter- seniors' access to hospital care. spected member of the Committee on national Communist movement wanted Seniors in West Virginia can expect to pay Ways and Means. a snappy title for its newspaper, Stalin from $535 to over $1,000 in additional out of Ms. DUNN of Washington. Mr. Chair- came up with a real show-stopper. The pocket expenses for less coverage and fewer man, like many seniors in my district, newspaper was called: For a Lasting services than they get from Medicare today. my own parents sometimes have been Peace, For a People’s Democracy. The The current deductible is expected to go from frightened by the rhetoric that has strategy was simple—make capitalists the current $100 to $150 next year, and above been generated in this debate. I rise mouth a Communist political slogan $150 between now and 2002. today to clear away some of that emo- when they quoted the newspaper. The My West Virginia seniors can't afford addi- tionalism, perhaps to set the record Soviet Union and its affiliated Com- tional premiums, additional deductibles, addi- straight, and to reassure my parents in munist parties were hardly committed tional costs of 20 percent for home care, or to Bellevue, WA, and seniors around the to peace or democracy, but the slogan lose access to their own physician, hospital, country. got considerable mileage. Mr. Chairman, if I we able to speak and emergency response ambulances. Today, Mr. Chairman, we have the I am appalled at the mean-spiritedness of to them for a few minutes today this is what I would tell them: same type of subterfuge being carried H.R. 2425, Mr. Chairman. I am appalled that out by the majority in this body. They anyone would treat our seniors as tiresome Mother and Dad, our Medicare plan will preserve your right to stay in the current have given this economic monstrosity old people not important enough for their Gov- a politically correct title, ‘‘The Medi- ernment to champion their health care needs. Medicare. You can stay in the system just as it is, if you want to. That is a fact. You can care Preservation Act of 1995’’. This These seniors have lived and worked long, also choose one of the new options, every one legislation will neither preserve nor hard lives, giving to society at large, to their of which will be very clearly explained to protect Medicare. It will simply strip own communities, end up being tossed out of you. But the truth is that nobody will be away benefits to America’s most vul- their health care systemÐtoo poor and too forced out of traditional Medicare. If you nerable and voiceless citizens of our disenfranchised to have their Government look wish to remain in traditional Medicare, fee- country in order to pay for an out- after their health needs. for-service, traditional service, if you want to keep your current doctor with no change rageously large tax break for the Mr. Chairman, we may not have the votes wealthiest individuals. to defeat this measure, but we can and we will to a doctor you do not know or do not want, I have several names to propose for continue to tell our seniors that the $270 bil- you can do that. That is a guarantee, and the Federal Government will continue to provide the legislation that we are considering lion cut wasn't necessaryÐbecause the Medi- two-thirds of your part B premiums. There today, Mr. Chairman. care trustees stated plainly that only about will be no increase in your copayments, $89 billion would be necessary to ensure its First of all, this could be called ‘‘The there will be no increase in your deductibles Robin Hood in Reverse Act of 1995.’’ It solvency for the next decadeÐat least to and there will be no decrease in your bene- 2006. fits. clearly deserves that title. It robs the poor to give to the rich. A $270 billion Mr. DINGELL. Mr. Chairman, I yield Mr. Chairman. I also want to assure cut is unnecessary to save Medicare. 11⁄2 minutes to the distinguished gen- seniors that nobody will be forced into Democratic alternatives—the one we tleman from Illinois [Mr. RUSH]. HMOs or forced to go to a doctor that are permitted to consider today as well Mr. RUSH. Mr. Chairman, I want to they do not know. Managed care is just as others that should be considered— thank the gentleman for yielding me one of several options we provide in our would keep Medicare solvent without time. Medicare Preservation Act. Mr. Chairman, it was bad enough Over the past several months, I have imposing a huge burden on our senior that Republicans last year voted talked to constituents who deal with citizens. The reason we have this eco- unanimously to reject legislation pro- the Medicare system every single day. nomically irresponsible legislation is viding Americans with the health secu- Throughout those talks I have been so the Republicans can offer a $245 bil- rity that every other advanced Nation guided by several principles that my lion tax cut to the wealthy. in the world provides to its citizens, folks and seniors around the country Second, we could call this legislation leaving 41 million of our fellow citizens are looking for in Medicare reform. Bash the Seniors Act of 1995. Premiums without health care. This year the Re- They want Medicare saved for their for our senior citizens will increase by publicans want to cut $182 billion out children and for their grandchildren. some $400. Since a third of all seniors of Medicaid with a big, big chunk of They want the problem solved, not just barely get by on their monthly Social those savings coming from dispropor- postponed, and they want to choose for Security checks, this Republican legis- tionate share payments under that pro- themselves among the plans and the lation will force seniors to choose be- gram. And now Republicans want to doctors they know. This is my promise, tween health care and food, or between cut Medicare so that hospitals cannot my commitment to the seniors of health care and heat, or between keep their doors open. today. health care and rent. Mr. Chairman, let me ask the Repub- Mr. GIBBONS. Mr. Chairman, I yield Third, we could logically call this licans how on Earth they expect these such time as he may consume to the The Them That Has Gets Even More hospitals to survive. On air? How do gentleman from California [Mr. LAN- Act of 1995. While our low-income sen- they think they will be able to con- TOS]. iors—those in the sunset of their tinue to provide services to 41 million (Mr. LANTOS asked and was given lives—will be forced to dig deeper in uninsured Americans if they cut off all permission to revise and extend his re- their meager resources. Meanwhile, sources of support for them. These hos- marks.) those earning over $100,000 a year will pitals are already in serious financial Mr. LANTOS. Mr. Chairman, I receive half of the Republican tax trouble before all of these additional strongly oppose this economically break. Furthermore the wealthiest 1 costs even hit them. They have the bankrupt proposal that will damage percent of Americans will get an aver- lowest margins of revenue over costs of seniors and children. age tax break of $19,000. Those who any type of hospital, a full 25 percent Today, the House is considering the need this tax break least are the ones below the average. They have the high- so-called Medicare Preservation Act. who get the most, while costs for our est number of hospitals of any type Naming it does not make it so. We seniors are increased. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10343 Mr. Chairman, I could continue with b 1330 very, very difficult and expensive rules a number of other titles for this legis- This is the minority views about our and regulations, tort reform, and anti- lation, all of which would more accu- Medicare proposal, which is much less trust legislation. rately describe the impact of this ill- and most of it plowed back into the Mr. Chairman, giving senior Ameri- named, ill-conceived, ill-considered sell system. And I quote, cans the option to choose from among out of our senior citizens for the bene- For more than a decade, Congress has cut the many new health care plans is the fit of special interests. back on payments to doctors and hospitals absolute key to saving Medicare. I My point is clear. This is poor legis- until they no longer cover the costs for Med- want to talk just about one of those lation. It should be rejected. I urge my icare patients, and the additional massive options: Provider Sponsored Networks, colleagues to repudiate this ill-named cuts in reimbursement to providers proposed PSN’s. bill. in this bill will reduce the quality of care for Mr. Chairman, I have a message to Mr. GIBBONS. Mr. Chairman, I yield the Nation’s elderly. my mother-in-law: If you like tradi- 3 minutes and 30 seconds to the gen- Mr. Chairman, will reduce the qual- tional Medicare, you can continue to tleman from Michigan [Mr. LEVIN]. ity of care, the gentleman was saying, choose it just like you have it today. (Mr. LEVIN asked and was given per- for the Nation’s elderly. There will be Part A, part B, Medigap; can you keep mission to revise and extend his re- no place else to shift. it just like you have got it, if you marks.) I do not expect the Republicans to would like to do that. But, I would like Mr. LEVIN. Mr. Chairman, I just eat their words in public, but we are for you to consider one of these excel- want to explain, so that everybody un- not going to let them gobble up Medi- lent choices known as Provider Spon- derstands, why this is such an extreme care on this day, October 1995. sored Networks. proposal. Mr. ARCHER. Mr. Chairman, it is sad Mr. Chairman, they are locally orga- that we have to replow this ground. The gentleman from Washington [Mr. nized care networks formed by doctors The gentleman from Michigan [Mr. and hospitals. They will provide coordi- MCDERMOTT] referred to this chart. LEVIN] misspoke. The gentleman And what it does is to show how the nated care that allow the providers to knows it. projected or the capped expenditures achieve the efficiencies and cost con- Mr. Chairman, we were not dealing on Medicare are below the projected trols that have been forbidden by laws with a Government takeover of the en- rate of inflation. Now, those numbers in years past. tire health care system in this country. Mr. DINGELL. Mr. Chairman, I yield do not come from the gentleman from My remarks, and our minority views, 15 seconds to the gentleman from Flor- Washington. They do not come from were directed toward that. But as a ida [Mr. DEUTSCH]. Democrats. They come from CBO, part of that overall health care pro- Mr. DEUTSCH. Mr. Chairman, let me which is essentially controlled by the gram, CBO scored the cuts in Medicare just point out that under the Gingrich Republicans. And there is nothing that and Medicaid at $490 billion. That was Medicare plan, the hospitals in and the gentleman from Ohio [Mr. intolerable. It was intolerable, particu- around the district of the gentleman PORTMAN], or anybody else can say larly independent of any trans- from Georgia [Mr. NORWOOD] would lose that changes that. formation of Medicare to make it more $232 million over the next 7 years to Mr. Chairman, this resolution as- efficient. pay for the program and tax cuts for sumes an inflation rate under 4.9 per- So once again, Mr. Chairman, the the very rich in this country. cent. Under 5 percent—4.9. The CBO gentleman has taken this completely Mr. GIBBONS. Mr. Chairman, I would figure is 7.1. And that is why, as the out of context. yield myself 30 seconds to respond to gentleman from Washington [Mr. Mr. GIBBONS. Mr. Chairman, I yield the gentleman. MCDERMOTT] says, we end up with this 30 seconds to the gentleman from Mr. Chairman, I would respond to the gap of $1,000 per beneficiary in the year Michigan [Mr. LEVIN]. gentleman that he better tell his moth- 2002. Mr. LEVIN. Mr. Chairman, let me er-in-law the whole truth. There will The gentlewoman from Connecticut read some of the gentleman’s specific not be any fee-for-service, because [Mrs. JOHNSON] asked where are the words a year ago. ‘‘Make no mistake under the Archer bill, the Gingrich bill, changes in benefits? The answer is, as about it. For the elderly in this coun- it will be abolished, because the Sec- the gentleman from Washington [Mr. try, these cuts are going to devastate retary of Health and Human Services MCDERMOTT] said, when we have a their program under Medicare.’’ must take all the cuts in this bill out $1,000 shortfall, something has to give. Mr. Chairman, the gentleman from of fee-for-service. So, she may look for And who is going to give are hospitals Texas [Mr. ARCHER] is moving in a 180- it, but it just will not be there. who are underfunded, who are, in turn, degree different direction. The reason Mr. DINGELL. Mr. Chairman, I yield going to either shift it to the private for it is because my colleagues on the 2 minutes to the distinguished gen- sector, or are going to close emergency other side have got a $245 billion tax tleman from Massachusetts [Mr. MAR- rooms, or who will have to cut benefits. cut for very wealthy families, and they KEY]. That is the problem. have to find a way to pay for it, and it Mr. MARKEY. Mr. Chairman, not Now, Mr. Chairman, I want us to is on the backs of the seniors of this since the feudal days of lords and serfs refer to history. My friend, the gen- country. That is not fair. has such an effective system of transfer tleman from Texas [Mr. ARCHER], does Mr. BLILEY. Mr. Chairman, I yield of wealth from the poor and giving it not like me to quote his previous state- 11⁄2 minutes to the gentleman from to the rich been enacted. ment. I understand that. ‘‘Make no Georgia, [Mr. NORWOOD]. Mr. Chairman, the trustees of Medi- mistake about it,’’ he said just a year Mr. NORWOOD. Mr. Chairman, I care said that part A is $90 billion in ago, ‘‘for the elderly in this country, know this debate must be very difficult arrears over the next 10 years. The these cuts are going to devastate their on our seniors trying to determine Democratic substitute solves that program under Medicare.’’ what is fact and what is not. It is par- problem. The Republican substitute Our Medicare cuts in the resolution ticularly difficult with so much misin- solves that problem and then takes out about which he was talking were $168 formation coming out on this floor. an additional $180 billion more than is billion, and most of that was plowed But before the gentleman from Ohio needed. back into the Medicare System. Here [Mr. BROWN] has an opportunity to talk Now, listen to this. Of the 37 million we have a proposal for $270 billion, and about the hospitals in the 10th District Americans on Medicare, 11 million of what they are saying is it is going to of Georgia, I want the gentleman to them are widows living on an income of save Medicare. We need to save Medi- know that those hospitals are having $8,000 a year or less. Under the Repub- care from the Republican majority of increased funding each year over the lican proposal, those 11 million widows, the House of Representatives. next 7 years. I would like for the gen- by the year 2002, each year will have Mr. Chairman, I want to read from tleman to also know that for the first their Medicare part B premiums go up the gentleman’s minority views, if the time in history of this government, we $300 to $400 a year. gentleman does not like my reference are giving the hospitals the oppor- Mr. Chairman, in that same year, to his words. tunity to lower their cots by repealing those who make more than $350,000 a H 10344 CONGRESSIONAL RECORD — HOUSE October 19, 1995 year will get a $19,000 tax break. It paying for their tax cut to the rich, light one of the innovative additions to takes 60 widows paying $300 to $400 a this is the plan that they will have. the Medicare system in H.R. 2425: the year more to give a tax break into the This is the new Medicare maze that our incentive it provides for citizens to ex- pockets of the wealthy making $350,000 Republican colleagues present. They pose and attack Medicare fraud and a year. have got one bureaucracy after an- abuse. I am also pleased by the legisla- Mr. Chairman, under the Republican other. tion’s measures that implement stiff plan, the rich get rich and the poor get Mr. Chairman, we have a lot of new new criminal penalties. For those con- poorer, and that is wrong. Just plain commissions. A baby boom commis- victed of Federal health care fraud, wrong. We have a better country than sion. We have got boxes. We have got embezzlement or false billings, the leg- that. arrows. We have got quite a new orga- islation provides for up to 10 years in There is no uniform sacrifice here. nization of the health care system that prison. There is no limit placed on the The contract with the country club for those seniors who could not decide penalty’s prison term if such a crimi- that the Republicans signed a year ago today whether they were getting a cut nal violation should result in bodily in- on the steps of the Capitol requires the or increase are going to need to go jury. poor in this country to be tipped upside back from their retirement to get a Until now, Medicare beneficiaries down. GOP used to stand for ‘‘Grand doctorate to figure out how they are have participated in a system that sim- Old Party.’’ Today, it stands for ‘‘Get going to get health care. ply did not provide adequate enforce- Old People.’’ Mr. Chairman, there is one thing ment mechanisms or adequate civil or Mr. BLILEY. Mr. Chairman, I yield 1 that is certain: These red arrows com- criminal penalties. Without these, we minute to the gentleman from Ohio ing from the plan to pay for a tax cut have lacked an effective deterrent to [Mr. OXLEY]. for the wealthy, out of the hide of the waste. Fraud and abuse continues to (Mr. OXLEY asked and was given seniors of this country. rob the system and the taxpayers that Mr. ARCHER. Mr. Chairman, I yield 2 permission to revise and extend his re- finance it. marks.) minutes to the gentleman from Texas, The Medicare Preservation Act, Mr. OXLEY. Mr. Chairman, we have Mr. SAM JOHNSON, a true American through innovative and focused task hero, a respected member of the Com- heard today about many of the im- forces, financial incentives that em- mittee on Ways and Means. provements that this bill makes to the power seniors, and stronger criminal Medicare Program. Foremost among Mr. SAM JOHNSON of Texas. Mr. Chairman, unlike my friend, the gen- and civil penalties, unequivocally ac- these is what we call the seamless web. knowledges and addresses these prob- Today, millions of retirees are forced tleman from Texas [Mr. DOGGETT], we are not interested in the next election; lems. The current Medicare system is by rigid and antiquated Medicare rules losing 10 cents on the dollar to waste, to disenroll from their employer’s we are interested in the future of America. fraud, and abuse—$50 million every day health plan—even if the coverage they Mr. Chairman, Republicans have that could have and should be used for receive was better than that provided faced the challenge head on. We have patient care. Let the word go out to by Medicare. Just because you retire addressed a broken system. Instead of those who would bilk the Medicare sys- shouldn’t mean that you have to give scaring seniors and ignoring the prob- tem—once this bill is passed, enforce- up the coverage you’re used to—but lem, we have worked with seniors and ment is innovative and it is real. Bar- today, that’s the case. Under the bill, produced a solution. Most importantly, ney Fife has his walking papers, and your 65th birthday doesn’t have to be we have not allowed Democrat scare the terminator is on the job. the day you give up your association or tactics and politics as usual to keep us b 1345 employer coverage. This bill frees re- from doing what is right for America. tirees from this unreasonable and Mr. Chairman, I plan to choose a Mr. DINGELL. Mr. Chairman, could counterproductive requirement. Under medical savings account. I just turned we have a recapitulation of the time? our plan, retirees can remain in their 65, and now I do have a Medicare card. The CHAIRMAN. The gentleman preretirement health plan, so long as it I am thankful that this bill will allow from Texas [Mr. ARCHER] has 17 min- meets important Medicare standards. me to get out of the inefficient system utes remaining, the gentleman from In fact, this bill allows members of as- of 1965 and into a program and choose Florida [Mr. GIBBONS] has 17 minutes sociations and labor unions to main- an option that is better suited for me remaining, the gentleman from Florida tain their current coverage even after 30 years later in 1995. [Mr. BILIRAKIS] for the gentleman from they retire. Why do we feel it is so im- Mr. Chairman, with a medical sav- Virginia [Mr. BLILEY] has 18 minutes portant to create this seamless web? ings option, I will get a high-deductible remaining, and the gentleman from Because Medicare should create oppor- insurance policy and a cash deposit in Michigan [Mr. DINGELL] has 181⁄2 min- tunities—not obstacles—to better a medical savings account to cover a utes remaining. health care coverage and greater senior significant portion of the deductible. Mr. DINGELL. Mr. Chairman, I yield satisfaction. There are no copayments. I am empow- 1 minute to the distinguished gentle- Mr. DINGELL. Mr. Chairman, I yield ered to make my own decisions con- woman from Arkansas [Mrs. LINCOLN]. 15 seconds to the gentleman from New cerning my health care without the in- (Mrs. LINCOLN asked and was given Jersey [Mr. PALLONE]. terference of a middle man. I can be a permission to revise and extend his re- Mr. PALLONE. Mr. Chairman, I cost-conscious consumer and, with oth- marks.) wanted to point out that under the ers, fundamentally empower and Mrs. LINCOLN. Mr. Chairman, I Gingrich Medicare plan, the hospitals change the health care delivery sys- thank the gentleman for yielding time in and around the district of the gen- tems in America. to me. tleman from Ohio [Mr. OXLEY] will lose The accounts are available for all The people of the First District of $144 million over the next 7 years. qualified medical expenses; a great ad- Arkansas sent me here to put people Mr. DINGELL. Mr. Chairman, I yield vantage over the current system. There above politics. Unfortunately, here 1 minute to the distinguished gen- are many other options, but no one is today we have got both sides who real- tleman from Texas [Mr. DOGGETT]. going to be forced into any particular ly seem more interested in making Mr. DOGGETT. Mr. Chairman, today plan. In the true American spirit, we campaign commercials rather than if an elderly American wants quality know that people want different good policy. One cuts too much and the health care, all they need is this. Even choices and this bill makes those other does not do enough. if they are not an American hero, like choices available. What the American people do not the gentleman from Florida [Mr. GIB- Mr. Chairman, this is a vote to save know is that there is a proposal out BONS] who has this Medicare card, they Medicare and give seniors a choice. there that we have not been allowed to are going to get quality health care the Mr. BILIRAKIS. Mr. Chairman, I bring to the floor that actually makes way seniors have for the last three dec- yield 1 minute to the gentleman from good common sense, reasonable policy. ades. Ohio [Mr. GILLMOR]. The Republican bill will close the doors But, Mr. Chairman, after Speaker Mr. GILLMOR. Mr. Chairman, I of rural hospitals. The Republican bill GINGRICH and his cohorts finish today wanted to take a few moments to high- will penalize the rural areas by cutting October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10345 fee-for-service, when we cannot afford of-pocket costs for seniors will be just $4 more American Association of Retired Persons managed care without infrastructure. each month in 2002 than under President [AARP], and the Seniors Coalition. The Republican bill will dig into the Clinton's plan. And Medicare will be preserved One key aspect of the Medicare Preserva- pockets of senior citizens. The Demo- for the next generation, not just for the next tion Act that I particularly want to make note cratic bill has missed the opportunities election. of is the bill's provisions combating fraud and to restore complete dignity and sol- Despite all the rhetoric during this debate abuse. The Government Reform and Over- vency of Medicare while balancing the that Republicans are cutting Medicare, spend- sight Committee, which I chair, has held a se- budget. ing per beneficiary will increase from $4,800 ries of hearings to examine the problem of I came here to preserve the dignity of next year to $6,700 in 2002 under H.R. 2425. waste and fraud in the Medicare and Medicaid senior citizens who depend on Medicare Furthermore, we have spent $844 billion on programs. As I learned at the hearings, the and to restore the faith of the young Medicare over the past 7 years, and under General Accounting Office [GAO] estimates people who are paying now into the this legislation we will spend $1.6 trillion over that these programs will lose approximately system but will not use this program the next 7 yearsÐan increase of $742 billion. $26 billion this year alone to fraudulent activi- for decades. This is not the democratic Only in Washington can a spending increase ties. Without question, waste, fraud, and process that I learned in civics class, be called a cut. abuse drive up the cost of these programs and it is no wonder that the American What is more, seniors will be offered more and make it increasingly difficult not only for people are frustrated. choices of health care plans, in addition to tra- Medicare beneficiaries, but for all individuals Mr. ARCHER. Mr. Chairman, I yield ditional Medicare. Under the bill, a to afford quality health care. such time as he may consume to the MedicarePlus program will be established to As a result of these hearings, I helped intro- gentleman from Pennsylvania [Mr. allow beneficiaries to enroll in a range of pri- duce legislation to crack down on the problem CLINGER]. vate or employer-based health plans, including of waste and fraud in the Medicare and Medic- (Mr. CLINGER asked and was given managed-care plans, traditional fee-for-service aid programs. This legislation, the Health Care permission to revise and extend his re- plans, high deductible insurance/medical sav- Fraud and Abuse Prevention Act, H.R. 2326, marks.) ings accounts, or so-called provider-sponsored contains substantive measures that will serve Mr. CLINGER. Mr. Chairman, I rise networks [PSN's] formed by health care pro- as a valuable deterrent against health care in strong support of this bill. viders. In some cases, these plans could fraud. Mr. Chairman, I rise in support of H.R. mean more or better benefits for seniors, such The Medicare Preservation Act strengthens 2425, the Medicare Preservation Act. I did not, as free eyeglasses or prescription drug bene- Federal efforts to combat fraud and abuse in however, arrive at my decision to support the fits. However, none will be forced to change the Medicare program by creating new crimi- bill easily or without hesitation. As someone plans or change doctors under the bill. These nal penalties for those who fraudulently abuse who represents a very rural district with an fundamental reforms will not only provide the Medicare program, providing monetary in- aged population, I am keenly aware of the im- beneficiaries with a broader range of health centives for individuals who report a violation portance of Medicare in meeting the health care choices but will also strengthen the exist- that results in savings in the program, dou- care needs of older Americans. ing Medicare Program. bling sanctions for filing false claims or com- Last spring, the Board of Trustees for the mitting fraud, and authorizing funding to bol- Medicare Trust Fund warned in its 1995 an- I am very encouraged by other provisions in ster the Health and Human Services Inspector nual report that the hospital insurance, part A the bill as well. H.R. 2425 will reform medical General's anti-fraud efforts and payment safe- portion of the Medicare Trust Fund will start malpractice law by establishing uniform stand- guard activities. going bankrupt beginning as early as next ards for health care liability actions and cap- year and will run out of money by 2002. The ping non-economic damages at $250,000 in a I am very pleased that the Medicare Preser- Board of Trustees for the Medicare Trust particular case. The bill also establishes a vation Act addresses this serious issue and in- Fund, which is a bi-partisan panel that in- commission to recommend long-term struc- corporates some of the tough, anti-fraud provi- cludes three of President Clinton's Cabinet tural changes to preserve and protect Medi- sions contained in the Health Care Fraud and secretaries, state clearly in the report that the care when the Baby Boom generation begins Abuse Prevention Act. Indeed, these anti-fraud Federal Government has no authority to pay retiring in 2010. Finally, this legislation con- measures are long overdue and will create hospital bills if funds in the part A trust fund tains a lock-box mechanism that places all significant savings in the Medicare program. are depleted. What is more, the Medicare part savings from part B into a Medicare preserva- Furthermore, I pledge to continue working with B trust fund, which pays for physician and out- tion trust fund and prohibits any transfers to my colleagues on the Government Reform patient services, is also in financial trouble and pay for future tax cuts. and Oversight Committee to carry on the effort needs to be addressed. Without significant re- Throughout the debate, I have heard a lot of to crack down on health care fraud and abuse. form, part B expenses are projected to double misinformation that Republicans are trying to Another area of the legislation that has been by 2002. push Medicare reforms through Congress of particular concern to me throughout this The reason for the imbalance between what without sufficient hearings. That is simply not processÐalong with my colleagues on the Medicare takes in and what it pays out is that true. The Medicare Preservation Act is the cul- Rural Health Care Task ForceÐis Medicare's the Medicare Program is growing at an mination of months of hearings by the House payment rate to Medicare contractors, known unsustainable rate of 10.5 percent, more than Committees on Ways and Means and Com- as the average adjusted per capita cost twice the rate of increase for private health merce, who have jurisdiction over the Medi- [AAPCC] rate. One of the primary structural care spending, which is 4.4 percent. Control- care Program. Altogether, these committees reforms contained in the Medicare Preserva- ling this excessive growth rate is the nec- held nearly 30 hearings throughout the sum- tion Act is the establishment of Medicare-plus essary, responsible, and moral thing to do. mer and into the fall to find ways to control organizations. When I learned of Medicare's financial out- Medicare's unsustainable growth rate, make The AAPCC is based on a complex formula look, I conducted a survey of the Pennsylva- the program more efficient, and offer seniors which determines Medicare's payment rate to nians I represent. By an overwhelming num- more choices in the type of coverage they re- certain types of plans that will be offered ber, my constituents agree that Congress ceive. under the Medicare-plus program, specifically, should act promptly to preserve and protect During that time, I, too, have been studying health maintenance organizations [HMOs], this vital insurance program, which serves this issue and actively seeking feedback from provider-sponsored networks, and medical nearly 36 million Americans, but should do so my constituents. In addition to the thousands savings accounts. However, because the in a responsible manner that goes after fraud of survey forms, letters and phone calls on AAPCC formula is tied to Medicare utilization, and abuse and addresses rural concerns. Mr. Medicare I have received from constituents, I which is typically lower in rural areas, wide ge- Chairman, I believe that this legislation, have visited senior centers and met with hos- ographic disparities have arisen between rural though it is not any easy fix, achieves these pital administrators in my area of Pennsylvania and urban communities. This variation makes crucial goals while ensuring that Medicare will to discuss proposals to preserve and protect it economically impossible for Medicare to be preserved for future generations. the Medicare Program. Here in Washington, I offer choices to beneficiaries in many rural First, I want to clarify the impact this legisla- have met with the House Rural Health Care areas. tion will have on seniors. Beneficiaries will see Task Force to discuss the impact of Medicare Five counties in my part of Pennsylvania no increase in their copayments or deductibles reform proposals on rural areas, and I have have payment rates that are below the na- and will continue to pay 31.5 percent of the heard regularly from such organizations as the tional average, which directly impacts the abil- part B premium, as they do today. In fact, out- Hospital Association of Pennsylvania, the ity of HMOs and PSNs to operate in these H 10346 CONGRESSIONAL RECORD — HOUSE October 19, 1995 counties. Although the bill, as originally draft- their own health plan. These seniors the ban, and there is little reason to believe ed, made adjustments that began to correct are fully capable of choosing from a va- that lifting the ban now will have some other the disparity, the changes did not go far riety of health plans to get the cov- effect. Finally, while the legislation contains a enough and would have failed to lift payment erage that best fits their needs. Mr. useful provision that allows physicians to es- rates to a sufficient level. Chairman, the seniors of America de- tablish organizations to compete for business Fortunately, after much deliberation with the serve nothing less than freedom of with HMOs, the bill exempts these physician- Republican leadership and the drafters of the choice. We have heard today from op- sponsored organizations from the State licens- bill, my colleagues on the Rural Health Care ponents of saving Medicare, of this leg- ing requirements that other health care provid- Task Force and I were successful in negotiat- islation here today to give seniors ers have to meet, and it exempts them from ing substantive improvements to the AAPCC choices, that seniors will be forced to the balance billing restrictions that apply to formula. I feel confident these changes will put join HMOs. Nonsense. Under our bill, other providers. State licensing protects the my district on a more level playing field with what happens to seniors is they can re- quality of care that patients receive, and bal- urban areas and will ensure that rural America main in the current fee-for-service sys- ance bill restrictions ensure that patients bene- won't be left behind. Rural America should be tem. fit from the purchasing power wielded by the allowed to participate in the new range of Mr. Chairman, we have also heard Federal Government. Exempting physician- choices that will be created under the Medi- that benefits offered to enrollees in sponsored organizations from these require- care Preservation Act and be part of the 21st Medicare Plus plans would not compare ments is unwise because it creates an uneven Century Government. favorably to those in traditional fee- playing field for different competing provid- Despite this positive change, there are still for-service plans. That is also non- ersÐand because it could allow inadequate areas in the bill that I feel could be improved, sense. The same benefits or better ben- regulation of an industry with tremendous po- including the level of hospital reimburse- efits will be available for seniors. tential for fraud and abuse. mentsÐnamely the Prospective Payment Sys- Vote for freedom of choice. Vote for Every member of Congress understands tem update factor, disproportionate share pay- the Medicare Preservation Act. that Medicare must be reformed in order to ments, and inpatient capital, the timing of Mr. GIBBONS. Mr. Chairman, I yield keep program costs under control. Where Graduate Medical Education Trust Fund pay- such time as he may consume to the Democrats disagree with the Republican ma- ments to academic health centers, and the gentleman from Pennsylvania [Mr. jority is on what reforms are necessary to treatment of ancillary services provided in COYNE]. keep Medicare solvent, and on whether Medi- skilled nursing facilities, which, under the bill, (Mr. COYNE asked and was given per- care beneficiaries should be forced to bear the will be subject to routine service costs. mission to revise and extend his re- triple burden of Medicare reform, balancing In the end, I remain strongly supportive of marks.) the Federal budget, and paying for a tax cut the fundamental goal of saving Medicare for Mr. COYNE. Mr. Chairman, I rise in for the affluent as well. I urge my colleagues current and future beneficiaries; we simply opposition to the Republican plan. to vote this proposal down, and to work on a cannot afford to do nothing. The Medicare Mr. Chairman, I rise to oppose this legisla- bipartisan solution to the problems confronting Preservation Act ensures the solvency of the tion. The Republican Medicare reform bill will Medicare. Medicare system without jeopardizing the undoubtedly be adopted by this body today, Mr. DINGELL. Mr. Chairman, I yield medical coverage seniors need and addresses but I strongly believe that the policy decisions such time as she may consume to the Medicare's long-term solvency by putting the that are reflected in this legislation are unnec- distinguished gentlewoman from Ohio structural changes in place that will enable essarily harsh, unprincipled, and unwise. [Ms. KAPTUR]. Congress to address the ``Baby Boom'' gen- The $270 billion in Medicare cuts contained (Ms. KAPTUR asked and was given eration's entrance into retirement. I firmly be- in this legislation are not necessary to keep permission to revise and extend her re- lieve that the Medicare Preservation Act is the the Medicare trust fund solvent for the next 10 marks.) only plan that will accomplish these goals. years. In fact, less than $100 billion in cuts are Ms. KAPTUR. Mr. Chairman, I thank Mr. ARCHER. Mr. Chairman, I yield 2 needed to meet that goal. Significant long- the gentleman and rise in opposition to minutes to the gentleman from Min- term changes will be necessary in order to ad- this Republican plan under which the nesota [Mr. RAMSTAD], another re- dress the impact that the baby boom genera- seniors in our community alone will spected member of the Committee on tion will have on the Medicare system, but lose over $377 million over the next 7 Way and Means. such major changes should be addressed in a years. Mr. RAMSTAD. Mr. Chairman, I rise more thorough, thoughtful manner than that I rise today in opposition to the bill before us today in strong support of freedom of which has characterized the process by which and to raise serious concerns with the manner choice for America’s seniors in their this legislation was developed. in which H.R. 2425, the Medicare Preservation health plans. Why should not Ameri- I believe that the so-called Medicare Preser- Act, has been railroaded through the House of ca’s seniors have the same choice in vation Act is unprincipled because its primary Representatives. Literally millions of citizens in health care plans as every other Amer- goal is not, in fact, the preservation of the our country depend on Medicare as their life- ican? All of us know that most Ameri- Medicare system. The real objective of this line. These 36 million older and disabled peo- cans secure their health care coverage legislation is clearly to produce savings in ple receive medical insurance through this through their employers. They have a order to balance the budget and finance the program. Congress must proceed carefully be- vast variety of health plans from which Republican tax cut. If anyone doubts that, they fore taking any action that will affect the lives to choose. How many choices do Ameri- should carefully consider the fact that the pro- and futures of millions of our families and their ca’s seniors have under Medicare? Only posal to cut $370 billion out of Medicare grew loved ones. Cutting $270 billion from Medicare two: fee-for-service and traditional out of Republican efforts to pay for the Con- and then transferring that money for tax cuts HMOs. tract With America's tax cutsÐnot the Repub- to the rich is absolutely wrong. Now, with all respect to my friends licans' concern over the future of this vital pro- TIMING from Massachusetts, no Sate is more gram. On Friday, September 29, legislation was advanced in their innovative health I believe that this legislation is unwise be- officially introduced to reform Medicare. What care, quality of health care and innova- cause it ignores much of our past experience did the leadership of the House do next? Did tive health care choices than the good with the Nation's health care system. For ex- it hold comprehensive hearings on the most State of Minnesota. Minnesotans have ample this legislation would repeal Federal sweeping changes to Medicare since its incep- a vast array of health care choices, nursing home standards that were enacted in tion 30 years ago? NoÐthey allowed only 1 ranging from traditional indemnity 1987. These standards were not established day of hearings before their bill was distributed plans, to points of service plans, to on some whim; they were adopted in re- to Members and left town, only to return on HMOs. It is reasonable to expect then sponse to reports of unacceptable conditions October 9 and proceed with marking up the that seniors in Minnesota would have a in nursing homes across the country. It is rea- bill. No senior citizens were even invited to similar range of choices. But how many sonable to assume that absent these stand- testify. choices to Minnesota’s seniors have ards, such conditions will return. Another ex- The committees marked up around the under Medicare? Only two: fee-for-serv- ample is the repeal of the ban on physician re- clock until Wednesday October 11. Mr. Chair- ice or traditional HMOs. ferrals to labs in which they have financial in- man, the legislative process used to move this I have heard from countless seniors terests. Such referrals increased Medicare bill has been a disgrace. This Congress has who want the opportunity to choose costs unnecessarily prior to the imposition of spent 48 days holding hearings on October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10347 Whitewater, Ruby RidgeÐwe even spent an billion tax cut for the privileged few in our soci- lute cap on pain and suffering at afternoon debating snailsÐbut they could not ety. $250,000 even though he could face ex- manage to hold more than 1 day of hearings I cannot and will not vote for a bill which cruciating pain and suffering for every on Medicare. provides a tax cut to the wealthy on the backs day for the remainder of his life. Yet a The very people who will be most affected of our senior citizens. CEO who could not perform his job be- by these cuts, our Nation's seniors, have been FRAUD AND ABUSE cause of the same exact injury would subject to arrest and silenced as the leader- As I visit the senior centers of my district face no such cap. ship rushed this bill through committees. one message resonates. It is time to cut fraud Similarly, with this bill the House Could we not have allowed just 1 day to hear and abuse. Find your savings by hiring more Republican leadership is saying that their concerns? With $136 billion in the current investigators to crack down on the crooks in the woman who loses her reproductive Medicare part A trust fund there are funds to the system, do not make cuts at the expense capacity as a result of medical mal- meet obligations for 7 years. We know we of seniors. Isn't it ironic that the majority practice would have her damages must act, but why the rush? passed legislation earlier this year that would capped at $250,000. Does anyone here Members, especially those not on the com- eliminate 72 fraud and abuse inspectors at believe that a woman’s reproductive mittees of jurisdiction such as myself, have HHS Office of the Inspector General. The plan capacity is worth a mere $250,000? been given very little time to review these before us actually weakens the ability of HHS Now, on antitrust and fraud, there is sweeping changes. This is not the way to leg- to detect waste, fraud, and abuse. In fact, the more. Under the False Claims Act that islate. We have disenfranchised the American HHS Inspector General June Gibbs Brown allowed whistleblowers to sue for those public by not allowing their elected representa- states that this bill would: who defraud taxpayers, we gutted, it tives to do their jobÐto analyze and make an Make the existing civil monetary penalty and has been taken out by the Republicans. informed vote on Medicare reform. And the antikickback laws considerably more lenient That provision has returned $1 billion American people have been barred from testi- and place an insurmountable burden of proof to the Government in savings from fying, and senior citizens in the hearing room on the Government to punish illegal kickbacks; fraud, waste, and abuse, $1 billion. This were even arrested. Relieve providers of the legal duty to use bill will gut that law. REPUBLICAN PLAN AND TAX CUTS reasonable diligence for insuring that the I am saying to my colleagues, do not Mr. Chairman, this past weekend I met with claims they submit to Medicare and Medicaid be fooled by this phony new health our community's health advisory group, a bi- are true and accurate; care. The Committee on the Judiciary partisan group of citizens from my district rep- Create new exemptions to the law which has not had a second’s worth of hear- resenting health professions, businesses, could be exploited by those who wish to pay ings on any of these antitrust, anti- labor, retirees, insurance, hospitals, and all rewards or incentives to physicians for the re- fraud provisions. health professions. The group was charged ferral of patients; and divert to private contrac- Mr. BLILEY. Mr. Chairman, I yield 1 with analyzing the Medicare trustees report tors scare resources currently devoted to law minute to the gentleman from Georgia and the Medicare Preservation Act. enforcement against fraud and abuse. [Mr. DEAL]. The consensus of the group was that these In conclusion, let us take our time and truly Mr. DEAL of Georgia. Mr. Chairman, Medicare cuts are draconian. Any changes in study the changes that are needed to provide like many of my colleagues, I held Medicare should be used only for the preser- both long-and short-term solutions to our sys- meetings with my constituents this vation of Medicare and should not be used to tem of Medicare financing. Let me quote from summer about Medicare. The No. 1 provide a tax cut for the wealthy. Our health the book ``Intensive Care'', ``The health care complaint that most senior citizens advisory group stated that they would not op- system in the U.S. is far too complicated for had was the amount of money that was erate a business the way this bill has been anyone or any group to claim that a single re- being spent for services that were not considered and that the Congress is making form plan is the solution to the crisis. Rather rendered, for overcharges for drugs and too many changes too fast. The members of than taking a huge first step with a new supplies, and for general waste. They the group also stated emphatically that this is untested system, wouldn't it make sense to are angry, and well they should be, absolutely the wrong time to be discussing a pilot test a number of proposals? This is the when they see Medicare paying $2 for tax cut whose beneficiaries are primarily the only reasonable method to determine what an aspirin, $12 for a box of Kleenex, and wealthier among us, with those in upper in- works and what doesn't work. The danger with thousands of dollars for services that comes emphasizing that it is right that they scrapping any old system of any kind is that were unnecessary or never delivered. pay their fair share. a new system may not be any better.'' We must stop these abuses of the sta- Our health advisory group suggests a short- Mr. Chairman, let us heed this advice. Send tus quo. They are costing at least 10 term solution must address waste, fraud, and this bill back to the committees of jurisdiction cents out of every Medicare dollar, $50 abuse, spiraling health costs of prescription and let us do this reform in a reasoned, bipar- million a day, that will amount to $1.3 drugs, labs, equipment, doctor and hospital tisan manner. fees, home health care, vision and dental Mr. GIBBONS. Mr. Chairman, I yield trillion over the next 7 years. care, and durable medical equipment. New 2 minutes to the gentleman from Can we do better than that? Of course ways to fix the long-term financing of Medicare Michigan [Mr. CONYERS] who is the we can, if we let our senior citizens must also be explored including the high cost ranking Democrat on the Committee have a part in pointing out these of pharmaceuticals and private insurance. Re- on the Judiciary, which, unfortunately, abuses. They know better than a gov- search and development of drugs is a cost of waived all chances of participating in ernment bureaucrat what services and doing business and should not be passed on this debate today through its chair- supplies they receive. They are tired of the consumers in the form of higher prescrip- man’s actions. being told not to worry about the fraud tion drug prices. A national commission must (Mr. CONYERS asked and was given since Medicare is paying for it. They be set up for this purpose of developing a permission to revise and extend his re- know, even if some in government long-term solvency plan for the Medicare Pro- marks.) don’t, that it is their tax money that is gram beyond 2010. Mr. CONYERS. Mr. Chairman, before being wasted. The trustees report has been cited as the I talk about the antifraud and anti- This bill gives Medicare recipients a reason reform is needed. I agree. Medicare is trust provisions, let me point out that voice in the process. These are men and facing a short-term financing crisis in the part the medical malpractice provisions in women who lived through the Depres- A hospital insurance [HI] trust fund which we this bill for the first time tells the sion, fought in the World Wars, and must solve this year and a long-term crisis States that the Big Brother Federal built this Nation by hard work and sac- which needs much more careful consideration. Government is going to preempt them rifice. If they are empowered rather However the plan before us cuts $270 billion in the area of medical malpractice, and than victimized, they will help elimi- from Medicare when the trustees only call for the provisions are a gift for the irre- nate the thieves and con artists who $90 billion in savings. In addition, the plan be- sponsible and the reckless. cheat Medicare out of $50 million every fore us doubles part B premiums and we all Take the case of Mr. King, who re- day. know that not one dime of that money will go cently lost the wrong leg in an amputa- Let us pass this bill and stop this to the HI trust fund cited in the trustees report. tion in one of the worst medical mal- outrage. Where is all this money going? To a balanced practice cases in recent times. He Mr. GIBBONS. Mr. Chairman, I yield budget? No. It is being used to pay for a $245 would have been forced to face an abso- myself such time as I may consume. H 10348 CONGRESSIONAL RECORD — HOUSE October 19, 1995 The gentleman just does not know Mr. DINGELL. Mr. Chairman, I yield tee on Commerce: Julia Searles, 75; Jo- what he is talking about. We pay hos- 2 minutes to the distinguished gentle- seph Rourke, 90 years old; Theresa pitals based on a capitated basis. We do woman from Illinois [Mrs. COLLINS]. McKenna, 68 years old; Bert Seidman, not pay hospitals for all that foolish- (Mrs. COLLINS of Illinois asked and Loretta Adkins, Cecelia Banks, ness that the gentleman just read off. I was given permission to revise and ex- Doretha Beverly, Barbara Greenwell, do not know where he got that infor- tend her remarks.) Gladys Lyles, Roberta Saxton, Annie mation. Mrs. COLLINS of Illinois. Mr. Chair- Earl, Marie Roots, Lilly Valentine, Mr. BLILEY. Mr. Chairman, I yield man, I rise in opposition to H.R. 2425, Gertrude Snead, Ruth Thorn, Edna such time as he may consume to the the ‘‘Get Old People, Gingrich Repub- Custis, all over age 69 who do not make gentleman from Georgia [Mr. DEAL]. lican, Put The Hurt on Seniors, Medi- $133,000 a year. Mr. DEAL of Georgia. Mr. Chairman, care Destruction Act of 1995.’’ This bill Mr. Chairman, the 7-year freeze on DME it is very clear that there are those is nothing more than a mean-spirited payments once again demonstrates the who wish to try to defend the status attempt by the majority to destroy the lengths to which the Republicans have been quo. We are here to change the status basic health care rights all older Amer- driven by adopting an arbitrary cut of $270 bil- quo and do something about these icans now enjoy in order to give tax lion in Medicare so that they finance a tax cut problems. breaks to their wealthy, big business, for the rich. Mr. DINGELL. Mr. Chairman, I yield special interest buddies. Never in all In an attempt to protect these Medicare 30 seconds to the distinguished gen- my time in Congress have I witnessed a beneficiaries, I attempted to offer amendments tleman from Illinois [Mr. RUSH]. greater legislative travesty than the to restore these provisions. Unfortunately, the Mr. RUSH. Mr. Chairman, under the ill-conceived proposal we have before Republicans would not let me. Gingrich Medicare plan, the hospitals us today. Let me also address the blatantly undemo- in and around the district of the gen- To begin with, the rule we just con- cratic process by which this proposal, which tleman from Georgia [Mr. DEAL] will sidered stifles any amount of reason- will directly impact the health and well-being of lose approximately $159 million over able debate on this legislation. For in- 37 million older Americans and nearly every the next 7 years. stance, with the exception of pap smear family in the Nation, has been brought forth. Last week, in the Committee on testing, this bill eliminates quality as- Not one public hearing has been held in which Commerce, the Republicans delivered surance guarantees that are now in the legislative specifics of the drastic Medicare thousands of bogus letters. The seniors place for patients who have diagnostic changes we are about to act on were in plain of my district and my State requested or other types of testing done in their view. This is appalling and flies in the face of that I deliver a symbol of their true doctor’s office laboratories. the legislative process. It probably should not be surprising feelings regarding the Republican Med- After flagrantly spending the taxpayer's time that the Republican Medicare pro- icare plan, a cut of pure grade bologna. and money without a second thought to con- posal—which bends so close to special duct 28 days of hearings on Whitewater, 10 Mr. BLILEY. Mr. Chairman, I yield 1 interests and tilts so far from the best days of hearings on Waco, and 8 days of minute to the gentleman from Colo- interests of America’s senior citizens— hearings on Ruby Ridge, it is crystal clear that rado [Mr. SCHAEFER]. would eliminate requirements for qual- the Republican party has put partisan politics (Mr. SCHAEFER asked and was given ity and accuracy of laboratory tests. above the public interest. permission to revise and extend his re- This, like the Republicans’ blatant and The fact that Democrats had to convene marks.) cruel elimination of national standards hearings on the lawn of the Capitol in order to Mr. SCHAEFER. Mr. Chairman, I rise for nursing homes, is one more way of provide a public forum to examine the GOP in strong support of the Medicare Pres- saying to the ill, the infirmed and the plan is compelling evidence, in and of itself, ervation Act. This well thought-out aged: you’re on your own—good luck! that the Speaker and his troops know that package takes an important step to- Where is the rationale for eliminat- their proposals cannot stand up to public scru- wards ensuring the solvency of Medi- ing quality standards for cholesterol tiny. Moreover, it speaks volumes to the enor- care for today’s beneficiaries and for tests, colon and prostate cancer screen- mous disconnect that exists between the Re- generations to come. ing, needle biopsies to detect publican party and the rights and needs of In addition to the numerous hearings precancerous conditions, glucose mon- older Americans today. the Ways and Means and Commerce itoring and so on? There isn’t any! Such a disconnect became extremely ap- Committees held on saving Medicare, Equally disturbing is the fact that parent on October 11, when 13 seniors, some we all got an earful of advice during this Republican bill places a seven-year of whom were over 90 years old and relegated our respective town meetings. At my freeze on Medicare payments to provid- to wheel chairs, came to ask questions about town meetings, many good suggestions ers of durable medical equipment such the Republican Medicare proposal prior to were put forward. However, more than as wheel chairs, electric beds, walkers markup by the Commerce Committee. They anything else, seniors asked that we and, yes, even oxygen. Now this freeze were promptly arrested and hauled off to jail at vigorously attack the waste, fraud, and is at a time when more and more the direction of the committee chairman! abuse that now plagues the system. Americans are aging and the need will During the Democratic ``lawn'' hearings, Senior citizens I have talked with be greater. however, we helped answer the question, just routinely witness overbilling and need- This freeze will cause severe disrup- what does the Republican Medicare proposal less tests. ‘‘Don’t worry,’’ some say. tions in the health care and quality of do? It charges seniors more for medical care, ‘‘Medicare will pay it.’’ Unfortunately, life for sick and/or infirmed Americans medicine, wheelchairs and medical devices. It seniors know it is they, their children who need their wheelchairs and walk- forces seniors to abandon their own doctors and grandchildren who really foot the ers to get around more easily, elec- for some uncharted course through the HMO bill. trical beds to rest comfortably and ox- system. It takes $270 billion in Medicare fund- There are many steps the Medicare ygen to breath effectively. By putting ing away from seniors, doctors, and hospitals Preservation Act takes to combat a freeze on oxygen, the Republicans are all to pay for tax cuts for the wealthy. In short, waste, fraud, and abuse. None is more literally taking the breath of life out of it devastates the health care program upon basic and makes more sense than sim- the bodies of old folk. Only God has which so many millions of Americans have ply doubling the monetary fines for de- that right. come to rely. frauding the system. The money col- Mr. Chairman, I heard a Member a Among the many witnesses were several of lected through these fines will be im- few minutes ago say that he was glad my constituents from Chicago who testified mediately recommitted to pursue addi- that he had made 65 and qualifies for about the devastating consequences of the tional anti-fraud efforts. Medicare. A lot of people qualify for GOP so-called reforms. Mr. Chairman, this legislation will Medicare who do not make $133,000 a Dr. William Troyer, director of External Serv- literally save Medicare from ruin. year, as he does. And not only that, ices for the University of Illinois at Chicago Rooting out the waste, fraud, and people who use facilities like wheel- Medical Center, an academic health center abuse is an important piece of the over- chairs and the like were among those which houses the Nation's largest medical all package. I urge all of my colleagues who are thrown out of the committee school and serves thousands of 7th District to join this important effort. by the Republican side in the Commit- residents, gave a bleak view of the future under Republican Medicare changes. To quote Dr. Troyer, ``a gradual weakening and eventual demise'' of UIC Medical Center will October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10349 result from the more than $7 billion in cuts to [Mr. SHAW], a respected member of the Second, a beneficiary incentive pro- direct and indirect medical education funding Committee on Ways and Means, the gram will be established where individ- proposed by the GOP. chairman of the Subcommittee on uals who report cases of fraud and Following Dr. Troyer, Mr. Lacy Thomas, Human Resources. abuse can share the amount collected chief financial officer of the Cook County Bu- (Mr. SHAW asked and was given per- against those who are fined. Just think reau of Health Services, was equally dismal in mission to revise and extend his re- of the power of this provision, Mr. his predictions. As a safety net provider for the marks.) Chairman. There are currently 37 mil- disadvantaged and underserved in Chicago, Mr. SHAW. Mr. Chairman, I rise lion Americans in the Medicare pro- the Bureau will be unable to deliver basic care today in support of the Medicare Pres- gram. This means there are 37 million for this population due to the total elimination ervation Act, and to deliver to this leg- potential private attorney generals to of assistance to non-U.S. medical graduatesÐ islative body a message from my senior help stop fraudulent and abusive prac- graduates which comprise nearly 40 percent constituents in south Florida. Stop the tices. I know this will please many of of Chicago Medical Society physicians. In ad- fraudulent and abusive practices my constituents, especially the Simons dition, $8 billion in reductions for disproportion- against the Medicare system. Do some- of Hallandale, FL, who wrote to me re- ate share payments to hospitals serving the thing about it, and just stop it. cently to inform me that they saved indigent, such as Cook County, will only serve On September 6, I mailed a letter to Medicare $4,000 by reporting suspect to exacerbate the pain felt by these patients. all of my constituents who qualify for billing practices of their doctor. Yet, I believe the most compelling testimony Medicare which explained the problems Third, under this legislation, direct came from Ms. Irene Nelson, a senior from that face the Medicare program. In this spending for Medicare-related activi- Chicago, who spoke eloquently regarding her letter I asked for their input on how to ties of the inspector general of the De- fears of the Republican Medicare cuts. She preserve the system. To my surprise, partment of Health and Human Serv- stated, over 90 percent of those who responded ices will significantly increase. These It is obvious to me that the people who are said that Congress must stop the fraud activities include: First, prosecuting making these decisions are completely out of and abuse that they feel is widespread. Medicare-related matters through touch with the daily struggles of senior citi- Just listen to what is going on out criminal, civil, and administrative pro- zens like me. I wonder if any of these people ceeding; second, conducting investiga- have ever been forced to decide between eat- there. ing, heating, and paying that outstanding On September 22, I received a letter tions relating to the Medicare pro- medical. I doubt it very much! But that is from Mrs. Jack Barnett, whose hus- gram; third, performing financial and what I, and many other seniors out there, band at one time was the chief of sur- performance audits of programs and will be forced to do if the Republicans are al- gery at his hospital in New Jersey. operations relating to the Medicare lowed to cut Medicare. Today Dr. Barnett is an invalid living program; fourth, performing inspec- Mr. Chairman, it is of extreme importance with his wife in Hollywood, FL. Mrs. tions and other evaluations relating to that the American people are provided with Barnett noticed last year that they the Medicare program; and fifth, con- this information on the Republican plan to gut were receiving billing statements for ducting provider and consumer edu- Medicare in the dark of night and leave our feeding tubes which Dr. Barnett never cation activities regarding Medicare Nation's seniors holding the bag. used. The company charging for these fraud and abuse. After promising to balance the Federal services received $2,765, $3,870, and I want to stress to my constituents budget in 7 years, increase military spending, $4,411 from Medicare. Mrs. Barnett that this legislation is not a paper and provide hefty tax cuts to the richest Amer- asked her husband’s nurse if she had tiger. This bill provides serious money icans in the country, the GOP is looking for a ever seen anything like this before, and to stop fraud and abuse: At least $430 magic potion to fund these big promises. when the nurse saw the name of the million in 1996; $490 million in 1997; $550 Unfortunately, the Republicans seem to company, she stated that two of her million in 1998; $620 million in 1999; $670 think Medicare is going to be the cure-all. In other patients were billed for the same million in the year 2000; $690 million in pushing a package of the deepest Medicare thing by the same company. 2001; and $710 million in 2002. This is a cuts in the program's 30-year history, $270 bil- Mrs. Audrey Vitolo of Deerfield serious financial commitment that the lion, the GOP wants to immediately increase Beach, FL was charged $600 for a sim- Congressional Budget Office said will the cost of Medicare to the average senior citi- ple blood test. Medicare paid the bill. save Medicare money. Finally, this bill establishes a health zen by nearly $1,000, and force many to give She told me she felt victimized. care anti-fraud task force. This task up their own doctors. Mr. Ted Murphy of Fort Lauderdale, force will be a coordinated effort by the This is bad policymaking and bad medicine FL, was charged $10,000 for a simple op- Department of Justice to prosecute for senior citizens. eration on his eye lid. Even though this In my State of Illinois, the proposed cuts will health care fraud offenses. was an outpatient procedure, Medicare eliminate health care coverage outright for Mr. Chairman, the Medicare Preser- paid the bill. He told me that he com- more than 58,000 individuals with disabilities vation Act is the toughest, most seri- plained to the hospital, but no action over the next 7 years. In addition, 23,000 sen- ous attempt this Congress has ever was taken. ior citizens will lose coverage. taken to stop fraud and abuse in the Mr. Chairman, I want my constitu- Out-of-pocket costs will increase by an aver- Medicare program. I am proud to have ents to know that their message came age of $3,500 over the next 7 years for each contributed to the effort to address the through loud and clear, and that Con- of Illinois' 1.62 million Medicare recipients. issue of fraud and abuse, and I know gress today is taking serious steps to Further, Illinois will be denied $6.2 billion in when my constituents learn of their stop fraud and abuse. Federal health care assistance over the next 7 new rights under the Medicare pro- This Medicare bill will make it a years. gram, they will be proud of this Con- Federal offense to engage in fraud, I am outraged at the efforts of the GOP to gress too. I urge my colleagues to vote theft, embezzlement, false statement, gut this essential program for no reason other for this most important legislation. bribery, graft, and illegal remunera- than to pay for $245 billion in tax cuts for the Vote to preserve and strengthen Medi- tions, including kickbacks. Civil pen- rich. It is unnecessary, it is outrageous, it is care. wrong. alties have been doubled and incentives As the saying goes, ``You can fool some have been added to encourage people to b 1400 people some of the time, but you can't fool all report cases of fraud and abuse. Mr. GIBBONS. Mr. Chairman, I yield the people all of the time.'' The vast majority First, the Secretary of the Depart- such time as he may consume to the of the American people are not fooled Mr. ment of Health and Human Services gentleman from Ohio [Mr. SAWYER]. Chairman. Pass these Medicare cuts and you will be required to alert beneficiaries (Mr. SAWYER asked and was given will discover that cold, hard fact pretty darn of instances of fraud and abuse against permission to revise and extend his re- quick. the program. A toll-free number will be marks.) I urge my colleagues to vote ``no'' on H.R. established to report cases of fraud and Mr. SAWYER. Mr. Chairman, today, Con- 2425. Let's not take the ``care'' out of Medi- abuse. Also, at the request of any per- gress is debating cuts to the Medicare pro- care. son, the Secretary will publish a spe- gram. Mr. ARCHER. Mr. Chairman, I yield 2 cial fraud alert, which notifies the pub- As the post-war generation ages and their minutes to the gentleman from Florida lic of practices that are suspect. parents outlive all previous generations, we H 10350 CONGRESSIONAL RECORD — HOUSE October 19, 1995 are facing the largest elderly population in our While the public is being told we need to Doing nothing is not an option. But doing Nation's history and, therefore, the largest make these changes in order to save the sys- the wrong thing is no better. Today we face a Medicare beneficiary population. Our national tem, the fact of the matter is that the proposed trio of choices concerning the future of Medi- policies must reflect this changing reality. As cuts far exceed the amount needed. It is part care and our prospects for balancing the we seek ways to balance the Federal budget, A of Medicare which is scheduled to become budget. we must also continue investing in our Na- insolvent by the year 2002 and its $90 billion The Board of Trustees of the Medicare Hos- tion's futureÐincluding ensuring that both cur- which is needed to avoid this catastrophe. Yet, pital Insurance Trust Fund indicate that we rent and future retirees will have the resources the combined cuts in payments to doctors and have traditionally maintained a 10- to 12-year they need to survive. hospitals surpasses this figure. More startling balance in the fund, and, currently, we are However, the Republican Medicare proposal is the fact the premium increases, which have only 6 years from going broke. We are obli- would cut benefits for current retirees, those nothing to do with keeping part A of Medicare gated to take action to ensure the solvency of who no longer have the opportunity to prepare solvent, will further reduce Medicare costs. the fund. for their retirement, in order to increase discre- The combined cuts, premium increases, and By most estimates, we could control the tionary spending for current working age peo- other changes to the system will reduce Medi- growth of Medicare spending over the next 7 ple. This type of policy perpetuates the gen- care by $270 billion over 7 years. This leaves years by about $90 billion and protect the in- eration battle for my pot of money. Instead, we a large gap of $180 billion. tegrity of the fund by extending its balance to need to work together to find ways to reduce Even a simple examination of this proposal 10 years solvency. But that course ignores the the deficit, ensure the stability of Medicare, yields numerous questions. Why are we pro- fundamental problem that entitlement spend- and invest in the future. posing to wreck havoc in rural America by ing must be further contained if we are going We also have to learn from our history. As jeopardizing the delivery of health care there; to meet our balanced budget goal. a nation, America cannot afford to return to Why are we proposing to increase premiums Our second option, which I have voted for the bad old days before the Medicare program for beneficiaries, many of whom will only be and will continue to support, is to control Medi- was created. Medicare has helped secure our able to make these payments through great care growth by $170 billion over the next 7 Nation's seniors against the threat of poverty personal sacrifice; and, why are we moving to years. That would secure the trust fund and and has limited the high costs of emergency undermine public hospitals? contribute the necessary cost controls which, and non-insured health care. Medicare has al- There are only two answers that are readily when combined with the rest of the coalition lowed our Nation's elderly to take care of their discernible. One is that excessive Medicare budget, would bring us to balance in 7 years. own health needs, regain self-respect, and, in cuts facilitate a cut in taxes further down the We must do both of those thingsÐpreserve turn, remain active members of society. road; the other is that these cuts could allow Medicare for our seniors, and balance the I support efforts that enable us to extend the the budget deficit to be reduced by some fac- budget on behalf of future generations of our life of the Medicare program which has been tor. While I could support both tax and budget sons and daughters. so important to the health of many older reductions, I cannot support such an effort The third option, which is before us today, Americans. That is why I have supported the under these circumstances. Why would we takes $270 billion out of the Medicare Pro- Democratic alternative which ensures the sol- want to jeopardize the welfare of our senior gram. It will stabilize the trust fund and put us vency of the Medicare trust fund through citizens to either give more money to wealthier on a 7-year path toward a balanced budget. 2006Ðthe same as the Republican proposalÐ individuals or to reduce a budget deficit? Are But it also takes $100 billion more out of Medi- without making harmful and excessive cuts to there not more equitable approaches we could care than is necessary to achieve financial the Medicare program. follow to achieve these goals? solvency of the Medicare trust fund and to bal- The American health care system, despite I would propose that, foremost, we consider ance the budget. This additional $100 billion, its shortcomings, is the envy of the world. sacrosanct the welfare of those who have coming directly from Medicare, will be used to Medicare has opened the door for many made significant, lifetime contributions to this help finance a $245 billion tax cut for some of Americans to quality health care. The Repub- nation. Whatever approach we use to stimu- the wealthiest people in America. lican proposal will undermine the graduate late investment in this country should not be As Cochair of the Rural Health Care Coali- medical education program, and hurt urban done on the backs of our senior citizens. Our tion, I have long been concerned with preserv- and rural hospitals which are already strug- budget deficit is real. Yet how can we in good ing an adequate and affordable health care gling to remain open. Finally, the Republican conscience engage in this wholesale attack system for people in rural areas such as the proposal will mean that premiums will double against senior citizens when other, more 19th district of Illinois, which I am privileged to in 7 years, meaning that for the poorest of the measured alternatives remain at our disposal? represent. The approach being advanced elderly, health care will continue to absorb Let us make an honest effort to address our today encourages health maintenance organi- more and more of their living costs. budget deficit problem without strangling our zations to provide Medicare services, an ap- The Republican Medicare bill is simply bad most vulnerable citizens. And, let us consider proach which may work well in urban areas policy. It pits one generation against another, policies which stimulate economic activity with- but will never adequately serve the rural peo- rich against poor, Democrats against Repub- out exacerbating our deficit. ple of this country. Why would a health care licans. The Republican Medicare bill does not Mr. GIBBONS. Mr. Chairman, I yield provider establish a system in a rural area invest in our future, nor does it help current re- such time as he may consume to the where the monthly payment is approximately tirees. gentleman from Illinois [Mr. POSHARD]. $300 when it receives nearly $500 for provid- I urge my colleagues to vote against this (Mr. POSHARD asked and was given ing similar services in a more urban area? bill. permission to revise and extend his re- This week, the Illinois Hospital and Mr. GIBBONS. Mr. Chairman, I yield marks.) HealthSystems Association wrote me a letter such time as he may consume to the Mr. POSHARD. Mr. Chairman, due to the which states: gentleman from New Mexico [Mr. PAS- concerns I have regarding the future of our IHHA continues to be strongly opposed to the magnitude of Medicare reductions that TOR]. rural health care system and the people who are contained in this proposal. The House (Mr. PASTOR asked and was given depend on those facilities, I rise in strong op- measure calls for approximately $76 billion permission to revise and extend his re- position to the bill, H.R. 2425. in Medicare reductions to be achieved by re- marks.) It is difficult to misread the conclusions con- ducing payments to hospitals. Of this total, Mr. PASTOR. Mr. Chairman, as we consider tained in the report of the Entitlement Reform reductions to Illinois hospitals would be $3.5 this sweeping piece of legislation today, let us Commission, which states that without fun- billion. For the hospitals in your district, at least make an attempt to honestly describe damental change, our entire Federal budget the reductions amount to $119 million. what is being proposed. To begin, we are re- will be consumed by entitlements and interest As the specifics of this proposal became ducing Medicare payments to hospitals and on the debt by the year 2012. That means clear, I traveled my district to listen to the peo- doctors. Secondly, we are increasing the pre- none of the tax money sent to Washington will ple who run the hospitals and clinics and the miums paid by beneficiaries. And, although we be available for national defense, our transpor- patients who depend on them to maintain their are considering some modest changes in how tation system, education, law enforcement, quality of life. One after another, hospital ad- health services will be provided, the fact that science or space, national parks or any of the ministrators in my district told me of the hun- Medicare payments are being cut and pre- other functions of government which operate dreds of thousands of dollars they would lose miums are being increased remain the most with discretionary funds. It will all be commit- under this plan. Rural hospitals are valuable salient features of the legislation. This is what ted to interest on the debt and entitlement not only for their vital health care services, but most alarms me about this proposal. spending. for providing some of the best paying jobs in October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10351 our communities. They cannot be allowed to makes the health care waste fraud a of three medical liability claims are dry up and blow away, leaving people wanting growth industry and a new way of life closed without any payment to the for medical care. for a lot of Willie Suttons. claimant, but only after large legal and Mr. Chairman, we cannot continue the Medi- Mr. BLILEY. Mr. Chairman, I yield 3 administrative fees have already been care System as it presently exists which today minutes to the gentleman from Illinois incurred. stands near bankruptcy. We should and must [Mr. HYDE], chairman of the Commit- Further, the increasing insurance consider asking seniors who are financially se- tee on the Judiciary. premiums for malpractice coverage cure to pay more for their share of the Medi- (Mr. HYDE asked and was given per- represent only a part of this problem. care Program. I am on record supporting a bill mission to revise and extend his re- The estimates are that the costs of de- which would means test Medicare premiums marks.) fensive medicine run from $20 to $25 for higher income individuals to make the sys- Mr. HYDE. Mr. Chairman, I rise in billion a year. tem more fair. strong support of H.R. 2425, the Medi- Numerous other entities in addition to doc- We cannot simply make the short term fix to care Preservation Act of 1995. tors and hospitals such as pharmaceutical Mr. Chairman, there is no question sustain the trust fund. It is equally irrespon- manufacturers and those that manufacture that reform of the Medicare Program is sible to cut the Medicare Program to pay for medical devices or provide blood or tissue imperative if it is to survive. But its a tax cut which Republican analysts admit will services are also impacted by the same liabil- mere survival is not the goal of this add $95 billion to the national debt. Both ity concerns. Finally, as we move more and legislation: What we seek is to preserve courses of action are wrong. more into a managed care system, the scope Medicare by keeping it solvent while Let us come together as a deliberative body of third-party liability is also a matter of in- strengthening and improving the cov- to secure the trust fund, balance the budget, creasing concern. erage and options it provides to this and put our country in a position to care for its There is no question but that our health Nation’s elderly. We must not squander people and compete in the international mar- care system is seriously burdened by both the this opportunity to deal comprehen- ketplace in the coming century. We can do threat, and the reality, of liability suits facing sively with the multitude of issues better for all generations of Americans, and I medical practitioners and health care provid- which bear on the efficient delivery of stand ready to work with anyone of any party ers. The Health Care Liability Reform legisla- to make better choices than the one before us health care in this country. As the chairman of the Committee on tion that is included in this bill will solve this today. serious national problem. It is unfortunate that the leadership of both the Judiciary, I would like to point out parties will not allow the moderate Democrat some particularly important provisions EASING OF ANTITRUST BARRIERS FOR PHYSICIAN SERVICE NETWORKS proposal to come forward on this floor for a contained in this bill that fall within vote. This proposal is the best option available our Committee’s jurisdiction. Specifi- Provider service networksÐthose composed because it accomplishes both a balanced cally, the bill contains provisions de- of doctors, hospitals, and other entities who budget and a fiscally sound Medicare trust signed to facilitate the operation of the actually deliver health care servicesÐare po- fund, but does not overreach by downsizing revised Medicare Program—notably, tentially vigorous competitors for Medicare Medicare another $100 billion for fund a tax health care liability reform, antitrust beneficiaries. The benefits to the Medicare cut which is unnecessary. relief for provider service networks, Program of their participation would be lower My hope will be that this sensible approach and an antitrust exemption for medical costs and higher quality of care than in to fiscal responsibility will be allowed next self-policing entities. The combined ef- nonprovider sponsored health plans. Costs week in the reconciliation bill and that eventu- fect of these changes will provide a fer- would be lower because contracting with a ally this Congress will achieve the middle tile environment for the delivery of PSN instead of an insurer could eliminate a ground that is necessary to solve these prob- Medicare services in a manner which layer of profit and overhead. Quality would be lems. maximizes consumer choice. Liability higher because providers, and particularly Mr. GIBBONS. Mr. Chairman, I yield reform will generally decrease the cost physicians, would have direct control over 30 seconds to the gentleman from Wis- of providing health care services, and medical decision-making. Arguably, physicians consin [Mr. KLECZKA]. eliminate many of the frivolous law- and other providers are better qualified than Mr. KLECZAK. Mr. Chairman, last suits which are clogging our courts. insurers to strike the balance between con- year the Democrats had a proposal to Antitrust relief for provider service serving costs and meeting the needs of the extend the solvency of Medicare by networks, or PSN’s, will increase com- patient. cutting $168 billion in the program. The petition for contracts under the Medi- There are obstacles, however, to the forma- speaker who just addressed us from care system, thereby increasing choice tion of PSN's. One of the most serious is the Florida indicated to the committee at and decreasing costs. Providing an application of the antitrust laws to such groups that time, ‘‘We have here in this bill antitrust exemption to medical self- in a manner which does not allow the network the seeds of destruction of Medicare. regulatory entities will encourage phy- to engage in joint pricing agreements, regard- Let’s not destroy a health care pro- sicians and hospitals to police them- less of whether its effect on competition is gram in this country that we know selves, and will contribute to a reduc- positive rather than negative. works well and that our seniors are de- tion in malpractice, fraud, and abuse. Antitrust law prohibits agreements among pending on it.’’ Now he comes to the HEALTH CARE LIABILITY REFORM competitors that fix prices or allocate markets. floor supporting a bill cutting $270 bil- Our health care system is clearly Such agreements are per se illegal. Where lion. being burdened by a number of cost- competitors economically integrate in a joint Mr. Chairman, I guess those seeds based pressures. One of these costs is venture, however, agreements on prices or have germinated. the threat of liability suits facing med- other terms of competition that are reasonably Mr. DINGELL. Mr. Chairman, I yield ical practitioners and health care pro- necessary to accomplish to procompetitive 30 seconds to the distinguished gen- viders and the large dollar amounts benefits of the integration are not necessarily tleman from Pennsylvania [Mr. KLINK]. they are forced to spend to protect unlawful. Price setting conduct by these joint Mr. KLINK. Mr. Chairman, we are themselves against these legal actions. ventures should be evaluated under the rule of hearing about this bill cutting waste, The average physician has a 40-per- reason, that is, on the basis of its reasonable- fraud, and abuse. It is odd that the cent chance of being sued at some time ness, taking into account all relevant factors GAO, the Department of Justice, and in his or her career. This increases to affecting competition. the HHS Office of Inspector General all 52 percent for surgeons and to 78 per- Current Department of Justice-Federal have very grave concerns about what cent obstetricians. The estimate is Trade Commission guidelines require that a this bill does to provisions in the Medi- that medical malpractice premiums physician group share substantial financial risk care bill that would allow them to do now total $10 billion annually. The av- before being considered a joint venture and law enforcement. In fact, if my col- erage annual medical premium for a thus eligible for rule of reason analysis. Their leagues like waste, fraud, and abuse, doctor specializing in obstetrics in definition of substantial financial risk is too which we all agree now account for some urban areas now exceeds $100,000 rigid, thereby eliminating from the market about 10 percent of all that is spent on a year. PSN's which would provide an expanded set Medicare and Medicaid, my colleagues Many liability cases brought against of consumer choices and increase competition are going to love this bill because it doctors are frivolous. In fact, two out in the market for health care services. H 10352 CONGRESSIONAL RECORD — HOUSE October 19, 1995 The proposed legislation overcomes this 1 minute’s hearing on medical mal- people off of these expensive doctors, barrier by mandating that the conduct of an or- practice reform. The Judiciary Com- because now it is costing us $3 billion ganization meeting the criteria of a provider mittee was cut out. more, these doctors are a lot of money, service network be judged under the rule of Mr. DINGELL. Mr. Chairman, I yield as my colleagues know; ask them, they reason. The result will be to permit a case by 1 minute to the distinguished gen- can tell us how much they want; and case determination as to whether the conduct tleman from New York [Mr. TOWNS]. get them on these programs where we of that PSN would be procompetitive, and thus Mr. TOWNS. Mr. Chairman, make no can ration the care, then it is not real- permissible under the antitrust laws. It is im- mistake about it. What we are doing ly cutting services. It is not really cut- portant to understand, however, that this is not here today is applying a $270 billion ting money, it is cutting the services, an exemption from the antitrust laws. In no meat-ax approach to a $90 billion prob- and so do not call that a cut. event would providers be allowed to set prices lem merely to pay for a $245 billion tax Now some may say, Well, how are or control markets so as to injure competition. cut for the wealthy. these old people going to shop around, Only an organization meeting specified cri- Let me say that I know my col- feeble as they are in wheelchairs, and teria would qualify for this more liberal, rule of leagues want to help their rich friends, find one of these for-profit organiza- reason consideration. The network must have but let me say to the Republicans, tions to give them care? My Demo- in place written programs for quality assur- Please find another way to help your cratic friends, I want them to know ance, utilization review, coordination of care, friends. Do not do it on the backs of they can stay in the program they are and resolution of patient grievances and com- senior citizens, those that have worked in. They can stay there, and it is dis- plaints. It must contract as a group, and man- all their lives to come to this point criminatory if one of these for-profits date that all providers forming part of the now and to be told we are going to cut, do not let them in. group be accountable for provision of the serv- cut, cut, cut. Now there is a problem. There is ices for which the organization has contracted. Let me just talk about two lies here nothing in the law that says these for- ANTITRUST EXEMPTION FOR MEDICAL SELF-REGULATORY very quickly. No. 1 is that we are going profits have to go in communities ENTITIES to go after fraud and abuse. My col- where there is sick people. There is Standard setting is a cooperative activity en- leagues are not going after fraud and nothing in here that says they have to gaged in by the providers of health care serv- abuse; they are cutting half of the peo- go to the rural areas, there is nothing ices in this country. Those entities have a long ple that is supposed to go find fraud in here that says they have to go to the history of protecting the public with standards and abuse. How are they going after it inner city, and why should they? They for medical education, professional ethics, and if they eliminate half of the people are in the business of making money. specialty certification. These activities have in- that are supposed to look for it? And There are sick people in these commu- creasingly been challenged under the antitrust the last one is choice. The biggest lie of nities, and we have to avoid it, but the laws in recent years, typically by those who all is choice. If they do not have the re- meanest thing of all, my Republican fail to meet the standards. Congress at- sources, they have no choice. friends, and I wish they could help me tempted to address this problem with the Mr. GIBBONS. Mr. Chairman, I yield to explain this, is that for years we Health Care Quality Improvement Act of 1986, 3 minutes to the gentleman from New have known when one works and they 42 U.S.C. § 11101 et seq., which provided York [Mr. RANGEL]. have no insurance, when someone is antitrust protection for peer review actions (Mr. RANGEL asked and was given poor and they have no coverage, they conducted in good faith. While beneficial, this permission to revise and extend his re- go to the public hospitals. I ask, why law shifted the debate in antitrust litigation marks.) did you hit them so hard? Mr. Chair- over peer review to whether the participants Mr. RANGEL. Like so many of my man, that is where people have no acted in good faith and has not served to stem friends here, Mr. Chairman, I am sick place else to go. the tide of antitrust law suits. and tired of these Republicans being Mr. ARCHER. Mr. Chairman, I yield 3 The medical self-regulatory entity exemption beat up on really. Most of the chairmen minutes to the gentlewoman from Con- included in our legislation would bar antitrust and certainly the committee people necticut [Mrs. JOHNSON], chairman of suits against medical self-regulatory entities have nothing to do with this. Someone the Subcommittee on Oversight of the that develop or enforce medical standards. told them that they had to find a $245 Committee on Ways and Means who This would include activities such as accredi- billion tax cut. Do my colleagues think has given so much of her time and her tation of health care providers and medical these people, kind and gentle as they knowledge in developing this plan. education programs and institutions, tech- are, will be going after housing, and job Mrs. JOHNSON of Connecticut. Mr. nology assessment and risk management, de- training, and lunch programs? No, it is Chairman, the goal of this bill is very velopment and implementation of practice not their fault. simple. It is to preserve Medicare for guidelines and parameters, and official peer And let us get another thing straight current retirees and for future retirees. review proceedings. The exemption would about this $270 billion cut. It is a sav- Why do we want to do this? Because cover suits against individual members of the ings; do my colleagues not get it? What the twin pillars of retirement security groups which undertake these activities as it means is that, as we find U.S. popu- for American seniors are Social Secu- well as the organizational entity on whose be- lation growing and people getting rity and Medicare, and believe me, half they act. older, and becoming more ill, and hav- when the Trustees of Medicare say next The scope of this antitrust protection is not ing to see more doctors and more hos- year they are going to pay out more absolute, however, Activities by a medical self- pitals, we are going to give them some money than they are going to take in regulatory body that are conducted for pur- more money. So who the heck is saying and in 5 years after that they are going poses of financial gain or which would inter- that they are not giving more? What to use up all their savings and be fere with the provision of health care services they are not doing is taking care of broke, I think that is a crisis. I think of a provider who is not a member of the pro- those older people the way they should that is a problem. I think delaying ad- fession that sets the standard would not be be taken care of because they have de- dressing that problem is going to make covered or exempted by this legislation. cided to legislate the rate of inflation. it harder, not easier. Mr. Chairman, H.R. 2425 represents a his- Now another thing which we have to So I am proud to support a bill that toric step forward in improving the delivery of understand is that we want to save says simply we have a crisis, that to health care in America. It deserves the sup- money by taking these old folks off of preserve Medicare we have to fix it, port of every Member of this body. this fee-for-service, seeing their own and we can do it. It is actually not very Mr. DINGELL. Mr. Chairman, I yield doctor business. Cannot my colleagues hard. It means reducing the rate of 30 seconds to the gentleman from not understand that? We have these growth in Medicare from 10 percent Michigan [Mr. CONYERS]. private organizations. They meet every down to 6.5 percent. Mr. CONYERS. Mr. Chairman, I say month. Most of them are Republican, Why do we think we can do this? Be- to the gentleman, great statement. The but what has that got to do with it? cause the private sector has already re- gentleman’s district loses in hospital When they are there, they do not have duced the rate of health care cost fees $260 million. The legal news points meetings asking how many lives did we growth to 3 percent. We can preserve out doctors mop up on medical mal- save. They want to know many bucks Medicare by reducing its growth rate practice reform, and you have not had did we make. Now the quicker we get to twice that of the private sector. We October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10353 can do that, and we can do that in a going to make. They have set the infla- rural doctors in this country quit test- way that opens up new opportunities tionary rate. Who are they, the Oracle? ing completely. for seniors because Medicare is an old- They cannot do that. The fact is we had a well-intentioned fashioned program that does not pro- What they have done here by setting plan. There were problems with pap vide prescription drugs nor cover pre- those unofficial rates, they have cheat- smears in this country, but there were vention, all of which can save money. ed the senior citizens of this country. not that kind of problems. Now what Right in Boston today we have two My Medicare card is shivering in my we do is we have patients paying two plans open to Medicare seniors offering pocket when I sit here and listen to and three times for the same testing, all Medicare services, prescription some of this, because what they are waiting 2 and 3 days to get the same re- drugs, and a number of other services, doing is fooling the senior citizens. sults back. CLIA was well-intended. It for zero premium. That is a zero-pre- They say to me, ‘‘Don’t scare them.’’ I has now been changed. We will have mium choice. need to scare them and say, ‘‘Look out, quality because we are going to trust it is coming.’’ I ask the Members, our caregivers to give us quality. b 1415 would they know a hurricane is coming Mr. GIBBONS. Mr. Chairman, I yield That means for the same dollar we and not do anything about it? myself such time as I may consume. are investing into Medicare, these I am saying, and all over this coun- Mr. Chairman, I would ask the gen- folks in Boston, our senior citizens, are try I will continue to say that they are tleman, how many 65-year-old older going to get choices that buy better not telling the full truth to these sen- women in his district were pregnant than Medicare benefits. That is what ior citizens. Mr. Chairman, the honor- last year? How many 65-year-old this is all about. It is about controlling able gentleman from Pennsylvania women, older women, were pregnant in costs in Medicare by opening up to sen- [Mr. GREENWOOD] this morning said, his district last year? iors the kinds of plans that in the pri- and also my sister here who is a health Mr. DINGELL. Mr. Chairman, I yield vate sector have preserved benefits and care expert, bringing down the infla- 30 seconds to the distinguished gen- reduce the rate of medical inflation in tion rate. Who told them they can do tleman from Pennsylvania [Mr. KLINK]. this country. that? They do not know what is going Mr. KLINK. Mr. Chairman, I thank And how do we get the $270 billion? to happen. I rebut that stand very the gentleman for yielding time to me. This is how we get it. We reduce the much, because they cannot do that. Mr. Chairman, I just wanted to say rate of growth in hospital reimburse- I can tell Members how many of that under the Gingrich Medicare plan, ment rates and doctor reimbursement them are going to be hurting when medical providers and hospitals around rates so they go up 6.5 percent instead they get back home. People back home the district of the gentlewomen from of 10 percent. You Democrats keep do not know they are up here pontifi- Connecticut [Mrs. JOHNSON], and she jumping up and saying ‘‘We are cutting cating. They do not know that. But spoke just a few moments ago, are funding to hospitals’’. Mr. Chairman, I when they get back there and they going to lose $129 million over the next ask Members to ask their kids if they look at how their hospitals are going 7 years. That is what I call choice can pay more than the 19 percent of broke, they are going to come to them under the Gingrich Medicare programs. payroll that they are now paying for and say, ‘‘What gives here? How can The doctors and hospitals are going to Social Security and Medicare so we can you be the Oracle at Delphi?’’ lose $152 million. That is choice. let those hospitals grow at 10 percent Mr. UPTON. Mr. Chairman, I yield 2 Janis Joplin, if she were alive, would instead of 6.5 percent. Ask them that. minutes to the gentleman from Okla- say freedom is just another word for They will tell us they cannot afford it. homa [Mr. COBURN]. being forced to choose between your Yes, we can guarantee Medicare to (Mr. COBURN asked and was given doctor, who will leave the traditional our seniors by slowing the rate of permission to revise and extend his re- Medicare plan, and whatever else you growth in reimbursements to hospitals marks.) are going to do. and physicians, and by getting tough Mr. COBURN. Mr. Chairman, many of Mr. DINGELL. Mr. Chairman, I yield on fraud and abuse. Incidentally, if the the people of this country sent new 11⁄2 minutes to the distinguished gen- Members on that side of the aisle do representatives to this Congress, rep- tleman from Maryland [Mr. HOYER]. not like our fraud and abuse provi- resentatives that have a basis of expe- Mr. GIBBONS. Mr. Chairman, I yield sions, why didn’t they propose tougher rience. 30 seconds to the gentleman from laws when they were in the majority As a practicing physician who con- Maryland. for 40 years? tinues to care for Medicare patients The CHAIRMAN. The gentleman We get $2 billion more in revenues and Medicaid patients, whose practice from Maryland [Mr. HOYER] is recog- from our fraud and abuse provisions be- was made of a majority of Medicaid nized for 2 minutes. cause we are tougher than we have and Medicare patients, I have truth- (Mr. HOYER asked and was given been in the past. So, the $270 billion fully and honestly looked at this bill. permission to revise and extend his re- comes from slowing the rate of growth This bill is going to save Medicare. It is marks.) in reimbursements to doctors and hos- not perfect, but it does the things that Mr. HOYER. Mr. Chairman, we had pitals, cracking down on fraud and we need to do to preserve this program. the opportunity to see a tape from a abuse and, yes, requiring seniors to To do otherwise, to put a band-aid on consultant to a Republican meeting. continue paying premiums to cover 31 it, is wrong. The consultant said ‘‘Use soothing percent, just what they are paying I want to share with the Members for words for your radical change. Tell today, and, though the Members on a moment what happened and what we them you are saving Medicare. Tell that side never mentioned it, in our have done by changing some of the sys- them you are giving them choices. Ex- plan requiring rich seniors to pay tem. Not long ago, in the late 1980s, a press moderation in your radicalism more. We are proud of our plan. It pre- program called the Clinical Laboratory and swear that the $270 billion cut in serves Medicare and protects seniors. Improvement Act was introduced. The Medicare has nothing to do with the Mr. GIBBONS. Mr. Chairman, I yield effect of the act is that you can have a $245 billion cut in taxes,’’ and hope 1 minute and 30 seconds to the gentle- pregnancy test at home using tech- that the public is lulled into apathy. woman from Florida [Mrs. MEEK]. nology today that the Federal Govern- So we hear on this floor talk by our (Mrs. MEEK of Florida asked and was ment says your doctor is not capable of Republican colleagues of preserving given permission to revise and extend using unless approved by the Govern- and reforming a health care system her remarks.) ment. that 93 percent of them opposed in 1965. Mrs. MEEK of Florida. Mr. Chair- As a result of that, what we see is Beware, the wolf in sheep’s clothing. man, who do the Republicans think that 30 percent of the doctors, and Beware those who want to save that they are, the Oracle of Adelphi? They mainly in rural America, are still test- which they eschew. Beware those who have just put a bill together where ing, 54 percent of the doctors stopped want to come from the majority party they arbitrarily set interest? They some form of testing because of this in Washington and help you. look forward to the year 2002, and they law. Seven percent dropped tests for Mr. Chairman, if we pass this bill have said how much money people are other reasons, and 9 percent of the today, before too long Medicare for H 10354 CONGRESSIONAL RECORD — HOUSE October 19, 1995 millions and millions of Americans will The Republican plan will undermine Medi- Thirty years ago the Congress made a become Medigone. Oppose this Repub- care in other ways as well. promise to the American people. That promise lican medical killing proposal. Medicare-plus Programs will be allowed to was a bold commitment to entitle older Ameri- Mr. BLIILEY. Mr. Chairman, I yield 1 cherry-pick low risk seniors, leaving traditional cans, poor children, families, and the disabled minute to the gentleman from Califor- Medicare subject to the higher costs of ad- to health coverage through the Medicaid and nia [Mr. BILBRAY]. verse selection. Medicare Programs. Today, our new Repub- Mr. BILBRAY. Mr. Chairman, not too The plan creates incentives for doctors and lican leaders are turning their backs on that long ago I got a call from a senior citi- hospitals to leave traditional Medicare for promise. zen in my county about the fact that Medicare-plus options that permit them to Why? The facts are that they cut Medicare she was billed for two mammograms. charge seniors higher feesÐcreating the prob- When she confronted the billing agent so deep to pay for their tax breaks. American ability that seniors who cannot afford higher seniors will be forced to pay more out of their on it, they assured her that she was Medicare-plus charges will be unable to find wrong and she was just a senior, just a pockets, will have less choice in selecting their doctors and hospitals willing to treat them. own doctor and will receive a lower quality of senior and did not understand. The And, the plan actually weakened sanctions mistake is the seniors understand. This service, so that the Republicans can use sav- against waste, fraud and abuse. ings for a tax cut. women pointed out that it was phys- I believe that we need to take steps to fix ically impossible for her to have two what's broken with Medicare. None of the $270 billion that the Repub- mammograms, because she had had We must crack down on the waste, fraud, licans are cutting out of the Medicare Program surgery 2 years before, and when this and abuse. will go back into the Medicare trust fundÐnot billing agent found out about their I know that seniors are willing to bear their one cent. It will all go back into the general mistake, the comment was ‘‘Well, it is fair share of the costs of balancing the Federal Treasury. The Republican lockbox is a gim- not your money, ma’am. Why are you budget for our children and grandchildren. mick. It does not change the fact that the cuts worried about it?’’ But this debate is not about fixing what's are there to be counted in determining wheth- For too long, people have been saying wrong. er the budget is balanced and you can't give to the seniors ‘‘It is not your money, It's not about changing the parts of Medi- those tax breaks, and balance the budgetÐ do not worry about it.’’ The seniors care that don't make sense. not without cuts. Did the Republicans cut de- care. In this bill, we are going to fight It's about charging seniors more for health fense to pay for their tax break? No, they cut fraud by creating a neighborhood care. Medicare and Medicaid. watch strategy for fighting Medicare It's about giving seniors less for their Medi- fraud. We are going to allow the sen- The Medicare trustees say that the pro- care dollars. iors to participate, not only in choos- posed cuts are more than three times greater And it's about filling the tax cut hole. ing their program for their health care, than the $89 billion recommended to keep the I urge my colleagues to vote ``no'' on the but also participate in fighting fraud. Medicare trust fund solvent. I doesn't take a Mr. Chairman, I strongly support Republican Medicare plan. Ph.D. in mathematics to figure out that the this concept, because I think if we real- PARLIAMENTARY INQUIRY $270 billion in Medicare cuts will cover the ly want to be serious about fighting Mr. THOMAS. Mr. Chairman, I would cost of the $245 billion tax break. fraud, then have the guts to allow the ask the Chair, what are the rules in When I came to Congress in January as a seniors to participate in these pro- terms of sloganeering, buttons worn on freshman Member of Congress, I expected grams and approve this bill. the floor when participating in debate? Congress to take care in passing laws. Not in Mr. Chairman, I rise in opposition to the The CHAIRMAN. The Chair has al- this Congress. The Medicare cuts that are be- Medicare package before us today. ready stated that wearing badges on fore the House today got 1 day of hearingsÐ The Republicans have proposed cutting the floor while participating in debate 1 day. And, the committee members didn't $270 billion out of the Medicare system. is against the rules of the House. even have the real bill in front of them before They did not choose $270 billion because it Mr. DINGELL. Mr. Chairman, I will the hearing started. Today we have 1 day of is needed to save the trust fund, or because take it off, and I will be delighted to debate, with no amendments allowed, on the there is $270 billion worth of waste, fraud, and give it to the gentleman from Califor- basic health care program relied on by millions abuse in the system, or because cutting $270 nia. It will benefit him highly. of Americans. We spent all of yesterday on billion will improve seniors' health. Mr. Chairman, I yield 15 seconds to the floor of the House talking about fishÐ They chose $270 billion because they have the distinguished gentleman from New seems to me we could have waited to deal a huge fiscal hole to fillÐa hole created by an Jersey [Mr. PALLONE]. with fish and used at least part of that time to unnecessary and irresponsible tax cut for the Mr. PALLONE. Mr. Chairman, I deliberate on the fate of American's seniors. wealthy. thank the gentleman for yielding time The Republicans have committed to bal- to me. The impact on the State of California will be ancing the budget, increasing spending on de- Mr. Chairman, I just wanted to point large. California will lose $27.5 billion in Medi- fense, and cutting taxes. out that under the Gingrich Medicare care funding over 7 years. California will lose If revenues are going down by $245 billion, plan, the hospitals in and around the $816 million next year alone and the losses and you're going to balance the budget, district of the gentleman from Califor- will only increase as each year passes. The you've got to raid the bank somewhere else. nia, [Mr. BILBRAY] will lose $345 million combined potential loss in Federal health care That somewhere else is Medicare. over the next 7 years in order to pay spending in California over 7 years will be at The Republican plan is not driven by a de- for a tax cut for the rich. least $44.1 billion. In 1996 California will lose sire to save Medicare. Mr. DINGELL. Mr. Chairman, I yield $1.5 billion in Federal health care spending Ninety-three percent of Republicans voted and the loss per year will increase every year against the Medicare Program at its creation. such time as she may consume to the gentlewoman from California [Ms. after 1996 reaching a whopping loss of $12.1 Ninety-nine percent of House Republicans billion in 2002. To put this in perspective, the voted to cut more than $280 billion out of the LOFGREN]. (Ms. LOFGREN asked and was given State of California's entire budget for this fiscal program in 1995. year was $42 billion. The personal cost for This Republican plan is a stake in the heart permission to revise and extend her re- Seniors in my State will be high. They can ex- of the medical insurance program 37 million marks.) pect their premiums to double by the year seniors from all walks of life rely on for their Ms. LOFGREN. Mr. Chairman, I op- 2002. Let me repeat that: California seniors health security. pose the bill. The Republican plan will increase charges Mr. Chairman, I rise today on the behalf of will pay double what they are paying now in to seniors with an average income of $13,000 the thousands of senior citizens, parents, chil- just 6 short years. And Medicare spending per per year so that people with incomes of dren, women, hospitals, doctors, nurses, beneficiary will be cut by $1,700 by the year $350,000 per year can get a $20,000 dollar health-care providers and workers who live in 2002. tax cut. my district and have written to me, talked to In my district in Santa Clara County, CA the I don't think that's fair, and I don't believe me and pleaded with Congress to stop these effects of these cuts will be profound. By the it's right. ill-conceived cuts to Medicare. year 2002, Santa Clara County's Medicare October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10355 loss will be $1.2 billion. Next year alone, newspaper that perhaps not everybody The Republican Party is taking health care Santa Clara will loss $33.4 million in Federal in our listening or viewing audience dollars from low- and middle-income retired Medicare money. I was a Santa Clara County saw. It had this patient lying in bed in Americans to give billions to insurance compa- supervisor for 14 years and I can tell you from a hospital on a life support system, and nies and the already wealthy. experience the ramifications of these cuts will at the foot of the bed he was identified You can bet Americans will remember next be far-reaching. Counties and hospitals will be as Medicare, and there were two Re- November. forced to thin the health care soup. Costs will publican elephants there that were Mr. GIBBONS. Mr. Chairman, I yield be shifted and care will jeopardized. Patients dressed in doctor’s attire and they said, such time as he may consume to the in other insurance programs will feel itÐtheir ‘‘He needs immediate surgery to sur- gentleman from North Carolina [Mr. costs are likely to go up or coverage down. vive,’’ and the nurse was behind the WATT]. I have received letters from both private and two elephants and she was standing in (Mr. WATT of North Carolina asked public hospitals in my district that tell me they front of the Jackass and a man who oc- and was given permission to revise and do not know how they will be able to cover the cupies the other end of Pennsylvania extend his remarks.) Medicare losses. Public hospitals form the Avenue, and said ‘‘No, no, the family Mr. WATT of North Carolina. Mr. backbone of the safety net in most counties. insists, no surgery. They believe in Chairman, I rise in strong opposition They provide substantial amounts of care to faith healing.’’ I think it pretty well to the scam on the senior citizens of low-income populations and the uninsured. describes so much of the rhetoric that America. They rely heavily on Medicaid and Medicare to has been going on here in this debate. Mr. GIBBONS. Mr. Chairman, I yield pay for that care. These hospitals also provide We got from the administration’s such time as he may consume to the wide range of regional and community serv- trustees the death sentence. They gentleman from California [Mr. DIXON]. ices that are often not otherwise available, handed down the death sentence on the (Mr. DIXON asked and was given per- such as trauma care, children's specialty serv- fate of Medicare. mission to revise and extend his re- marks.) ices, spinal cord injury rehabilitation and burn b 1430 care. Medicaid and Medicare ensure that Mr. DIXON. Mr. Chairman, I rise in these hospitals remain financially viable to It required some kind of immediate opposition to this bill. provide these much needed services. In Cali- attention. Now, to be sure, we could Mr. Chairman, I rise today in strong opposi- fornia the number of people who rely on public have enacted blood transfusions out of tion to the Medicare Preservation Act of 1995 hospitals is growing. And, growing along with my children and my grandchildren by (H.R. 2425), a bill which cuts $270 billion from it at an even more alarming rate is the number tripling their taxes as a way of address- the Medicare Program over the next 7 years. of uninsured people. ing this problem. But there are more This bill would make these cuts by substan- While the financial side of these cuts is im- efficient ways and ways that employ tially increasing out-of-pocket costs for bene- portant, the human question of serving people certain options that have been preva- ficiaries and reducing the payments to health in need is paramount. On behalf of all of those lent in the private sector all along, and care providers, which has serious implications people who live in the 16th district of Califor- that is guaranteeing people more for the quality of care our seniors deserve. nia who have taken the time to write, to call choice and more control over their own Under this bill, beneficiaries face a retire- and to speak up against these cuts, I ask my medical coverage. ment plagued by higher health costs. The bill colleagues here in Congress, not to turn your The fact of the matter is I am con- permanently increases the beneficiary's por- back on this American promise. Don't turn fident that the Republican approach tion of the Medicare part B premium to 31.5 your back on America's seniors and unin- can address this problem and simulta- percent, resulting in a $48 billion increase in sured. It isn't too late to say: ``this goes too neously hold those escalating costs on costs over 7 years. far.'' an annual basis to just a little more Hospitals and other health care institutions, Mr. DINGELL. Mr. Chairman, I yield than 2 percent than the escalating already facing severe budget constraints, 1 minute to the distinguished gen- costs in the private sector. That is not would face a $70 billion cut in Medicare pay- tleman from Virginia [Mr. SISISKY]. too much to expect. ments. Roughly half would come from a re- (Mr. SISISKY asked and was given The fact of the matter is this is long duction in the inflation adjustment received by permission to revise and extend his re- overdue legislation. It is a shame we hospitals. Skilled nursing facilities would find marks.) waited until the 11th hour to finally themselves $10 billion poorer. Hospitals which Mr. SISISKY. Mr. Chairman, I have take a look at it, but I support H.R. treat a disproportionate share of low-income just completed, 7 weeks ago, an oper- 2425. I urge all of you too. beneficiaries get their funding cut twice. One ation for rectal cancer. I was able to af- Mr. GIBBONS. Mr. Chairman, I yield cut will come from the inflation adjustment and ford the prescreening of that, even such time as he may consume to the another cut will come from a reduction in though I am on Medicare, but I found gentleman from Massachusetts [Mr. funds from the disproportionate share program out today that it is not even included OLVER]. [DSH] by $9 billion. in this bill. How can we be (Mr. OLVER asked and was given Health care providers participating in tradi- uncompassionate for people who can- permission to revise and extend his re- tional Medicare would face an extra hit from not afford to get these examinations? marks.) the so-called failsafe provision. This provision Mr. OLVER. Mr. Chairman, I rise in It just seems to me that that is one of would require the Secretary of Health and opposition to this legislation., the things that should be included. Mr. Human Services to further reduce payments to Mr. Chairman, today the Republican Party Chairman, I do not need 30 seconds doctors and hospitals if Medicare spending ex- takes on the onus for dismantling Medicare, more to say that I do not believe in at- ceeds the targets for a given year. the health care guarantee within Social Secu- tacking, and doing this from the Demo- These reductions would apply only to tradi- rity. crats or Republicans, but just from And you can bet the Republican Party has tional Medicare and are estimated to result in utter compassion for people, I promise its sights on dismantling Social Security as an additional $31 billion in cuts. The failsafe the Members, to get that examination, well. provisions clearly demonstrate the bias they do not have to worry about fraud And to what end? To create a comprehen- against the traditional Medicare fee-for-service and abuse then. Nobody will ask and sive health care system which 80 percent of system, on which the vast majority of bene- beg for that examination, I promise Americans want? No. ficiaries now rely. that. But for goodness sakes, care To serve extremists in the Republican Party. Until very recently, doctors would have about people who do need that exam- To serve the insurance companies and the faced nearly $55 billion in cuts. However, the ination. American Medical Association. Republicans made a last minute change in Mr. ARCHER. Mr. Chairman, I yield 2 The Republican Party in cutting $270 billion calculating payments to physicians to secure minutes to the distinguished gen- from health care for American retirees to give the endorsement of their bill from the Amer- tleman from Illinois [Mr. CRANE], $245 billion in tax cuts. ican Medical Association [AMA]. chairman of the Subcommittee on More than half of the tax cut goes to fat cats Another enticement for doctors is the bill's Trade of the the Committee on Ways already making over $100,000 per yearÐwhile arbitrary limits on the recovery of damages in and Means. 75 percent of the people taking Medicare cuts malpractice suits. Such a provision has noth- Mr. CRANE. Mr. Chairman, there was to pay for that tax cut live on less than ing to do with Medicare and does not belong an interesting cartoon in yesterday’s $20,000 per year. in the measure. It is shameful that the GOP would commingle the cost of delivering health care with tort reform. H 10356 CONGRESSIONAL RECORD — HOUSE October 19, 1995 We know that Medicare's insolvency must from Virginia [Mr. BLILEY] has 10 min- As I hear people from this side of the be addressed. We also know that it is not nec- utes remaining, and the gentleman aisle coming down and saying, ‘‘Trust essary to do so by cutting $270 billion from from Michigan [Mr. DINGELL] has 91⁄4 us, we are so compassionate,’’ the rea- the program. Treasury Secretary Robert minutes remaining. son we do not trust you is that you RubinÐone of the Medicare trusteesÐwrote Mr. BLILEY. Mr. Chairman, do I were not for this program to begin to Speaker GINGRICH to let him know that have the right to close for the Commit- with. You waved the trustees’ report $270 billion in cuts are not necessary to keep tee on Commerce? around as to why you had to cut this, the program solvent. Also, the Republicans The CHAIRMAN. The gentleman not the tax cut, but the trustees. But have admitted that their bill will only keep from Virginia is reserving the right to you will not wave your 961-page bill Medicare solvent until 2006. That is the same close. past the trustees to see if they fixed it. length of time that the Democratic alternative, Mr. BLILEY. Mr. Chairman, I yield 2 No; no; no. which cuts only $90 billion, would keep Medi- minutes to the gentleman from Con- We fix it as much as you fix it. We do care solvent. necticut [Mr. FRANKS]. what they do about fixing. You go on Why are the Republicans recommending Mr. FRANKS of Connecticut. Mr. to raid it. You do not really like that. these Medicare cuts? Because they need to Chairman, in the 103d Congress, all par- You do not really like people pointing find $245 billion to pay for their tax cut pro- ties involved in the delivery of health that out. posalÐmost of which benefits corporations care services as well as those receiving You also turn on the fraud faucet, as and higher income Americans. care recognized that change was in the Attorney General said. That is why The American people want a different ap- order. However, the public said ‘‘no’’ to we do not trust you, and that is why proachÐone which ensures Medicare's sol- the radical government takeover Clin- this is a tragic day because you are un- vency but without jeopardizing the quality of ton plan and ‘‘yes’’ to a market-driven raveling social Medicare as we know it care that Medicare beneficiaries currently re- system. and Medicaid as we know it, and you ceive. The alternative offered by Democrats Now in the 104th Congress, we are at- know it. on the Ways and Means Committee would tempting to address the unacceptable Mr. ARCHER. Mr. Chairman, I yield 2 make smaller reductions in the Medicare Pro- double-digit growth of Medicare which minutes to the gentleman from Ne- gram without raising premiums. However, the would lead to its bankruptcy. Our plan braska [Mr. CHRISTENSEN], another re- alternative was rejected by the Ways and provides health care security for today spected member of the Committee on Means Committee Republicans. and tomorrow’s seniors. It does so Ways and Means. It is ironic that the Republicans named their without increasing the tax burden on Mr. CHRISTENSEN. Mr. Chairman, bill the Medicare Preservation Act. It should be families and without increasing copays 30 years ago Medicare, when it was renamed the Medicare Devastation Act. This or deductibles for seniors. started, was estimated to cost, in 1995, bill jeopardizes the health care of beneficiaries Like in the general population, Mr. $9 billion. The people who were operat- and places a heavy burden on health care Chairman, Medicare-plus will allow ing the Government back then miscal- providers. We should not be making deep cuts seniors to choose from a variety of culated a little bit. Today it costs $178 in Medicare to pay for tax cuts. America's sen- plans. If seniors would like to stay in billion, a $169 billion miscalculation, a iors deserve better. the traditional Medicare plan, they miscalculation that has caused an in- Vote ``no'' on the Medicare Preservation Act. can. Our plan will help end waste, credible stress upon the system, a mis- Mr. GIBBONS. Mr. Chairman, I yield fraud, and abuse in our current system. calculation that the Medicare trustees 1 minute to the gentleman from Ten- It offers regulatory relief to help curb said would bankrupt the system in the nessee [Mr. FORD]. the growth of health care costs. year 2002, and that we were given the Mr. FORD. Mr. Chairman, under the We also protect the quality of health choice of whether we should let it go Gingrich Medicare plan, the hospitals care for the future by protecting and bankrupt or whether we should try to in and around the district of the gen- strengthening our teaching hospitals. save it. tleman from Illinois [Mr. CRANE], who It should be noted, Mr. Chairman, that Since working on this plan for the spoke earlier, will lose about $67 mil- better managing the services would not last 8 months, I am proud to say this lion over the next 7 years. mean lesser services. It would mean plan is going to offer a lot of choices. It Mr. Chairman, I have been receiving doing things better and smarter. is going to offer choices to my 84-year- calls all afternoon in my office with We have incentives in our plan to en- old grandmother. It is going to offer this debate being heard throughout courage all involved in Medicare to choices to my soon-to-be 65-year-old fa- America. People are saying: ‘‘Please, play a role in better managing each ther. It is going to give him the oppor- do not vote for the Gingrich Medicare dollar spent on health care. tunity, as he lives in rural America, to plan.’’ The Democrats would like to give the get into a medical savings account. It I am not going to vote for that plan public the impression that they have is also going to give him the oppor- today. I want my constituents to know the market cornered on compassion. tunity and choice to get into a pro- that. Oh, how wrong. Oh, how wrong. vider-sponsored network. In my district alone, I say to the gen- A variety of plans will give us com- He thinks he can manage his money tleman from Texas [Mr. ARCHER], hos- petition and will thus increase the better than the Federal Government pitals in my area will lose $457 million likelihood of a more efficient system. can. over the next 7 years. There are clear Mr. DINGELL. Mr. Chairman, I yield I am proud this plan is going to save winners and losers in this Gingrich myself 15 seconds. Medicare for whose who want to re- Medicare plan. The losers are the elder- I note for the record that, under the main in the current Medicare system ly and the hospitals throughout Amer- Gingrich Medicare plan, hospitals in and offer choices for those who want to ica. and around the district of my good get into new Medicare, Medicare-plus. Those winners are the health insur- friend, the gentleman from Connecti- This is a good plan. ance industry, and naturally we know cut [Mr. FRANKS], in Waterbury, CT, I urge strong support for passage of those who will receive the huge tax will lose $211.8 million over the next 7 the Medicare Preservation Act. breaks. years so the rich can get a tax cut. Mr. GIBBONS. Mr. Chairman, I yield There will be a substitute that will Mr. Chairman, I yield 1 minute to the 30 seconds to the gentleman from New come soon to this bill that Democrats distinguished gentlewoman from Colo- York [Mr. ENGEL]. will being solvency to the Medicare rado [Mrs. SCHROEDER]. Mr. ENGEL. Mr. Chairman, this sign plan only with $90 billion, and not the Mrs. SCHROEDER. Mr. Chairman, I says it all. Shame on NEWT GINGRICH $270 billion under the Gingrich plan. just came to say we now know what and the Republicans for what they are Mr. BLILEY. Mr. Chairman, could I this is all about. The Speaker said the doing to senior citizens in this country. inquire how much time remains? crown jewel is going to be the tax cut, Shame on them for what they are The CHAIRMAN. The gentleman the tax cut for the parade of million- doing to people who have worked hard from Texas has 8 minutes remaining, aires we have seen going in and out of all of their lives. the gentleman from Florida has 81⁄2 his office recouping what they have in- At least our Republican colleagues minutes remaining, the gentleman vested in GOPAC and everything else. have been somewhat consistent. This October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10357 bill came out of the Committee on tleman from Texas [Mr. FIELDS], has everyone will suffer because of the reduced Ways and Means. They certainly found hospitals that charge $35 a day, be- health care delivery systems available to many ways to be mean to senior citi- cause they are going to lose $102 mil- them. zens in this country. lion, and so that is about all they are This bill is not a Medicare Preservation Act. Our colleagues talk about choice, our going to be able to provide is $35 worth It's the Medicare Destruction Act. Thirty years Republican colleagues. The only choice of service. ago, 93 percent of all Republicans voted senior citizens are going to have under Mr. Chairman, and Members of the against MedicareÐtrying to kill it before it was this legislation is whether or not to House, today the Gingrich Republicans bornÐnow they're trying to kill it again. The buy dog food to eat because that is all snatched from the elderly of this coun- $452 billion savings attained at the expense of they will be able to afford after they try the finest health care system in the our older Americans, our poor women and get through paying for health care world, the most comprehensive health children and even the working children of sen- under this bill. care system in the world, that gives ior citizens will be used to pay for a $245 bil- Shame, this bill ought to be rejected. the finest quality of health care in the lion tax cut which benefits a minority of Mr. BLILEY. Mr. Chairman, I yield world, and they do so not to strengthen wealthy Americans. It is not fair, it is not right, 11⁄2 minutes to the gentleman from that system, not to preserve that sys- it is not necessary. We should vote ``no.'' Texas [Mr. FIELDS]. tem, they do so simply to snatch over b 1445 (Mr. FIELDS of Texas asked and was $200 million in excess cuts to provide a Mr. GIBBONS. Mr. Chairman, I yield given permission to revise and extend tax cut to the wealthiest. his remarks.) This day is the day that a system 2 minutes to the gentleman from Mas- Mr. FIELDS of Texas. Mr. Chairman, that has been built up to provide secu- sachusetts [Mr. NEAL]. Mr. NEAL of Massachusetts. Mr. facts should be important in this de- rity and protection for America’s elder- Chairman, this Republican Medicare bate. ly, for the people who built this Nation bill is a direct assault upon hospitals Mr. Chairman, when most Americans and fought its wars, this is the day we across America. The bill includes the who are in managed care plans go to start to shred that system, and in a largest cuts in the history of Medicare, the doctor, it costs $10. However, Medi- matter of years it will not be whether and do not kid yourself, they are aimed care recipients, such as my mother and they force you out of the system, there at our hospitals. grandmother, pay the first $100 and will be no system that people have Do not be fooled by this rhetoric. The then 20 percent of the remainder. When come to expect in this country. Gingrich Medicare bill does much more most Americans go to the hospital, Mr. GIBBONS. Mr. Chairman, I yield than tinker around the edges with the they pay $35 a day. Seniors, on the 30 seconds to the gentleman from New way hospitals are reimbursed. These other hand, pay a $716 deductible for Jersey [Mr. MENENDEZ]. Republican Medicare cuts jeopardize the first 60 days and then $179 for every (Mr. MENENDEZ asked and was the ability of hospitals to continue to day afterwards. That is because while given permission to revise and extend provide quality care. most Americans have a choice, seniors, his remarks.) Republicans say that the cuts to hos- choices are made for them by Washing- Mr. MENENDEZ. Mr. Chairman, I pitals included within this bill are just ton bureaucrats. hope my New Jersey Republican col- reductions in growth. This is simply So after months of hearings and care- leagues will remember that not only not true. The Republican Medicare bill ful study, we will vote today on legisla- will we be hurting New Jersey senior will bring real pain to many hospitals tion that will not only ensure the long- citizens who will pay $1,000 for the across America. This bill could include term fiscal health of Medicare, but also privilege of getting less but we will outright cuts to many hospitals, hos- create choice by providing options for lose $14 billion, $7 billion from Medi- pitals that are already vulnerable and senior citizens. This bill moves the de- care, $7 billion from Medicaid. That is in difficult financial situations. cision-making down the Potomac not right. It is wrong. It is not nec- We have the luxury in this Congress River, outside of the beltway and into essary, and there is not one New Jersey today of looking at Medicare in a vacu- the hands of people like my mother and Representative who can stand on this um. Hospitals do not have this luxury. my grandmother. floor and in good conscience vote for When drastic cuts to Medicare dis- The Medicare Preservation Act of this package. This is not the Medicare proportionate share and teaching hos- 1995 offers seniors the opportunity to Preservation Act. It is the Medicare pitals are coupled with outlandish Med- continue participating in the existing Destruction Act, and New Jersey is one icaid cuts that are coming, our Na- ‘‘fee for service’’ system, if they want of the prime targets. tion’s hospitals are going to be left out to. However, it will give them much Mr. Chairman, I rise today in strong opposi- to dry. Public hospitals, community greater choice. Seniors will have the tion to devastating Medicare. Common sense hospitals, and old urban hospitals, dis- chance to opt into HMO’s or to buy pri- dictates that taking $270 billion out of your ac- proportionate share hospitals and vate health insurance policies. countÐand telling you that you will be better teaching hospitals, they simply cannot They will be able to select the medical sys- offÐjust does not make sense. If this bill absorb the cuts of this magnitude, as tem that best suits their needs; that saves passes, it will hurt Americans of all ages. Sen- Republicans naively suggest. them money; that provides the most benefits iors will be hurt because they will have less The Medicare bill will damage the for the lowest cost. choice in their health care. They will be hurt quality of care that our hospitals This bill creates tax-free ``medisave'' ac- because they will pay over $1,000 more by enjoy. It is that simple. Vote against counts that provide seniors incentives to shop the year 2002. To remain in Medicare as they this ill-conceived, unwarranted, and around for the most cost-effective care and to know it, they will be forced to pay substantially unwise attack. reward seniors who maintain healthy habits. higher prices than they do today. Their chil- Mr. ARCHER. Mr. Chairman, I yield This bill will also help retirees maintain pre- dren will be hurt because they will be ex- myself 1 minute. viously held employer-provided health cov- pected to step in and help their older parents Mr. Chairman, a great deal of infor- erage. meet these rising Medicare and nursing home mation has been presented today. Some Finally, according to one study, if Medicare expenses, at the same time they're trying to numbers have been called cuts, some is not reformed soon, the average increase in send their kids to school. have been called increases. I think it is cost per household, in my district alone, ini- If this bill passes, our hospitals will be se- important that we focus on why this tially will be $1,541. Therefore, I urge my col- verely impacted. I hope my New Jersey col- difference occurs. leagues to pass H.R. 2425 because under this leagues remember that Medicare provides 45 The hospitals will get an increase in bill, seniors, like my mother and grandmother, percent of all hospital revenuesÐ76 of our every year under our plan, compared to are winners. New Jersey hospitals will be on a critical list. the previous year, but the Democrats Mr. DINGELL. Mr. Chairman, I yield Many of those hospitals receive over 65 call those cuts, because they are using 1 minute to the distinguished gen- percent of their revenue from Medicare; and, the CBO projections that assume that tleman from California [Mr. MILLER]. if this bill passes, they may be forced to con- health care costs are going to go up at Mr. MILLER of California. Mr. Chair- solidate, offer fewer services, or even close. over 10 percent per year. That projec- man, Members of the House, it is a Any of those options adversely impact every- tion is unsustainable. We all know good thing my colleague, the gen- one in the community; not just seniors. And that. H 10358 CONGRESSIONAL RECORD — HOUSE October 19, 1995 But if we take anything off of that in benefits, will always remain as an recipients that they don’t currently unsustainable increase, they call it a option. have, and it is much better than the cut. If we increase above today’s level Mr. Chairman, I do not ever want to fiscal band-aid that has been proposed of expenditure and above the rate of in- look in the eyes of one of my seniors by my Democratic colleagues across flation, they still call that a cut. As I and say ‘‘Medicare went bankrupt on the aisle. have said earlier, only in Washington is my watch.’’ Mr. Chairman, I want my former pa- an increase, because of this phony pro- Mr. DINGELL. Mr. Chairman, I yield tients and, now my senior citizen con- jection, called a cut. We are not cut- myself 15 seconds to note that the hos- stituents, to have good health care. ting hospitals, we are increasing them pitals of my friend, the gentleman from Our final vote on this measure will at a slower rate. Michigan [Mr. UPTON], under the Re- probably be after a Presidential veto Mr. DINGELL. Mr. Chairman, I yield publican bill will lose $211 million over and then an agreement between the 1 minute to the gentleman from Texas, the next 7 years so we can give a tax President and Congress. If at that Mr. GENE GREEN. cut to the rich. time, I am not happy with a plan that (Mr. GENE GREEN of Texas asked Mr. GIBBONS. Mr. Chairman, I yield protects our senior citizens’ health and was given permission to revise and myself 30 seconds. care than I will vote accordingly. Un- extend his remarks.) Mr. Chairman, I sat through a num- fortunately, I don’t have a crystal ball. Mr. GENE GREEN of Texas. Mr. ber of hearings with the gentleman For today, I vote for the bill because it Chairman, it is a sad day that the from Texas [Mr. ARCHER] and heard is moving in the right direction. House is about to pass this crown jewel him make the same speech. I have lis- Mr. GIBBONS. Mr. Chairman, I yield of the contract which slashes a $270 bil- tened to him all day make the same 30 seconds to the gentleman from Cali- lion from Medicare in order to pay for speech. He says there are not any cuts fornia [Mr. WAXMAN]. a budget busting $245 billion tax cut. in his bill. I do not know which one it Mr. WAXMAN. Mr. Chairman, the The bill that is about to be passed by is in, the one he introduced the other preceding speaker talked about the de- Speaker GINGRICH and the Republican day of the one he introduced last night, cisions that have to be made and who majority will add hundreds of dollars but the CBO just gave a scoring table will make those decisions. I would sub- every year to seniors’ out-of-pocket on his bill, whichever one it is, and mit if people are herded into HMO’s be- medical costs and force seniors to give says it cuts $270 billion. Now, some- cause they really have no other choice, up their life-long doctors, without sav- body is stretching the truth. because they cannot afford anything ing Medicare past the year 2006 and Mr. BLILEY. Mr. Chairman, I yield 2 else, the decisions will be made by a without cutting, in fact increasing the minutes to the gentleman from Iowa bureaucrat in an HMO that wants to problems, of fraud, abuse, and waste. [Mr. GANSKE]. maximize the profit for the HMO. That This bill is about as much designed Mr. GANSKE. Mr. Chairman, every- is not the way the decisions for health to save Medicare as the grim reap is de- body in this Chamber cares deeply care should be made in this country. signed to bring happiness to our lives. about the health care of our senior citi- Mr. DINGELL. Mr. Chairman, I yield Mr. Chairman, I urge everyone to zens. Prior to last November, I was a 15 seconds to the distinguished gen- continue this fight. The decision today doctor taking care of Medicare pa- tleman from Ohio [Mr. BROWN]. is just round one. The Democrats will tients, and I too am especially con- Mr. BROWN of Ohio. Mr. Chairman, continue to fight this extreme bill if it cerned about this issue. Which is why I the previous speaker, the gentleman is enacted. The senior citizens in my am going to support the Medicare Pres- from Iowa [Mr. GANSKE], my friend on district and around our country de- ervation Act. the Committee on Commerce, his hos- serve better. I hope the Senate will Mr. Chairman, for many years the pitals in and around his district will change it. If not, I pray the President Health Care Financing Administration lose $241 million over the next 7 years will veto it. has been tightening the tourniquet on because of the Gingrich Medicare cuts. Mr. BLILEY. Mr. Chairman, I yield health care by price controls, and bu- Mr. DINGELL. Mr. Chairman, I yield 11⁄2 minutes to the gentleman from reaucratic paperwork, and regulations. 1 minute to the distinguished gentle- Michigan [Mr. UPTON] who was so help- If we do nothing substantive and struc- woman from Connecticut [Ms. ful in helping us revise the AAPC for- tural, then you will see much more of DELAURO]. mula. the same, and no longterm solution to Ms. DELAURO. Mr. Chairman, Hu- Mr. UPTON. Mr. Chairman, days like explosive costs. A tourniquet too tight bert Humphrey remarked in 1977: today we need to think about the rea- can cause gangrene. It was once said that the moral test of gov- sons why we are here. Are we here to This bill makes an honest effort to ernment is how that government treats talk about problems or are we here to provide structural changes that will those who are in the dawn of life, the chil- dren, those who are in the twilight of life, solve them? The current Medicare Pro- allow seniors to choose options in the elderly, and those who are in the shad- gram today is going bankrupt. You which they will be able to make deci- ows of life, the sick, the needy, and the know that, and we know that. Can you sions, in consultation with their doc- handicapped. imagine the answer to the question in tor, about their health care, rather Mr. Chairman, this Republican con- the next decade if today we shirk our than having that decision made by a trolled House miserably fails that responsibility from saving Medicare faceless Government bureaucrat. moral test. I stand here in this Cham- from going bankrupt, what seniors will The question, Mr. Chairman, is not ber ashamed, ashamed that my Repub- say about this Congress? ‘‘What the whether decisions are going to have to lican colleagues are trading, trading hell happened when you all saw the be made, the question is who is going the health security of our Nation’s el- writing on the wall? What did you do?’’ to make that choice—the Government derly for a tax break for the rich. Two years ago there was a lot of talk or the patient? They talk about attacking fraud and about the Clinton health care plan, and I have devoted a great deal of abuse in the system, but it is bogus, for the more that folks heard about it, the thought to this bill and I have studied the Republican plan turns back the more they did not like it, and it never and read it. This bill is not exactly the clock on statutes to combat fraud and even came up for a vote. Today, as I way I would have written it, but many abuse. They repeal the laws that pro- have met with hundreds and hundreds thoughtful people have worked on this hibits fraudulent practices, like prohi- of seniors and many of my providers, I bill and I hasten to add that I am under bitions on doctors who refer patients to realize that the more folks understand no illusion that my solutions are the providers that they or a family mem- this bill, knowing that the alternative only way to achieve a good end. ber personally profit from. is either doubling the FICA tax or let- However this bill does have provi- The Washington Post says it best, ting Medicare go belly up, the more sions in it for patient protections that ‘‘Gingrich Places Low Priority on Med- they like the idea of themselves choos- I have worked with many Members on, icare Crooks.’’ ing the plan that fits their needs best. it does start to address the inequity in Mr. GIBBONS. Mr. Chairman, I yield The right to choose, with knowledge geographic variations of reimburse- myself 15 seconds. that they can keep Medicare the way ment that exist under the current sys- Mr. Chairman, I know since there are they have it now, without a reduction tem, it does offer choices to Medicare no cuts in this bill and everything is an October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10359 increase, I know the gentleman from about reforming the Medicare programÐit is ficiaries are likely to pay higher premiums to Texas [Mr. ARCHER], will be sad to about tax cuts for wealthy Americans and an get the same or fewer benefits. That is not learn that the Texas Medical Center in arbitrary march to a seven year deficit reduc- what I would characterize as more choices. Houston will lose $500 million, $500 mil- tion target. These cuts are three times more This bill also represents the possible dis- lion. than any estimate of what is necessary to mantling of my state's medical education infra- Mr. Chairman, I yield 1 minute to the make Medicare solvent. structure. As a result of the proposed cuts in gentleman from Maryland [Mr. Treasury Secretary Robert Rubin, managing the Medicare program, Rhode Island alone will CARDIN]. trustee of the Medicare Trust Fund, has re- lose $20 million (10%) of its medical education Mr. CARDIN. Mr. Chairman, let me cently stated that ``no member of Congress budget each year. This bill does nothing to ra- correct some of the misstatements that should vote for the $270 billion in cuts believ- tionalize the graduate medication education have been made by my colleagues on ing that reductions of this size have been rec- system financed through Medicare; rather, it the other side of the aisle. ommended by the Medicare trustees or that simply guts GME which will translate into a re- First, it has been said that our bene- such reductions are needed now to prevent an duction in the quality of health care and re- ficiaries will not have to pay anymore imminent funding crisis. That would be factu- duced access for many citizens as teaching because we are just continuing the cur- ally incorrect''. hospitals close and downsize. rent law. That is not correct. Accord- Here is why the Republican cuts in Medi- The Republican proposal that this House ing to the Congressional Budget Office, care are not about reforming the system and will vote on today will increase costs for health ‘‘It would increase the portion of costs are about paying for a tax cut for the rich and coverage for seniors, reduce quality and ac- borne by beneficiaries through pre- a forced march to deficit reduction. The Medi- cess, and burden working parents. But most miums relative to current law.’’ care Part A Trust Fund is not faced with an importantly, this bill represents nothing less Under the bill before us, the premium unprecedented and immediate crisis. The than a betrayal of the trust of the people of increase goes up to $87 a month for trustees are required by law to report each this country and a reversal of a generation of part B. Under the bill that we will be year on the status of the Part A Trust. The guaranteed health care for the elderly. bringing forward as a substitute, it is trustees have on eight previous occasions b $30 a month less. That is $360 a year. warned that the Trust Fund would be insolvent 1500 For seniors who on average have a within seven years. On each of these occa- Mr. DINGELL. Mr. Chairman, I yield modest income, that is a lot of money. sions, the Congress and the presidentÐwith- 1 minute to the gentleman from Penn- Second, CBO has estimated seniors out alarmist predictions of collapseÐtook ap- sylvania [Mr. HOLDEN]. will have to pay an extra $1,000 a year propriate action to protect the fund. Mr. HOLDEN. Mr. Chairman, the in order to be able to maintain the Republican proposals go far beyond the Gingrich Medicare plan will have a same benefits. When it costs you more Part A Trust Fund and also reach into the Part devastating effect on health care for to maintain the same benefits, it is a B Trust Fund. Their plan calls for about $170 citizens in Pennsylvania. I spent the cut. billion in cuts to Part A of Medicare, which summer talking to my hospital admin- Let me quote finally from the Wash- funds hospitalization, and about $100 billion in istrators and they tell me that cur- ington Post. You have quoted the cuts to Part B, which pays for doctor visits and rently they are reimbursed $1.01 for Washington Post before the plan was ancillary services. The Part A Trust is financed every dollar of services they provide to unveiled. The Washington Post said, by employer and employee contributions, and a Medicare patient. Under the Gingrich ‘‘It is not clear that Government con- ``savings'' will be retained by the Trust. How- plan they will be reimbursed $.88 for tributions would any longer even pay ever, since the federal deficit is calculated by every dollar of services they provide. for basic insurance.’’ including the surplus of the Part A Trust, these There are two choices that our hos- Mr. DINGELL. Mr. Chairman, I yield savings will be used to fund the tax cut and pitals are going to be left with: Cost such time as he may consume to the mask deficits in other public accounts. Part B shift on to employers and working fam- distinguished gentleman from Texas is funded by premiums paid by the elderly and ilies who are paying premiums, or re- [Mr. EDWARDS]. the Treasury. Savings here will directly re- duce services for senior citizens. This (Mr. EDWARDS asked and was given bound to tax cuts and deficit reduction. plan is unacceptable. permission to revise and extend his re- And the cuts we will vote on today are not Mr. Chairman, the American people marks.) only about senior citizens paying more for less cannot be fooled. The American people Mr. EDWARDS. Mr. Chairman, I rise health care; the cuts are also about straining know that the Medicare trustees have in opposition to this unfair, hastily put the intergenerational benefit of the Medicare called for $90 billion to make the sys- together legislation. program. When Congress passed the Medi- tem solvent to the year 2006. The Mr. DINGELL. Mr. Chairman, I yield care program in 1965, we assured working Democratic plan does that. And the such time as he may consume to the families that they would not have to choose American people also know that the gentleman from Rhode Island [Mr. between investing in their children and caring Republican plan only puts in $90 billion REED]. for their elderly parents when they became old to make the plan solvent to 2006, and (Mr. REED asked and was given per- and frail. I have heard from many middle-aged the rest of the money is being used for mission to revise and extend his re- working parents in my district who are afraid a tax break and to balance the budget marks.) of what these Medicare cuts will mean for their on the backs of senior citizens. That is Mr. REED. Mr. Chairman, I rise in familiesÐHow will they find the means to en- wrong. opposition to the Republican proposal. sure that their parents receive quality health Mr. GIBBONS. Mr. Chairman, I yield For more than 30 years, the Medicare and care in their old age? How will they choose myself 1 minute. Medicaid programs have exemplified our na- between their parents and their children? Mr. Chairman, I apologize to every- tional commitment to care for seniors, disabled Surely this is not reform. one that this debate has been so hur- Americans, and low-income Americans. In es- This bill also repeals the current prohibition ried, but it is not my fault. Mr. GING- sence, it is the tangible evidence that, in the against physician self-referral. These laws pro- RICH prescribed the time we would have most affluent and productive country in the vide vital protections for consumers. It has on this debate. Yesterday he gave the world, we would not let millions of Americans been well documented that physician self-re- House 4 hours to talk about shrimp. suffer because they were too old, too poor, or ferral leads to excessive utilization, fraud and Yesterday, Mr. GINGRICH gave the too ill to fend for themselves, Because of our abuse, and drives up the cost of health care. House 4 hours to talk about shrimp. investments in Medicare and Medicaid, we The Congressional Budget Office estimates Today he gave us 3 hours to talk about have also created the most sophisticated and that these changes to the physician self-refer- the benefits of 40 million Americans, highest quality health care system in the ral laws will cost Medicare an additional $400 the most fragile of our Americans, too, world. million over the next 7 yearsÐ$400 million in by the way. So much for Republican But today, Republicans will begin their all- patient abuse in over-testing and over-refer- priorities and for Mr. GINGRICH’s con- out assault on these programs by cutting the ring! cern about people versus shrimp. Medicare program by $270 billion. These cuts Republicans claim that this bill will give sen- Mr. Chairman, this is a horrible piece represent the most sweeping changes in the iors more choices. However, the real truth is of legislation. We know most of the Medicare program since its establishment in that the Republicans will squeeze down so Medicare people are not sick. Ninety 1965. And let me be clear, these cuts are not hard on payments to health plans that bene- percent of them are not sick. We only H 10360 CONGRESSIONAL RECORD — HOUSE October 19, 1995 spend about $1,300 apiece on them. The balance in 2002, with a debt the following CHER] will yield his 5 minutes to his Republican bill takes all that money, year, if adjustments are not made. However, speaker, then the gentleman from gives it to the insurance companies, the President's Medicare Board of Trustees Michigan [Mr. DINGELL] and the gen- the medical savings accounts, and shows that only $79 billion is needed to keep tleman from Florida [Mr. GIBBONS] will leaves Medicare with all of the sick the trust fund solvent. That means we are each yield their 2-plus minutes to the people. It will ruin Medicare as it now looking at $181 billion in unnecessary cuts. minority leader, and then the closing is. That $181 billion could go a long way in pro- debate will be by the gentleman from Mr. DINGELL. Mr. Chairman, may I tecting seniors from increased premiums or Virginia [Mr. BLILEY]. discuss how many speakers we have re- cuts in services. The CHAIRMAN. The gentleman maining. I know the gentleman from Mr. DINGELL. Mr. Chairman, I yield from Texas [Mr. ARCHER] is recognized. Texas has said he has one, the gen- 1 minute to the distinguished gen- Mr. ARCHER. Mr. Chairman, I yield 5 tleman from Virginia has indicated he tleman from California [Mr. WAXMAN]. minutes to the gentleman from Califor- Mr. WAXMAN. Mr. Chairman, today has one, and I am not certain how nia [Mr. THOMAS], chairman of the many my good friend from Florida has. we are discussing only the Medicare Health Subcommittee of the Commit- Mr. GIBBONS. I have one more, Mr. bill. We talked about it in terms of the tee on Ways and Means, a gentleman relationship to the tax bill that is com- Chairman; it is for the minority leader, who has contributed massively in the ing up next week. I want to mention and I will yield him the balance of my development of this plan. the relationship between Medicare and time. (Mr. THOMAS asked and was given Mr. DINGELL. Mr. Chairman, I have Medicaid, which is coming up next week. permission to revise and extend his re- a similar situation. marks.) Mr. Chairman, I yield such time as he Mr. Chairman, we have no program to protect seniors when they become so Mr. THOMAS. First of all, I want to may consume to the gentleman from thank my colleagues, Mr. Chairman, OSTELLO]. frail that they require nursing home Illinois [Mr. C for allowing me to be part of a major- (Mr. COSTELLO asked and was given care. We have relied on Medicaid to ity that has rejected politics as usual. permission to revise and extend his re- take care of that. But next week the What we have heard today from the mi- marks.) Medicaid program is going to be re- nority was a lot of sloganeering, figu- Mr. COSTELLO. Mr. Chairman, I rise in op- pealed and there will be no guarantee rative and literal baloney, and that position to the bill. of a person in a nursing home getting what we propose to do is, in fact, bold Mr. Chairman, I rise today in opposition to coverage after they spend every cent and innovative. And I think those are the Medicare Preservation Act. For the 30 they own. There will be no protection appropriate words, but I also believe it years since it was signed into law, Medicare for the spouse of that nursing home is radical. has been the primary source of health care resident or the children of that nursing coverage for Americans 65 and older. Today, home resident or the lien to be put on Mr. Chairman, what we propose to do I fear, we are going to put the security of our the home. is to not follow the politics as usual so- seniors' health care in jeopardy. There will be no protection in the lution. What is the politics as usual so- This bill cuts $270 billion out of the Medi- standards of care that will be given in lution? Fix Medicare until the next care Program over 7 years. Two hundred and that nursing home because all of that election. seventy billion dollars can only come from one law has been repealed under the bill When the Democrats were in the ma- of two places: Cuts to seniors or cuts to pro- passed out of the Committee on Com- jority that is exactly what they did. In viders. Either way, my district loses. People merce. the last 10 years, between 1985 and Mr. Chairman, we should not think of lose. Mr. Chairman, I held Medicare forums today, the Democrats fixed Medicare Medicare alone, we should think of it with each of the hospitals in my district. All of over and over again. Six times the in the context of the tax cut the money them, without exception, said $270 billion cuts Democrats either raised the payroll tax from Medicare will pay for and the would be disastrous to their facilities. At least or raised wages subject to the payroll other undercutting of services for the two hospitals will close. A hospital in East St. tax. That is how they fixed Medicare. elderly under Medicaid. Louis is the only health facility in the area that And in 1993, they even blew the lid off Mr. GIBBONS. Mr. Chairman, may I of wages. There is no limit to the pay- provides obstetric care. What will happen if inquire of the Chair how much time I there is no where in the city to deliver babies? roll tax being applied to wages today have officially remaining? thanks to the solutions offered by the The hospitals in the 12th District of Illinois The CHAIRMAN. The gentleman have already streamlined operations. They former majority. This new majority from Florida [Mr. GIBBONS] has 21⁄4 have cut staff and services. They feel addi- will not buy that approach. Quick fixes minutes remaining, the gentleman are out. Real solutions are in. tional cuts will be so detrimental to services, from Texas [Mr. ARCHER] has 5 minutes Mr. Chairman, this is a quote from they would rather close than compromise remaining, the gentleman from Vir- President Clinton, and it is up there quality of care. Is this what we've come toÐ ginia [Mr. BLILEY] has 3 minutes re- because I, frankly, admire that he had forcing hospitals to close and threatening the maining, and the gentleman from health and safety of entire communities to pay the guts to say it. I counted over 100 Michigan [Mr. DINGELL] has 21⁄2 min- times the Democrats went to the well for a tax cut? utes remaining. and said cut. Is it because they just do If $270 billion does not come from provid- Mr. DINGELL. Mr. Chairman, I note not get it or is it because this is more ers, seniors are going to feel the burden of we have, I think on this side, about 21⁄2 of the demagoguery and the ``slowing the growth in Medicare spending.'' minutes each, something like about 4, sloganeering? Even the President of Haven't we asked enough of our senior citi- 41⁄2 minutes, but my good friends over the United States admits that when we zens? Mr. Chairman, I support a balanced there have 8 minutes. budget. In fact, I voted for the balanced budg- Mr. ARCHER. Mr. Chairman, my un- slow the growth of Medicare, we do not et constitutional amendment. However, if we derstanding of the agreement is they cut it, we slow the growth of Medicare. are serious about balancing our budget, we will reduce their time to one speaker, Mr. Chairman, what we do is slow the should not be talking about a huge tax cut we will then use our last speaker, their growth of Medicare. That is how we which clearly is going to benefit the very speaker will then speak, and then the make the savings. We do not stay at a 1 wealthy in our society. gentleman from Virginia [Mr. BLILEY] 10 ⁄2 percent increase because it will go If we are serious about reforming Medicare, will close. bankrupt if we do. Hospital spending we should be engaging in open debate about The CHAIRMAN. Is that the under- goes up under our program. It does not how to keep Medicare solvent into the next standing of the gentleman from Michi- go up as fast as it was going to go up, century. It is hypocrisy to call for a $245 billion gan? but $652 billion will be spent between tax break while cutting Medicare by $270 bil- Mr. DINGELL. Mr. Chairman, I am now and 2002 on hospitals. lion. Granted, there are major problems with not quite sure I understand what was Physicians: Payments to physicians the Medicare Program. However, Medicare is said. I note they have 8 minutes over go up every year. Not a cut, but a re- no closer to going broke than it has been the there and we have something like 4. duction in growth. In fact, over those 7 nine times in the past that we have faced simi- The CHAIRMAN. My understanding years, more than $315 billion will be lar solvency issues. Medicare will be at a zero is the gentleman from Texas [Mr. AR- paid for physician services under the October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10361 Medicare program proposed by the Re- mittees for the great work that they the health facilities in this country. publicans, and every year those pay- have done in working on this issue. But The ones that will be closed are the ments grow larger. I rise today with sadness and almost ones we can least afford to close; the Mr. Chairman, in home health care, disbelief of what I am afraid is about to ones in the inner city, the ones in the the same thing. Every year the pay- happen to what I believe to be the most rural areas where people already have a ments go up. More than $150 billion important program, the most impor- lack of health care facilities. over the next 7 years. And every year tant help that the people of our coun- Yes, medical education will be af- the payment to the home health care try have enjoyed now for over 30 years. fected. Medicare and Medicaid now pay industry will go up. We are not making I say to the Members that this is the over 60 percent of the costs of medical cuts, folks, we are slowing the growth. kind of vote that comes once in a gen- education. In an intensely competitive Mr. Chairman, there has been a lot eration, maybe once in a career, about world, private health insurance will said about changes, and frankly, this is the very future of one of the most im- pay less and less and less of medical one of the more exciting parts about portant efforts that our country has education. So, the Government is the the Republican program. What we are ever made. only entity that will do this. doing is opening up the Medicare pro- Mr. Chairman, the cuts, the changes, Mr. Chairman, I have told this story gram to the choices available to more the modifications that are called for in many times. My son was diagnosed and more Americans today. The Medi- Medicare, and Medicaid next week, are with terminal cancer in 1972 at the age care savings accounts, the provider the largest changes in these great of 2. We were devastated. The next sponsored organizations, the seamless health care programs that have ever morning, a young resident showed up coverage that has been discussed will been called for, by far. If they were bright-eyed and bushy-tailed at 7 be available so that individuals can go being made because they were nec- o’clock in the morning. He met my from the workplace to the rocking essary to balance the budget, that wife and I, and he said: chair and not have to change or look would be one thing; if they were being I know you are devastated, but I stayed up for a new kind of a health care pro- made to save Medicare, that would be half the night on the computer and I found a gram. The coordinated health care pro- another thing; but, in my opinion, if we therapy that I think might, do not get your grams will be expanded and improved. look at these changes and then we look hopes up, but it might save his life. We are This is what we will get under the at the amounts of money that are pro- going to try. Republican program to preserve Medi- jected to be saved and then we look at Let me tell my colleagues something. care. This is what is offered now. This the tax break, which is included in the That day we needed that doctor and we is what seniors will have available: very same budget, no matter how peo- needed those ideas. We needed good Prescription drugs, routine physicals, ple may try to separate the issues, we medical education. We needed the qual- the cancer physical that was discussed. will see that the reason for these deep, ity of this health care system. And I Seniors will have available eye exams, severe, damaging cuts in Medicare are am telling my colleagues today, if lenses, ear exams, hearing aids, and to pay for a tax break for the wealthi- these cuts are made this deeply, the dental coverage. That is available est Americans. medical education that has been the today and it will be available under the Mr. Chairman, I would ask us to just bright light of this health care system new program. imagine, just think in our minds of two through our entire lives will be ripped Mr. Chairman, let us talk about individuals, two families, if you will. apart. eliminating fraud and abuse. We find Think first of a frail 85-year-old Mr. Chairman, I say to the ladies and it. We double the civil penalties. We es- woman, who, undoubtedly, lives in the gentleman of the House, this vote tablish new criminal penalties, and, your district, and I know lives in mine. is a vote of conscience. It is a vote of more important, we have already values. It is a vote of what is right and b passed medical malpractice. We did 1515 wrong. And I ask my colleagues before that in March. Think of an 85-year-old who today they deliver this vote today, to exam- Here is the bottom line. What do we lives on their Social Security, maybe ine their consequences, because if we get for the money out of the Repub- $7,000, $8,000, $9,000 a year. That is all do what is wrong instead of what is lican program? A sound program until the income they have. My colleagues right, in the days ahead every time you 2010. We are in the black, or the blue, on the other side may not think that face a senior citizen who is trying to if you will, until 2010. The Republican $45 a month is a big deal out of their scrape it out on $8,000 or $9,000 a year, program gets us clear to the baby Social Security check to pay the in- my colleagues are going to know that boomer generation. The Democratic creased premium, but to them, they they voted to make life harder for program has a $300 billion deficit in the are already counting every penny, them. same time. every month, in order to get by. Every time my colleagues pass a Mr. Chairman, let us focus on sen- Mr. Chairman, I have met seniors health clinic or a rural hospital that iors, but let us remember people who who have a $3,000 prescription drug bill has been closed, they are going to turn are paying their taxes now want a pro- now that comes out of that $9,000 a their back on that. And every time gram as well. The Republican program year. They are counting every penny they meet somebody’s family who had preserves, protects, and makes sure every month. The change that is being somebody who died because of the lack that Medicare is available for those called for here will ask them to pay $40 of medical education, they will know who pay the bills today. or $45 additional a month that will we did the wrong thing. Mr. DINGELL. Mr. Chairman, I yield come out of their Social Security Mr. Chairman, I say to my col- the balance of my time to the distin- check. Tell them that this is not a big leagues, do the right thing today and guished gentleman from Missouri, [Mr. deal. refuse to go along with this program GEPHARDT], the minority leader. It would be one thing if that were to which is not being done for the right Mr. GIBBONS. Mr. Chairman, I yield balance the budget or to save Medicare. reasons, but for the wrong. the balance of my time to the gen- But think about the other person. The Mr. BLILEY. Mr. Chairman, I yield tleman from Missouri [Mr. GEPHARDT], family making $500,000 a year that, for such time as he may consume to the and say that he has, for years, toiled on the Republican tax break, will get over gentleman from Virginia [Mr. this problem. He was a member of the $19,000 a year in the tax break. It is GOODLATTE]. Health Subcommittee of the Commit- wrong by anybody’s light to take $400 a (Mr. GOODLATTE asked and was tee on Ways and Means, and I can per- year from somebody who is 85 and frail given permission to revise and extend sonally remember his long and effec- and living on 9 grand a year and give it his remarks.) tive work on this program. to somebody who is making a half a Mr. GOODLATTE. Mr. Chairman, I Mr. GEPHARDT. Mr. Chairman, I million dollars a year. That is pre- rise in strong support of the Medicare want to first congratulate the ranking cisely what this budget is calling for. Preservation Act of 1995. member of the Committee on Ways and Mr. Chairman, that is not all. When This historic legislation will preserve, pro- Means and of the Committee on Com- we make cuts this deep in Medicare tect, and strengthen this vital lifeline to our merce and their colleagues on the com- and Medicaid, we close 25 percent of senior citizens. H 10362 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Mr. Chairman, today we are voting on a re- the trustee’s report to the American The Republican proposal cuts $270 billion alistic solution to a crisis situation. America's people and we asked them for their from Medicare and deprives millions of seniors seniors, families, doctors, and employers all best advice. We listened. We listened to health care when they need it the most. agree that Medicare is broken and this legisla- our friends and neighbors in thousands It will force our parents and grandparents to tion fixes it. of town hall meetings from coast to choose between medical care, food, and shel- By saving Medicare from bankruptcy, we coast. ter. It will force hospitals and providers around ensure that the program will be there to serve We listened in 40 congressional hear- the Nation to curtail services or close for good. the health needs of seniors. We are giving ings this summer, 10 of them in my It will roll back efforts to crack down on seniors the choice in selecting the best health committee alone; more hearings in my waste, fraud, and abuse. It will lead to lower care plan for their needs, including the right to committee on Medicare than the other the quality of care, increase patient abuse, keep the same Medicare coverage and doc- side held in the last 6 years combined. and cost the Medicare program over $1 billion. tors they have now. Finally, we are guarantee- We heard 70 witnesses who gave thou- These cuts are cruel. The deficit should not ing Medicare's solvency well into the next cen- sands of pages of testimony. We lis- be lowered at the expense of the elderly. Sen- tury so that the program can serve future gen- tened to the views of Americans of iors should not have to suffer in order to give erations of seniors. every political stripe. tax breaks to the rich. Contrary to all of the talk about cuts in Med- We did a computerized search of arti- For over 30 years, Medicare has protected icare, spending per person will actually in- cles on Medicare, just since the begin- the health and financial security of millions of crease by nearly $2,000Ðfrom $4,800 today ning of the year. There were more than Americans. These men and women did not to $6,700 in 2002. Total Medicare spending in- 11,000 articles on Medicare this year in work for decades and pay their taxes just to creases by 54 percent from $178 billion this the major newspapers alone. have the rug pulled out from under them as year to $274 billion in 2002. Leave it to the big We listened and we learned. We they prepared to retire. The Republican pro- spenders here in Washington to call such in- learned that as good a program as Med- posal would do just that. It would decrease the creases cuts. icare is, as important as this program value of seniors' savings and seriously drop Choice is a key part of this Medicare legisla- has become to America’s seniors, there their quality of life. tion. Those who want to stay with their current is still plenty of room for improve- Seniors deserve more respect than this. Medicare plan can do so. No one will be ment. They should be able to enjoy their later years. forced to change coverage or doctors. We learned from health care man- They should not worry about whether they can Seniors will have the option to choose from agers in the private sector how new afford health care. additional health care plans under Medicare- managed care options can help hold Thousands of my constituents have told me plus. Options will include coordinated care down costs and give beneficiaries bet- to oppose the Republican proposal. They do plans, a physician service organization, or a ter quality care. We learned from ex- not want to pay more for less. They do not MediSave account. perts in health planning about the want to give a $245 billion tax cut to wealthy These plans are required to offer at least as value of medical savings accounts. Americans. They know that this proposal will good a benefit package as Medicare does Throughout the process, there hurt them, their families, and the country. now. Some of these new plans actually offer emerged a national consensus that more benefits, such as prescription drug and I oppose this bill and ask you to do so as Medicare can indeed be preserved. In well. eyeglass coverage which are not available fact, that it can be improved consider- under Medicare. They also can reduce out-of- Mr. DICKS. Mr. Chairman, I strongly oppose ably in the process. But, something H.R. 2425, Medicare legislation which I fear pocket costs and eliminate the need for else happened as well, because during MediGap insurance that costs $750 to $1,200 will hurt far too many AmericansÐliterally this 6 months, America has seen the making senior citizens less healthy and less fi- a year. difference between the two major polit- Today, seniors pay 31.5 percent of part B nancially well off than they are today under ical parties. costs and taxpayers pay the remaining 68.5 the current Medicare program. Mr. Chairman, while we were risking percent. That rate will not change. Premiums, Over the years here in the House, I have our careers to save Medicare, our oppo- therefore, will go up only because the cost of found that it is necessary to put major legisla- nents were frightening senior citizens. the program rises. The only exception will be tion like this into better focus by concentrating We developed a plan to save Medicare. for affluent seniors who will be asked to pay on how it will impact those people who will be They pulled neckties and broke glasses more. affected. By cutting $270 billion from Medi- By 2002, part B premiums will be $87 per and stormed out of congressional hear- care, this bill will hurt many of the people I month instead of the $46.10 per month today. ings. have come to know representing the 6th Dis- Under President Clinton's budget, which does Last week in my committee, they trict of Washington State. not offer a plan to preserve Medicare, monthly used senior citizens as props to disrupt And like most Americans, this drastic cut in premiums would increase to $83 per month. a plan to save Medicare for 37 million Medicare spending will affect my family. My That is only a $4 a month differenceÐwhich is Americans. Today, as we discussed our parents have been retired for years, still living not too much to pay to help save the Medicare plan, they have given us 3 hours of ex- in my hometown of Bremerton. And like most Program. cuses, 3 hours of politics, 3 hours of Americans their age, they depend on Medi- The bill provides fair but limited increases in hysterics. care to live a healthy and productive retire- spending on hospital and doctor services. Mr. Chairman, I would say: There ment. But because they are middle classÐlike Health care providers will have to manage you have it, America. In 3 very reveal- most people in the district I represent and under funding limits and compete in the mar- ing hours, the crystallization of the throughout AmericaÐthe large increase in out- ketplace on the basis of price and quality. differences between us. On the one of-pocket costs will lower their living standard, There will be a Medicare preservation trust hand, political courage, accountability, I cannot help but take it personally that the fund created within the part B Medicare Pro- leadership in solving a crisis. On the Republican majorities in Congress want to gram to ensure that senior's premiums go to other hand, excuses, distortions, over- lower my parents living standard in order to save Medicare and are not used for other pur- statements, misstatements, fear. pay for a huge tax cut that is really not nec- poses such as tax cuts. Mr. Chairman, I used to be a Demo- essary. Mr. Chairman, we must not miss this oppor- crat. It is sad for me to see a once- Over and over today we have heard the tunity to offer security for seniors and save great political party reduced to this. false charge that those of us who vote against Medicare for the next generation. I urge my Mr. EVANS. Mr. Chairman, do not let any- this legislation are against Medicare reform. colleagues to vote in favor of the Medicare one fool you. This proposal is not about sav- That is not true. I support the Democratic al- Preservation Act. ing Medicare, it is about giving tax breaks to ternative plan, which shores up Medicare's fi- Mr. BLILEY. Mr. Chairman, I yield businesses and wealthy Americans. nancial health without increasing costs for myself the balance of my time. It pays for a $245 billion tax break for the beneficiaries. This Democratic alternative cuts Mr. Chairman, for the 6 months that rich by breaking seniors backs. It makes Medicare spending by just one-third of the have followed the Medicare trustee’s health care less accessible and more expen- GOP's $270 billion of cuts. The simple fact is report, we have held a national debate sive. It will close hospitals and other health fa- that the House leadership needs the whole on the question of how best to save cilities. And it will cost thousands of Americans $270 billion in Medicare cuts in order to pay Medicare from bankruptcy. We took their jobs. for their huge tax cut. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10363 As we here in Congress ask the American Mr. ACKERMAN. Mr. Chairman, it is not years, but Republicans want to cut $270 billion people to roll up their sleeves for deficit reduc- quite Halloween but the majority is already to achieve the same objective. Ironically, the tion, it is absolutely unfair to make middle- playing trick or trick. Democratic plan offered during Committee class retirees on Medicare pay for this tax cut. In the spirit of the season, the Republicans consideration of this bill actually extends the For that reason, I oppose this Medicare legis- are about to commit the Medicare massacre. trust fund solvency to the same year, 2006, as lation. My colleagues on the other side would have the Republican plan, while only cutting about Mr. STOKES. Mr. Chairman, today, the us believe that Medicare is in some unprece- $90 billion. The truth is that Republicans are House is debating H.R. 2425, the Medicare dented state of crisis and that without their searching for a way to finance their budget pri- Preservation Act of 1995. I am strongly op- meat cleavers and chain saws the program orities, and are using Medicare cuts as a cash posed to H.R. 2425, and I plan to vote for its will cease to exist. honey pot to pay for a $245 billion tax break defeat. In my opinion, the legislation rep- In fact, most of their bill's Medicare cuts will for wealthier people and increased military resents a full attack on the health of our Na- not be dedicated to the so-called trust fund cri- spending, not for helping the Medicare trust tion's elderly population. sis, not one penny of the cuts the bill makes fund or the American health care system. H.R. 2425 slashes $270 billion from health in Medicare part B, and not one penny of the We all know that some improvements need care services for the elderly. We know that to increases in part B premiums paid by bene- to be made in the Medicare Program. After all, achieve this enormous reduction, health care ficiaries will go into the trust fundÐthe only the health care laws have been constantly premiums for seniors will double. Also re- part of Medicare that needs propping up. evolving for decades. For instance, I hear from moved from the bill are limitations on the The trick, Mr. Chairman, is that the bill will seniors all of the time about the high cost of amount that doctors and hospitals can charge force seniors and doctors out of fee-for-service prescription drugs. A sound outpatient pre- patients. I am also opposed to the bill because medicine by arbitrarily limiting the growth in scription drug benefit should be part of Medi- it opens the door for fraud and abuse. Current Medicare, as people live longer, not for rea- care. Certainly we need to crack down on provisions that are designed to prevent kick- sons of health care policy, but simply to meet fraud and abuse within the system so that cru- backs and provide accurate billing are re- budget targets. In addition, the bill's failsafe cial health care dollars aren't going down the pealed. This provision alone will cost Amer- mechanism, this gimmick that automatically re- drain. Ironically, however, the Republicans cut ican citizens over $1 billion. duces payments if the targets are not met, money for inspectors of waste, fraud and only cuts from the fee-for-service portion of abuse in the fiscal year 1996 appropriations Mr. Speaker, the enactment of H.R. 2425, Medicare, not from the HMO's. bill, and this Medicare bill will make it more the Medicare Preservation Act of 1995, would The bill also allows doctors, for the first difficult to curb fraud and abuse by changing be devastating to seniors throughout America. time, to ``balance bill'' senior citizens for the the standard for making sure Medicare claims In my home State of Ohio, 1.6 million Medi- difference between what Medicare pays and are accurate, and repealing the 1987 laws care beneficiaries would suffer from reduced the providers' actual costs. governing nursing homes. benefits and a lower quality of life. Earlier The other trick, according to our Republican In the process of bleeding the Medicare today, while our Republican colleagues were colleagues, is that they are protecting the sol- trust fund, the Republican scheme is going to pushing to gut the Medicare program, a non- vency of Medicare for future generations. But destroy seniors' health care security. Under profit research organization, Speak Out! USA, as we all know, the bill cuts three times the this bill, overall Medicare spending will be cut sponsored a special Medicare hearing with amount the Medicare trustees say is nec- by $6,795 per senior over the next 7 years, testimony from all 50 States. I was honored to essary. meaning that in 2002 there will be $1,747 less attend this important hearing where Medicare In reality, the Republican bill extends the in Medicare dollars per senior in that year it- beneficiaries and their families testified about solvency of the trust fund until 2006. Precisely self. their experience with Medicare and concerns where we would be if we adopted the trust- This Republican Medicare cut scheme will about proposed cuts in the program. ees', and not the Republicans' level of cuts. increase seniors' monthly premiums by $53.5 Mr. Chairman, I applaud Speak Out! USA Mr. Chairman, the trick under the Repub- billion over 7 yearsÐthis means an individual for putting a human face on the Medicare de- lican Medicare plan is that seniors will pay senior will pay approximately $490 more per bate. It would be impossible to hear from sen- more and get less. The treatÐI guess will year in premiums by 2002. This amount will ior citizens who have real life experience with have to wait until next year. be doubled for married couples. This is a lot Medicare and then enter this Chamber and Mr. VENTO. Mr. Chairman, I rise today in of money considering that 80 percent of Medi- vote to demolish the program. One of the wit- opposition to H.R. 2425, a bill which will radi- care beneficiaries earn less than $25,000 a nesses at the Speak Out! USA hearing was cally change the nature of health care in the year, and none of the premiums go into the Bishop Marvin Johnson, a resident of my con- United States, decimating seniors' health care Medicare trust fund, but are a part of the gen- gressional district. Bishop Johnson is a min- security. eral revenue bottom line instead. Once again ister of the Good Sheppard Divine Spiritual Medicare is one of our Nation's most suc- this illustrates the true impact of the GOP ef- Temple in Cleveland. He is confined to a cessful programs. It was established over 30 fortsÐfinancing their priority which is a tax wheelchair and began receiving Medicare dis- years ago as a national commitment to assur- break for the wealthy. ability payments for diabetic ulcers on his feet ing seniors health care coverage. Before it The Republicans are going to cut $150 bil- in 1992. Bishop Johnson's testimony was very was enacted in 1965, only 46 percent of sen- lion from payments to providers. There is not moving and to the point. It served as an im- iors had health coverage. Today 99 percent of one hospital in this country that won't be af- portant reminder of the people we are pledged seniors are assured of access to health care. fected by this drastic cut. This, combined with to represent as Members of this body. As we Medicare is an intergenerational contract be- the proposed Medicaid cuts in the GOP budg- debate the Medicare issue, I want to share his tween working Americans and seniors, and it et plan, mean that hospitals will be forced to testimony with my colleagues. represents a commitment from our Federal shut down, or try to make up the difference in TESTIMONY OF BISHOP MARVIN JOHNSON, GOOD Government that seniors should not have to cost by increasing and shifting health care SHEPARD DIVINE SPIRITUAL TEMPLE choose between buying food or going to the costs onto Americans of all ages. Hospitals SPEAK OUT! USA SPECIAL HEARING ON MEDICARE doctor. may well start to turn away Medicare and Medicare has served America's senior citi- I would be on the streets if it were not for Medicaid patients, just as some physicians do Medicare. I pay for my own medication from zens well for 30 years. Most seniors are not already today. my Social Security check. I don’t have fam- well off. Under Medicare, seniors have com- Another disturbing part of the Republican ily to help me. My diabetic condition keeps plete freedom to select the health care plan of proposal is the ``look back'' proposal where me from working and I am forced to live on their choice, with guaranteed coverage. Now Republicans say they will make unspecified full-time disability. I came to Washington to Republicans want to slash Medicare. They say cuts in the future. When Republicans say tell our elected officials to save the Medicare that they are doing this to save the Medicare ``look back'' seniors should ``look out.'' The Program. If the Nation’s poor don’t have trust fund. Well, Medicare is in danger, be- GOP's so-called safety valve provides compli- Medicare, many people will not be able to go cause the Republicans are in control. The ance with their scheme to cut Medicare, but to the hospital when they are sick. Without Medicare, I would not be able to buy insur- changes they are proposing are going to cost no safety, no security, and no health care for ance for myself. Medicare three times what is needed to ex- Medicare recipients. Through the Medicare Program, I receive tend the trust fund solvency to the year 2006. Provisions of the Republican scheme will quality care from the Visiting Nurse Asso- The trustees of the Medicare trust fund have fundamentally restructure Medicare, shifting ciation. If the Medicare Program is gutted, I stated that it would take approximately $90 bil- seniors out of fee-for-service care by putting have nowhere to turn for health care. lion to shore up the Medicare system for 10 resources into other untried and untested H 10364 CONGRESSIONAL RECORD — HOUSE October 19, 1995 forms of care such as medical savings ac- policy, you read the fine print.'' Well, I urge my needs of seniors or the fiscal needs of the counts and provider-sponsored organizations, colleagues to look at the fine print of the Re- Medicare trust fund, but by the political agen- therefore making traditional fee-for-service publican plan and see the bottom line which is da of the Republican majority. care so prohibitively expensive for most sen- that seniors and Americans of all ages are In fact, the first Medicare action taken by iors as to eliminate the option. Ironically, the going to pay more for less. the Republicans was last spring, in the $354 new medical savings accounts will actually Medicare represents our Nation at it's best. billion tax cut bull they pushed through. And cost Medicare money, with estimates ranging It represents the desire on the part of the peo- ironically, it was designed to make Medicare's to $15 billion over 7 years, as more trust funds ple to pull together and care for those who financial problems worse. How? By draining are passed out to healthy seniors who may otherwise might not have enough resources to $36 billion in revenue out of the Medicare Part not even need medical care, draining the have access to health care. Instead of building A trust fund. To offset that action, Republicans funds which cost taxpayers billions. Provider- upon this success, by responsibility managing now have to make larger cuts in the hospital sponsored organizations will be exempt from Medicare and expanding health care coverage insurance program than otherwise necessary. State financial and consumer protection re- to all Americans, this Republican bill rolls back These additional cuts will, inevitably, result in quirements, which insurers and HMOs have to the progress that has been made. I urge my a lower quality of care for seniors. comply with, meaning that provider-sponsored colleagues to vote against the Republican The Republican plan also raises the pre- organizations will not be put on a level playing plan. miums that help fund Part B of Medicare, field with these other providers. This is a pre- Mr. SKAGGS. Mr. Chairman, this Repub- which primarily pays doctors' bills. They're scription for problems, not health care policy. lican Medicare bill is tragic almost any way also trying hard to get seniors to opt out of the We also need to look at what Republicans you look at it. It's tragic because it will make Medicare program altogether. By reducing are doing for Medicaid, the companion health life harder for many older Americans in order spending on part B, which is paid for by gen- care program which helps so many seniors to make life easier for a few who are already eral tax revenue, the GOP frees more money get access to nursing home care. They are financially comfortable. And it's tragic because to funnel into tax breaks for people making going to turn over complete control of this pro- we're missing an opportunity for genuine re- over $100,000. And, of course, the savings gram to the States, stripping away mandates form. from those moves won't do a thing for the in- that guarantee coverage to children, the elder- Medicare is in need of corrective surgery. solvency problem in part A, which is the ill- ly, and the disabled. The Republican Medicaid This bill instead prescribes amputation. ness they're purporting to treat. scheme cuts the program by $182 billion in 7 By any reasonable assessment, Medicare It's perfectly clear what's happening. The years, a 20-percent reduction, and abolishes has been a resounding success. Since it was Republicans need to squeeze money out of the entitlement status and State maintenance signed into law by President Johnson in 1965, the Medicare program to provide a promised of effort. Minnesota was one of the biggest the system has dramatically improved the lives $245 billion tax breakÐthe crown jewel of the losers in the restructuring of the House Medic- of millions and millions of older Americans and so- called Contract With AmericaÐto some of aid formula and is going to lose $3.4 billion their families. the wealthiest people and corporations in the over the next 7 years under the House plan. Before the system was created, over half of country. And, to add insult to injury, the This is a cut of over 21 percent. all seniors had no health insurance at all, and Speaker of the House has been busy cutting These changes will affect every person in largely because of that problem, one-third backroom deals in a desperate attempt to get this Nation, whether indirectly through their lived in poverty. Today, thanks to Medicare, this travesty to pass. health care costs increases due to the rising virtually all seniors have insurance, and less First, he bought the AMA's endorsement number of uninsured people, or directly if they than 13 percent live below the poverty line. with concessions they wanted. Then, astound- have to deal with the cutbacks in their cov- That's hardly the outcome Republicans pre- ingly, he decided to loosen the rules on Medi- erage or their parents', spouse's or child's dicted. In 1965, 93 percent of Republicans in care fraud. Rather than making things tougher coverage. Congress voted against creating the system in on those who cheat the system, and drive up The problems we face with health care de- the first place, because it was, they said, so- costs, the Speaker will make fraud and abuse mand a response, but a long term solution re- cialized medicine. easierÐjust to win the support of powerful in- quires more than slashing health care cov- Thirty years later, the Medicare system re- terest groups. erage. The need remains not to consider Med- mains essentially a private, market-oriented Let me stipulate: much more needs to be icare and Medicaid in a vacuum, but to ad- system. It's substantially less bureaucratic done to assure the long-term sustainability of dress the health care system as a whole. The than the private sector system of health insur- Medicare than just fixing the part A trust fund trustees of the Medicare trust fund strongly anceÐabout 2 percent of Medicare goes to- shortfall. We need to ask those beneficiaries oppose the Republican plan because the ex- ward administrative costs versus anywhere who can pay more for their care to do so. We tensive cuts go far beyond program reform or from 6 to 25 percent in the private health in- need to tackle the systemic failings in the deficit reduction. surance market. Every American agrees Medi- overall health insurance and to rein in costs. What a difference a year makes. Last fall care must be maintained and must be put on But these matters ought to be addressed on 1994, the Congress was struggling to expand a sound financial footing. their merits, and in the context of health care health care to those without Medicare, Medic- Medicare does face some serious actuarial reform generally, not as mere mans to the end aid or private coverage. There were over 40 problems. Medicare costs have been rising of a tax cut we can't now afford. million uninsured Americans from working along with the skyrocketing cost of all health So it is, as my Republican colleagues have families then and the number has risen by 1.4 care. Those cost increases have outpaced claimed, a historic day. Thirty years ago, Re- million more in the past year. Today Congress revenue increases, so that the part A trust publicans voted in large numbers against isn't even addressing the issue of those with- fund, which pays primarily for hospital cov- Medicare. They will do so again today. out health care, but pulling back and punching erage, needs to be shored up. Older Americans, who have worked hard, holes in the American health care programs, According to the Medicare trustees, the Part and played by the rules, and paid into the sys- Medicare and Medicaid, that help people. A trust fund faces a shortfall over the next tem for a generation, deserve better from us. What a shame and what a disgrace that the several years of about $90 billion. Other more I urge my colleagues to vote against the bill. modest programs that provide dignity to the el- pessimistic analyses range up to $130 billion. Mr. SERRANO. Mr. Chairman, I rise in derly and the disabled, and compassion and So, we need to find $90 billion in savings or strong and determined opposition to H.R. empathy for those without means, in fact 16 additional revenue to keep part A solvent. 2425, the Medicare so-called Preservation Act million children, are being bled for priorities But it is clear this is not the problem the Re- of 1995. that place tax breaks for the wealthy ahead of publican majority is trying to solve. H.R. 2425 is a very bad bill. It comes to the health care for the needy. No, the Republicans set out to reach two floor after a very flawed process and under ar- At the Democrats' hearings on the Capitol other goals; first, to cut taxes, mostly for the tificial time limits imposed by the Republicans lawn and at public meetings in Minnesota, I've wealthy; and second, to balanced the budget to prevent full and free discussion of the is- learned anew from a broad spectrum of peo- in 7 years. To make this math work, and given sues. ple who will be hurt by the GOP policy path. other priorities, they close to reduce Medicare H.R. 2425 is driven by the Republicans' dra- Not only from doctors and hospitals, but from spending by $270 billion, or two to three times conian budget, which means it is based on seniors who rely on them for their health care what's necessary to deal with the Part A trust very bad numbers, not on any understanding security. One senior at the hearing gave these fund problem. of health care in this country. It will have far- words of wisdom, ``Seniors weren't born yes- In other words, the size of the Medicare re- reaching, negative impacts on most Ameri- terday. They know what before you sign any ductions wasn't driven by the health-care cans. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10365 H.R. 2425 would cut $270 billion in future pressed harder and harder, helping their par- would be forced to cripple working Americans Medicare spending. That is three times the ents with higher Medicare premiums and other by raising the payroll tax by 44 percent. The size of any previous provision to address the health care costs while dealing with cuts in only other alternative would be to allow Medi- Hospital Insurance Trust Fund's solvency. Yet their children's student aid. care outlays to reach 100 percent of Federal it will extend the HI Trust Fund's year of ex- Because of the close relationship between revenues by the year 2030 and bankrupt the haustion only to 2006Ðthe same year the Medicare and Medicaid, the House should be entire country. Democrats' much more modest proposal, able to considerÐand, where necessary, do The Republican Party has a plan to save, based on the Medicare trustees' recommenda- something aboutÐthe impacts on each of preserve, and improve Medicare for today's tions would. changes in the other as well as the cumulative beneficiaries and for future generations. The The balance of the $270 billion does nothing effects of changes to both. Medicare Preservation Act offers seniors the What will be the combined impact of Medi- to shore up the HI Trust Fund, but, instead, same cost effective choices for quality health care and Medicaid cuts on our health system? makes possible $245 Billion in unnecessary care available to younger Americans, but de- A report by Barents Group LLC prepared for tax cuts aimed at the wealthiestÐmore than velops innovative ways to save health care the Greater New York Hospital Association es- half the tax break goes to people making over dollars; all while still delivering the best health timates that, over 7 years, New York City resi- $100 thousands a year. care to all Americans without cutting a single Seniors would pay twice the current part B dents will pay $2 billion in excess part B pre- dollar to beneficiaries. Let me make that clear, premium in 2002, as well as higher deductible miums; and hospitals and long-term-care facili- regardless of Democrat's demagoguery, there and copayments. ties together will lose more than $24 billion. By are no cuts in this legislation, Mr. Speaker. Cost growth would be held below the growth 2002, job loss will total 140,000, of which in private sector health spending. Seniors who 112,000 will be in health care sector. Medicare payments will increase at a high have greater health needs than the working The Healthcare Association of New York rate of 6.5 percent allowing for a $2,000 in- population, would be forced to pay much State estimates that the 16th district will lose crease from the current $4,800 today to more, particularly as fewer providers would be over $2 billion and nearly 11,000 health care $6,700 in 2002, for every single beneficiary. willing to accept rock-bottom Medicare reim- jobs. Individual hospitals will lose hundreds of Correct me if I am wrong, but a $2,000 in- bursement rates, and protections from balance millions of dollars. crease is not a cut in any teacher's math billing would be repealed. Otherwise, seniors And what would be the impact on Medicare class. Currently, Medicare recipients pay 31.5 would have to give up their choice of doctors if a State, given authority to set Medicaid eligi- percent of their Medicare part B premium. and accept second-class health care in under- bility and coverage and a shrinking pot of Under the MPA, traditional Medicare recipients funded managed care plans. Medicaid dollars, decides it cannot afford to will continue to pay 31.5 percent of their Medi- Hospitals are already reeling from changes fund long-term care? Under the proposed care part B premium. The MPA does not in- in the health care industry; the hits they would caps on Medicare spending, how will Medicare clude changes to the deductible or the co-pay- take in reduced payments for graduate medi- cover the much more expensive hospitaliza- ment. Again, how can this mean that seniors cal education, bad debt, disproportionate low- tion that will surely result? pay more? The truth of the matter is that be- income patient load, and the like, would put What recourse will seniors have if a State cause the Medicare Program is a 30-year-old many hospitals, particularly the public hos- decides not to fully cover the Medicare pre- dinosaur, seniors actually pay more money in pitals that serve the poorest populations and miums, deductibles, and copayments of the el- traditional Medicare for fewer services than our great teaching hospitals, at great risk of derly poor? Their coverage would effectively their children and grandchildren do in the closing. be ended, and it is unlikely that managed care health care open market. Special deals for various portions of the plans will have sufficient enrollment capacity This historic legislation empowers seniors health care industry would weaken consumer soon enough or in enough places to meet the by offering choices through MedicarePlus cov- protections and make it much harder to com- needs of all seniors who need low-cost health erage which includes coordinated care pre- bat Medicare fraud and abuse, kickbacks, and care. ferred provider organizations, local union or I believe the House ought to be able to con- other anticompetitive behavior. association policies, HMO's, private fee-for- sider situations like this, but separating consid- Meanwhile, medical research and the care service, medical saving's accounts, or continu- eration of Medicare from Medicaid by nearly a provided by specialized institutions such as ing traditional Medicare. Most of these choices week will make it impossible. our children's hospitals are very much at risk. are currently available for every other Amer- The process, too, is very bad. Medicare is Mr. Chairman, there is much more I could ican. Why should senior citizens continue to being rushed to the floor without full consider- say in opposition to this bill, but I will not go get the short end of the stick? The MPA goes ation by all the committees with jurisdiction. on. I simply urge my Republican colleagues to a step further and opens the health care play- The Judiciary Committee majority actually come to their senses and support the Demo- ing field to hospital and doctor coordinated or- waivedÐjust gave awayÐits jurisdiction over cratic alternative, which extends Medicare's ganizations who can network to offer direct crucial changes in medical malpractice, anti- life just as long as H.R. 2425 without all the medical care to beneficiaries saving the cost trust rules, the False Claims Act, and other harmful baggage. At a minimum, I urge of a middleman. Since hospitals are burdened antikickback penalties. That is just not right. all my colleagues to oppose this dangerous, with a large portion of the Medicare payment Nor should the House consider Medicare ill-considered bill. reimbursement savings, creating provider apart from the rest of reconciliation, just so the Mr. EVERETT. Mr. Chairman, I rise today in service organizations [PSO's] will allay some Republicans can try to convince the American strong support of the Medicare Preservation of their burden while opening up a whole new people that there is no relationship between Act. Yes, reforming Medicare is intimidating. choice for direct medical care. Medicare cuts and tax cuts for the wealthy. Yes, maintaining the status quo is easier. Under a fair and open process, this House Well, my constituents did not send me up here Medical savings account [MSA's] will allow would consider and amend all parts of rec- to take the easy way out, but to make hard seniors who choose this option to completely onciliationÐthe inexplicable tax increases on choices in the best interest of the second dis- control how their Medicare contribution and the working poor, the unnecessary tax cuts for trict of Alabama and for this country's future. out-of-pocket money is spent. They will re- the wealthy, the dangerous attack on workers' I believe that there is nothing more abhor- ceive their Medicare contribution each year in pension funds, the reckless spending cuts rent than using the power of this institution to one sum which will be deposited into their across the budget, as well as the excessive terrify the elderly, the disabled, and the poor. medical savings account. They can then cuts and changes in Medicare and MedicaidÐ But, the House Democrats are doing just that. choose a high deductible policy which best fits together. While they are well aware that the Medicare their needs, maintaining at least 60 percent of The House should be able to consider the Program is in a state of crisis, they continue the cost of the deductible in their MSA at all cumulative impacts of all the changes and to spout fear rhetoric. We all know, and even times. They can then use the balance of their make necessary adjustments. American's so- Democrats cannot deny, that Medicare is MSA for doctor's visits, prescription drugs, called sandwich generation, for instance, as a growing at over 10 percent every year. In eyeglasses or other medical-related expenses. result of reconciliation, will find themselves order to sustain this rate of growth. Congress If they are hospitalized the MSA pays for the H 10366 CONGRESSIONAL RECORD — HOUSE October 19, 1995 deductible and then insurance pays for the almost three times the amount necessary. As a result of these meetings, the Repub- rest. If money is left over in the MSA at the Why?Ðto pay for tax cut for wealthy Ameri- lican Members of the House of Representa- end of the year, the money belongs to the cans. tives have written, and now passed, the Medi- senior and can be used for any purpose or The Republican plan reduces Medicare care Preservation Act [MPA]. The MPA saves can be rolled over into the next year's MSA. spending by $270 billion, but increases bene- Medicare by addressing the very areas of con- MPA not only keeps the Medicare Program ficiary cost-sharing by $55 billion by raising cern voiced by those who depend on Medi- healthy into the 21st century, but finally gives monthly premiums. Under the proposal, the care to pay for the cost of their health care. seniors the power and choices they deserve. premium will rise from the current $46.10 to Mr. Chairman, I read a speech not long ago The legislation also includes long awaited li- $87 in 2002. These figures are in direct con- which was given by the CEO of the Chrysler ability reforms, strong incentives for combating trast to the alternatives. Under the Democratic Corp., Mr. Eaton. In his speech he referred to fraud and abuse, and many other reforms alternative, the premium will increase to only a period of time some 15 years ago when the which will only improve the Medicare health $58 in the same year. If current law were con- Japanese were taking over a large portion of care delivery program. The amazing thing tinued, the premium would increase to $61. the American automobile market. about this is that the MPA does not cut a sin- In addition, the majority's ill-advised pro- The Japanese were beating the domestic gle dollar from a beneficiary check, nor does posal will result in seniors losing the ability to automakers in the area of quality and price, it ask seniors to pay a single dollar more than choose their own doctors. Proponents of this very similar to the way the private health care they now pay. Again, in simple language, measure contend that beneficiaries will have industry is beating today's Government-run there are not cuts to beneficiaries in this bill, unlimited choice, but the bill provides financial Medicare Program in quality and price. Mr. Speaker. and other incentives to entice physicians to What did the big three U.S. automakers do? Mr. Chairman, we must all take the respon- accept only MedicarePlus enrollees. There- They looked at the process of how they were sibility for protecting and caring for our grand- fore, if a doctor decides to stop participating in manufacturing cars. They pulled together su- parents and parents and of those disabled ei- the traditional fee-for-service Medicare, his or pervisors, union leaders, consumer groups, ther physically, emotionally, or financially. But, her patients are essentially left with no choice dealers, and anyone who they thought might we also have a responsibility to our younger at all. have valuable input in how to change the taxpayers who are not only future beneficiaries IN short, the Republicans' priorities are re- process of manufacturing. of Medicare, but the future of this country. At versed. Their Medicare plan helps the greedy As a direct result of changing the process, this point they are paying 68.5 percent of the at the expense of the needy. That is simply the quality of their products has increased two Medicare part B premium. Like most seniors, wrong and I will vote against this shortsighted and one-half times and they are building the they simply cannot afford to pay more. Private and punitive legislation. I urge my colleagues same number of cars with half the work force. health care organizations have been success- to do the same. Mr. Chairman, the process of Medicare is Mr. COLLINS of Georgia. Mr. Chairman, ful in the last several years at finding savings what the MPA changes. over the past several months I have held by actively seeking new and innovative ways Let's look first at who will be covered by many townhall meetings for the purpose of lis- to deliver the quality health care that Ameri- Medicare under the MPA. Everyone. That's tening and learning about Medicare from the right everyone who receives Medicare today. I cans expect and deserve. The Republican people of Georgia's Third Congressional Dis- Medicare Preservation Act accomplishes this will say it againÐeveryoneÐeach and every trict. I have met with groups of senior citizens, individual who is eligible for Medicare today same goal for America's seniors. physicians, and hospital administrators to bet- In support of the Medicare Preservation Act, will remain in the Medicare insurance pro- ter understand their concerns about the cur- I challenge Democrats to quit their scare tac- gram. Each and every individual who will be- rent Medicare insurance program. tics and join Republicans as we get down to I have learned from senior citizens of their come eligible for Medicare in the future will be the business of saving Medicare today and fear of losing their Medicare insurance. They covered under Medicare when they reach the protecting and preserving the program into the have shared with me their concerns about ex- Medicare age. No oneÐnot one senior or dis- 21st century. cessive fees charged by doctors and hos- abled person will be mandated to leave the Mr. GEJDENSEN. Mr. Chairman, I rise pitals. They have brought me copies of com- current Medicare insurance program. today to express my strong opposition to Newt plicated doctor and hospital bills they have re- Mr. Chairman, the American people are now Gingrich's bill to cut the Medicare Program by ceived. They are frustrated with these billing hearing a great deal of rhetoric about how the $270 billion in order to pay for a tax break to procedures. Our seniors are concerned over Republicans are ending Medicare. Some spe- the wealthy. excessive charges and fraudulent use of their cial interest groups, and even some of our Contrary to their recent pronouncements Medicare insurance money. own colleagues in Congress, are engaging in that the cuts in H.R. 2425 are necessary to I learned of the frustrations of doctors and scare tactics and giving false, misleading infor- save Medicare, it is clear that the Republicans hospitals that try to provide health care to mation about our plan. Well that is just what do not want to save the Medicare system. Medicare patients under intrusive regulations it is: Rhetoric. The truth isÐthe Medicare They want to eliminate it. In fact, they have a and complicated reimbursement rules that Preservation Act does not and will not end longstanding record of opposing the program. have been forced onto them by past Con- Medicare. In fact Mr. Speaker, the MPA does In 1965, 93 percent of Republicans voted gresses. They also shared their concerns not cutÐI repeatÐdoes not cut Medicare ben- against the bill which established Medicare. about excessive testing and the overpracticing efits. Throughout the years, the trustees have of health care due to the fear of lawsuits. Doc- Well, if MPA does not cut Medicare, how do predicted imminent bankruptcy for the pro- tors and hospitals are frustrated because they we plan to save $270 billion over 7 years at gram. And, every time, Democrats have taken are not allowed to legally discuss the delivery an average of $36.5 billion per year? The an- the steps necessary to keep this pay-as-you- of health care within a community because of swer is we are making the changes our senior go system solvent. In 1970, the trust fund was antitrust laws. citizens requested to make. And by making supposed to go broke in 1972. In 1972, it was Mr. Chairman, in simple terms, the people those changes the taxpayers will spend $270 to be bankrupt in 1976. In 1993, the trustees of Georgia's Third District know and under- billion less than will be necessary under the reported that the trust fund would go broke in stand this Congress must address the prob- current Medicare insurance program. 1999. However, thanks to reforms in the sys- lems within the Medicare insurance program Mr. Chairman, we have a choiceÐeither we tem enacted as part of the Omnibus Budget such as overcharging, waste, and fraud. They correct the major problems within the Medi- Reconciliation Act of 1993 [OBRA #93], the also understand that in 1996, the Medicare in- care process or we raise taxes on every work- life of Medicare was extended until 2002. surance trust fund will begin paying out more ing person in the Nation. In the past, raising OBRA 93 passed the House of Representa- money than the trust fund collects from payroll taxes has been Congress' answer to fixing tives without one Republican vote. Where taxes deducted from each and every paycheck Medicare. In fact, the payroll tax and the in- were Newt Gingrich and his friends then? earned by the working people of this country. come base have been raised 23 times over Earlier this year, the Medicare trustees re- But, Mr. Chairman, I am not the only Mem- the past 31 years to fund runaway cost in the ported that the Medicare part A trust fund ber of Congress who has listened and Medicare system. needed $90 billion in cuts to remain solvent learned. The message I heard from the people But raising taxes decreases a family's in- for the next decade. For that reason, I will of my district can be repeated by almost every come, increases the cost of consumer goods vote for the Democratic alternative which Member of this House of Representatives who and services, and increases the cost of living saves exactly that amount. Nevertheless, heard the same concerns in meetings held for everyone, including seniors, who are on Newt Gringrich and his loyal followers in Con- throughout their districts and out across our Medicare and a fixed income. Rather than gress have crafted a bill to cut the program by great Nation. raising taxes again, Republicans have chosen October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10367 to fix Medicare, according to what our senior doneÐit only makes good business sense to earn $125,000, their part B premium will in- citizens have requested. Let's take a quick keep up with your accounts payable. But at crease gradually to a point they could pay for look at some of the changes our seniors have this point nothing surprises me about how the the whole premium. suggested. current Medicare insurance program is oper- Mr. Chairman, there are a lot of misleading First, we are reducing the growth of exces- ated. comments about what happens to the money sive payments to doctors and hospitals. The Next we heard what folks were saying about saved by passing the Medicare Preservation Medicare Preservation Act consolidates a waste, fraud, and abuse. Therefore the Medi- Act. What will happen to those dollars? First of clumsy multiple layer reimbursement process care Preservation Act includes several provi- all the hospital trust fund, which pays for part which is unfair to general practitioners and sions to eliminate waste, fraud, and abuse. A Medicare insurance, will continue to collect very favorable to specialized medicine practi- Provisions such as: the payroll taxes needed to sustain itself. Sec- tioners. It also simplifies the reimbursement One, requiring the Secretary of Health and ond, the fewer dollars needed to subsidize the process in a more fair and equitable manner. Human Services to alert individuals entitled to part B insurance, less general fund dollars, will The Medicare Preservation Act will simplify Medicare of scams aimed at ripping off Medi- be needed to pay for Medicare. Of course, Mr. hospital bills so those insured by Medicare will care and providing a tollfree number to report Speaker, as you know the general fund is al- better understand the billing process while at such scams. ready overdrawn by some $5 trillion. the same time reducing the growth of reim- Two, rewarding beneficiaries who report There are the changes to the current Medi- bursements for hospital care. One of the real huge illegal charges and rewarding them for care insurance program. However, there are problems with many hospitals is the lack of good ideas which save Medicare dollars and other options for health care which will be utilization of the entire facility or low occu- improves the program. This will be a good in- available under the Medicare Preservation Act pancy rates. Yet many hospitals continue to centive for those who are covered by Medi- known as MedicarePlus plans. These new build and add on to their hospital. care to help keep down program costs and re- MedicarePlus options include: One, provider- Have you ever wondered why? One reason port fraud and abuse. sponsored organizations; two, medical savings is a part of the Medicare reimbursement for Three, a voluntary disclosure program for accounts; and three, health maintenance orga- hospital care is based on the capital invest- doctors who may have unintentionally over- nizations. ment of the hospital. In other words the more charged for Medicare services. There is no Each new option is a marketplace program. the hospital makes capital investment, the such provision in current law. Each option will be completely voluntary. No more reimbursement they get from Medicare. Fourth, heavy fines on doctors who commit one insured by Medicare will be required to Well the Medicare Preservation Act will slow fraud against Medicare. select one of these options. The success of down the unnecessary building by reducing Five, a Medicare integrity program whereby these options will be determined by the mar- the reimbursement based on capital invest- the Secretary can contract with private con- ketplace according to the quality of care pro- ment. This should have been done many cerns to review activities of doctors, audit the vided, and the fees charged for the care pro- years ago. cost reports, determine whether Medicare vided. If an individual is not satisfied with ei- Mr. Chairman, back during the late 1970's I should or should not have paid for services ther the quality of care or the price charged, served as chairman of the board of commis- charged, and gives the Secretary the authority they will have the ability to go back to the cur- sioners for a rural county in Georgia. The to collect overcharges. rent Medicare system. county has a Hill-Burton Hospital and the local Six, establish within the Department of Jus- Mr. Chairman, the Medicare Preservation government was responsible for keeping the tice an antifraud task force. Act is a good idea. It is a plan which I fully be- doors open. Our hospital was losing money Third, the Medicare Preservation Act estab- lieve will ensure that Medicare will be there for and had a high account receivable owed to it lishes a trust fund for medical education. Cur- me 14 years from now when I become eligible by Medicare. rently teaching hospitals receive additional re- for Medicare insurance. As one who was responsible for the peo- imbursement money to help pay for medical Mr. HORN. Mr. Chairman, we have endured ple's tax dollars, I paid a visit to the Blue education; again increasing the cost of Medi- a great deal of campaign rhetoric regarding Cross-Blue Shield insurance company and care. the Republican tax cut proposal and its al- asked why they had not fully reimbursed the Fourth, the Medicare Preservation Act es- leged affects on the reforms we offer today to hospital for the bills submitted. They looked in tablishes a baby boomer commission. This Medicare. I would like to refute the well- the file and said, ``we are discounting your bills commission will begin now to look ahead for choreographed Democratic attempt to sideline because you are not charging us enough.'' I ideas of how to best ensure that Medicare will a valiant effort to save Medicare. could not believe what I had heard. Our hos- be there for those Americans born during or The Republican plan to strengthen and save pital was being penalized by Medicare rules after World War II. In the past Congress has Medicare has nothing to do with the tax cut because we were not charging enough for our waited until a crisis occurs before taking an proposed for working families. When we hospital care. It is no wonder Medicare has action. This commission will change that passed the revenue bill in the House we had had money problems for a long time. precedent. It is a very needed provision be- already made the spending cuts to permit a Mr. Chairman, if we are reducing doctor and cause when the baby boomers reach Medi- tax reduction. And they know that. There is a hospital reimbursements, we also must help care age there will only be 2.5 workers per gap as wide as the Grand Canyon between them reduce their cost of operation or we may Medicare insured, compared to today where what they know and what they say. discourage them from serving the Medicare in- there are 3.3 workers per Medicare recipient. Even if the budget were balanced, Medicare sured. We are reducing their costs by includ- Fifth, there is a provision requiring a look- would still have to be saved from bankruptcy. ing in the Medicare Preservation Act a provi- back commission to review the Medicare Pres- The President claims that, ``not 1 red cent of sion commonly known as malpractice reform. ervation Act changes and how they are work- the money being paid by seniors will go to the Today, doctors and hospitals pay ridicu- ing. This will give Congress an idea of just trust fund. It will go to fund a tax cut that is lously high premiums for malpractice insur- what affect Medicare reform has on the cost of too big.'' The President is wrong. He ought to ance and most feel they have to practice de- Medicare and recommendations for any nec- read the law. Under current law, premiums fensive medicine to avoid lawsuits. Both the essary corrections needed to protect benefits. and payroll taxes paid into the Medicare trust cost of the insurance and the overpracticing of Mr. Chairman, many of our seniors are wor- funds can only be used for the Medicare pro- medicine have led to higher costs for health ried about whether copayments or their hos- gram. This is true for both the trust fund that care. pital deductible will be increased under the pays hospital expenses, part A, and the trust Additionally, the Medicare Preservation Act Medicare Preservation Act. The answer is no. fund that pays physician and other expenses, includes an antitrust provision so doctors and I will repeat the answer, noÐcapital NOÐno. part B. As the Medicare trustees stated in their hospitals can legally discuss better ways to The question has also been asked, will my April 1995 report: ``The assets of the trust fund deliver health care to a community. It is just part B premium increase? The answer is: The may not be used for any other purpose.'' plain common sense to allow providers this part B premium deducted from Social Security Now let us address the so-called tax cuts flexibility. checks will remain at the current 31.5-percent for the rich. The House Budget Committee es- Another good idea included in the Medicare level. This is different from the Democrats timated that 74 percent of the $500-per-child Preservation Act is to purchase the necessary substitute which would have dropped the part family tax credit will go to families making less equipment to better track how much we pay B premium deduction to 25 percent. Under the than $75,000 per year. The 4.7 million working doctors and hospitals for health care delivered Medicare Preservation Act, those individuals families earning $25,000 a year and below will to each Medicare insured beneficiary. You insured by Medicare who have an annual in- no longer pay any Federal income taxes; fami- would think this would have already been come of $75,000; and for those couples that lies earning between $25,000 and $30,000 will H 10368 CONGRESSIONAL RECORD — HOUSE October 19, 1995 have 48 percent of their Federal tax liability $270 billion out of Medicare. It's not pretty. In these communities to attract and keep doctors wiped out; although families with incomes of fact, it's more bad math and good govern- and maintain local hospitals. $100,000 will only have their Federal taxes re- ment. Essentially, they set themselves a 7 There is no question that there is an excess duced by 5 percent. year timeline for reaching a balanced budget. of hospital beds in some communities and that President Clinton penalized seniors with a An admirable goal. But, then they insisted on some hospitals could be closed. The problem retirement income above $34,000 by imposing a $245 billion tax cut. What NEWT GINGRICH with this plan is that, as a result of these dras- higher taxes on them in his 1993 tax bill. The called the crown jewel of the Republican tic cuts, the wrong hospitals will end up clos- Republican Contract with American legislation agenda, turns out to be a combination of tax ing. Hospitals in many of the smaller commu- provides tax relief to senior citizens by phas- credits and tax cuts that help the richest 1 per- nities in my district are in precarious financial ing out the President's 1993 Social Security cent. Then, they turned their sights on discre- situations, and if they close, there may not be benefits tax. We also help seniors who con- tionary spending, squeezing as much as they another facility for 75 miles. tinue to work after turning 65 by raising the could out of programs that help kids, families, When I visited with the head of one of these earnings limit. If you continue to work and and the underprivileged. hospitals in my district his message was clear. earn more than $11,280 after turning 65, you Left with a $270 billion shortfall, they de- Ed Bland of Colusa Hospital said simply, currently are hit with a tax on your Social Se- vised a last-minute plan to squeeze exactly ``When you put everyone on a starvation diet, curity benefits. I think seniors who desire to that amount out of Medicare. the small and the weak die first.'' work should be encouraged to work, not pun- Coincidence, conspiracy, or incompetence? This Medicare plan, combined with the un- ished with lost benefits. Our revenue proposal Regardless, the true losers are the 37 million precedented Medicaid cuts that are also pro- raised this earnings limit from $11,280 to seniors who depend on MedicareÐthe real posed, will be a one-two punch to rural resi- $30,000. Is a senior earning $30,000 rich? I crown jewel of our 30 year commitment to dents. Out of the patients the hospitals in my do not think so. quality health care. area serve, approximately 43 percent receive Mr. Chairman, what the naysayers do not Just over 3 weeks ago, Democrats here in Medicare reimbursed service and 17 percent want to admit is that the Republican proposal Congress decided we'd had enough Enough Medicaid reimbursed service. On the average, to save Medicare is a viable plan not only for bad math, enough bad policy, enough dis- this means a full 60 percent of the care these those who currently depend on its services but regard, on the GOP's part, for open debate hospitals provide is federally financed care. also for the generations to follow. and free discussion. If these Medicare reductions go into effect, Mr. Chairman, 30 years ago as the legisla- We staged our own series of hearings to hospitals in my district alone would have $175 tive assistant to Senator Thomas H. Kuchel, evaluate the elements of the Republican pro- million taken out of their budgets over the next the Republican Whip/deputy leader of the posal. We invited health care providers, Medi- 7 years. There is no way you could take that Senate, I was part of the working group that care beneficiaries, and health policy experts to much out of our hospital budgets without met with key Members of the Johnson admin- present their views in the court of public opin- harming the quality of patient care these facili- istration to put together what became known ion, right here in the shadow of the Capitol. In ties could offer. What we have before us is a Medicare deci- as Medicare. I have been a strong supporter some ways, I regret that we had to step out- mation actÐput Medicare on a starvation diet, of Medicare over the three decades since that side the convention and custom of the House, raise premiums for seniors, drive up their out- time. and away from a committee system that I re- Today, we are preserving, strengthening, of-pocket costs, bankrupt rural hospitals. All of spect, to conduct these hearings. this to give the wealthiest in this country a tax and saving Medicare from bankruptcy. We But, as I listened to these witnesses, I felt, have provided much improved choices for all break. at last, that we had begun the real public dia- senior citizens. The result is a much improved The alternative to today's Medicare decima- log. In some cases, we heard the views of Medicare which will meet the needs of the cur- tion act is a sensible, equitable reform plan people who had been shut out of the official rent and future generations of older Ameri- that does not jeopardize the health and secu- debateÐshut out of the single day of Repub- cans. rity of millions of seniors and their families. Vote for the Medicare Preservation Act of lican-led hearings in the Ways and Means The Democratic alternative has no premium 1995. History will prove we did the right thing. Committee. increases for Medicare beneficiaries, expands Mr. FAZIO of California. Mr. Chairman, we I have also been listening to seniors in my choices of providers and plans, adds new pre- are not talking today about Medicare preserva- district, hearing about how this Medicare deci- ventive benefits, and implements tougher tionÐwe are talking about Medicare decima- mation proposal would be devastating to them. fraud and abuse standards. It reduces Medi- tion. The Republican Medicare proposal flunks It is estimated that this plan will cost seniors care spending by two-thirds less than the Re- the test by which we judge sensible health $400 a year more in premiums costs. This publican plan, only $90 billion, but extends the policy. On all counts, it fails to measure up to may not sound like much to the people who solvency of the trust fund to the same year as the standards that the American people de- are benefiting from the tax breaks in the over- the Republican planÐ2006. mand and deserve. It reflects not the informed all budget package. But keep in mind that Let me reinforce this pointÐthe Democratic consensus of the millions of seniors who de- more than half our seniors have no pension alternative would preserve the Medicare trust pend on Medicare, but the arbitrary will of a income other than a Social Security check and fund for until 2006. This is the same exact handful of Republican leaders. half of these seniors get less than $7,000 a time frame as the Republican's proposal to Health policy experts agree that this plan year. save Medicare. will actually end up hurting seniors, not help- These are not just faceless statistics. Listen Mr. Chairman, I will not support a plan ing them. At the expense of Medicare bene- to the words of Mary Hopkins, a Medicare re- which claims to save Medicare by taking $270 ficiaries, primarily seniors on fixed incomes, cipient who lives in my district in Carmichael, billion out of the program in order to fund $245 this Medicare plan lines the pockets of special CA. billion in tax breaks for the wealthy. I urge my interests. And the scope of the planÐfar ex- My husband’s employer went bankrupt, colleagues to join me in rejecting this Medi- ceeding what is necessary to shore-up the wiping out all his benefits. He now works care decimation act. Medicare trust fund well into the next cen- part time at McDonald’s to make ends meet. Mr. MURTHA. Mr. Chairman, we simply I suffer from arthritis, asthma, and a heart turyÐis a dead-giveaway that the cuts are, in cannot solve Medicare in a partisan manner, condition, so I am taking a lot of medication and that's why this is the wrong bill, at the fact, simply a vehicle to finance tax cuts for and see my doctor at least every 3 months. people who don't need them. I am very concerned about how I would pay wrong time, for the wrong reasons. It's the This so-called Medicare Preservation Act for any increase in my copayments for Medi- wrong bill because it increases premiums, re- isn't about making Medicare more efficient. It's care service. There is no room in our budget duces coverage and reduces choices for older not about working with seniors and health pol- for any further medical expenses, so we Americans while closing rural hospitalsÐas icy experts to craft sensible reforms that guar- would have to go on welfare. Where are the many as half the hospitals in our area would antee our seniors the safety and security they savings there? close, according to the Pennsylvania Hospital deserve. While I believe this plan to cut Medicare will Association. It's the wrong time because we're This plan is about one thing. It is about be bad for hundreds of thousands of people not in a crisis situation that demands the dras- squeezing the people in the middle, and the like Mary Hopkins, I know it will be even tic steps contained in this legislationÐwe have people who have worked hard and paid into worse for rural residents. My district in north- time to study the alternatives and develop a Medicare all their lives, in order to give the ern California encompasses many rural areas bipartisan consensus. And it's the wrong rea- people at the top a $19,000 tax break. and small towns. The fragile economies of sons because the savings won't go to the The New York Times, in a recent article, ex- rural areas often mean many residents have Medicare trust fund, but instead would go to- plained exactly how the GOP decided to cut little or no insurance, making it difficult for ward a tax cut slanted toward the wealthy. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10369

Let's separate Medicare from the budget-tax Speaker GINGRICH that the way to keep Medi- to Medicare. As someone who believes in the cut issue, and work for legislation which guar- care solvent is to operate on it with an axe, in- democratic process, I am outraged that the antees that older Americans will continue to stead of a scalpel. new majority only allowed for one day of pub- have access to affordable, quality health care Speaker GINGRICH would like to convince lic hearings on this assault on Medicare. As a of their choice. the American public that Medicare is in a sud- former Petaluma City Council member, I re- For the last 30 years, Medicare has worked den crisis. However, concerns about the Medi- member that we talked longer and harder very wellÐit's enabled senior citizens to get care Trust Fund are not new. The Medicare about sidewalk repairs than the House of Rep- the health care they need without facing finan- Trustees have on eight previous occasions resentatives has about an issue which affects cial disaster. The backers of this legislation warned that the Trust Fund would be insolvent the health of millions of Americans. This is un- claim we're in a crisis situation which de- within 7 years. Each time, Congress re- fair and undemocratic. mands the drastic steps contained in this leg- sponded immediately in a bipartisan way to So, I am here to speak out for the people islation, but that's simply not true. make the changes necessary to keep Medi- who have been shut out of the democratic This bill does everything senior citizens care solvent. However, the cuts proposed by process by this new majority. These people don't wantÐit makes health care more expen- Speaker GINGRICH go far beyond what is should not be silenced, and they should not sive, it forces them to go to doctors they don't needed to protect the Medicare Trust Fund. see their concerns ignored by a Congress want, and if they need to go to a hospital, it What is more, since the proposed premium in- bent on pursuing a partisan agenda. may risk their lives by forcing them to travel creases do not even contribute to the Medi- We would all do better if we listened care- farther, because according to the Pennsylva- care Trust Fund, it is clear that the new major- fully to those we represent. As one man in my nia Hospital Association, half the hospitals in ity is increasing premiums only to pay for a district said, ``I worked hard all my life, raised western Pennsylvania may close if this bill is special interest tax giveaway, not to strength- ten kids and fought in two wars to live my life signed into law. And the legislation doesn't do en Medicare. in peace. Living on only $801 a month, I need what everyone, including seniors, feels is nec- In other words, the Gingrich Medicare plan all the help I can get.'' essaryÐto guarantee the stability of Medicare is a major cut. According to the non-partisan To my colleagues on both sides of the aisle, for more than 10 years. Congressional Budget Office, the rate of I would like you to remember these words. The supporters of this legislation should growth in health care spending per person in Think about this man, and the millions of sen- stop worrying so much about reaching a cer- the private sector over the next 7 years will be iors just like him all over America who do not tain number for savings and start paying atten- 7.9 percent. The Gingrich Medicare plan, how- deserve second rate medical care and who do tion to the needs of senior citizens. We should ever, brings the rate of growth of Medicare not deserve to have their pockets picked for a take our time and come up with a bipartisan spending down to 4.9 percent per beneficiary. special interest tax giveaway. I call on my col- solution which starts with addressing the This means that the Gingrich plan will not leagues to reject this bill, take the tax give- waste, fraud, and high administrative costs in keep up with the pace of inflation and the aways off the table, and get on with the bipar- the Medicare system. The savings we could growing population of older and disabled tisan job of restoring Medicare's solvency by get from those areas are enough to stabilize Americans. As a result, there will be major in- eliminating rampant waste and fraud. Stand up for seniors by voting down this bill. Medicare and avoid the premium increases creases in costs: by the year 2002, seniors Mr. BORSKI. Mr. Chairman, I rise today to and limits on care which are going to penalize will spend $400 more in Medicare premiums. denounce the majority's plan to cut $270 bil- older Americans. Moreover, seniors may lose their choice of lion from Medicare and $182 billion from Med- Medicare is too important to too many peo- doctor because they will be forced into a Gov- icaid over the next 7 years in order to pay for ple to be lost in political rhetoric. Seniors ernment-mandated managed care plan. In ad- $245 billion in tax breaks for the wealthy. should feel confident they're receiving the best dition, hospitals and emergency rooms will be These excessive cuts are unnecessary and possible care at a cost they can afford. So forced to reduce care and many will close. harmful to America's senior citizens, working let's not throw 30 years of success away in a Some health care experts predict that up to 25 families, and the health care industry. panicÐlet's protect Medicare, and not make it percent of all hospitals could close if Speaker It is my honor to represent the Third con- a program where only the wealthy can get the GINGRICH's assault on Medicare becomes law. gressional district in Pennsylvania, the twenti- best care. But I do support making Medicare stronger. eth oldest congressional district in the country. Ms. WOOLSEY. Mr. Chairman, now is the That is why I voted for the Democratic sub- Pennsylvania is the second oldest State in the time to stand up for seniors by voting down stitute to reform Medicare, and am a cospon- Nation where one out of six residents is a this plan to raid Medicare to provide tax sor of H.R. 2476, the Common Sense Medi- Medicare recipient and one out of seven is a breaks for wealthy special interests. Instead of care Reform Act. Medicaid recipient. In the Third Congressional continued partisan bickering, we need a bipar- The Democratic substitute saves $90 billion District, approximately 100,000 residents rely tisan effort to save Medicare by eliminating the over the next 7 years. It reduces seniors' pre- on Medicare. Approximately 400,000 people in waste and fraud that cost billions each year. miums, while providing coverage for new ben- Philadelphia rely on Medicaid. I come to this floor today as the Represent- efits such as more frequent mammograms, Not only will the senior citizens in my district ative for Sonoma and Marin Counties in Cali- colorectal screenings, Pap smears and diabe- suffer, but all citizens, our health care system, fornia. As I always say to my colleagues, I am tes screening. The Democratic substitute in- and the entire Philadelphia economy will be so fortunate to represent such a concerned creases seniors' choice of health care cov- endangered by these insidious cuts. Let me and caring constituency. erage, but does not force them to give up their give you an example. At the Episcopal Hos- For the last several months, I have been own doctors. Under the Democratic substitute, pital in Philadelphia, 88 percent of the people speaking to the people in my Congressional the Medicare program will be strong and sol- who enter the hospital are Medicare or Medic- District. I have been speaking with senior citi- vent, and seniors will continue to receive high aid beneficiaries. If these cuts are approved, I zens, with hospital administrators, with physi- quality care from doctors they know and trust. don't know how the Episcopal Hospital will cians, and with working families. Seniors are I also support the approach taken in the survive. Several other hospitals in my district, scared to death because they will have to pay Common Sense Medicare Reform Act, which in other parts of Philadelphia, and across the more for less at a time when so many are strengthens Medicare by eliminating real State of Pennsylvania, are on the critical list struggling to get by. And families are scared to waste, fraud, and abuse in the Medicare sys- as well. Health care workersÐas many as death because they do not understand how tem. It will also save the amount needed to 25,000 in Philadelphia and up to 6,000 in the they will support aging parents and send their keep Medicare solvent for years to come. This Third District alone, will be at risk of losing kids to college at the same time. The people bill will give law enforcement more tools to their jobs. Communities will lose their local of Sonoma and Marin Counties have spoken fight Medicare fraud, a crime which harms hospitals when these devastating cuts force loud and clear: they do not support $270 bil- Medicare and the American taxpayer. And this them to close their doors. In addition, working lion in Medicare cuts in order to pay for $245 bill, unlike the new majority's plan, will require families will pay more for their own health care billion in tax breaks for wealthy special inter- that any funds recovered through cuts or sav- as a result of the cost shifting which will follow ests. ings from waste, fraud, and abuse will be these cuts. The new majority is making the argument automatically returned to the Medicare Trust But none of this deep, human pain seems to that these massive cuts in Medicare are need- FundÐnot used to pay for a special interest matter to this majority. In Washington, these ed to save the system. I agree that Medicare tax giveaway. days, a chill wind blows over our Nation's sen- and Medicaid can be improved, and that Con- In addition, I would also like to raise my ob- ior citizens. A lack of compassion fills the air. gress should vigorously support efforts to jection to the way that Speaker GINGRICH has The senior citizens in the Third District, and make this system better. But I disagree with conducted the debate on his massive changes across the Nation, will pay more for their H 10370 CONGRESSIONAL RECORD — HOUSE October 19, 1995 health care, have less choice regarding their pointing fingers at the other rather than engag- These Americans want the right to choose doctor, and receive a lower quality of care. ing in substantive discussion of real solutions their doctors. If premiums are such that they Balance billing protection, which prohibits to address the rapidly rising costs of Medicare. cannot afford fee-for-service plans, that choice health care providers from charging seniors I would like to share with my colleagues is effectively taken away. more than 15 percent above the Medicare re- what I have learned from my constituents, and I have also heard countless stories of imbursement rate, will be eliminated. Seniors tell you some of their personal stories. I have waste, fraud, and abuse within the Medicare who enroll in HMO's because it has become been greatly impressed by their understanding system. Seniors have told me about receiving financially impossible to remain with their fam- of the changes being proposed and their ideas bills for services they did not receive. When ily doctor will have no protection against addi- about how to reform Medicare. they questioned the bills, they were told by tional charges once they are locked into an The plan before us is not Medicare reformÐ Medicare administrators that it was easier and HMO. That's the bad news. There is no good it is Medicare destruction. The bill cuts Medi- cheaper to just pay. ``If I ran my business like news in this Republican plan. care by $270 billion over 7 years even though those Medicare folks,'' one told me, ``I'd be Now, let me tell you the worst news. Every- the Medicare trustees have stated that cuts of going broke, too.'' one knows that Medicare is for our senior citi- about $90 billion will extend the life of the part To counter fraud, one group of seniors in zens and Medicaid is for those who are less A trust fund to 2006. my district has suggested an incentive pro- fortunate. But, what people across America My constituents have asked: ``why does the gram for reporting abuses. Others suggested don't realize is that Medicaid also pays for the Gingrich plan cut Medicare by $180 billion making Medicare billing easier for consumers long term care costs of senior citizens. In more than what the trustees say is nec- to understand. They explained that people Pennsylvania, 65 percent of all long term care essary?'' To them, the reason is clear: To pay need to know exactly what the doctors and costs are paid for by Medicaid. After our sen- for an ill-timed tax cut. They want the focus on hospital are charging to make sure that those iors have exhausted the savings they have saving Medicare and balancing the budgetÐ tests and services were receivedÐand nec- worked so hard to accumulate over their life- not on cutting taxes. ``We can't afford a tax cut essary. I agree that legislative change is nec- time, they go on Medicaid to receive the nurs- now,'' wrote Glenda Masek. ``And I'm a reg- essary to crack down on waste, fraud, and ing home care they so desperately need. With istered Republican,'' she added. abuse, and a bipartisan approach is essential. Many seniors recognize the financial prob- the costs for a modest nursing home averag- Health care reform is essential. But the re- lems facing Medicare and express a fervent ing about $4,000 a month, it is easy to under- form must help seniors, one of our most vul- desire for reforms. Some seniors told me they nerable populations. I strongly believe that we stand how typical Philadelphia seniors could are willing to pay slightly higher premiums and can make reforms to Medicare that attack easily drain their savings in a short time. After deductibles, as long as the increases are fair. these savings are depleted, Medicaid provides fraud and abuse and which lower costs. ``Some of us can afford to pay a little more,'' I urge my colleagues to vote against the seniors with a safety net. As a result of these Irwin Gerst acknowledges. ``But many seniors cuts, this safety net is now gone. The guaran- Medicare Preservation Act, an oxymoron if are on fixed incomes and so any increases there ever was one. tee that Medicaid will cover Medicare costs for should be minimal and gradual and not used poor senior citizens is now gone. Some laws Mr. BARCIA. Mr. Chairman, when people to offset tax cuts.'' reach the age of senior citizens, their biggest that enable the Government to stop fraud, Like these individuals, I cannot support a concern is their ability to maintain their quality waste, and abuse are now gone. proposal that will take money out of the pock- of life. They have worked all their lives. They These exorbitant and heartless cuts are not ets of Medicare beneficiaries who have an av- have sacrificed. Many have served in our Na- designed to fix or save Medicare. They are erage income of $13,000 a year. Under the bill tion's Armed Forces. They are owed a great being enacted in order to give $245 billion in before us beneficiaries' monthly premiums will debt for their years of contribution. tax breaks to the country's wealthiest individ- rise to $87 by 2002, as compared to $61 uals. Despite all the rhetoric from the majority, I agree that we need to make responsible under current law, and $1,700 less will be reductions in the cost of the Medicare Pro- one fact is clear: The savings from the Medi- spent per beneficiary. These figures translate care cuts will not go back into the Medicare gram. But we also need to make sure that we into higher costs for less care. maintain a viable health care system that pro- trust fund. They will pay for tax breaks for the Not all my constituents can afford the in- vides hospitals, doctors, nurses, and the other wealthy. Our senior citizens on fixed incomes creases: cannot afford these increased costs. The Med- One San Pedro senior, Katie Brazerich, support mechanisms that people need when icare system can not afford these excessive pleads: ``Please don't cut my Medicare bene- their health demands it. The bill before today cuts. fits and raise my premiums. Every single dol- just does not do this. The ability to have access to health care is I have traveled my district and asked hun- lar is needed to help with my living expenses. vital for the elderly. Last year, many of us dreds and hundreds of my constituents if they There isn't any extra left for me to cut.'' support $270 billion in Medicare cuts and ``Don't bankrupt us just because we are liv- heard from our senior citizens who were con- $182 billion in Medicaid cuts in order to pro- ing longer,'' comments her neighbor. cerned that proposed changes to the health vide $245 billion in tax breaks for the wealthi- ``These cuts are cruel,'' Lillian Watson ob- care system would leave them without access est in our country. The answer is always the serves. to their own doctor, would drive up their pre- sameÐno. Joyce Short, a 75-year-old Westchester miums, would force them into managed care I will vote against this mean-spirited legisla- resident told me, ``I paid into it [Medicare] all systems when they did not want them. In my tion and I urge my colleagues to do the same. my life, and now I need it.'' own district, in response to a questionnaire Ms. HARMAN. Mr. Chairman, on behalf of Another, 71-year-old Mary Ford, fears she that I sent out last year, 43 percent said the hundreds of seniors in the 36th District of Cali- will be put out in the street. ``I have been diag- choice of their own doctor was the most im- fornia with whom I met over the course of this nosed with Lupus and probably will be com- portant element of health care. This year, debate, I rise in strong opposition to this bill pletely bankrupt if these cutbacks go through. nearly 60 percent of my constituents said that that would decimate Medicare, our most suc- We are the same Americans who went they did not want to see HMO's instead of cessful Federal program. through the Depression.'' being able to choose any doctor. And by a 2- For more than 30 years, Medicare has guar- I support expanding choices for Medicare to-1 margin they said that we should maintain anteed health care coverage for seniorsÐ99 beneficiaries. While the bill purports to do this, spending on Medicare and Medicaid, not cut percent of whom are now coveredÐand it has a choice is not a choice when it becomes too it. dramatically reduced poverty among seniors, expensive and when doctors move elsewhere. The Michigan Health and Hospital Associa- from 33 percent in 1965 before Medicare's What supporters of the so-called choices in tion has written to me claiming that these an- creation to 13 percent today. this bill do not mention is that under their plan, ticipated cuts in Medicare and Medicaid will I have carefully read the Medicare trustees beneficiaries will no longer have extra billing probably result in many rural hospitals closing. report. I agree that Medicare must be re- protection. This means health care providers I have several rural counties. How can I go formed. We must extend the solvency of the can charge seniors above what Medicare re- back to my constituents and say I supported part A trust fund and take steps to control imburses for the same services they receive a proposal that meant that their local hospital Medicare's high rate of growthÐ10 percent a without additional charge under Medicare was likely to close? Where would these peo- yearÐto save Medicare for today's seniors today. Fear of extra billing will drive seniors ple go for treatment, especially in an emer- and for generations to come. out of fee-for-service arrangements. gency, when the hospital closed? How many Unfortunately, Washington is at it again ``I don't want to be forced into an HMO,'' doctors would locate in rural areas where it playing politics. Members from both sides of Virginia Balesteri told me. ``And I don't want would be difficult to get to hospitals where the aisle have been more concerned with my children to have to take care of us.'' they could adequately treat their patients? October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10371 Some will say that doctors and patients can necessary'' to avert the projected bankruptcy punishment for those engaged in fraud; curtail- go to hospitals in the nearest city. Bay Medical of Medicare by the year 2002. I am pleased ing malpractice abuse; and, providing regu- Center in Bay City, one place that would be a that today House Republicans are fulfilling latory relief to improve efficiency and help likely alternative, tells me that the cuts in Med- their commitment to saving Medicare by stem the growth in health care costs. icare proposed by this bill would mean a loss adopting this legislation. Mr. Chairman, I urge my colleagues to rec- of $70 million in revenue between now and The Medicare Preservation Act represents a ognize the Medicare crisis, and to support the 2002. That is before we add in the impact of major overhaul of Medicare. The proposal is Medicare Preservation Act. Only by acting the Medicaid proposals we will consider next aimed at preserving, protecting, and strength- now, can we preserve, protect, and strengthen week. Bay Medical Center could be in serious ening Medicare, while empowering seniors to Medicare for generations to come. jeopardy if these proposals pass. if this hos- choose the health care plan that best suits Mr. WELDON of Pennsylvania. Mr. Chair- pital were to close, where would my constitu- their needs. man, we have heard in this debate on the ents who need assistance go? The principle behind this legislation is floor today and over the past few months an Yesterday we spent 4 hours debating choice. The Medicare Preservation Act con- unrelenting barrage of denial, disinformation, shrimp and lobsters. Today we get only 3 tains an important and innovative feature that distortion, and demagoguery from the Demo- hours to debate the future of a health care will give seniors more choice as well as intro- cratic Party on the subject of Medicare. That's system for millions of senior citizens and for duce a truly competitive framework, called why it is no wonder so many senior citizens millions more who will need to make use of Medicare-plus. Medicare-plus will give bene- have expressed concerns about this bill. that system in the future. We were able to de- ficiaries new options to select from a broader Denial, because the nonpartisan Medicare bate thirteen amendments for shrimp and lob- array of privately offered plans, with the Gov- Board of Trustees, which includes three mem- sters. Today senior citizens will be restricted ernment paying the premiums. These plans bers of President Clinton's own Cabinet, is- to only one. Earlier this year I celebrated pas- could include private traditional insurance, sued a report in April stating that the Hospital sage of new House rules requiring a three- HMO's, new physician-hospital networkÐpro- Insurance trust fund will be able to pay bene- fifths vote to impose any tax increase. If this vider-sponsored organizationsÐcoordinated fits for only about 7 more years. The trustees bill does not raise feesÐtaxesÐfor our sen- care, Medisave plans, and limited enrollment said that even under the best estimates, if iors, why must we waive this provision? We plans sponsored by unions or trade associa- nothing is done, the trust fund will be ex- were sent here to do the people's business, tions. Under Medicare-plus, standard Medicare hausted by 2002. Yet the Democrats deny not to give greater consideration to shrimp and benefits will be retained so that future bene- there is a problem and say do nothing. lobsters, nor to go back on the reforms we ficiaries will be assured that their benefits will Disinformation, because the Democrats made at the first available opportunity. not be reduced. Moreover, if a health plan can speak falsely of massive cuts in Medicare, Mr. Chairman, I cannot support this bill. It provide Medicare benefits at less than the when it can plainly be demonstrated that Med- jeopardizes health care for our seniors. It does Government contribution, the plan can either icare spending goes up each year under the not give them the kind of system they want provide additional benefits or provide a rebate Medicare Preservation Act, that we will spend and deserve. It is being forced through without to beneficiaries. almost $2,000 more per Medicare beneficiary adequate review, and it breaks our word. Our I want to stress the significance of the pro- by 2002 under this plan, and that there are no seniors deserve better. We can and should do vider-sponsored organization [PSO] portion of cuts. better. the bill. This area gives recognition to the im- Distortion, because the Democrats want you Mr. JOHNSON of South Dakota. Mr. Chair- portant competitive aspects of having PSO's to believe that these supposed cuts, which man, I rise in strong opposition to H.R. 2425, as a choice option for Medicare recipients don't exist, will pay for Republican tax cuts for legislation designed to reduce Medicare fund- while also according these entities certain the rich, another figment of the Democrats' ing by $270 billion over the next 7 years. Federal protections. In my view, the ability of imaginations. Yet this bill contains a lock-box While I support constructive efforts to stabilize providersÐdoctors and hospitalsÐto offer provision that puts all savings back into Medi- the Medicare part A trust fund and other ef- health services directly to Medicare recipients care. Furthermore, the Republican tax cuts for forts to promote administrative efficiencies and adds an extremely important new aspect to the middle classÐincluding a $500 a year simplification, the plain fact is that this bill the pulsating revolution already taking place in credit per child for working familiesÐhas al- does little to strengthen Medicare and is pri- the private health care market. In fact, these ready been paid for by other savings in the marily designed to free up $270 billion in order providers are already offering health services Republican budget. We did that months ago. to finance the cost of the $245 billion tax cut to employees covered under the Employee The Democrats choose to ignore that incon- and $60 billion defense pork provisions con- Retirement Income Security Act [ERISA] cov- venient fact. tained in Speaker GINGRICH's budget reconcili- ered plans sponsored by employers and Demagoguery, because Democrats have ation bill. unions. Under the PSO option, Medicare en- engaged in a conscious effort to frighten sen- Seniors in South Dakota have always been rollees also will have the freedom to choose ior citizens, to scare them into thinking some- willing to make some adjustments to assist the doctors and hospitals they think will pro- one is trying to take away their benefits. It is with Federal budget deficit reduction and they vide them the best care at the lowest cost. absolutely outrageous. They are sending vid- realize the need for some health care reforms PSO's and similar entities, which continue to eos to senior centers claiming that this bill will that will slow down the growth of health care drive down the cost of private health care, will ``destroy Medicare, not save it.'' This prompted inflationÐbut they are also wise and experi- be an important element of the solution to the dean of the University of Pennsylvania's enced enough to know when someone is try- containing Medicare health costs and preserv- Annenberg School of Communications, Kath- ing to sell them the Brooklyn Bridge. I have ing quality health care. leen Hall Jamieson, quoted in the Philadelphia been holding town meetings on the Medicare The extension of choice of coverage to Inquirer, to state, ``It's inappropriate to target a and Medicaid issue all around South Dakota, members of qualified associations and Taft- vulnerable population with that kind of informa- and the bipartisan opposition to H.R. 2425 is Hartley multiemployer plans is also another tion.'' overwhelming. Seniors want Medicare re- key element for expanding the choice of Medi- It's far worse than inappropriate. It's offen- forms, but they absolutely do not want wealthy care-plus coverage and allowing seniors to sive to suggest that Republicans don't care special interests laughing at them all the way continue their care under organizations that about seniors, that we want to harm seniors. to the bank at their expense. they looked to while working. Moreover, I want My 85-year-old mother relies on Medicare and Mr. Chairman, I support alternative legisla- to stress that the PSO, qualified association, Medicaid and Social Security and I resent hav- tion which is designed to stabilize the Medi- and multiemployer plan options under the bill ing anyone on the other side suggest that I care part A trust fund and does so in a man- does not amend or modify the Federal pre- don't care about my mother. That my party ner which does not raise premiums or reduce emption framework under ERISA. doesn't care about seniors. benefits to seniors. I cannot and I will not, While providing choice in new options for Despite the distortions, despite the dema- however, support this misdirected, ``Reverse beneficiaries, the bill simultaneously allows gogues, despite the bitterly partisan rhetoric, it Robin Hood'' attack on Medicare and Medic- any Medicare beneficiary to remain in or re- is Republicans who are facing up to the prob- aid. turn to the current fee-for-service system lem and taking action to save Medicare. The Mr. FAWELL. Mr. Chairman, I rise in sup- where they choose their own doctor or hos- Medicare Preservation Act does just what its port of H.R. 2425, the Medicare Preservation pital. Other priorities of the Medicare Preser- name says. It preserves Medicare for seniors. Act of 1995. In April, the Medicare Board of vation Act include: combating Medicare fraud It saves Medicare for the next generations. It Trustees concluded in their annual report that and abuse by rewarding seniors who discover strengthens Medicare for all of us. This bill will ``* * * prompt, effective and decisive action is and report fraud and abuse; increasing the attack waste, fraud, and abuse. It will give H 10372 CONGRESSIONAL RECORD — HOUSE October 19, 1995 seniors more health care choices. It does not Mrs. COLLINS of Illinois. Mr. Chairman, I My second amendment would remove the raise copayments, deductibles, or premium rise in opposition to this rule and in opposition 7-year freeze on payments for durable medical rates. The Medicare Preservation Act ensures to the underlying bill, H.R. 2425. equipment [DME]. that Medicare will be there well into the future. Democratic Members of Congress and sen- H.R. 2425 will cause severe disruptions for Mr. Chairman, I urge all my colleagues to iors across this Nation continue to ask for free seniors and the elderly who need their oxygen join in support of this bill. It is our responsibil- and open debate on the extreme and unnec- to breathe, electrical beds, wheelchairs and ity to act. We have to step up to the plate. No essary Medicare cuts that are before this body walkers to move about. Without these needed one else can. We must have the courage to today. They have yet to be heard, let alone and essential items, seniors and the disabled act. Let us do the right thing and save Medi- answered. could be forced into potentially life threatening care. There were 10 hours of debate on the legis- situations. Mrs. CHENOWETH. Mr. Chairman, I rise lation that established the Medicare Program Unfortunately Mr. Chairman, the Republican today to once again remind the American peo- 30 years ago. Today we have half that time on leadership just doesn't care. I urge all my colleagues to vote ``no'' on this ple of who has a plan to save Medicare and a bill to dismantle it. There were 20 hours of who doesn't. rule and ``no'' on the bill. debate earlier this year on legislation to send Mr. KOLBE. Mr. Chairman, today, Congress My constituents are understandably con- U.S. aid overseas. Today we have one-fourth has a historic opportunity to pass legislation cerned over what might happen to Medicare. of that time to consider ripping $270 billion in that will allow recipients of MedicareÐboth Instead of putting legislation where their health care away from older Americans. present and futureÐthe freedom to choose mouths are, opponents of Republican Medi- Where is the logic? their doctors, their health plans, and the health care reforms have done nothing but use in- Last week during markup of H.R. 2425, 13 care services they decide are appropriate for flamed rhetoric to frighten and confuse people. senior and elderly citizens were led out of the them. It is time we allow Medicare recipients In fact, I've seen some newspapers describe Commerce Committee and arrested just be- access to the same choices in health care that it as ``MediScare.'' cause the committee chairman and his GOP the rest of us have. That is the heart and soul I am happy to point out, however, that one colleagues were unwilling to answer the most of this legislation. of the newspapers in my districtÐthe Idaho basic questions about the consequences of It's become abundantly clear in the last sev- Statesman out of BoiseÐrecently endorsed passing the Republican Medicare bill. The rule eral months that Medicare faces a very real the Republican Medicare proposal. To quote we have before us on this bill continues this threat of bankruptcy. It is this looming bank- the Statesman ``GOP-sponsored reforms in gag order by denying Members on both sides ruptcy of the trust fund that first alerted the Congress make a modest beginning at getting of the aisle the opportunity to participate in a country to the need for extensive changes if Medicare costs under control * * * Without fair and democratic review of H.R. 2425 and we were to save the Medicare system. What their passage, senior citizens won't have a to offer amendments to this drastic legislation. won't work is another Band-Aid. Yet, for dec- viable health-care system.'' I am submitting As members of the National Council of Sen- ades that has been the Democrats' only an- the Stateman's editorial for the RECORD. ior Citizens testified before Democrats on the swer to ensure solvency of the Medicare trust The problem we are facing is this: If we Government Reform and Oversight Committee fund. The trustees themselves have told us it don't act to strengthen Medicare, the benefits yesterday, the flame of democracy continues needs a systemic fix to be real. This year, available now just won't be there in the future. to be smothered by the Gingrich Republicans. once again, the Democrats have proposed the We must not let politics as usual get in the Yesterday I presented testimony on two same quick fix solution and have failed to deal way of protecting the security that all Ameri- amendments before the Rules Committee that honestly with the underlying structural prob- cans should have when they retire. We need I believe would improve certain deficiencies of lems of the Medicare system. By simply re- to keep our eyes on the facts. H.R. 2425. My amendments were not made in ducing payments to hospitals and physicians, I know I couldn't bear to look at my grand- order. The Rules Committee didn't bother to the Democrats Band-Aid staves off bankruptcy children and explain to them we had the listen to me, and therefore didn't bother to lis- for another 2 or 3 years. This is simply irre- chance to fix the system in 1995 but didn't. ten to my senior constituents and hundreds of sponsible; it's what we've done for too long on Let's stop the bickering and pass Medicare thousands like them around this country. too many other issues. It's why Medicare reform now. My amendments are designed to restore faces such a bleak future today. [From the Idaho Statesman, Oct. 11, 1995] current protections for seniors who have diag- H.R. 2425 doesn't wait for disaster to wash CONGRESS CAN TRIM MEDICARE nostic tests performed in a doctors' office and over us; it takes action now to assure the fu- Public health assistance for billionaires is to ensure that our elderly continue to have ac- ture security of Medicare for seniors. By pro- hardly what Americans had in mind for Med- cess to durable medical equipment such as viding fundamental changes to the structure of icare when it was created 30 years ago. But wheelchairs, electrical beds, walkers, and oxy- the program, the Medicare Preservation Act such unintended consequences are one of the gen. will keep Medicare solvent for at least 15 reasons the massive health insurance pro- years, until the baby boomer generation be- My Clinical Laboratory Improvement Act gram is going broke. gins retiring. We freely acknowledge that an- [CLIA] amendment would reinstate quality as- GOP-sponsored reforms in Congress make a other deeper fix will be required then, but this surance guarantees for patients who have modest beginning at getting Medicare costs legislation gives us time to see how well free under control. Lawmakers can also set in- testing done in physician office laboratories by market solutions can work to retain health come limits for recipients or have high-in- striking the provision in the bill that eliminates come recipients chip in more for their cov- care costs. the requirements of CLIA for labs in doctors' The heart of this legislation is the expansion erage. They also need to allow recipients to offices. pick private plans as an alternative to the of Medicare beneficiaries choice of health care traditional Medicare program. It probably should not be surprising that the options. The private health care market has Such reforms are necessary because the Republican Medicare proposalÐwhich bends demonstrated that health care services can be current program covers virtually every so close to special interests and tilts so far provided in a cost-effective way while main- American, not just the needy. For example, from the best interests of America's senior citi- taining the patient's quality of care. Such care when Boise billionaire J.R. Simplot had hip- zensÐwould eliminate requirements for quality is found in alternative health care systems, replacement surgery last spring, Medicare and accuracy of laboratory tests. This like the such as managed care system, health mainte- covered some of the costs. That simply Republicans' blatant and cruel elimination of nance organizations, preferred providers orga- makes no sense to Simplot or anyone else. national standards for nursing homes, is one Congress also needs to get the paperwork nizations and medical savings accounts. Cur- under control. Look at what Vice President more way of saying to Medicare beneficiaries: rently, Medicare recipients have not had wide Al Gore discovered about just one rule of the You're on your ownÐgood luck. access to these options. With passing of H.R. Health Care Financing Administration, the What is the rationale for exempting office 2425 Medicare recipients will not have to rely agency that directs Medicare and Medicaid. labs? What is the rationale for exempting one on a system that is a relic of 1965 medicine. That one rule generated 11 million forms. specific testÐpap smearsÐfrom such labs? If It is unfortunate that my colleagues across Each hospital spend about $22,500 a year fill- it is critically important for doctors' offices to the aisle, do not recognize the need for com- ing out those forms—and Medicare is gov- meet quality standards for pap smears, why prehensive reform. Their bill provides no secu- erned by 3,200 pages of federal regulations. GOP Medicare reforms are scheduled for a shouldn't those same quality standards be met rity for seniors who rely on Medicare today, vote next week in the House. A similar bill when it comes to cholesterol tests, colon and because it extends its life by only a year or is pending in the Senate. Without their pas- prostate cancer screening, needle biopsies to two. It provides even less assurances for fu- sage, senior citizens won’t have a viable detect precancerous conditions, and glucose ture seniors who are counting on Medicare to health-care system. monitoring? be there for their retirement. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10373 Even if the Medicare trust fund were not hefty tax break to people making over with the relationship between patients and facing bankruptcy, this legislation would make $200,000. The Gingrich plan cuts Medicare their doctors. sense. It allows Medicare recipients access to too deeply and hurts senior citizens without Unlike President Clinton's 1994 health care the same range of choices in health care that really strengthening the program. reform plan, the Medicare Preservation Act will other Americans have. Similar to the Federal I am not willing to sacrifice the quality of not force anyone to leave the current system, Employees Health Benefit Plan, Medicare re- health care for senior citizens to pay for NEWT nor will it force seniors into mandatory health cipients would receive information each year GINGRICH's $20,000 tax break for individuals alliances. Proposed reforms will offer Medicare about different health care providers and plans making over $200,000 a year. beneficiaries more choices and better benefits in their area. And like other Americans, they Seniors will pay more and get less. The cost than they enjoy now. will be able to choose who provides their of health care will climb and Medicare benefits Let me review carefully the proposed re- health care. won't keep up. Seven years from now seniors forms. First, Medicare would continue to be Arizona has been on the forefront in devel- citizens and health care providers will find available to any beneficiary, and seniors could oping a successful managed care market. themselves in a hole because of a tax cut for keep their current coverage. There would be Over a decade ago, the Arizona Medicaid pro- the wealthy. no change in copayments or deductibles. Pre- gram, AHCCCS, was established as a man- For senior citizens the plan means up to mium rates for Medicare part B would remain aged care system. Now, with an extensive $1,200 in extra out-of-pocket expenses, limits at 31.5 percent of total costs, which would network of HMO's seniors are enrolling in the on their choice of doctors and decreases in fu- mean an increase of only $4 a month above same system in increasing numbers. They ture benefits. what is scheduled to occur under current law. are, by and large, very satisfied with the Central Texas rural hospital administrators The only exception would be for wealthy health care services offered by the competing have told me their hospitals could close as seniors: single seniors making $75,000 a year health plans and have found that some plans Medicare payments drop dramatically. Rural or senior couples making $125,000 a year offer services outside the required Medicare hospitals in central Texas have a high per- would be asked to pay higher part B pre- services, such as eye glasses, lower or no centage of Medicare patients because of our miums. copays for visits and lower prescription drug large population of senior citizens. Some hos- Average spending per beneficiary would in- prices. They can compete on these added pitals can't keep their doors open with the low crease by $1,900 over the next 7 years. If services because they hold costs down on level of reimbursement that the Gingrich plan seniors don't like their current plan, or if they basic services. offers. are unable to change plans, they would have Then there are medical saving accountsÐ I oppose the Gingrich Medicare plan be- options. Seniors who do not make a choice an option not available now to any Medicare cause no one really knows what is in it. The would be enrolled automatically in the tradi- recipient. This option will allow seniors to buy 968 page Medicare bill landed on my desk tional Medicare system. a high deductible, catastrophic policy and pay Wednesday night and was being revised Second, the Medicare Preservation Act for out of pocket expenses with the cash from today, the same day I am forced to vote on it. would allow beneficiaries to choose several their Medicare payment. If they use health Central Texas senior citizens, medical profes- private sector options in a new Medicare Plus care services prudently, they can even pocket sionals, and taxpayers have no idea what is in plan. Every year, beneficiaries would receive the excess as income. It turns health care the bill. information about the approved plans available consumers into cost-conscious health care To railroad legislation through the House in their area. All they would have to do is purchasers. that directly affects 37 million senior citizens check off their plan of choice. Will these optionsÐand there are othersÐ and their families is absolutely unfair. To pass Health plans under this MediChoice option save money and prevent Medicare from going such legislation before my constituents and would be selected by the seniors, not the Gov- bankrupt? Yes, because private health care is American citizens have a chance to review it ernment. Seniors would choose a complete more efficient and consumer driven choices and express their views is irresponsible. plan with its medical providers in return for more cost effective than a government admin- There is no question that we must reform more benefits. Unlike the traditional Medicare, istered one-size-fits-all health care program. Medicare to preserve it for future senior citi- they could choose less out-of-pocket ex- Medicare costs grew at about 10.5 percent zens. I'm willing to make the tough choices to penses for coinsurance and deductibles, out- last year. But, in the private sector, large em- cut spending, preserving the program, and patient prescriptions drugs, eyeglasses and ployers actually saw their cost decrease by balance the budget. However, Newt's Medi- hearing aids. 1.1 percent. The marketplace can work in care plan simply does not pass the fairness A third option would allow seniors to take health care. test. complete control of their health care with The Medicare Preservation Act addresses Mr. ALLARD. Mr. Chairman, this year Medi- MediSave, a kind of medical savings account. another concern of seniors and taxpayers care turned 30, and while it has served the The Government would pay for a catastrophic alike by putting in place a systematic program country well, it is still running on a 1965 en- illness policy. Seniors would draw the remain- to combat fraud and abuse. As Medicare is gine. ing balance of their benefits from an account designed right now, doctors are paid for pro- In the last 30 years, medical procedures to pay a significant portion of their deductible. cedures whether or not the patient needs it. and technology have made tremendous ad- The high deductible policy would have no That means the taxpayer gets ripped off, and vances. Medicare has not. It is out of touch copayments, limiting seniors' out-of-pocket the Medicare patient often doesn't get the with today's health care system. Medicare is costs. proper care. By allowing providers and hos- like a 1965 carÐit looks nice and elicits nos- No one would be denied coverage due to ill- pitals and insurers to compete for your busi- talgia, but it gets terrible gas mileage and ness or preexisting conditions. Every plan par- ness, the system will root our fraud and you're never sure how long it will run. Without ticipating in Medicare must take all applicants abuse, and will squeeze out waste. Further- any reforms, Medicare can run cruise control and allow everyone to stay in a plan as long more, seniors who find fraud in their bills will only until the year 2002 before sputtering out as they want. Seniors would not only keep be rewarded with a percentage of the money of gas. their health care, but it would be better and recovered. Major reforms are needed if Medicare is stable for years. Mr. Chairman, this legislation provides our going to last. First, we have to slow the rate I've heard countless horror stories about seniors with health care they can trust and be- of growth in Medicare spending from 10.5 to waste, fraud, and abuse in the Medicare sys- lieve in. It is not riddled with burdensome Fed- 6.5 percent a year. Even with these changes, tem. The act would remedy that in part by re- eral mandates on providers. As a con- the average Medicare yearly benefits per per- warding recipients who report misuse of tradi- sequence, it allows physicians to do what they son will increase from $4,800 this year to tional Medicare. It also would require private do bestÐprovide top quality care for their pa- $6,700 by 2002. Medicare plans to set up a toll-free phoneline tients. It is about time we allow seniors to The second step calls for major changes to receive billing complaints. And it would im- have the same type of health care as the rest that gives senior Americans more flexibility pose strict penalties on anyone who defrauds of us have. Let's pass this real Medicare re- and choices of medical plans to replace the Medicare. Furthermore, it would compel facili- form. outdated, bureaucratic one-size-fits-all plan ties to give patients cost estimates to guard Mr. EDWARDS. I come to the well today designed by Congress 30 years ago. against later bill padding. because, like many Americans, I am con- Medicare recipients should have the same Giving seniors more flexibility and control of cerned about fate of the Medicare Program. opportunities as other Americans to select the their health care is critical. Our seniors' future I cannot support NEWT GINGRICH's plan to health care options that are best for them. The should be controlled by them, not the Federal cut $270 billion from Medicare while offering a Federal Government should stop interfering Government. Simply fretting about the system H 10374 CONGRESSIONAL RECORD — HOUSE October 19, 1995 will not help Medicare survive into the next malpractice law; seventh, establishes a pro- sponded and fixed the payment structure for century. spective payment system for home health the providers. This trustee's report is no dif- When we are engaged in the predictable services; eighth, creates a separate new trust ferent. The Congress should not rush to a political wrangling over this important issue, fund, funded from both Medicare and the Fed- ``fix'' which will jeopardize the health security we must never lose sight of our ultimate goal: eral Treasury, to finance teaching hospitals that has been guaranteed these past 30 A health care system that delivers the best and graduate medical education programs; years. possible service to our seniors. and ninth, creates a fail-save budget seques- I say ``rush to a fix'', because that is exactly Mrs. FOWLER. Mr. Chairman, in emergency tration mechanism to reduce Medicare fee-for- what has been the process followed by the rooms, medical teams frequently have to use service spending if budget targets are not met. Republican majority. Without a single day of what are called heroic measures to resuscitate It is urgent for Congress to address the hearings by either Committees of jurisdiction someone who's dying. This week in Congress, Medicare crisis. The administration's Medicare this bill is being rammed through. No one has we are trying to rescue our desperately ill board of trustees reported on April 3 that read this bill. They could not have, because it Medicare system, and H.R. 2425 is the heroic under current policies, the hospital insurance was only put into final form late last night. measure that will save the patient. trust fundÐMedicare part AÐwhich pays for For all the declamation that the Republicans H.R. 2425 clamps down on overpayments, inpatient hospital care and other related care seek only to ``save'' Medicare from bank- fraud, and abuse. It provides new choices for for those age 65 and over as well as the long- ruptcy, why do we have to vote on a bill that seniors, like medical savings accounts, pro- term disabled, will be bankrupt by the year has not been read, has not been published for vider service networks, and private health in- 2002, unless the system is reformed. the public to read and comment on, and has surance, but not force them into change. It is, therefore, critically important that Con- not been analyzed? The fine print has been Some have said that Republicans are cut- gress and the President take immediate action written in secret with various special interest ting Medicare to pay for a tax cut for the rich. to preserve, protect, and improve Medicare groups, like the American Medical Association. Wrong on both counts. The tax cut was paid not only for those who rely on the program The process is outrageous. I could not pos- for long agoÐand we are not cutting Medi- now, but for those of us who expect to begin sibly vote for a bill that has not seen the sun- care. Spending per beneficiary will continue to receiving benefits in the years ahead. One shine of public scrutiny. The Republican strategy is to seize upon increase by nearly $2,000 per beneficiary over thing is certain: doing nothing will guarantee the trustees report as though it justifies this the next 7 years. the bankruptcy of the program and will lead to radical reversal of guarantees for medical care Scare tactics and lies will not save the Med- a major health care crisis for millions of senior without even one day of hearings. If the Re- icare system, but working together and pass- citizens. publican majority truly believe the course of ing the Medicare Preservation Act will keep Regrettably, practitioners are promoting action they are pursuing is good for the sys- Medicare strong and healthy for us and our mediscare rather than trying to work with the tem, then they should be willing to allow it to children. Congress to preserve, protect, and improve be reviewed, analyzed and objectively studied Mr. GILMAN. Mr. Chairman, I rise today in Medicare, using the Medicare reform debate by all parties affected, and not only a select support of H.R. 2425, the Medicare Preserva- as a tool to scare our seniors into believing tion Act. I would like to commend the gen- few. that Medicare spending will be severely cut. Second, one of the most serious concerns tleman from Texas [Mr. ARCHER] for introduc- On the contrary, payments made to help sen- that I have about the estimated cuts of $270 ing this important measure. iors will go up, not down. Medicare spending billion is that it will penalize the poorest and Over the past months, I have heard from per beneficiary will increase by almost $2,000 the sickest of our seniors. These brutal cuts many of my constituents concerned about cut- from $4,800 to $6,700 over the next 7 years. are not needed. They are proposed because ting the Medicare program. Unfortunately, Although I support H.R. 2425, I do have res- the Republicans had to come up with ``sav- there have been a number of mediscare critics ervations about the bill. I feel that this bill does ings'' in Federal spending to balance the misrepresenting the current Medicare reform not help my district hospitals from experienc- budget which they are committed to do by the proposals. ing financial hardship. I hope that as we year 2002. H.R. 2425 overhauls the current Medicare progress through our efforts to reform the ail- The reason they had to come up with this system and slows its growth to achieve a pro- ing Medicare system, we will further look to large cut in spending in Medicare is because jected $270 billion in savings over 7 years. It find ways to help hospitals that have received the deficit is $245 billion larger than when you limits increases in payments to hospitalsÐex- unfair reimbursements under the current geo- started. The increase in the deficit by $245 bil- cept for rural hospitalsÐto save over $130 bil- graphic reclassification regulations. lion is due to your tax cuts by this amount. If lion to keep the Medicare part A hospital in- Mr. Chairman, whenever Americans have you cut taxes by $245 billion, obviously you surance [HI] trust fund solvent until fiscal year faced a crisis, we have come together as a have that much less revenues, that much 2010. It freezes the part B premium at 31.4 nation to solve our problems. The problems more deficit, and that much more red ink. percent of program costs and restructures facing Medicare are serious, but can be re- In order to cover this loss of revenue the payments to providers. Additionally, the bill solved if we keep an open mind and are all Republican majority had to find programs that contains a lock-box mechanism that places all willing to do our part to protect, preserve, and they could cut in order to have a balanced savings from part B into a Medicare preserva- improve Medicare. We must do it for our cur- budget by the year 2002. They cut here, and tion trust fund and prohibits any transfers to rent recipients and for future generations. they cut there, but nowhere were there funds pay for future tax cuts. Accordingly, I support H.R. 2425, and urge to cover this enormous tax revenue giveaway. In order to clear the record, please bear in my colleagues to vote in favor of it. And so their budget ax turned to Medicare. It mind that H.R. 2425 contains a number of fun- Mrs. MINK. Mr. Chairman, 30 years ago I was not to save the solvency of Medicare. It damental reforms to provide beneficiaries with had the great privilege of voting for the Medi- was to meet the goal of balancing the budget a broader range of health care choices and care program. It has changed the character by the year 2002. Let no one fool you into strengthens the existing program. and quality of life for all seniors over 65 years thinking that this cut of $270 billion in Medi- Specifically, the Medicare reform bill: First, of age, and has allowed their children to build care is needed to ``save'' Medicare from bank- establishes a Medicare plus program that al- their lives without the fear of costly illnesses of ruptcy. This Medicare cut is to balance the lows beneficiaries to enroll in a range of pri- their parents which could consume all their budget deficit because of tax giveaways of vate or employer-based health plans, including earnings and savings. The Medicare program $245 billion, more than half of which go to per- managed care plans, traditional fee-for-service has liberated families and allowed the elderly sons who have taxable incomes in excess of plans, or high deductible insurance/medical and their children the freedom of knowing that $100,000. savings accounts; second, allows health care the best health care would be made available. If the Republican tax plan did not have providers to establish provider-sponsored or- It placed the cost of hospital care in part A on these $245 billion of tax cuts, the budget ganizations that can offer Medicare plus prod- all the working people and their employers by would have a $245 billion surplus. If the budg- ucts; third, establishes a Commission to rec- assessing a payroll tax of 1.45 percent on the et had a $245 billion surplus there would not ommend long-term structural changes to pre- worker and on the employer. This part A is be any need to cut Medicare. serve and protect Medicare when the baby what the trustees report indicated will be in fi- The connection between the tax cut for the boom generation begins retiring in 2010; nancial trouble in the year 2002. very wealthy people and the cuts in Medicare fourth, strengthens Federal efforts to combat Let us understand that the Medicare trust- funding are directly related. Without the fraud and abuse in the Medicare program; ees have reported previously, eight times in former, there would not need to be the latter. fifth, eases or eliminates regulations banning fact, that part A hospital care was in fiscal dif- Third, last year when we were debating the physician self-referrals; sixth, reforms medical ficulty. And each time the Congress re- Universal Health Care plan for all Americans, October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10375 we all knew that with rising health care costs Eighth, as these changes are being made, care program. Seniors who report a verifiable it was imperative that we act to rein in these the possibility that the quality of health care incident of abuse, fraud or waste will receive costs. This was the central motivation for the will be lowered is great. There will be less a financial reward. Criminal and civil penalties President's initiative. We held months of hear- safeguards. Even under this cloud, the Repub- will also be strengthened for anyone caught ings in three committees on these proposals. lican plan enacts limits of liability for negligent defrauding Medicare. Cleaning up the program It was fully debated. It failed to pass. No one and faulty medical care. Remember that pa- is one of the best ways to save Medicare with- can say that Democrats were blind to the tient who went into the operating room expect- out cutting benefits. need for reform, the need for change, and the ing that his left leg would be amputated, and The Medicare Preservation Act lives up to need to cut costs of medical care. We are re- woke up in his room with his good right leg the obligation we in Congress owe to Ameri- corded in favor of health care reform. But not gone. His left leg was so badly infected that it ca's seniors. We have a non-negotiable re- a reform bill that was written in the dark, in se- too had to be amputated, leaving him without sponsibility to ensure that Medicare meets the cret, without any of us really knowing what the any legs at all. Do you honestly think that hav- health care needs of seniors who have worked impact will be on our elderly, on our existing ing this doctor and hospital pay him $250,000 hard all of their lives and contributed their health care providers, and on the quality of is adequate compensation for his loss? He is share for health security. Our plan preserves, health care. elderly and has no economic losses which protects and strengthens Medicare for the next Fourth, the real cost savings in Medicare is could be used to treble his award. This bill has generation, as opposed to the President and in routing out fraud and abuse. This is the a $250,000 liability limit. This is unfair to the his liberal allies in Congress, who offer a dis- place for the Federal Government to move in public. It is another reason I cannot vote for ingenuous press release to Band-Aid Medi- and crack down on the abuse. It has been this bill. care until the next election. noted that we could save $80 billion over a 7- From the mail I have received, there are a Mr. OWENS. Mr. Chairman, this bill takes year period if we installed tougher rules and myriad of other provisions in this bill, that re- us back to a time when the elderly expected regulations to rout out fraud and abuse. In- quire further review. I cannot answer the ques- to live in poverty sooner or later because of stead we are now advised by the Justice De- tion posed. No one can. It would be irrespon- mounting health care bills they could ill afford partment that indeed the Republican bill will sible to vote for this bill. to pay. Thirty years ago, with the swipe of a make it easier to commit fraud and get away This is a day the Republican majority will pen, President Johnson erased such fears of with it. How do we know? No one saw the bill have to answer for in the years ahead. As the impoverishment, working with a Democratic to read it until last night. Most of us only saw tragic consequences enfold over the next 7 Congress to overcome a hostile Republican the bill this morning. years, seniors will die before their time, and as minority. Our Government made a solemn Why are the majority Members of this rural hospitals close all persons living in those promise to our senior citizens back then, but House afraid to have their ideas aired in the areas will die before their time. This is not a now the new Republican majority is proposing open and subject to public scrutiny? historic day. It is a sad day in the history of to break that contract with our seniors and Fifth, I am very concerned that the rural America. make them live in fear once again. Mr. EMERSON. Mr. Chairman, the choice hospitals and clinics in my district will be The $270 billion that the Republicans pro- before Congress today is clear. We can act forced to close. Why can't we have full hear- pose to cut from Medicare will buy them their now to preserve and strengthen Medicare as ings before this catastrophe occurs? I rep- $245 billion tax cut for the rich, $51 billion of the President's own Medicare Trustees rec- resent rural communities for whom life and which will go directly into the coffers of large ommend, or we can do nothing and let Medi- death depends on the ability of these health corporations. It is sad that the Republicans' care go bankrupt in less than 7 years. Clearly, facilities to survive. priorities are so upside down. If they were to it would be the height of irresponsibility to let reduce corporate subsidies by the same per- Sixth, in 1993 the Congress passed a law Medicare go broke. We have an absolute obli- centage as the budget as a whole, as called that said that the cost of Medicare part B, doc- gation to America's senior citizens to save for in the budget resolution, they would need tors and laboratory services, would be paid by Medicare, and I am pleased that Congress is to take $122 billion over 7 years from the enrollees at the rate of 25 percent of the costs working to do just that. of the program. The Federal Government paid The Medicare Preservation Act will save pockets of the Fortune 500 fat cats free- 75 percent of the cost of part B. The Repub- Medicare without cutting benefits or increasing loaders. Obviously, that won't happen. lican bill before us today raises this premium seniors' out-of-pocket costs. This year, Medi- Instead, America's seniors will pay $400 charge paid by the enrollee to 31.5 percent of care per beneficiary spending averages about more in premiums each year by the year the total cost. Without cost controls, this $4,800. This amount will increase to $6,700 2002. My home State of New York will lose means that the amount of money that the en- per beneficiary under our plan. $25 billionÐ$650 million from my district rollee has to pay will rise astronomically. If the Much has been made in this debate about alone. And these figures don't even begin to cost of doctor's care rises, the 31.5 percent process. I believe the Medicare Preservation tell the horror story that will result from the that has to be paid by the enrollee must also Act is a good example of what the legislative Medicaid cuts the Republicans will inflict upon rise. The failure of the Republican plan is that process is all aboutÐtaking a bill and making the American people next week. Those cuts it does nothing to curb the rising costs of it better. will be neatly buried in the budget reconcili- health care. For example, after meetings and discus- ation package, as the Grand Old Party re- Seventh, the Republicans like to argue that sions with the leadership, we have secured moves the final shreds of dignity that the poor- they are not cutting funding only reducing the important rural funding changes to better est of the poor have left. percentage of increase. In point of fact the Re- serve rural citizens. As a senior member of Deep cuts in Medicare will expel seniors out publican plan restricts the growth rate to 4.9 the Rural Health Care Coalition, I am pleased of nursing homes or bankrupt their families percent whereas the private sector estimates that this Medicare reform package will signifi- who will have to pay for $40,000 a year nurs- the growth rate of costs of health care at 7.1 cantly boost Medicare reimbursement rates to ing home bills . Not only will seniors be forced percent. That is the major source of cuts. Any rural counties, like those in Southern Missouri. to pay more money for fewer services, they time your family budget has a 2.2-percent We all know that rural America faces unique also will have to give up their own doctors as shortfall of earnings you know that you will health care challenges, and our plan responds they are herded into HMO's. Finally, many have to cut how you spend. Accordingly under by changing a Medicare reimbursement for- hospital officials have predicted that up to 25 the restrictions of only 4.9 percent growth in mula to attract more doctors and health care percent of all hospitals could close their doors Medicare costs, there is no other conclusion to provider options to rural areas. Much work re- because of these Republican Medicare cut- be reached than that benefits will have to be mains to be done to improve health care qual- backs. cut and that the restrictions will shrink the re- ity and access in rural regions, and our Medi- Mr. Chairman, I am submitting for the record imbursements to providers and many Medi- care preservation plan is a leap in the right di- a chart showing the billions of dollars that hos- care beneficiaries will find themselves without rection. I look forward to working with the Sen- pitals, nursing homes, and home health care any provider at all. This unrealistic restriction ate to see that the legislative process contin- agencies in my district will lose so that my of the rate of growth is the real culprit. More ues to move the plan to save Medicare for- constituents can see the negative impact that people are going to reach 65 years of age. ward. Republican Medicare and Medicaid cuts will Health care costs are going to rise. A cap on The Medicare Prevention Act also gets have on the quality of health care services the costs means benefits will have to be cut. tough on abuse, fraud and waste in the Medi- they receive. H 10376 CONGRESSIONAL RECORD — HOUSE October 19, 1995 PRELIMINARY ANALYSIS OF THE HOUSE AND SENATE MEDICARE REFORM PROPOSAL ON NEW YORK STATE [7-YEAR IMPACT 1996 TO 2002—LOSSES IN $MILLIONS]

Medicaid-Federal Medicare funds District Representative Type of facility Facility name Budget cap/ House Senate House Senate lookback

11 ...... Major R. Owens ...... Hospitals ...... Catholic medical center (St. Mary’s of Brooklyn division ...... $122.9 $136.3 $31.0 $32.7 $6.1 to $16.2 HHC (Kings County Hospital Center) ...... 376.5 429.1 59.5 50.0 5.3 to 14.0 Interfaith Medical Center (All Divisions) ...... 114.6 142.6 71.9 56.5 8.5 to 22.5 Kingsbrook Jewish Medical Center ...... 44.6 38.1 74.4 57.7 10.7 to 28.4 University Hospital of Brooklyn ...... 79.5 77.0 93.1 71.9 11.4 to 30.4 Nursing homes 1 ...... Carlton Nursing Home Inc ...... 8.2 6.4 Caton Park Nursing Home ...... 6.8 5.3 Center for Nursing & Rehabilitation Inc ...... 24.2 18.7 Dover Nursing Home ...... 2.3 1.7 Flatbush Manor Care Center ...... 12.7 9.8 Madonna Residence ...... 17.3 13.3 Marcus Garvey Nursing Home Company Inc ...... 18.4 14.2 NY Congregational Home for the Aged ...... 4.1 3.1 Oxford Nursing Home ...... 12.8 9.9 Prospect Park Nursing Home ...... 11.4 8.8 Rutland Nursing Home Co. Inc ...... 47.9 37.1 Certified home health 1 .... Interfaith Med Ctr/Jewish Hosp Med Ctr of Brooklyn Home Care Dept ...... 1.0 0.8 Kingsbrook Jewish Medical Center Home Care Department ...... 2.9 2.3 St. Mary’s Hospital of Brooklyn Inc. Home Care Department ...... 17.0 13.1 The Brooklyn Hospital Center Home Health Services Division ...... 3.2 2.5 Visiting Nurse Association of Brooklyn, Inc ...... 15.3 11.8 Long term home health 1 . St. Mary’s Hospital of Brooklyn ...... 11.0 8.5 Visiting Nurse Association of Brooklyn Inc ...... 15.4 11.9 1 Insufficient Medicare data to estimate facility-and agency-specific impacts.

Mr. HEINEMAN. Mr. Chairman, I rise today [From the Raleigh News & Observer, Oct. 16, is designed to limit the growth in payments as a 65-year-old citizen on Medicare. I speak 1995] to hospitals and doctors. not only for myself today, but I speak for the DEMOCRATS HOPE THAT SCARING GRANNY That’s not to say the Republican plan millions of seniors in our country who depend WILL BRING VOTES won’t cause pain. It will lead to higher pre- (By Rob Christensen) miums, less choice in doctors and other new on Medicare. I also speak for my children and restrictions on coverage. It could cause hos- grandchildren who will one day need a finan- There’s a new soap opera on the tube these pitals heavily dependent on Medicare and cially sound Medicare system. days: a political commercial paid for by the Medicaid to close—especially the hospitals Teamsters and aimed at Republican Rep. Mr. Chairman, as a senior citizen I have serving the poor in inner cities or rural Fred Heineman. areas. been very disturbed by all the rhetoric, scare A middle-aged couple stand in their kitch- But some pain is necessary if we are to tactics and fear which have been injected into en, fretting. Hubby says he can’t believe how stem the tide of red ink and to prevent the the Republicans want to cut Medicare just to the Medicare debate. People who use these Medicare program from growing broke. give a tax break to the rich. The Mrs. says negative tactics are wrong. They are not being Nearly every serious examination of the she might have to quit her job to take care truthful in addressing the problem we have federal budget deficit has concluded that we of Granny if the cuts go through. with Medicare. It is a simple fact. In 7 years, must slow the growth of the huge entitle- Meanwhile, Granny is eavesdropping in the ment programs such as Social Security and in the year 2002, the system will go broke un- dining room, an anguished look on her face. Medicare. less it is reformed. The commercial nearly brought tears to People are living longer. Medicine and The Medicare Preservation Act will save the my eyes. I wanted to reach out, pat her on the arm and say: ‘‘It’s all right, Granny. The medical treatment is becoming more expen- Medicare Program $270 billionÐsavings which sive. In 1965, 14 percent of the federal budget will go directly into the Medicare Program by Democrats will take care of you.’’ The TV ad is part of a national campaign went for Social Security and Medicare. law. by the Democratic Party and its allies to Today, it’s more than one-third. The President knows the problem. In 1993, portray the Republicans in Congress as a If you rule out a tax increase, the only re- Bill Clinton said, and I quote ``I will rec- group of cold-hearted rich folks who want to alistic way to balance the budget is to slow ommend reducing the growth of spending in deny the elderly crutches and walkers so the tremendous growth in such entitlement they can buy a nicer Mercedes. programs as Medicare, Medicaid and Social Medicare dramatically and in Medicaid. This Security, said Dick Stubbing, a public policy will not be a cut. Don't let people tell you it is The reason for the Democratic public rela- tions blitz is a GOP plan making its way professor at Duke University and a federal a cut. We simply have to reduce this incred- through Congress to reduce projected spend- budget expert. ible rate of spending to save the system.'' I ing for Medicare by $270 billion during the Scaring Granny has always been a political agree with Bill ClintonÐhe is right. next seven years. winner for the Democrats. While the House Democratic leadership of- At a forum at Durham’s Preiss-Steele Much of the public has never trusted the Place the other day, the Democratic Party Republicans to protect social programs. So- fered no plan, our Democratic colleagues in cial Security and Medicare were passed by the other body finally put out their version of rolled out some of its biggest guns to attack the Republican Medicare plan. Democratic liberals—under the leadership of a plan to reform Medicare. It saves $90 billion. ‘‘Insane,’’ Dick Gephardt, the House Demo- Franklin Roosevelt and Lyndon Johnson— It has one problemÐit simply delays the date cratic leader, said of the GOP Medicare pro- over the opposition of conservative Repub- of bankruptcy for 3 years beyond 2002. posal. ‘‘A tax cut for the wealthy,’’ said Rep. licans who decried such programs as social- The Medicare Preservation Act will increase Eva Clayton. ‘‘Extreme cuts,’’ said Rep. Mel ism. According to a recent Times-Mirror poll, 45 percent of those surveyed trusted the per beneficiary spending from $4,800 to Watt. To put a nice face on the Democratic at- Democrats to reform the Medicare program, $6,700 in 2002. Seniors will stay in the current tacks, let’s call it political hyperbole. It’s a while 32 percent trusted the Republicans. Medicare systemÐwith no increases in good example of why Congress finds it so dif- ‘‘Some who are pushing for current Medi- deductibles or copaymentsÐunless they ficult to balance the federal budget and re- care plan are of the same view as those who choose MedicarePlus. If a senior chooses duce the huge debt. fought the creation of Medicare in 1965 and MedicarePlus he or she will be able to choose What the Democrats fail to mention is in 1995 are trying to deny the comforts our from a variety of plans, with different benefit that the Republican plan proposes to IN- senior citizens,’’ Clayton told the Preiss- options. The Medicare Preservation Act also CREASE Medicare, not cut it. Steele residents in Durham. ‘‘Should they be trusted? I think not.’’ attacks waste, fraud, and abuse and rewards The GOP plans calls for a slowing of Medi- care’s annual growth from 10 percent per The Democrats are trying to tie Medicare seniors who help weed out fraud. year to 6.4 percent. growth cutbacks to $245 billion in tax cuts Let's stop playing politics with Medicare. It is In 1994, we spent $160 billion on Medicare. the Republicans are pushing. But the pro- too important for our senior citizens; they de- If left unchanged, annual Medicare costs are posed tax cuts, which would be like pouring serve better. projected to rise to $345 billion by 2002. gasoline on the roaring fire of the federal Under the GOP plan, Medicare spending debt, are a separate issue. I urge my colleagues on both sides of the would increase to $247 billion per year by Of course, the Democrats did not invent aisle to reject the rhetoric and start dealing 2002, an INCREASE of 54 percent. political demagoguery. Most recently, the with reality. Vote for H.R. 2425, support our Of the $270 billion in Medicare growth re- Republicans did their part to scare the elder- senior citizens and save Medicare. ductions in the GOP plan, about $200 billion ly and everyone else when they distorted the October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10377 Clinton administration’s health care pro- soundly rejected at the polls in last year's his- credit will go to families which make less than posal. toric elections. And of course, this year's rhet- $75,000 a year. This credit also means that But for the moment, it’s the Republicans oric is just as untrue as it has been in pre- families earning less than $25,000 will not pay who are trying to do right—and the Demo- crats who are trying to scare Granny. vious years. any Federal taxes, and those earning $30,000 This issue is so important to so many peo- will see a 48 percent Federal tax cut. [From the Herald-Sun, Oct. 17, 1995] ple, it should be above partisan politics, misin- Other aspects of our tax package include a GIVE GOP CREDIT FOR IDEAS formation, and lies. But because the American capital gains tax cutÐ77 percent of bene- However much one might quibble with the people deserve to know what's really going ficiaries will be families that earn less than way the GOP in Congress is bearing down on on, it has become necessary for Republicans $75,000, a repeal of President Clinton's tax on the Federal deficit, this must be said: At to respond to these false claims. Social Security benefits, and an adoption tax least somebody in Washington is trying to Let's analyze the sole argument Democrat credit to families making less than $60,000 a lasso those dollar-gorging entitlement pro- critics have used in this debate: The Repub- year. grams. licans are cutting Medicare to pay for tax cuts Obviously, any claim that Republican middle Everybody knows that entitlements—So- for the rich. There are three distinct parts to class tax cuts are aimed at the rich is inac- cial Security, Medicare, Medicaid and so this statement, and all three of them are com- curate to say the least. Moreover, if the Re- on—are the arch stones of a balanced budget. publican Medicare reform plan is passed, the Unless these programs are brought under pletely false. In this World Series season, they control, they will literally bankrupt the hope to convert these pitches into a home run, wealthiest seniors will have to pay a greater United States. It’s that simple, and it’s that but all they do is strike out. Big Time. percentage of their Medicare premiums, while serious. Pitch 1: ``The Republicans are cutting Medi- middle income recipients will pay the same Democrats on Capitol Hill do the country care . . .'' This is simply not true. Any way shareÐ31.5 percentÐthat they are paying and themselves a disservice by running you slice it, more money will be spent on Med- now. Strike Three. This last false claim com- around and screaming that the GOP in effect icare every single year. If Republican reforms pletes the strikeout in the Democrats' attempt plans to cast the elderly loose on ice floes, are enacted, overall spending will rise from to hit a home run with ideas they should have Fling that $270 billion ‘‘cut’’ in Medicare retired years ago. spending over the next seven years out to a $161 billion this year to $274 billion in 2002. chapter of the AARP, and the gasps will The average Medicare recipient will receive Perhaps the most destructive result of come on cue. $4,800 in benefits this year, and the average spreading false information and using class In fact, even under the GOP plan, federal recipient will receive $6,700 7 years from now. warfare tactics is that they purposely divide outlays for Medicare and Medicaid are ex- What Republicans are doing is containing Americans at a time when we need to try to pected to rise through the year 2002. How- the current growth rate of 10.5 percent, which bring people back together. Instead of spread- ever, the rate of increase will be slowed, and is unsustainable and will bankrupt the Medi- ing misinformation and envy, we should be that’s where much of the projected $270 bil- having an honest debate about how we can lion in savings will come from. care system in 7 years. The good news is that Somehow, this part of the GOP plan never we can save the program from bankruptcy by make all Americans healthier and more finan- gets beyond the Democrats’ gatekeepers. limiting growth to approximately 6 percent a cially stable in their old age. Anything less is This is not to say, though, that the GOP year. This comes to roughly a 40 percent in- just plain wrong, and I hope that the Clinton plan is above criticism. Converting Medicaid crease over the next 7 years. Only in Wash- Democrats decide to put aside their class war- into a block-grant program for the states is ington is a 40-percent spending increase con- fare and join us in an honest debate very a risky venture, especially for poor states. If sidered a cut. Strike One. soon. I believe this bill is a step in the right di- the block grant money runs out, the states rection and I'm proud to support it. will have to come up with the balance—not Pitch 2: ``. . . to pay for tax cuts . . .'' The fact is that every red cent of Medicare savings Mr. BUNNING. Mr. Chairman, I rise in sup- an easy thing to do in North Carolina, port of the Medicare Preservation Act. It's a Maine, Mississippi, New Mexico and other will go directly to the Medicare trust fund, and low-wage states. not one penny will go to pay for tax cuts of good bill. Furthermore, the GOP plan scraps an im- any kind. To make this perfectly clear, the It preserves MedicareÐit strengthens Medi- portant law that prohibits physicians from Ways and Means Committee adopted a care. It keeps Medicare from going bankrupt. And ‘‘double dipping’’ their patients. Double-dip- lockbox amendment which specifically states ping occurs when a physician charges pa- best of all it gives senior citizens more op- that all Medicare savings must be used to tients for blood work and other tests done at tionsÐmore choices. a laboratory in which the physician has a fi- make the system solvent, and not to pay for I think you will all agree that Members of the nancial stake. The law came about a few tax cuts. There is absolutely no link between U.S. Congress have a pretty good health care years ago in response to widespread abuses Republican efforts to save Medicare and to system. in such arrangements, but the GOP promised lower taxes. We get a booklet every year that lists the last week to toss it out in return for the The House passed its tax reform bill last options available to usÐinsurance plans or American Medical Association’s endorse- spring, and every one of those cuts were paid ment of the reform plan. PPO's and HMO's. We get a wide range of for at the time by cutting wasteful spending in choices. We can pick a plan that suits our If the Democrats have a straight-flying other areas. Also, even if the budget were al- arrow in their quiver, it’s their criticism of needs and our family's needs. It's a pretty the GOP’s proposed $245 billion tax cut. The ready balanced, and the tax burden were at good deal. leadership of both houses of Congress has an acceptable level, Medicare would still have I have enrolled in a PPO. I still get to see signed off on the cut. Reducing entitlement to be saved from bankruptcy. In other words, my family doctor. I show him this card and my spending while cutting taxes has all the fla- the Medicare trust fund would be broke in 7 office visit only costs me $10. And I have this vor of guns and butter. It would be far better years no matter what kind of income tax policy other card that I can take to the drug store to get a grip on entitlement programs, then we have. Strike Two. go for tax cuts. and pick up my prescription medicine and no Pitch 3: ``. . . for the rich.'' By now, it matter how much it costs, I only pay $10. As we said, quibbles. The GOP seized the should be clear that Republicans are not cut- initiative in this struggle a year ago, and It's a pretty good deal. seems likely to keep it. The Democrats—yes, ting Medicare, and that Medicare reform is un- This Medicare reform bill that we are con- there are some still left in Congress—have related to tax reform. The third piece of misin- sidering today gives the senior citizens of our only themselves to blame for their impo- formation in the Democrats' one-sentence country the same kind of options that Mem- tence. Medicare strategy is that our tax reform pack- bers of Congress now have. It will give them Mr. HILLEARY. Mr. Chairman I rise in sup- age is geared toward the wealthy. the same kind of choices we have. port of H.R. 2425Ðthe Medicare Preservation The truth is that if the House-passed tax re- That's the beauty of this bill. We save Medi- Act and encourage my colleagues to do the form bill becomes law, the rich will pay a larg- care. We strengthen Medicare and on top of same. This issue is so important to so many er share of taxes. According to the Joint Eco- it all, we make Medicare better. people, it should be above partisan politics, nomic Committee, the richest 10 percent will We are going to hear a lot of outrageous misinformation, and lies. pay 48.6 percent of all taxesÐup from the cur- rhetoric about how we are slashing benefits. Throughout this autumn's important debate rent 46.6 percent. Moreover, the top 1 percent That's hogwash. It's political hogwash. And I, on how to save Medicare from bankruptcy, op- will pay 18.2 percentÐup from the currently for one, think that this program is a little too ponents of the Republican plan have used 18 percent. important to play political games with. oneÐand only oneÐargument against the The idea that the Republican tax reform bill This bill is a good bill. It gives senior citi- plan: The Republicans are cutting Medicare to unfairly benefits the rich is simply ridiculous. zens the same kind of health care that Mem- pay for tax cuts for the rich. This is the same The centerpiece of our package is the $500- bers of Congress enjoy now. That's a pretty hollow rhetoric, based on class envy, that was per-child tax credit, of which 74 percent of the good deal for everybody. H 10378 CONGRESSIONAL RECORD — HOUSE October 19, 1995 We don't cut benefits for senior citizens. Our ton of complex issues. And we might have to well-being of millions of our citizens is irre- bill doesn't increase copayments. It doesn't in- go back in next year or the year after and fine sponsible. crease deductibles. tune it. But this bill provides a good basic Mr. Chairman, it is ludicrous to rush this It increases the average amount of money foundation for the long term financial health of enormous and far-reaching legislation through that Medicare spends on every beneficiary by our Medicare Program. the House in the hopes that the public won't nearly $2,000 over the next 7 years. It preserves Medicare. It strengthens Medi- be quick enough to figure out what's in it. I Sure we slow the growth rate. If we don't care. It gives senior citizens the same kind of urge all my colleagues, in the name of the 37 slow the growth rate of Medicare spending, choices in health care that Members of Con- million senior citizens we represent, to reject Medicare will bounce over the cliff to bank- gress have. And it makes Medicare more effi- this course of action, and vote against this bill. ruptcy in just a few years. cient and more cost-effective. Mr. BALLENGER. Mr. Chairman, I rise Ten percent growth rates simply cannot be I urge my colleagues to support and pass today to express my support for H.R. 2425, sustained. Everybody knows that. And our bill this bill. And I urge the President to quit play- the Medicare Preservation Act. Furthermore, I slows the growth rate to 61¤2 percent. But that ing politics with the health care of our senior rise to thank the Members who understood the is still growth. It is not a cut. citizens and sign this bill when it reaches his urgency of the Medicare Board of Trustees re- It is not a cut because we slow the rate of desk. port showing that trust fund reserves will be growth in Medicare spending by providing Ms. SLAUGHTER. Mr. Chairman, I am very fully depleted by 2002 and created a plan to more choices, not by cutting benefits. concerned that we are being forced to vote on save it. Unfortunately, President Clinton has By providing more optionsÐmore choicesÐ this measureÐwhich if enacted would be dev- been content to do nothing. I think the mes- we introduce competition into Medicare. We astating to the health and well-being of our sage is clear folksÐMedicare is going broke put private sector ideas to work. We inject the seniorsÐwithout adequate time for the Amer- and the Republican leadership has undertaken free enterprise system into the Medicare sys- ican public or the Members of this House to the task of saving it. tem. It will make it more efficient and more study the bill and learn exactly how the 37 mil- The Republican plan, the Medicare Preser- cost-effective. lion people covered by Medicare will be af- vation Act, will not take away Medicare but At the same time, if someone is happy with fected. Such drastic changes to a system as rather will protect, preserve, and strengthen it. Medicare just the way it is; if someone is a lit- massive and crucial as Medicare cannot be We are not cutting Medicare, instead, we are tle nervous about trying something new; if they responsibly considered with just 3 hours of allowing Medicare to grow at about 6 percent. are happy with the traditional fee for service floor debate. Under the Republican budget, spending per and don't want to change, they can keep their We will don't fully understand the con- beneficiary will increase from $4,800 to $6,700 existing Medicare plan. sequences of what this bill will do, but what lit- over the next 7 years. You will get to keep Our bill doesn't force anybody to change. It tle we do know is looking pretty bad. In addi- your current doctors, and the Government doesn't force anyone to join an HMO if they tion to doubling senior's Medicare payments, won't force you into any plan that you don't don't want to. It doesn't force them to change forcing seniors to give up their long-time doc- want to be in. This is your rightÐto a choice doctors or hospitals or anything. Anyone who tors and shutting millions of infirm Americans of doctors, of plans, and to a system that's se- likes Medicare just the way it is can keep out of nursing homes, there are some little cure for current and future retirees. Each year going along just like they have been. known provisions that seriously and negatively Medicare beneficiaries will receive a form from People like thisÐpeople who don't want to affect the health and well-being of our seniors. the Government that lists available plansÐtra- change MedicareÐshould like this bill too. It Take, for example, the bill's provisions to ditional Medicare, managed care organiza- preserves Medicare and traditional fee for ease the ban on physician self-referralsÐthat tions, new groups known as provider spon- service for them. It keeps Medicare from going is, doctors who refer Medicare patients to labs sored networks that will be set up by doctors bankrupt. in which they have a financial stake. We have and hospitals, and medical savings accounts, We are not in a situation where we can stick long know that this is a situation that is ripe for where you purchase a high-deductible policy our heads in the sand and say don't change abuse. In fact, the HH's Office of Inspector and the Government deposits money to cover anything, don't touch Medicare. If we do noth- General found that patients of referring physi- that deductible in an interest-bearing account. ing, Medicare will go bankrupt in 7 years. cians who owned or invested in independent If you do nothing, you're automatically enrolled President Clinton's appointees who serve as clinical labs received 45 percent more services in traditional Medicare. If you want another trustees to the Medicare trust fund have told than all other Medicare patients in general. plan, that's up to you. us that we need to make changes to keep the And the Consumer Federation of America Furthermore, to accumulate more savings, program solvent. We can't do nothing. Medi- found that doctors with a financial interest in the GOP plan would eventually end the sub- care is far too important to too many people. labs ordered 34 percent to 95 percent more sidy that goes to wealthy seniors who choose The Democrats in Congress want to stick tests than other physicians. And the New Eng- to remain in the traditional Medicare Program. their heads in the sand. The President wants land Journal of Medicine reported that doctors Wealthy beneficiariesÐsingle people earning to stick his head in the sand. They know full who owned imaging devicesÐlike MRI's, for more than $75,000 a year and couples earn- well that we are doing the right thing. They exampleÐordered imaging tests four times ing more than $150,000 a yearÐwould pay know full well that Medicare needs fixing. But more often than doctors who did not. the total cost of their premiums for the doctor they would rather play political games. That's why regulations have been imple- portion of Medicare part B. Projected savings They know they can win political points by mented to prohibit doctors from sending pa- would be approximately $10 billion. crying wolf, by saying that Republicans are tients for tests and services from which the Our plan also combats fraud and abuse. As cutting Medicare to pay for tax cuts for the doctor would profit. The Congressional Budget Medicare is designed right now, doctors are rich. They know it isn't true but they know they Office has estimated that easing this ban on paid for procedures whether or not the patient can win points by scaring people who are de- self-referrals will add another $1.1 billion to needs them. That means the taxpayers get pendent on Medicare. the cost of Medicare, through excessive and ripped off, and the Medicare patient doesn't Republicans knew there were political risks unnecessary testing and services. get the best care. By allowing providers, hos- when we took on this task. We knew it was Another provision of this bill that deserves a pitals, and insurers to compete for your busi- dangerous politically to tackle Medicare's lot more study and discussion is the section ness, the system will root out fraud and abuse problems. It would have been much easier for which would eliminate most Federal regulation and will squeeze out the waste. Seniors who us to pretendÐlike the PresidentÐthat Medi- of medical laboratories located in doctors' of- find fraud in their bills will be rewarded with a care wasn't in that bad of shape. fices. These regulations came about after percentage of the money recovered. In addi- It would have been much easier and safer Congress heard horror stories of patients suf- tion, regulatory relief would allow hospitals politically to slap a band-aid on Medicare like fering and dying as a result of inaccurate lab serving the same geographical areas to jointly the President wanted to do. tests. Most serious were the women who died plan to provide services and facilities, which But we didn't take the easy way out. Repub- from cervical cancerÐa disease that is almost they are currently precluded from doing by licans in Congress stepped up to the respon- always curable if caught earlyÐbecause their antitrust laws. The intent is to prevent a dupli- sibility of leadership and did the right thing. Pap smear test were misread. cation of expensive machines and services We didn't dodge the issue. And we ended up The fight against waste, fraud and abuse and to remove the costly use of an insurance with a bill that I think is about as good as pos- has earned bipartisan support throughout re- company or managed care organization as an sible. cent debates on health care financing. But, intermediary. This would help beneficiaries in It might not be perfect. It makes sweeping cutting vital regulations without giving serious rural areas where there are few managed care changes in a huge program and deals with a consideration to the affect on the health and groups. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10379 I urge all Members to support the Medicare determine if they will save any money. And $150,000 for couples higher premiums. Again, Preservation Act. With the support of the plans such as medical savings accounts and these premiums will not put one penny in the American Medical Association [AMA], the Sen- HMO's are only viable options for wealthy and part A trust fund. However, this revenue will iors Coalition, U.S. Chambers of Commerce, relatively healthy senior citizens. Therefore, go directly into the general fund. Means test- the National Taxpayers Union, and millions of these options are only available to the few ing in this form is unnecessary. seniors, we are providing Medicare for future seniors who fit that description. FAIL SAFE PROVISION generations. WASTE, FRAUD, AND ABUSE Mr. COLEMAN. Mr. Chairman, I am privi- Waste, fraud, and abuse is the single big- The entire Republican budget plan rests on leged to represent El Paso, TX, a community gest concern of my constituency regarding their ability to provide $270 billion in savings of approximately 600,000 people. Of this Medicare. I have spoken to many El Pasoans from the Medicare Program. However, the amount, almost 60,000 people receive Medi- and, by far, the largest complaint regarding plan falls short of these savings by $90 billion. care. In other words, 10 percent of El Paso's Medicare I have heard is ``Stop the waste and Yesterday, NEWT GINGRICH said he was afraid population is on Medicare. That is a significant fraud and you will find the money to support that his own CBO would substantially under- number. These are significant cuts. Medicare.'' score the savings he believed could be ac- I regret that the majority has not scheduled The Republican plan offers only three minor complished by using HMO's and other pro- more time for hearings nor the ability to review initiatives, a hotline, making nursing facilities vider plans. the plan. The Democratic leadership has been provide cost estimates, and stiffer penalties for If the CBO cannot come up with the magic forced to schedule additional days of hearings those found guilty of fraud. numbers Speaker GINGRICH wants, where do on the only space provided to us, the lawn of Again, there is no estimate on how much you think they will come from? From the 37 these programs will actually save and these the Capitol, so that the American people can million beneficiaries that Medicare now serves. have a chance to participate in the process measures are not comprehensive enough to Aware that this plan may not total the $270 that will affect 37 million of them. deal with the entrenched problem of fraud and billion, it includes a fail safe provision that will In fact, this back room dealing on the Medi- abuse throughout the system. allow future bureaucrats to make additional care plan has gone so far as to force senior EFFECT ON HOSPITALS AND PROVIDERS costs. citizens to stage protests in the Commerce The plan also contains significant changes Committee and be arrested by the Capitol Po- in assistance to health care providers. I had This hidden provision subjects beneficiaries lice. Also, in an article titled ``Bribes for Doc- previously sent a letter to El Paso hospitals to unknown future liability. If future decisions tors'' the New York Times points out that outlining the possible changes that might expose health care providers to additional Speaker GINGRICH ``brought the American occur under this plan and asked them to illus- cuts, they may pass the cost directly to the Medical Association behind his Medicare re- trate how these changes might effect the day beneficiary or drop out of the program alto- form program last week by handing out three to day functioning of their hospitals. I would gether. This would mean that even after pay- concessions.'' These concessions were not like to illustrate the destructive change this ing more money for less services this year, given in the light of day after debate. No, they plan would have by reading one of those let- seniors would be asked to do the sacrifice were given in a last minute desperate secret ters: again, sometime in the next seven years, to attempt to reign the AMA in. Expected Effects to . . . as a Result of achieve the same savings the original plan Medicare and Medicaid Reductions: proposed and have a choice of much fewer I have had over 500 constituents writing or Staffing: calling to urge me to oppose these cuts. One If funding is not available, . . . would face providers. constituent writes: the very real possibility of staff reduction by This plan is the wrong way to achieve the My wish is that the Democratic Party as much as 992 positions during the 7 year pe- savings that Medicare needs. This plan allows would hammer on the fact that President riod. We would lose $31,982,080 over the next the Republicans to attempt to balance the Clinton wanted health care reform 2 years 7-year period for the El Paso economy. Clinics: budget while giving a huge tax break to the ago. . . . The Republican Party bombarded most wealthy Americans on the backs of sen- the air waves stating that if it was not bro- Our clinics currently operate five days a ken, don’t fix it. It’s ironic that the moment week. The reductions would force a 50% cut- ior citizens and the disabled. It is wrong. the Republicans came into office, health back in operations to 2.5 days a week. Reduction in Services. Mr. BEREUTER. Mr. Chairman, this Mem- [care] had deteriorated so quickly, that now, The hospital district’s mandate is to care ber is pleased that the leadership has agreed the Republicans are the only solution to for indigent patients and we do not believe to improve the AAPCC formula used to deter- Medicare. that we could eliminate basic services. A re- mine county capitation payments for the I could not agree more. Not only has the duction in both Medicare and Medicaid dol- MedicarePlus program. This change is criti- Republican Party opposed the original drafting lars would lead to a rationing of resources cally important and will ensure that rural Amer- of this legislation, but they have continued to that would be manifested in a number of icans have the same access to the options in ways: be antagonistic toward its existence for years. 1. Eliminate Level One Trauma Services; the MedicarePlus program as citizens in urban Now after providing only an outline, we are 2. Reduction of Pharmacy, Physical Ther- areas. supposed to realistically debate the Repub- apy and all other outpatient services; This change will greatly improve the health lican effort to save Medicare in one day? I 3. Frequent delays in all inpatient services care options in rural areas by creating a for- have the same trouble believing this as my throughout every area of care. mula floor of $300 per month the first year for constituent does. 4. Elimination of elective cases in the oper- ating room and reserving the operating room all counties now below that level. It would rise However, I will limit my comments to the for emergencies only. This would lead to less to at least $320 the next year. Almost all minor details I am aware of regarding this funding support to the rest of the hospital counties in Nebraska fall in this category. In plan. and create a greater need for tax payor [sic] fact, in the 1st Congressional District of Ne- support. PART B PREMIUMS braska, 21 out of 25 counties, including Lan- First and foremost is my problem with the 5. Our current funding for Physician Serv- ice totaling $5,000,000 could be reduced by as caster County, will benefit because they are increase in part B premiums. The plan calls much as 50% causing us to care for mainly now well under the $300 county capitation for a continuation of the 31-percent premium indigent care patients. rate. instead of dropping the level to 25 percent as 6. Residency Programs: Our current fund- current law now dictates. This allows for an in- ing of 148 residents would be reduced by as This change also rectified the problem expe- crease of almost $700 a year by 2002. much as 60% or to only 59 residents. This rienced in some metropolitan areas such as Not one penny of this increase will go to- sets the pattern for future physician short- Seattle and Minneapolis whose medical com- ward the part A trust fund. This increase will ages. munities are more efficient providers of health The above possibilities could eliminate all care than other urban areas. only go toward the general fund and can be funded patients, putting greater risk on the used to balance the budget while giving a tax base. All planned admissions could be de- Mr. Chairman, since this improvement was $245-billion tax cut to the wealthy. layed and the hospital could become one made in the bill, this Member is pleased to CHOICE giant emergency room and triage hospital. support it. The outline states that it offers a choice to This is just one example of the type of de- Ms. BROWN of Florida. Mr. Chairman, the seniors in the type of health care organization structive impact this plan would have on our House of Representatives is the People's they would like to become a part of without community. I have received similar letters from House. We were sent here to Congress with limiting their ability to stay in the traditional all the other hospitals in El Paso. a mission: to serve the people. As Members of Medicare program. MEANS TESTING Congress, we should be listening to our con- However, the different choices available to The plan also proposes to charge seniors stituents and voting against proposals that will seniors have not been subjected to a test to with incomes over $75,000 for individuals and devastate our seniors. H 10380 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Here I have hundreds of questionnaires that colleagues argue, ``but the Medicare trust fund health care providers don't order extra tests or my constituents signed opposing drastic Medi- has faced bankruptcy before and the program unnecessary procedures simply for financial care cuts. During the break, I met with over has survived. Why do we have to make sure gain. 3,000 of my constituents at 14 town meetings dramatic changes now?'' The plan also asks doctors, hospitals and and they told me they are appalled at the Re- The answer is simple: The current Medicare seniors each to contribute a little toward sav- publican plan to cut Medicare. Oh, did I say crisis is of such magnitude that it demands a ing the program. For example, doctors and CUT? I meant GUT. long-term, comprehensive reform of the sys- hospitals will continue to see their Medicare Mr. Chairman, the Republican Leadership is tem. payments growÐbut not as fast as they would unhappy about us using the word CUT to de- In the past, Congress has always dealt with under current law. Seniors will be asked to scribe the Republicans' Medicare plan. Okay, Medicare's financial problems with short-term, pay a little more Part B premiums. Note that fine. Maybe CUT is not quite the right word. quick fixes. Several times over the past two even with these premium increases, seniors Well how about G-U-T? How do you like the decades, Congress has tinkered with Medi- will continue to only pay about 1/3d of the cost word GUT? The fact is that Republicans want care to shore up the financial problems in the of Part BÐand taxpayers will continue to sub- to destroy Medicare's security and leave our program. Usually, these short term solutions sidize 2/3ds of the cost. I think this is fairÐwe seniors stranded to fend for themselves. They involved raising payroll taxes, cutting pay- cannot force working families, many of whom say they are ``saving'' Medicare. ments to providers, or raising premiums and can't afford health insurance themselves, to in- Well, I come from Florida where I served for copayments for seniors. And these quick fixes crease their subsidy of the Part B program. 10 years in the Florida House. In Florida we worked, at least temporarily. After each one, have a saying for that kind of thing, ``That dog Medicare was able to limp along for a few But our proposal goes much further than won't hunt.'' more years, until the program had to be just attacking waste and limiting the growth of Thousands of my constituents have told me ``fixed'' again. payments to doctors and hospitals. The core that they are outraged at the Republicans' re- But the day of reckoning has arrived for of the Republican proposal is a truly revolu- verse Robin Hood tactics, stealing from the Medicare. For the first time in the program's tionary idea: Let seniors have the same health working people and giving tax breaks to the history, the costs of Medicare are growing so insurance choices that their children and wealthy. As we say in Florida, ``That dog won't rapidly that no amount of ``tinkering'' can make grandchildren have. hunt.'' up the difference. If Congress does nothing, Under our plan seniors would have three Two days ago, I spoke to the National Medicare spending will nearly double by options: First, join a private health insurance Council of Senior Citizens, who have been 2002Ðgrowing from $160 billion today to $318 plan and have Medicare pay the premiums; leading the fight against drastic cuts in Medi- billion in just 7 years. And that's before the Second, use Medicare dollars to purchase a care. NCSC has shown great courage and first wave of baby boomers starts to draw ben- high-deductible health plan and have savings true leadership in this fight and I want to say efits from Medicare. If left unchecked, such placed in a medical savings account. or Third, to them: Thank you. Thank you for your work. astronomical growth will swamp the Medicare stay in the current system. So, for example, if Thank you for your bravery. And thank you for program and add trillions of dollars to the na- you like the health plan you have at work, you your commitment to seniors. tional debt. can keep it when you retireÐand Medicare Recently in Washington, NCSC led a rally Why is Medicare growing so fast? The main will pay the premiums. If you want to join an- against Republican Medicare cuts by rolling problem is that the current Medicare program other private insurance plan, you canÐwithout out a giant Trojan Horse representing Repub- simply does not deliver health care cost effec- being excluded for preexisting conditions. And licans' empty promises on Medicare. tively. While innovations in the private health if you want to stay in the current government- And last week, seniors from NCSC came to care market have had some success in con- run Medicare system, you can do that, too. Congress to protest the fact that the Com- trolling health care costs, costs in the govern- The idea is that, by allowing seniors to join merce Committee was voting on a Medicare ment-run Medicare program have continued to more efficient private insurance plans, we can bill without having one hearing on it. For that, skyrocket. For example, while large private in- save money and give seniors more health they were arrested? surers cut their health care costs by 1.1 per- care options at the same time. Shame on my Republican colleagues for cent last year, Medicare costs grew by more In short, the Republican proposal is a fun- shutting out seniors from CongressÐthe Peo- than 10 percent. Of course, these results damental departure from past attempts to re- ple's House. As a Democrat who believes in should not be shocking: Should we really be form Medicare. Instead of trying to squeeze the Democratic process, I believe those sen- surprised that a government-run program such more money out the current system, we are iors deserve to be heard, and not arrested. as Medicare is characterized by rampant inef- proposing to change the system so that it can Seniors are the ones who made this country ficiency and skyrocketing costs? I think not. provide the same benefits for less money. And great, and we owe it to them to protect their To put it simply, Medicare is a 1960's gov- don't forget: Republicans are not proposing to health care. We should be celebrating and ernment insurance program that simply does cut MedicareÐunder our plan, benefits will still embracing our seniors, not stabbing them in not meet the demands of providing health care grow from $4,700 per person today to $6,700 the back by taking away their health care. in the 1990's. The system needs fundamental per person in 2002. Mr. KIM. Mr. Chairman, I rise today in sup- reform in order to survive. port of the Republican plan to save Medicare. That is why Republicans are proposing the Unfortunately, opponents of our plan reject I think everyone would agree that the Medi- ``Medicare Preservation Act''. Our proposal is the kind of fundamental reform Republicans care program has been an enormous success an attempt to save the Medicare system from are proposing. They want to tinker with the over the past 30 years. Because of Medicare, bankruptcy by making the program more effi- system some moreÐmaybe push Medicare's millions of senior citizens have gained access cient and cost effective. In doing so, it would bankruptcy back a couple of years. The prob- to the health care that they otherwise wouldn't reduce the growth of Medicare by $270 billion lem is, under this approach, we will be right have been unable to afford. over the next 7 years? back here in a few years, arguing over these But trouble looms just over the horizon for So how does our plan reduce the growth of same issues. Except, by then, the deficit will Medicare. As many people have heard by Medicare? have grown substantially, the Medicare trust now, the Medicare trustees recently warned The plan starts by declaring war on Medi- fund will be in even worse shape, andÐmost that the Medicare trust fund is going to be care waste and fraud. Among other things, the importantlyÐthe baby boom generation will be broke by 2002. That would be a catastrophe: plan dramatically increases penalties for fraud, that much closer to retirement. In fact, a re- If the Medicare trust fund is exhausted, the provides funds for new computer technology cent study estimated that the Medicare reform program cannot legally continue to provide that can identify fraudulent activities, and sets plan offered by the Democrats would leave benefits to senior citizens- leaving millions of up procedures for giving cash rewards to sen- Medicare $300 billion dollars in debt just as seniors without needed health care. iors who report abuse in the Medicare pro- we have to start paying for the baby boomers. In response, Republicans have put forth a gram. The plan also implements malpractice To me, that's irresponsible. dramatic plan to save Medicare from bank- reform to eliminate frivolous lawsuits which Finally, I want to respond to my Democratic ruptcy. Unfortunately, many of my Democratic drive up costs for everyone in the system. Fi- colleagues who accuse Republicans of cutting colleagues are skeptical of the need for re- nally, our proposal reforms how Medicare Medicare to provide a ``tax cut for the rich''. I form. ``We agree the system is in trouble,'' my pays doctors and hospitals to make sure that am here to tell you that nothing could be far- October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10381 ther from the truth. The fact, is Republicans proposal is that it offers seniors choices until fort to do so. But it's the only plan out there have already passed more than enough now only available in the private sectorÐco- that seriously addresses Medicare's financial spending cuts than are needed to pay for our ordinated care, Medical Savings Accounts and troubles. For the 37 million Americans in the proposed tax cut. The Republican budget res- provider-sponsored networks, to name a fewÐ system and those millions more in years to olutionÐpassed last AprilÐcontains $622 bil- and sufficient information to make good come, let's hope Congress and the White lion in non-Medicare spending cuts. That is choices. House can get beyond the rhetoric and work two-and-a-half times the amount of spending Some may opt for coordinated care to re- together to produce a responsible plan that cuts needed to pay for tax cuts. And let's look duce out-of-pocket costs or obtain prescription saves this vital system. And, in the process, at the tax cuts themselves: Is a $500 per-child drugs, eyeglasses or other coverage currently let's hope both sides can be more honest with tax credit a tax cut for the rich? Is a $500 tax excluded under Medicare. Others may want to the American public about how that's credit for the care of an elderly relative a tax take advantage of a Medicare Savings Ac- achieved. cut for the rich? Is cutting taxes on IRA with- count where beneficiaries can purchase a high I urge my colleagues to support this legisla- drawals or the sale of a home a tax cut for the deductible, low-cost insurance policy and the tion as a responsible approach to a very real rich? I think not. government deposits money that would have problem. So let's end this partisan bickering. We gone toward more traditional Medicare bene- Mr. FOGLIETTA. Mr. Chairman, there has must act now to save MedicareÐwhile there is fits into an interest bearing account that can been a lot of talk this year about contracts. still time to engage in rational, thoughtful re- be withdrawn tax-free to cover medical ex- First, there was the Contract With America. Or form of the Medicare system. By making the penses. as they call it in my neighborhood in south Contrary to the heated rhetoric, Medicare is system work more cost-effectively, we can Philadelphia, the contract on America. There not being ``cut''; spending per beneficiary will preserve, strengthen and simplify MedicareÐ is the contract with the American family. actually increase under the proposal from and make sure current and future generations Now I studied contracts in law school. A of seniors will have access to this vital pro- about $4,800 in 1996 to $6,700 in 2002. Granted, that is not as steep an increase as contract is not a very complicated thing: you gram. For these reason, I urge my colleagues agree to do something for me and I will do to support the Republican plan to save Medi- currently projected, but it remains a generous program. Moreover, despite claims from the something for you. care. As we vote on this bill today, let us all think Mr. PORTMAN. Mr. Chairman, Medicare's plan's critics, the House proposal does not in- crease copayments or deductibles. Premiums about what our parents did for us and for problems are now well known. The question is will increase in absolute numbers under the America. The generations of parents who whether official Washington has the courage House GOP plan, a bit more than they would stand at risk because of this legislation gave and foresight to fix them. If the partisan bicker- under current law. This is because the pro- decades of their lives at work to raise us, feed ing continues and nothing is done, the Federal posal locks in today's premium of 31.5 percent us, clothe us, to educate us. program providing health care insurance for of the cost of Part B services (doctors visits, They fought the Second World War for us, roughly 33 million seniors and 4 million dis- lab work, etc. . . .), rather than having the they saved the world from an enemy so evil it abled Americans won't be there for anyone. percentage paid by beneficiaries decrease is unthinkable to consider what would have We know that skyrocketing medical costs, (and the percentage of the public subsidy in- happened without them, our parents. an aging population and a decline in the ratio crease) as it would under current law. As a re- After World War II, men and women in this of workers paying into the system have placed sult, instead of paying $61 a month seven Chamber did a profound thing. They created a Medicare in dire financial straits. We know years from now as would be the case under way for our parents to live out their lives in se- about the alarming Medicare Trustees' re- current law, the amount would be approxi- curity, in peace, and in health. portÐthe Part A Trust FundÐwhich covers mately $87 a month. This reflects the fact that The created the Social Security and Medi- hospital, skilled nursing and home health serv- health care costs will go up in that time period. care systems. icesÐstarts paying out more than it takes in Most seniors I talk to are willing to see this next year and goes broke 6 years later. We These programs represent a covenant kind of increase if it is part of getting the sys- among generations. But now we are tearing also know that Medicare offers limited choices tem on its feet. to beneficiaries, is rife with fraud and abuse up that contract. Only those better off (individuals with in- They are tearing up that contract when they and, typical and entitlement programs, lacks a comes over $75,000 and couples with in- cost control mechanism. Such cost increases raise premiums on elderly Medicare recipients comes over $125,000) will pay a higher per- who just cannot afford it, and next week they are simply unsustainable in a program that centage of Part B premium costs. Again and now accounts for over 11 percent of the Fed- propose to cut Medicare to the bone to pay for again in my town meetings and discussions a tax cut for the wealthiest Americans. eral budget. This has led to annual cost in- with seniors, I've been impressed with the will- They are tearing up the contract by pushing creases in excess of 10 percent, at least twice ingness of people to pay a little more if it people too hard into a system that will take as high as private health care costs. helps put Medicare back on its feet. With all of this knowledge and after more The proposal also tackles fraud and abuse. their choice away. than two dozen public hearings and hundreds Seniors in my District and around the country They are tearing up that contract with huge of town hall meetings, comprehensive Medi- have offered innovative ideas to curb the fraud cuts to hospitals and doctors and that slam care reform legislation was introduced in the and abuse that adds billions of dollars in the door on access. House at the end of September. Democrats health care costs each year. The proposal re- These are senior citizens who have held up have dismissed the plan as a mere means for wards seniors who report fraud to the govern- their end of the contract. We have to keep our paying for Republican-sponsored tax cuts. ment and the government, in turn, increases part of the bargain. I urge my colleagues to This misses the point. The tax relief has al- penalties for those who defraud the system. oppose this bill and support the Gibbons-Din- ready been paid for with spending cuts and Those who have taken a hard look at the gell substitute. has nothing to do with Medicare reform. Re- benefits of increased choice and competition Mr. CASTLE. Mr. Chairman, I rise in support publicans, in turn, are too defensive about the believe that health care delivery can be im- of the Medicare Preservation Act. This is a re- politically sensitive task of curbing entitlement proved and costs reduced. In conjunction with alistic proposal which addresses the serious spending. Both sides need to be honest about affluence testing and reduced fraud and problem of Medicare's pending bankruptcy. the facts, get down to work on the serious abuse, many believe that savings will be gen- For the last 6 months, I've traveled throughout challenge before them, and stop the political erated adequate to keep the program solvent Delaware, held town meetings, and visited gamesmanship. Here's what the proposal just at least until the baby boom generation begins with senior centers to talk about this important introduced does and doesn't do. to retire. But they may be wrong. That's why program, which provides health care for It does allow beneficiaries to keep their cur- the current plan also builds in a ``failsafe'' roughly 100,000 aged and disabled Dela- rent coverage. If someone is currently enrolled mechanism, under which government pay- wareans. Delawareans want to know that this in the traditional fee-for-service planÐwhich ments to providers will be reduced if targets critical program will be there for them in the over 90 percent of beneficiaries areÐby doing are not met. future. They recognize that the Government nothing that plan is continued. But many will Is this plan perfect? No. It surely can be im- cannot afford to continue the Medicare Pro- want to change. The innovative aspect of the proved and there ought to be a bipartisan ef- gram as it currently exists. H 10382 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Medicare, created in 1965, is comprised of Medicare from bankruptcy and recognizes that However, the Medicare Program is sick, very two parts, part A and part B, which provide dramatic changes must be made and new op- sick. According to President Clinton's own ad- hospital coverage and doctor coverage for 99 tions must be provided to this important pro- visors, the Medicare system will face bank- percent of all older Americans. President Clin- gram. ruptcy in the next decade if fundamental re- ton's Medicare trustees have clearly and suc- Next year, the Federal Government starts forms do not take place. If the program goes cinctly stated that the program is in financial spending more on Medicare than it takes in broke, seniors will lose their Medicare hospital dire straits. Why? The Medicare Program grew and in 6 short years, the Medicare Program is coverage. at a rate of 10.5 percent last yearÐthree insolvent. Under the Republican plan, Medi- During the Medicare reform debate, I have times that of inflation and twice as much as care is preserved until 2010, benefits will con- worked to ensure that four goals are achieved. private sector medical costs. Further, the Gen- tinue to grow and patient choice is not only First, the long-term integrity of the Medicare eral Accounting Office [GAO] has estimated maintainedÐit is expanded. Older Americans system must be preserved for present and fu- that as much as $44 billion a year is wasted receiving Medicare can stay in the current sys- ture retirees. Second, lower-income seniors on Medicare and Medicaid fraud, and about tem, with their current doctor, without having must be protected from cost increases that 30 cents of every dollar is wasted or lost due to choose another health care plan. Or, they they cannot afford. Third, Medicare reforms to mismanagement by a Federal agency. can choose a private sector plan that offers should provide more competition and Thirty-seven million people depend on the more benefits, like prescription drugs or eye- consumer choice, not more Government con- Medicare Program, and it is frustrating to see glasses or put their funds into a medical sav- trol. And finally, the huge reimbursement dis- the program politicized. No oneÐnot Demo- ings account. crepancy between rural and urban counties crats, not RepublicansÐinvented Medicare's Under the Republican plan, there are no must be fairly adjusted. I am proud to say that financial crisis. The program has been head- cuts in spendingÐspending goes up 40 per- the Medicare Preservation Act meets these ing toward bankruptcy for years. During the cent over 7 years, with per beneficiary spend- goals. last Congress, President Clinton created a bi- ing increasing from $4,800 today to $6,700 in The Medicare Preservation Act will ensure partisan Commission on Entitlement and Tax 2002; there is no increase in Medicare that every Medicare recipient will continue to Reform, on which I was selected to serve, to copayments; there is no increase in Medicare receive affordable, high quality health care try to transcend politics and address entitle- deductibles; and there is no change in the cur- now and in the future. Medicare spending will ment programs in a responsible, bipartisan rent rate of Medicare premiums. Today and to- increase from $4,800 to $6,700 per person manner. morrow, premiums are 31.5 percent of Medi- over the next 7 years. Seniors will have more In forming the Commission, President Clin- care part B costs. They will continue to be cal- health care options including traditional fee- ton said ``This Commission will be asked to culated that way. for-service Medicare, managed care plans, grapple with real issues of entitlement reforms. In addition, the bill cracks down on waste, and medical savings accounts. Finally, the in- . . . This panel, I expect, will ask and answer fraud, and abuse that pervades the current crease in per capita payments for rural coun- the tough questions. . . . Many regard this as system, enacts tough malpractice reforms to ties will ensure that seniors who live in rural a thankless task. It will not be thankless if it end runaway spending and frivolous lawsuits, communities will have the same health care gives us a strong and secure and healthy and allows doctors and hospitals to join hands options as their friends in urban areas. American economy and society moving into in providing health care in a provider network The Medicare Preservation Act strengthens the 21st Century.'' While the final report to the arrangement. Lastly, the Medicare Preserva- Medicare for the 21st century. I strongly urge President did not endorse specific proposals tion Act clearly states that the savings from my colleagues to support passage of the H.R. to reform entitlement programs, it stated ``We slowing Medicare's growth rate must go back 2425. must act promptly to address this imbalance into the health care system in a lock box and Mr. KLECZKA. Mr. Chairman, today the new between the government's promises and its cannot be used for any other purpose. Republican majority has demonstrated that ability to pay.'' However, no further action was Enacting a bold Medicare preservation plan their position on Medicare has not changed in taken by the Democratic leadership in Con- is not only absolutely necessary; it is the re- 30 years. In 1965, Democrats enacted the gress or the President. sponsible action and the least we can do for Medicare Program amidst Republican opposi- In contrast, Republican leadership in Con- the 37 million Americans who depend upon tion. and today, despite the overwhelming suc- gress has bravely confronted the issue, refus- Medicare now and for the millions of Ameri- cess of this program, Republicans have voted ing to be thrown off track by those who are cans who will depend upon Medicare in the fu- to undermine it. I am not surprised that the trying to turn Medicare reform into a political ture. GPO has voted to make unprecedented cuts hot button. The Republican proposal recog- Mrs. THURMAN. Mr. Chairman, I rise today in this critical health care program, after all, nizes that we simply must control the pro- to express my opposition to the Republican they have never consistently supported Medi- gram's spiraling growth rate to guarantee that plan to cut Medicare to finance a $245 billion care. But to take $270 billion out of a program the program is maintained well into the future. tax cut for the wealthy. Under the Republican that protects senior citizens in order to pay for The proposal does not bow to the political plan, Florida will lose $28 billion from Medi- tax cuts and to balance the budgetÐthis is pressure of those who want a feel-good pro- care. As a result, my constituents will play simply extreme. posal that only scratches the surface of reform higher premiums, face uncertainty about their Republicans claim these cuts are to in order to provide a quick fix until after the ability to stay with trusted doctors, and lose strengthen the trust fund, which according to next election. their sense of health care security. the Medicare trustees is expected to become Having said that, I think it would be naive to Republicans have promised a utopian world insolvent 7 years from now, in 2002. But in the throw unconditional support behind any pro- of free choice and complete access to serv- last 20 years the trustees have projected that posal that modernizes a 30-year program. Re- ices. But, there is no choice when cuts in the the fund would be insolvent in 7 years or less forming Medicare is complicated business, fee-for-service program force seniors into at least nine times. In fact, just last year, the and we do not have crystal balls allowing us health maintenance organizations. And there trust fund was projected to become insolvent to predict perfectly the outcome of these bold is no quality service when our health care sys- in the year 2001Ð7 years out. Yet my Repub- reforms. I do have some reservations about tem for the elderly is cut to free up money for lican colleagues said nothing. In fact, the only the proposal. For example, I am concerned tax cuts. Paying more for the same service is provision proposed to date by the Republican about the potential impact of the ``look back'' a cut, and the Republicans know it. majority that has a measurable impact on the provision that allows additional savings to We need to stand up for the seniors of trust fund actually takes more than $87 billion come from doctor and hospital reimbursement America. Seniors were forcibly silenced during out of the fund over the next 10 years! For 30 rates if the amount of savings predicted under the so-called debate on this issue in commit- years it has been up to the Democrats to pro- the bill do not measure up. I want to ensure tee. When we tried to expose the Republicans tect and preserve Medicare. It looks as if it will that nursing homes continue to be a safe plan for what it is, we were shut out of hear- be up to us for the next 30 as well. place for our seniors. I want to ensure that ings and forced to meet on the Capitol lawn. In their new found concern about the Medi- some of the deregulatory provisions in the bill It is our obligation, as representatives of all care trust fund, the GOP plan cuts the pro- don't ultimately increase costs, like those relat- citizens, including the most vulnerable, to gram by $270 billion over 7 years. And their ing to physician self-referral. speak out and vote against these drastic cuts. plan does extend the life of the trust fund to Given the stakes here, however, the good Mr. LATHAM. Mr. Chairman, I rise to sup- the year 2006. However, what they don't tell cannot be set aside while we try to achieve port the Medicare Preservation Act. you is that the Medicare actuaries estimate the perfect. In its entirety, the proposal is real- Medicare has successfully provided basic that only $90 billion is needed to extend the istic, sensible, and fair. The proposal saves health care for our Nation's senior citizens. trust fund to that year. What are they doing October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10383 with the balance of the money? They are It dismays me that we have come this far in ruptcy. Others will say they need to raid Medi- using it to pay for tax cuts and deficit reduc- the process and are left with a Republican care to balance the budget (although at the tion. plan or the Democratic alternative. It did not same time they are proposing huge tax breaks In contrast, the Democrats have introduced have to come down to this. Democrats on the for the wealthiest Americans). What are the alternative plans that achieve the same level Ways and Means Committee and on the Com- real answers? of solvency that the Republican plan achieves, merce Committee attempted to work with Re- In understanding this latest attack on Medi- but at only a third of the cost. These proposals publicans to add these protections included in care, I believe it is important to look beyond reduce Medicare expenditures by only $90 bil- the Democratic alternative to the Republican the latest conservative rhetoric about Medicare lion over 7 years and still assure that the trust plan and to improve the GOP proposal. Ways and examine the record instead. The fact is, fund remains solvent for the next 10 years. and Means Democrats offered more than 35 since the 1950's, the GOP has consistently Because every penny of this $90 billion is tar- constructive amendments to the Republican opposed even the creation of Medicare. Many geted to the trust fund, we are able to bill. Of these, only four were accepted by the of the party's prominent leaders voted against strengthen the fund without weakening the Republican majority. Medicare when it was first established in program for current beneficiaries. Today we will not have the opportunity to 1965. And current party leaders have repeat- The Democratic substitute contains a series present constructive amendments because the edly attacked Medicare and Social Security. of responsible reforms combined with modest rule is closed. But they cannot hide from their If the Republican Party had been in the ma- improvements that put beneficiaries first. This agenda. Republicans on the Ways and Means jority in 1965, Medicare simply would not exist. alternative does not increase premiums, Committee voted in lockstep to reject an A full 93 percent of House Republicans voted copayments or deductibles. In fact, the plan amendment to extend basic consumer protec- against Medicare when it was introduced. In even eliminates excessive copayments that tions to Medicare beneficiaries who choose fact, the Republicans voted overwhelmingly beneficiaries currently pay for hospital out- managed care plans. They opposed an against the creation of Medicare on three patient services. Moreover, Medicare's current amendment, offered by myself, to safeguard other occasions in the early 1960's. limits on balance billing are retained, essential beneficiaries from a practice called balance Their arguments were extreme then and protections for Medicare beneficiaries in nurs- billing in which the patient is expected to pay they're extreme now. In 1965 they called Med- ing homes are preserved, and tough laws the difference between what the doctor icare ``socialized medicine'' and claimed it against fraud and abuse remain on the books. charges and what Medicare pays. Republican would ``impair the quality of health care, retard the advancement of medicine and displace pri- The Democratic bill updates Medicare bene- members voted against an amendment that vate insurance.'' Nevertheless, Medicare fits to prevent cancer and complications from would have restored funding for inner city and passed, and for many years was widely diabetes including colorectal screening, pap rural hospitals who serve the uninsured, and hailed, even by Republicans, as a triumph of smears, pelvic examinations, and increased rejected an amendment to retain the current government. coverage of breast cancer screening. Also, standards for nursing homes. They also voted against amendments to increase screening for Despite the doomsday predictions 30 years payment would be authorized for diabetes out- ago, Medicare has dramatically improved the patient self-management services and for breast and cervical cancer, rejected amend- ments to provide coverage for colorectal and health and welfare of American seniors and blood-testing strips for individuals with diabe- ensured that the elderly will never again have tes. prostate cancer screening, and turned back an amendment to provide better coverage for dia- to choose between health care and food or Our plan also offers expanded choice of betics. rent. providers and plans, permitting beneficiaries to These are just some of the proposals on Ironically, one of the reasons we even have enroll in preferred provider organizations which the Republicans have gone on record. a debate about reforming Medicare is because [PPO], point-of-service [POS] plans and pro- But today is the day to keep score. Today we of its profound success. Americans are living vider service organizations in addition to the each have a choiceÐto support senior citizens longer and more productive lives. That means current fee-for-service and HMO options. But or to support tax cuts for wealthy Americans. many more reach an age where greater health unlike the Republican bill, our reform proposal I urge my colleagues to not take lightly this problems can emerge. We should not use the also ensures that these new options are real decision. success of Medicare as a reason to recklessly choices. Plans must honor limits on balanced Mr. MFUME. Mr. Chairman, I rise today in cut the program. billing and they are paid adequately in order to opposition to H.R. 2425, the Medicare Preser- The Medicare Preservation Act being voted shield beneficiaries from additional out-of- vation Act. This bill makes the most sweeping on today does not preserve Medicare. Rather, pocket costs. changes in the Medicare Program since its es- it will violate the compact made with Ameri- Certainly, efforts to control spending require tablishment in 1965. Since assuming control of can's elderly over 30 years ago. This bill will that some limits be places on reimbursements Congress this January, House and Senate Re- push patients into managed care; provide ob- to all providers, including physicians. Since the publicans have been pushing for passage of stacles for Medicare beneficiaries to find a American Medical Association has been so the deepest package of Medicare cuts in the physician willing to provide them care because supportive of the GOP plan, the Democratic program's 30-year history. These changes will of lower reimbursement rates; double Part B alternative largely mirrors the Republican pro- increase the cost of Medicare to the average premiums for seniors living on a fixed income posal with respect to payment reforms. Spe- senior citizen by nearly $1,000 and force by the year 2002; close inner-city and rural cial caution is taken with reductions in pay- many to give up their own doctors. According hospitals which are already on the brink of ments to hospitals. Excessive cuts in hos- to the American Association of Retired Per- bankruptcy and give a few bad doctors an pitals, like those proposed by the majority, sons, the Republican Medicare cuts would be open license to provide shoddy treatment could be counter productive, negatively affect- ``the end of Medicare as we know it.'' since patients would no longer be able to rely ing the quality of care, reducing access to There is much in the bill that concerns me on the court system for redress. Additionally care and resulting in higher costs for the pri- and my constituents. However, the provisions this bill would repeal balance billing require- vate sector. The alternative plans includes of this bill to change nursing home standards ments for some categories of beneficiaries; reasonable reductions in hospital payments have raised the ire of many others. H.R. 2425 encourage doctors to perform unnecessary but also safeguards hospitals that serve the repeals current federal standards for nursing testsÐincreasing overall health care costsÐ uninsured in rural and urban areas. homes participating in the Medicare Program and allow them to refer patients to facilities I urge my Republican colleagues to stop and replaces them with a requirement that they have a financial stake in; and increase marching blindly for just one moment to con- nursing homes be State certified. costs by allowing healthier, younger seniors to sider this worthy, thoughtful alternative. If your Many of my elderly constituents and their opt out of Medicare through Medical Savings goal is to preserve the trust fund, this alter- families recall the days when some nursing Accounts while leaving sicker and older pa- native plan accomplishes that goal. If you homes were little more than abusive prisons tients in traditional Medicare. want to strengthen the Medicare program and for America's seniors. They are not impressed The Republican cuts in Medicare are mis- bring it into the twentieth century, this plan by this so-called preservation effort. guided and faulty. They go way beyond what gets there. If instead, you wish to pursue this Why the assault on Medicare? Why propose is reasonable or necessary to maintain the scorched earth policy in order to balance the deep and potentially devastating cuts in a pro- solvency of the program. And when you strip budget and pay for tax cuts, then you have gram that is a contract between Government away the rhetoric, all that remains is a huge that option before you today. But at least stop and seniors who have paid into the program tax break for the wealthy. They need a way to long enough to think about what it is that you all their lives? Some Republicans will say that pay for their trickle-down tax break, and they want to achieve. they are trying to save the program from bank- believe they can pull it out of the pockets of H 10384 CONGRESSIONAL RECORD — HOUSE October 19, 1995 struggling seniors. America's seniors were told Senior citizens don't want a band-aid solu- structured in such a way that it will survive far that their deepest beliefs in fairness, personal tion to the pending bankruptcy of Medicare. into the future. responsibility, social duty and contribution to They want a long-term solution which guaran- H.R. 2425, the Medicare Preservation Act of society would be rewarded if they trusted Con- tees that Medicare will be there for them. This 1995, accomplishes all of these goals while gress with their health care. Now Congress is legislation does just that. retaining the essential elements of traditional using Medicare cuts to pay for a tax break for Mr. GALLEGLY. Mr. Chairman, I rise in sup- Medicare. I truly believe that we have done the wealthy. port of H.R. 2425, the Medicare Preservation the right thing today in adopting these reforms. Despite the feel-good rhetoric, the reality is Act of 1995. We have taken a program that was failing, a that Medicare has been moved into the bulls- Mr. Chairman, when the majority in the Con- program on track to consume itself and we eye of the GOP target for massive cuts. When gress first took up the challenge of a poten- have given it new life. We rose above the you look at the shotgun of this crew and the tially bankrupt Medicare System as presented scare tactics and sound bites aimed at pre- other targets of the conservativesÐstudent by the Board of Trustees, I wanted to ensure venting us from having the courage to do the aid, summer jobs, Federal workersÐit looks that any reforms we initiated achieved two right thing and we did the right thing. less like responsible budget cutting and more goals: first, the reforms must make the trust I am proud to have had a hand in bringing like a drive-by shooting. fund solvent as far into the future as possible; about these badly needed reforms, and I look Mr. EWING. Mr. Chairman, the Medicare and second, none of the reforms could result forward to celebrating the positive impact our Board of Trustees reported last spring that in any degradation of current health services action today will have on current and future ``The Medicare Trust Fund continues to be se- now enjoyed by those covered by the Medi- Medicare beneficiaries. verely out of balance and is projected to be care System. Mr. HALL of Ohio. Mr. Chairman, today we exhausted in 7 years.'' This report was signed In the days and weeks leading to today's are debating H.R. 2425, the so-called Medi- by, among others, President Clinton's Sec- vote on the Medicare Preservation Act of care Preservation Act. Who can be opposed retary of the Treasury, his Secretary of Labor, 1995, literally thousands of constituents con- to preserving a program on which more than and his Secretary of Health and Human Serv- tacted me to discuss this legislation and to 37 million Americans are dependent? Unfortu- ices. voice their specific questions/concerns. As I nately, the bill does not live up to its title. began to research and consider the proposed Its supporters claim that unless action is Mr. Chairman, I am proud to stand up in reforms, their questions became my questions taken, the part A trust fund will be bankrupt in support of legislation which will provide a long- and I realized I could not in good faith cast my the year 2002. However, all that this bill does term solution to the financial problems in the vote before I had all the answers. is to move the date of insolvency back to the Medicare Program and guarantee that the pro- One of the things they wanted to know was third quarter of 2006 according to actuaries at gram will be available for senor citizens well whether the new plan would allow bene- the Health Care Financing Administration. At into the next century. In addition, this legisla- ficiaries to remain in the traditional Medicare what cost? tion will provide senior citizens with more System. The answer, of course, is absolutely. The part B premium will rise by an esti- choices in their health care decisions, while Only Medicare beneficiaries who choose to mated 89 percent. Payments to hospitals will guaranteeing that senior citizens in Medicare participate in one of the new MedicarePlus op- be cut, especially to hospitals that provide a now may remain in the program and keep tions will change plans. disproportional share of care to indigent pa- their current doctor and hospital if they Some were concerned by reports that the tients and teaching hospitals, and as a result, choose. This bill provides for an increase of Republican plan was ``cutting'' Medicare bene- many hospitals will be forced to close. Pay- Medicare spending from $4,800 per person fits. Was this true? Were we cutting Medicare? ments for home health care will be reduced now to $6,700 per person over the next 7 The answer was absolutely not. The plan we which will lead to more people being placed in years, while at the same time guaranteeing adopted today significantly increases Medicare nursing homes, but payments for nursing the solvency of Medicare. I am proud to sup- spending. Under the Medicare Preservation homes will also be reduced. port legislation which protects and preserves Act of 1995, average spending per beneficiary This is a bill to cut $270 billion from the Medicare without changing Medicare benefits, in California goes from $5,821 to $8,139 over growth of the Medicare Program over the next does not increase deductibles, and does not the next seven yearsÐan increase of more 7 years, far more than is needed to keep the change co-payments. than $2,300. program solvent. As painful as the cuts in the I would like to commend the Republican Many of those who contacted me had been bill are, the program changes in the bill are leadership for agreeing to alterations in the exposed to the false and inflammatory reports even worse. legislation which will guarantee a minimum that the money we were saving by reforming The bill is predicated on beneficiaries mov- Medicare reimbursement level for rural coun- Medicare would be used toward deficit reduc- ing into managed care plans such as health ties which for years have received substan- tion or tax cuts. In fact, nothing could be fur- maintenance organizations. It also provides for tially less than more populous areas. This ther from the truth. Any savings realized establishing medical savings account plans agreement will make the Medicare program through our reform of Medicare must stay in with high deductibles. These accounts could more fair than it has been for seniors who live Medicare. Period. be used for medical services not currently cov- in rural America, while at the same time pro- A final concern many seniors expressed to ered by Medicare. These options are all right viding an incentive for HMO's and managed me was whether the quality of the care they for people who are basically healthy, but they care programs to expand their services into currently receive would decline under a re- will have a devastating impact on those who rural America. This will provide seniors in rural formed Medicare. Well, I can report thatÐat a are not. Plans will vigorously compete for areas more choice in their health care deci- bare minimumÐseniors under this plan will be those in the first group; but the others will be sions. guaranteed the same benefits they have now, left behind in traditional fee-for-service plans. It is extremely unfortunate that some have no matter what specific plan they choose. At As more and more healthy people leave these decided to play politics with Medicare by scar- the same time, many seniors will be able to traditional plans, premiums will skyrocket, ing senior citizens into thinking that their bene- select a plan that may offer something they do which in turn will increase the exodus. fits will be cut by this legislation. It is uncon- not currently receive, whether it be prescrip- I believe a compromise Medicare bill can be scionable. Senior citizens deserve to live with tion drugs, eyeglasses, or better hospital care. passed, but in crafting this bill, the majority the security that Medicare will continue to be The bottom line is that the quality of benefits party did not seek input from this side of the there for them when they need it, and they in all cases will measure up to yesterday's aisle. They did not seek input from the public should not be the subject of partisan politics. Medicare and, in many cases, will improve. at large by conducting committee hearings. A This legislation simply controls the rate of These were the kinds of things I needed to small group of Members wrote the bill and growth of Medicare, which has been growing know before casting my vote today in favor of changes were made at the behest of certain more than 10 percent every year, much higher the Medicare Preservation Act of 1995. Like interest groups. This is not the way to legis- than inflation. Spending on the program will many of my constituentsÐand colleaguesÐI late. continue to increase, only at a more controlled was concerned about the rhetoric and misin- Mr. OLVER. Mr. Chairman, today the Re- rate. The bill accomplishes this objective by formation swirling around this issue prior to publican Party takes on the onus for disman- maintaining premiums at the current 31 per- the vote. However, once I had the facts at my tling Medicare, the health care guarantee with- cent level (rather than decreasing as sched- disposal I saw only one appropriate course. in Social Security. uled), reducing waste and fraud in Medicare, That course was supporting a reformed Medi- And you can bet the Republican Party has and encouraging managed care without forc- care System which increases benefits, ex- its sights on dismantling Social Security as ing anyone into it. pands the options to beneficiaries, and is well. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10385 And to what end? To create a comprehen- tion members on their attitudes concerning d. Provide seniors a medical savings ac- sive health care system which 80 percent of Medicare reform and specific reform ele- count option. Americans want? No. ments. Responses to the Chamber survey Favor, 88.2 percent; Oppose, 7.3 percent. (nearly 10 percent responded, 68.9% of which e. Allow provider groups (i.e., doctors and To serve extremists in the Republican Party. hospitals) to offer health coverage (similar To serve the insurance companies and the employ fewer than 50 workers) indicated strong support for market-oriented Medicare to managed care networks) directly to sen- American Medical Association. reform comparable to the House and Senate iors—a new proposal known as provider spon- The Republican Party is cutting $270 billion Majority plans for Medicare reform. The sored networks or PSNs. from health care for American retirees to give complete survey and results are provided Favor, 91.9 percent; Oppose, 5.7 percent. $245 billion in tax cuts. below. f. Require managed care plans to provide More than half of the tax cut goes to fat cats Medicare is ‘‘severely out of financial bal- out-of-network benefits at a higher cost to already making over $100,000 per yearÐwhile ance and the Trustees believe that . . . the beneficiary. 75 percent of the people taking Medicare cuts prompt, effective and decisive action is nec- Favor, 72.4 percent; Oppose, 18.2 percent. 4. For purposes of tabulation: type of orga- to pay for that tax cut live on less than essary.’’ Medicare reform has become a focal point nization: Business, 93.2 percent; Chamber, 4.3 $20,000 per year. percent; Other, 2.0 percent. Approximate The Republican Party is taking health care of the budget debate. Medicare—the national health insurance program for seniors—will number of employees: under 10, 29.4 percent; dollars from low- and middle-income retired run out of money in seven years, according 10–49, 39.5 percent; 50–99, 12.5 percent; 100–249, Americans to give billions to insurance compa- to the system’s trustees. Spending on Medi- 8.6 percent; 250–499, 3.7 percent; 500–4,999, 3.7 nies and the already wealthy. care and other entitlements threatens to percent; 5,000 +, 1.4 percent. You can bet Americans will remember next crowd out all other budget priorities and in- [From the U.S. Chamber of Commerce, November. crease the budget deficit. Economic Policy Division] Mr. MILLER of Florida. Mr. Chairman, I Previous approaches to Medicare reform THE MEDICARE CRISIS: THE TAX SOLUTION IS would like to insert the following letter, polling have failed to slow Medicare’s growth. NO SOLUTION results, and testimony on the Medicare Pres- Worse, these approaches have increased the The only solution detailed by the Medicare ervation Act by the U.S. Chamber of Com- burden on businesses and their employees Board of Trustees for achieving financial through higher payroll taxes and higher in- merce into the CONGRESSIONAL RECORD. balance in Medicare Part A is to raise taxes. surance premiums. Unfortunately, this is no solution at all. U.S. CHAMBER OF COMMERCE, Since 1970, Congress has raised payroll Higher taxes will rob working individuals of Washington, DC, October 18, 1995. taxes over 20 times and the Trustee’s Report their hard-won dollars, significantly increase Members of the U.S. House of Representatives: pointed out that payroll taxes would have to The Chamber urges your support for H.R. costs on small and large businesses alike and be raised by another 1.3 to 3.5 percentage bring the economy to the brink of recession. 2425, the Medicare Preservation Act. Because points to bring the system into balance. of the importance of this issue to our mem- The Trustees calculate that balancing the When you consider that many small and me- Medicare trust fund for the next 75 years re- bers and the budget reconciliation measure, dium size businesses already pay more in the Chamber will include this vote in its an- quires us to immediately hike the Medicare payroll taxes than income taxes and that payroll tax from 2.90% to 6.42%. While the nual How They Voted vote ratings. For your payroll taxes must be paid regardless of eco- information, I have included the results of a tax increase may seem to amount to only a nomic conditions, it becomes clear why Med- few percentage points, it amounts to hun- recent poll taken among Chamber members icare requires solutions other than tax in- concerning elements of Medicare reform dreds of dollars to the typical worker, thou- creases. sands of dollars to the small business, and which reflects overwhelming support for this We need your help. Please review the fol- legislation. billions of dollars for the economy. Analysis lowing questions on Medicare reform and by the Economic Policy Division of the U.S. Medicare is clearly in a state of crisis. FAX back your answers by close of business Over the past five years, the program has Chamber of Commerce suggests the follow- October 16. ing impacts on individuals, businesses and grown at a staggering annual rate averaging 1. Medicare should be modernized by adopt- the economy: 101⁄2 percent. Immediately ahead of us is a ing the market-based strategies private em- seismic demographic shift: the ratio of tax- For a worker making $30,000 a year, total ployers and health plans are using success- Medicare payroll taxes paid would jump to payers to Medicare beneficiaries is declining fully to improve health care quality and con- rapidly—from about four to one today, to $1,926 from the current $870. trol costs. These strategies include improv- A small business employing 25 such work- only two to one in the next fifty years. The ing the quality of care provided to enrollees, program as currently structured simply can- ers would be liable for an additional $13,200 increasing enrollee choice by expanding tax payment per year. not survive. health plan options, and reducing the rate of Just as clearly, the failed Medicare reform When aggregated across the entire econ- growth of Medicare spending. omy, the effect would be to lower real GDP approaches of the past will fail to measure Agree, 98.9 percent; Disagree, 0.6 percent. up to this crisis and will threaten both busi- by $179.4 billion within two years and hold 2. Two competing approaches to Medicare GDP about $95 billion lower 10 years later. ness and the economy. Since 1970, Congress reform have emerged in Congress. One more has raised payroll taxes over 20 times and This amount to a 3.1% decline in GDP in the limited approach addresses the Medicare short run. With economic growth projected the Medicare Trustee’s 1995 Report pointed Part A trust fund, delaying insolvency for an out that payroll taxes would have to be to average less than 3% over the next five additional two years through $89 billion in years, this decline could easily result in a re- raised by another 1.3 to 3.5 percentage points Medicare Part A trust fund, delaying insol- to bring the system into balance. When you cession. vency for an additional two years through These results are even more startling when consider that many small and medium size $89 billion in Medicare savings, primarily businesses already pay more in payroll taxes you consider that they represent an optimis- from reducing the rate of growth in Medicare tic evaluation, not a worst-case scenario. than income taxes and that payroll taxes payments to providers A second approach is OVERVIEW OF MEDICARE: WHY REFORM IS must be paid regardless of economic condi- more comprehensive in nature, addressing tions, it becomes clear why Medicare re- both Medicare part A (hospital bills) and NECESSARY quires solutions other than tax increases. Part B (doctors bills). Medicare Part A would Medicare is a nationwide health insurance We believe the long-term solution to Medi- be protected at least an additional 10 years program for older Americans and certain dis- care’s problem is comprehensive reform that through $270 billion in Medicare savings abled persons. It is composed of two parts: increases competition while restraining the achieved through increased competition and Part A, the hospital insurance (HI) program, growth in spending. Competition will help reducing the rate of growth in Medicare pay- and Part B, the supplementary medical in- bring prices down and will provide secure ments to providers. Which approach would surance (SMI) program. and expanded benefits for seniors. The Medi- you favor? Part A covers expenses for the first sixty care Preservation Act is a bold means of se- Limited, 4.3 percent; Comprehensive, 94.6 days of inpatient care less a deductible ($716 curing the solvency of the Medicare Trust percent. in 1995) for those age 65 and older and for the Fund and setting Medicare on a secure path 3. Do you favor or oppose the following ele- long-term disabled. It also covers skilled for the future. ments of Medicare reform? nursing care, home health care and hospice We urge your support for the Medicare a. Provide seniors choices between compet- care. The HI program is financed primarily Preservation Act during its consideration on ing health plans including existing fee-for- by payroll taxes. Employees and employers the House floor and throughout debate on service benefits. each pay 1.45% of taxable earnings, while the budget reconciliation measure. Favor, 97.4 percent; Oppose, 1.6 percent. self-employed persons pay 2.90%. In 1994, the Sincerely, b. Contain Medicare spending by increasing HI earnings caps were eliminated, meaning R. BRUCE JOSTEN. competition and reducing the rate of growth that the HI tax applies to all payroll earn- in Medicare payments. ings. U.S. CHAMBER OF COMMERCE—MEDICARE FAX Favor, 97.4 percent; Oppose 2.9 percent. Part B is a voluntary program which pays POLL RESULTS c. Increase managed care options for sen- for physicians’ services, outpatient hospital On October 11, 1995, the U.S. Chamber sur- iors. services, and other medical expenses for per- veyed 9,700 business, chamber and associa- favor, 93.8 percent; Oppose, 43.3 percent. sons aged 65 and over and for the long-term H 10386 CONGRESSIONAL RECORD — HOUSE October 19, 1995 disabled. It generally pays 80% of the ap- The same set of Trustees also oversees the WHERE MEDICARE IS HEADED IF WE DO NOTHING proved amount for covered services in excess Medicare Part B program. In their 1995 An- of an annual deductible ($100). About a quar- nual Report, they wrote: ‘‘Although the SMI Under current law, Medicare is projected ter of the funding comes from monthly pre- program (Medicare Part B) is currently actu- by the Congressional Budget Office to grow miums ($46.10 in 1995); the remainder comes arially sound, the Trustees note with great at a 10.4% average annual rate over the next from general tax revenues and interest. concern the past and projected rapid growth seven years. In 2002, the CBO projects Medi- Medicare is not a means-tested program. in the cost of the program. . . Growth rates care spending will reach $344 billion, claim- That is, income is not a factor in determin- have been so rapid that outlays of the pro- ing almost 16 cents of every dollar spent by ing an individual’s eligibility or, for Part B, gram have increased 53% in the aggregate the federal government. premium levels. Age is the primary eligi- and 40% per enrollee in the last 5 years.’’ Moreover, beginning next year, Medicare bility criteria, with the program also extend- (SMI Annual Report, pg. 3). ‘‘The Trustees HI expenditures will exceed the program’s ing to qualified disabled individuals younger believe that prompt, effective and decisive revenues. The HI Trust fund, which at year- than 65. action is necessary.’’ (pg. 3) end 1994 held $132.8 billion, will have to be Over the years, tax revenues for Medicare Obviously, the Trustees believe that the tapped to cover the projected $867 million Part A have exceeded disbursements, and so Medicare program deserves our careful, im- difference. mediate attention. The following pages the remaining revenues have been credited However, according to the Trustees’ An- to the Medicare HI Trust Fund. At the end of present the figures that led the Trustees to their conclusions. nual Report, this shortfall isn’t temporary. 1994, the trust fund held $132.8 billion. Instead, it will balloon to be about seven CONCLUSION OF THE TRUSTEES WHERE MEDICARE STANDS TODAY times larger in 1997, which is just the follow- Each year, trustees of Medicare’s Hospital Medicare is a huge federal program. In ing year, and more than twenty times larger Insurance Trust Fund analyze the current 1994: Medicare expenditures reached $160 bil- by 1999. Under assumptions reflecting the status and the long-term outlook for the lion, just over half the size of Social Secu- most likely demographic and economic trust fund, and their findings are published rity; Expenditures grew 11.4% from 1993; trends. 1996 will be the first year of hemor- in an annual report. The 1995 edition, issued Eleven cents of every dollar spent by the fed- rhage that will deplete the entire trust fund in April, demonstrated that the Medicare eral government went to Medicare; Medicare by 2002—just seven years away. The optimis- system is in serious financial trouble. The represented one-fifth of total entitlement tic set of assumptions buys us only a little program’s six trustees—four of whom are spending. time, with trust fund depletion projected in Between 1990 and 1994, Medicare grew at a Clinton appointees (cabinet secretaries Rob- 2006. Under the pessimistic scenario, the fund 10.4% average annual rate, almost three ert Rubin, Robert Reich and Donna Shalala, is exhausted as early as 2001. In other words, times the 3.6% average inflation rate over and commissioner of Social Security, Shir- within the next 6 to 11 years, it’s virtually the same period and twice the 5.1% average ley Chater)—reported the following conclu- certain that Medicare will be insolvent—un- annual growth of the economy as a whole. sions: less we take action. MEDICARE AND THE FEDERAL BUDGET Based on the financial projections devel- The danger of inaction was made clear last Medicare spending must be addressed as oped for this report, the Trustees apply an winter when the President’s Bipartisan Com- explicit test of short-range financial ade- part of the solution to balancing the federal budget. That’s because spending on federal mission on Entitlement and Tax Reform, quacy. The HI trust fund fails this test by a chaired by Sen. Bob Kerrey and then-Sen. wide margin. In particular, the trust fund is entitlements—such as Medicare, Medicaid and Social Security—soared 8.4% annually John Danforth, issued its final report. The projected to become insolvent within the focus of the report was to look not years next 6 to 11 years . . . (HI Annual Report, pg. on average between 1990 and 1994. Spending on discretionary, annually appropriated pro- ahead, but decades ahead to assess the im- 2) pact of federal budget trends. The report is Under the Trustees’ intermediate assump- grams—such as defense, education and infra- sobering: Under current trends, virtually all tions, the present financing schedule for the structure—increased 2.2%, which is less than federal government revenues are absorbed by HI program is sufficient to ensure the pay- the rate of inflation. Coming decades will see entitlement spending and net interest by ment of benefits only over the next 7 years even more pressure for entitlement growth, 2010, as shown in Chart 2. Deficit-financing (pg. 3) as the leading edge of the Baby Boom gen- will be required to cover almost all of the The program is severely out of financial eration reaches 65 in 2011. discretionary programs, including defense, balance and substantial measures will be re- Entitlements are not only the fastest health research, the FBI, support for edu- quired to increase revenues and/or reduce ex- growing portion of the federal budget, cation, and the federal judicial system. penditures. (pg. 18) they’re already its largest component, as . . . the HI program is severely out of fi- shown in the accompanying chart. Just over Ten years later, the situation is worse. nancial balance and the Trustees believe half of all federal expenditures is spent on Growth in entitlements is so explosive that that the Congress must take timely action entitlements; only a third go to discre- not only would the government have to bor- to establish long-term financial stability for tionary programs. If we are going to balance row to pay for discretionary expenses, it the program. (pg. 28) the federal budget—and keep it in balance would have to borrow funds to pay the lion’s The Trustees believe that prompt, effective over the long term—entitlement reform share of interest payments on the national and decisive action is necessary (pg. 28) must be part of the solution debt. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10387

MEDICARE’S IMPACT ON THE PAY STUB that would be necessary to balance the trust HI trust fund generated by having that work- fund. er on the payroll. In addition to detailing the projected dis- CURRENT LAW The Medicare contributions from both the sipation of Trust Fund under current law, Currently, the combined (employee and worker and firm don’t stop there, however. the Trustees’ Report also describes the meas- employer) Medicare tax rate is 2.90%, applied Because two-thirds of Medicare Part B (SMI) ures that would be necessary to shore up the to all payroll earnings. A worker earning is financed through general revenues (the trust fund over the next 25, 50 and 75 years. $30,000 a year in salary or wages, for in- other third coming from Medicare premiums If the expenditure formulas are not altered, stance, is directly taxed 1.45%, or $435 annu- and interest), a portion of the worker’s and then preserving the trust fund can only be ally, for Medicare Part A, the hospital insur- the firm’s general income taxes are also fi- done through increases in the payroll tax or ance program. Employers then match that nancing Medicare. The Trustees reported additional subsidies from general revenues. payment with another $435, resulting in $870 that $36.2 billion of general funds were used Table 1 illustrates the payroll tax increases of tax revenue earmarked for the Medicare to pay Medicare Part B claims in 1994. TABLE 1.—MEDICARE HOSPITAL INSURANCE PAYROLL TAXES

Current To balance the HI trust fund over the next— law em- ployee 25 yrs. 50 yrs. 75 yrs. plus em- Additional Total HI Additional Total HI Additional Total HI ployer tax tax tax tax tax tax

Tax rates (pct.) ...... 2.90 1.33 4.23 2.68 5.58 3.52 6.42 Pct. increase over current law ...... 45.9 ...... 92.4 ...... 121.4 Payroll earnings: $10,000 ...... $290 $133 $423 $268 $558 $352 $642 20,000 ...... 580 266 846 536 1,116 704 1,284 30,000 ...... 870 399 1,269 804 1,674 1,056 1,926 40,000 ...... 1,160 532 1,692 1,072 2,232 1,408 2,568 50,000 ...... 1,450 665 2,115 1,340 2,790 1,760 3,210 60,000 ...... 1,740 798 2,538 1,608 3,348 2,112 3,852 70,000 ...... 2,030 931 2,961 1,876 3,906 2,464 4,494 80,000 ...... 2,320 1,064 3,384 2,144 4,464 2,816 5,136 90,000 ...... 2,610 1,197 3,807 2,412 5,022 3,168 5,778 100,000 ...... 2,900 1,330 4,230 2,680 5,580 3,520 6,420 Source (for all tables): 1995 Annual Report of the Board of Trustees. Medicare Hospital Insurance Trust Fund. Table 1.D3, page 22, Calculations and macroeconomics simulations by the U.S. Chamber of Commerce.

To Balance the Medicare HI Trust Fund for span long enough to see most of the Baby relative to the income tax, a payroll tax can the Next 25 Years (through 2019): According Boomers through their lifetimes—would re- be particularly punishing to start-up firms to the Trustees’ analysis, the hospital insur- quire virtually doubling the hospital insur- or companies trying to weather a drop in ance payroll tax would have to rise from ance payroll tax from 2.90% to 5.58%. The in- business. 2.90% to 4.23% (a 46% increase) to keep the crease would have to be made immediately Table 2 shows the liability for Medicare HI HI trust fund in balance for the next 25 and remain permanent through the entire 50- payroll taxes that would be faced by firms of years. Further, the increase would have to be year period. Again, for the worker earning various sizes. Total liability is shown under made immediately and maintained through $30,000 a year, the total HI payroll tax rises current law and under the three tax rates the entire 25-year period. from $870 to $1,674, an increase of 92.4%. computed by the Trustees to bring the HI For our $30,000/year worker for whom $870 To Balance the Medicare Trust Fund for trust fund in balance over periods of 25, 50 is currently provided to Medicare HI, this in- the Next 75 Years (through 2069): Balancing and 75 years. crease means an additional tax of $399, bring- the trust fund over the next seventy-five For instance, a 25-person firm where the ing total annual hospital insurance payroll years—roughly through the life expectancy average worker earns $20,000 per year is cur- taxes to $1,269. And that’s before any other of an individual born this year, and the usual rently liable for a $7,250 tax payment for the federal and state payroll taxes (such as un- period for long-term fiscal solvency—would Medicare HI program (for their contribution, employment insurance and Social Security) require an immediate boost in the Medicare the workers themselves would be taxed an or federal and state income taxes. tax rate of 121.4%, from 2.90% to 6.42%. Total identical amount). To balance the trust fund However, even this increase in payroll HI payroll taxes for a worker earning $30,000 over the next 25 years, the combined em- taxes still leaves the trust fund exhausted in a year would rise from $870 to $1,926. 2019, with the oldest of the baby boomers just ployee and employer tax rate would have to shy of reaching their life expectancy. Be- MEDICARE’S IMPACT ON BUSINESS rise from the current 2.90% to 4.23%. Assum- cause of this demographic bulge, balancing Because it’s levied on employment levels, ing that the liability continues to be evenly the HI trust fund over a longer period would not income, the payroll tax due remains the split between the employee and employer, require even higher payroll taxes. same through both good and bad economic the firm will face an HI payroll tax of about To Balance the Medicare Trust Fund for times. This feature accentuates the pain of a 2.11% per worker. For our 25-person firm, the the Next 50 Years (through 2044): Balancing downturn on employers, who need to pay the total HI payroll tax would rise from $7,250 to the trust fund over the next fifty years—a tax regardless of profitability. Consequently, $10,575 per year. H 10388 CONGRESSIONAL RECORD — HOUSE October 19, 1995 TABLE 2.—MEDICARE HOSPITAL INSURANCE PAYROLL TAX ANNUAL EMPLOYER TAX LIABILITY [In dollars]

Number of employees— 5 10 25 50 100 500 1,000

Average salary: $20,000: Current law ...... 1,450 2,900 7,250 14,500 29,000 145,000 290,000 To balance Medicare HI over the next: 25 yrs ...... 2,115 4,230 10,575 21,150 42,300 211,500 423,000 50 yrs ...... 2,790 5,580 13,950 27,900 55,800 279,000 558,000 75 yrs ...... 3,210 6,420 16,050 32,100 64,200 321,000 642,000 Average salary: $30,000: Current law ...... 2,175 4,350 10,875 21,750 43,500 217,500 435,000 To balance Medicare HI over the next: 25 yrs ...... 3,173 6,345 15,862 31,725 63,450 317,250 634,500 50 yrs ...... 4,185 8,370 20,925 41,850 83,700 418,500 837,000 75 yrs ...... 4,815 9,630 24,075 48,150 96,300 481,500 963,000

MEDICARE’S IMPACT ON THE ECONOMY The results are striking: The economy Trustees’ Annual Report to LHM&A’s June would suffer through sharply slower eco- 1995 baseline forecast. To demonstrate the Raising payroll taxes to keep the Medicare nomic growth and higher unemployment in policy change working its way through the Hospital Insurance trust fund afloat imposes the near term. Over a longer period, the economy, we display the results for three of substantial burdens on both workers and economy is saddled with a permanent loss of the ten years of our simulation: 1997, 2000 firms. To measure what that means for the production and employment. As shown in and 2004. This gives us snapshots of he short- economy as a whole, we conducted several Tables 3 and 4, the degree of severity for term, intermediate-term and long-term im- policy simulations using the highly re- GDP and employment depends upon the in- pacts on economic output and employment. spected Washington University Macro Model crease in Medicare taxes enacted. In each case, the imposition of the Medicare from Laurence H. Meyer & Associates of St. The tables compare each of three alter- payroll tax increase takes place in the fourth Louis, MO. native tax simulations specified in the quarter of 1995. TABLE 3.—IMPACT ON GROSS DOMESTIC PRODUCT [Balancing the HI Trust Fund Through Raising Payroll Tax Rates]

Required Difference from baseline in given Pct difference from baseline in Medicare year, billions of 1987 dollars given year (pct.) Yrs to balance HI trust fund tax rate (pct.) 1997 2000 2004 1997 2000 2004

25 Yrs ...... 4.23 ¥68.4 ¥30.1 ¥36.1 ¥1.2 ¥0.5 ¥0.5 50 Yrs ...... 5.58 ¥137.1 ¥60.5 ¥72.1 ¥2.4 ¥1.0 ¥1.1 75 Yrs ...... 6.42 ¥179.4 ¥79.4 ¥95.6 ¥3.16 ¥1.3 ¥1.4

As shown in Table 3, if the government im- The short-term loss in output translates 75-year period, the Medicare payroll tax rate posed the most modest payroll tax increase— into 1.2 million fewer jobs relative to what would have to jump form 2.90% to 6.42%, enough to keep the Medicare trust fund in we would have had otherwise, as shown in triggering even stronger economic impacts balance for the next 25 years—production in Table 4. While this decline to about 1% of the than those described above. Production in the economy would be 1.2%, or almost $70 economy’s jobs, moderates over time, the the economy would be about 3% lower in 1997 billion, lower in 1997 than it would have been economy appears to have lost over 0.5% of its than it would have been otherwise, with the otherwise. By 2000, the percentage-point gap jobs permanently. long-term loss in output projected at 1.5%. between the alternative closes to within 0.5% Of course, all of this economic turbulence Over 3 million jobs would be eliminated in of the baseline level of production, but that puts the Medicare HI trust fund in actuarial 1997 relative to the baseline, with a projected distance is maintained even ten years after balance for only the next 25 years. To gen- permanent loss of about 1.5% of total em- the tax increase took effect. erate long-term actuarial balance for the full ployment over the long term. TABLE 4.—IMPACT ON EMPLOYMENT [Balancing the HI Trust Fund Through Raising Payroll Tax Rates]

Required Difference from baseline in given Percent difference from baseline Medicare year, millions of jobs in given year (pct.) Yrs to balance HI trust fund tax rate (pct.) 1997 2000 2004 1997 2000 2004

25 Yrs ...... 4.23 ¥1.2 ¥0.6 ¥0.8 ¥0.9 ¥0.4 ¥0.6 50 Yrs ...... 5.58 ¥2.4 ¥1.2 ¥1.6 ¥1.9 ¥0.9 ¥1.2 75 Yrs ...... 6.42 ¥3.2 ¥1.5 ¥2.2 ¥2.5 ¥1.2 ¥1.5

As dramatic as these figures are, there’s care problem must be solved by fundamental protect the financial stability of the pro- good reason to believe that they are optimis- program reform, not tax increases. gram. tic estimates. Because the macro model used Mr. BLILEY. Mr. Chairman, I yield TITLE XV—MEDICARE in these simulations treats the Medicare back the balance of my time. SEC. 15000. SHORT TITLE OF TITLE; AMEND- payroll tax like the Social Security payroll The CHAIRMAN (Mr. LINDER). All MENTS AND REFERENCES TO OBRA; tax, the increases in the tax rates apply only time for general debate has expired. TABLE OF CONTENTS OF TITLE. to the first $61,200 earned (in 1995, and rising (a) SHORT TITLE.—This title may be cited afterwards). That is, the model is not pick- Pursuant to the rule, an amendment in the nature of a substitute consisting as the ‘‘Medicare Preservation Act of 1995’’. ing up the economic impact of applying the (b) AMENDMENTS TO SOCIAL SECURITY higher tax rates to incomes over the taxable of the text of H.R. 2485, modified by the ACT.—Except as otherwise specifically pro- base. Thus, these results should be consid- amendment printed in House Report vided, whenever in this title an amendment ered a minimum measure of the economic 104–282, is adopted and the bill, as is expressed in terms of an amendment to or impact of raising Medicare payroll taxes. At- amended, is considered as an original repeal of a section or other provision, the tempts to account for this problem yield sig- bill for the purpose of further amend- reference shall be considered to be made to nificantly greater job loss and lower GDP. ment and is considered read. that section or other provision of the Social These results are available from the Eco- The text of the amendment in the na- Security Act. nomic Policy Division of the U.S. Chamber (c) REFERENCES TO OBRA.—In this title, of Commerce. ture of a substitute, as modified, is as the terms ‘‘OBRA–1986’’, ‘‘OBRA–1987’’, It is important to note that, even with the follows: ‘‘OBRA–1989’’, ‘‘OBRA–1990’’, and ‘‘OBRA– set of numbers presented here with its inher- Be it enacted by the Senate and House of Rep- 1993’’ refer to the Omnibus Budget Reconcili- ent bias toward underestimating the eco- resentatives of the United States of America in ation Act of 1986 (Public Law 99–509), the nomic impact, we can see that using payroll Congress assembled, Omnibus Budget Reconciliation Act of 1987 taxes to balance the Medicare trust fund im- SECTION 1. PURPOSE. (Public Law 100–203), the Omnibus Budget poses severe costs on the U.S. economy. The purpose of this Act is to reform the Reconciliation Act of 1989 (Public Law 101– These results clearly indicate that the Medi- medicare program, in order to preserve and 239), the Omnibus Budget Reconciliation Act October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10389

of 1990 (Public Law 101–508), and the Omnibus Sec. 15110. Penalty for false certification for ‘‘PART B—PAYMENTS TO TEACHING HOSPITALS Budget Reconciliation Act of 1993 (Public home health services. ‘‘Subpart 1—Requirement of Payments Law 103–66), respectively. Sec. 15111. Pilot projects. ‘‘Sec. 2211. Formula payments to teach- (d) TABLE OF CONTENTS OF TITLE.—The PART 2—REVISIONS TO CRIMINAL LAW ing hospitals. table of contents of this title is as follows: Sec. 15121. Definition of Federal health care ‘‘Subpart 2—Amount Relating to Indirect offense. Costs of Graduate Medical Education Sec. 15000. Short title of title; amendments Sec. 15122. Health care fraud. ‘‘Sec. 2221. Determination of amount re- and references to OBRA; table Sec. 15123. Theft or embezzlement. lating to indirect costs. of contents of title. Sec. 15124. False statements. ‘‘Sec. 2222. Indirect costs; special rules Sec. 15125. Bribery and graft. Subtitle A—MedicarePlus Program regarding determination of hos- Sec. 15126. Illegal remuneration with respect PART 1—INCREASING CHOICE UNDER THE pital-specific percentage. to health care benefit pro- MEDICARE PROGRAM ‘‘Sec. 2223. Indirect costs; alternative grams. payments regarding teaching Sec. 15001. Increasing choice under medi- Sec. 15127. Obstruction of criminal inves- hospitals in certain States. care. tigations of health care of- Sec. 15002. MedicarePlus program. fenses. ‘‘Subpart 3—Amount Relating to Direct ‘‘PART C—PROVISIONS RELATING TO Sec. 15128. Civil penalties for violations of Costs of Graduate Medical Education MEDICAREPLUS Federal health care offenses. ‘‘Sec. 2231. Determination of amount re- ‘‘Sec. 1851. Requirements for Sec. 15129. Injunctive relief relating to lating to direct costs. ‘‘Sec. 2232. Direct costs; special rules re- MedicarePlus organizations; health care offenses. Sec. 15130. Authorized investigative demand garding determination of hos- high deductible/medisave prod- procedures. pital-specific percentage. ucts. Sec. 15131. Grand jury disclosure. ‘‘Sec. 2233. Direct costs; authority for ‘‘Sec. 1852. Requirements relating to Sec. 15132. Miscellaneous amendments to payments to consortia of pro- benefits, provision of services, title 18, United States Code. viders. enrollment, and premiums. ‘‘Sec. 2234. Direct costs; alternative pay- ‘‘Sec. 1853. Patient protection standards. Subtitle C—Regulatory Relief ments regarding teaching hos- ‘‘Sec. 1854. Provider-sponsored organiza- PART 1—PHYSICIAN OWNERSHIP REFERRAL pitals in certain States. tions. REFORM ‘‘Subpart 4—General Provisions ‘‘Sec. 1855. Payments to MedicarePlus Sec. 15201. Repeal of prohibitions based on organizations. compensation arrangements. ‘‘Sec. 2241. Adjustments in payment ‘‘Sec. 1856. Establishment of standards Sec. 15202. Revision of designated health amounts.’’ for MedicarePlus organizations services subject to prohibition. PART 2—AMENDMENTS TO MEDICARE PROGRAM and products. Sec. 15203. Delay in implementation until Sec. 15411. Transfers to Teaching Hospital ‘‘Sec. 1857. MedicarePlus certification. promulgation of regulations. and Graduate Medical Edu- ‘‘Sec. 1858. Contracts with MedicarePlus Sec. 15204. Exceptions to prohibition. cation Trust Fund. organizations.’’ Sec. 15205. Repeal of reporting requirements. Sec. 15412. Modification in payment policies Sec. 15003. Duplication and coordination of Sec. 15206. Preemption of State law. regarding graduate medical medicare-related products. Sec. 15207. Effective date. education. Sec. 15004. Transitional rules for current PART 2—OTHER MEDICARE REGULATORY PART 3—REFORM OF FEDERAL POLICIES RE- medicare HMO program. RELIEF GARDING TEACHING HOSPITALS AND GRAD- PART 2—SPECIAL RULES FOR MEDICAREPLUS Sec. 15211. Repeal of Medicare and Medicaid UATE MEDICAL EDUCATION MEDICAL SAVINGS ACCOUNTS Coverage Data Bank. Sec. 15421. Establishment of advisory panel Sec. 15011. MedicarePlus MSA’s. Sec. 15212. Clarification of level of intent re- for recommending policies. quired for imposition of sanc- Sec. 15012. Certain rebates excluded from ‘‘PART C—OTHER MATTERS gross income. tions. Sec. 15213. Additional exception to anti- ‘‘Sec. 2251. Advisory Panel on Reform in PART 3—SPECIAL ANTITRUST RULE FOR kickback penalties for managed Financing of Teaching Hos- PROVIDER SERVICE NETWORKS care arrangements. pitals and Graduate Medical Sec. 15021. Application of antitrust rule of Sec. 15214. Solicitation and publication of Education.’’ reason to provider service net- modifications to existing safe Subtitle F—Provisions Relating to Medicare works. harbors and new safe harbors. Part A PART 4—COMMISSIONS Sec. 15215. Issuance of advisory opinions PART 1—HOSPITALS under title XI. Sec. 15031. Medicare Payment Review Com- SUBPART A—GENERAL PROVISIONS RELATING TO Sec. 15216. Prior notice of changes in billing mission. HOSPITALS and claims processing require- Sec. 15032. Commission on the Effect of the Sec. 15501. Reductions in inflation updates ments for physicians’ services. Baby Boom Generation on the for PPS hospitals. Medicare Program. PART 3—PROMOTING PHYSICIAN SELF- Sec. 15502. Reductions in disproportionate Sec. 15033. Change in appointment of Admin- POLICING share payment adjustments. istrator of HCFA. Sec. 15221. Exemption from antitrust laws Sec. 15503. Payments for capital-related PART 5—TREATMENT OF HOSPITALS WHICH for certain activities of medical costs for inpatient hospital PARTICIPATE IN PROVIDER-SPONSORED OR- self-regulatory entities. services. GANIZATIONS Subtitle D—Medical Liability Reform Sec. 15504. Reduction in adjustment for indi- rect medical education. Sec. 15041. Treatment of hospitals which PART 1—GENERAL PROVISIONS Sec. 15505. Treatment of PPS-exempt hos- participate in provider-spon- Sec. 15301. Federal reform of health care li- pitals. sored organizations. ability actions. Sec. 15506. Reduction in payments to hos- Subtitle B—Preventing Fraud and Abuse Sec. 15302. Definitions. pitals for enrollees’ bad debts. Sec. 15303. Effective date. PART 1—GENERAL PROVISIONS Sec. 15507. Permanent extension of hemo- Sec. 15101. Increasing awareness of fraud and PART 2—UNIFORM STANDARDS FOR HEALTH philia pass-through. abuse. CARE LIABILITY ACTIONS Sec. 15508. Conforming amendment to cer- Sec. 15102. Beneficiary incentive programs. Sec. 15311. Statute of limitations. tification of Christian Science Sec. 15103. Intermediate sanctions for medi- Sec. 15312. Calculation and payment of dam- providers. care health maintenance orga- ages. SUBPART B—PROVISIONS RELATING TO RURAL nizations. Sec. 15313. Alternative dispute resolution. HOSPITALS Sec. 15104. Voluntary disclosure program. Subtitle E—Teaching Hospitals and Graduate Sec. 15511. Sole community hospitals. Sec. 15105. Revisions to current sanctions. Medical Education Sec. 15512. Clarification of treatment of EAC and RPC hospitals. Sec. 15106. Direct spending for anti-fraud ac- PART 1—TEACHING HOSPITAL AND GRADUATE Sec. 15513. Establishment of rural emer- tivities under medicare. MEDICAL EDUCATION TRUST FUND Sec. 15107. Permitting carriers to carry out gency access care hospitals. Sec. 15401. Establishment of Fund; payments Sec. 15514. Classification of rural referral prior authorization for certain to teaching hospitals. items of durable medical equip- centers. ‘‘TITLE XXII—TEACHING HOSPITAL AND ment. Sec. 15515. Floor on area wage index. GRADUATE MEDICAL EDUCATION Sec. 15108. National Health Care Anti-Fraud PART 2—PAYMENTS TO SKILLED NURSING TRUST FUND Task Force. FACILITIES Sec. 15109. Study of adequacy of private ‘‘PART A—ESTABLISHMENT OF FUND Sec. 15521. Payments for routine service quality assurance programs. ‘‘Sec. 2201. Establishment of Fund. costs. H 10390 CONGRESSIONAL RECORD — HOUSE October 19, 1995

Sec. 15522. Incentives for cost effective man- PART 2—MEDICARE SECONDARY PAYER in paragraph (1)(A) is considered to have agement of covered non-routine IMPROVEMENTS elected the ‘Non-MedicarePlus option’. services. Sec. 15711. Extension and expansion of exist- ‘‘(B) MEDICAREPLUS OPTION.—An individual Sec. 15523. Payments for routine service ing requirements. who has made the election described in para- costs. Sec. 15712. Improvements in recovery of pay- graph (1)(B) to obtain coverage through a Sec. 15524. Reductions in payment for cap- ments. MedicarePlus product is considered to have ital-related costs. Sec. 15713. Prohibiting retroactive applica- elected the ‘MedicarePlus option’ for that Sec. 15525. Treatment of items and services tion of policy regarding ESRD product. paid for under part B. beneficiaries enrolled in pri- ‘‘(b) SPECIAL RULES.— Sec. 15526. Certification of facilities meeting mary plans. revised nursing home reform ‘‘(1) RESIDENCE REQUIREMENT.—Except as PART 3—FAILSAFE standards. the Secretary may otherwise provide, an in- Sec. 15527. Medical review process. Sec. 15721. Failsafe budget mechanism. dividual is eligible to elect a MedicarePlus Sec. 15528. Report by Medicare Payment Re- PART 4—ADMINISTRATIVE SIMPLIFICATION product offered by a MedicarePlus organiza- view Commission. Sec. 15731. Standards for medicare informa- tion only if the organization in relation to Sec. 15529. Effective date. tion transactions and data ele- the product serves the geographic area in PART 3—CLARIFICATION OF CREDITS TO PART ments. which the individual resides. A TRUST FUND PART 5—OTHER PROVISIONS RELATING TO ‘‘(2) AFFILIATION REQUIREMENTS FOR CER- Sec. 15531. Clarification of amount of taxes PARTS A AND B TAIN PRODUCTS.— credited to Federal Hospital In- Sec. 15741. Clarification of medicare cov- ‘‘(A) IN GENERAL.—Subject to subparagraph surance Trust Fund. erage of items and services as- (B), an individual is eligible to elect a Subtitle G—Provisions Relating to Medicare sociated with certain medical MedicarePlus product offered by a limited Part B devices approved for investiga- enrollment MedicarePlus organization (as PART 1—PAYMENT REFORMS tional use. defined in section 1852(c)(4)(E)) only if— Sec. 15601. Payments for physicians’ serv- Sec. 15742. Additional exclusion from cov- ‘‘(i) the individual is eligible under section ices. erage. 1852(c)(4) to make such election, and Sec. 15602. Elimination of formula-driven Sec. 15743. Competitive bidding for certain ‘‘(ii) in the case of a MedicarePlus organi- overpayments for certain out- items and services. zation that is a union sponsor or a Taft-Hart- patient hospital services. Sec. 15744. Disclosure of criminal convic- ley sponsor (as defined in section 1852(c)(4)), Sec. 15603. Payments for durable medical tions relating to provision of the individual elected under this section a equipment. home health services. MedicarePlus product offered by the sponsor Sec. 15604. Reduction in updates to payment Sec. 15745. Requiring renal dialysis facilities during the first enrollment period in which amounts for clinical diagnostic to make services available on a the individual was eligible to make such laboratory tests. 24-hour basis. election with respect to such sponsor. Sec. 15605. Extension of reductions in pay- Subtitle I—Clinical Laboratories ‘‘(B) NO REELECTION AFTER DISENROLLMENT ments for costs of hospital out- Sec. 15801. Exemption of physician office FOR CERTAIN PRODUCTS.—An individual is not patient services. laboratories. eligible to elect a MedicarePlus product of- Sec. 15606. Freeze in payments for ambula- fered by a MedicarePlus organization that is tory surgical center services. Subtitle J—Lock-Box Provisions for Medicare Sec. 15607. Rural emergency access care hos- Part B Savings from Growth Reductions a union sponsor or a Taft-Hartley sponsor if pitals. Sec. 15901. Establishment of Medicare the individual previously had elected a Sec. 15608. Ensuring payment for physician Growth Reduction Trust Fund MedicarePlus product offered by the organi- and nurse for jointly furnished for Part B savings. zation and had subsequently discontinued to elect such a product offered by the organiza- anesthesia services. Subtitle A—MedicarePlus Program Sec. 15609. Statewide fee schedule area for tion. PART 1—INCREASING CHOICE UNDER THE physicians’ services. ‘‘(3) SPECIAL RULE FOR CERTAIN ANNU- MEDICARE PROGRAM Sec. 15609A. Establishment of fee schedule ITANTS.—An individual is not eligible to for ambulance services. Subtitle A, Part 1 elect a high deductible/medisave product if Sec. 15609B. Standards for physical therapy SEC. 15001. INCREASING CHOICE UNDER MEDI- the individual is entitled to benefits under services furnished by physi- CARE. chapter 89 of title 5, United States Code, as cians. (a) IN GENERAL.—Title XVIII is amended by an annuitant or spouse of an annuitant. PART 2—PART B PREMIUM inserting after section 1804 the following new section: ‘‘(c) PROCESS FOR EXERCISING CHOICE.— Sec. 15611. Extension of part B premium. ‘‘(1) IN GENERAL.—The Secretary shall es- Sec. 15612. Income-related reduction in med- ‘‘PROVIDING FOR CHOICE OF COVERAGE tablish a process through which elections de- icare subsidy. ‘‘SEC. 1805. (a) CHOICE OF COVERAGE.— scribed in subsection (a) are made and PART 3—ADMINISTRATION AND BILLING OF ‘‘(1) IN GENERAL.—Subject to the provisions changed, including the form and manner in LABORATORY SERVICES of this section, every individual who is enti- which such elections are made and changed. Sec. 15621. Administrative simplification for tled to benefits under part A and enrolled Such elections shall be made or changed only laboratory services. under part B shall elect to receive benefits during coverage election periods specified Sec. 15622. Restrictions on direct billing for under this title through one of the following: under subsection (e) and shall become effec- laboratory services. ‘‘(A) THROUGH FEE-FOR-SERVICE SYSTEM.— tive as provided in subsection (f). Through the provisions of parts A and B. PART 4—QUALITY STANDARDS FOR DURABLE ‘‘(2) EXPEDITED IMPLEMENTATION.—The Sec- ‘‘(B) THROUGH A MEDICAREPLUS PRODUCT.— MEDICAL EQUIPMENT retary shall establish the process of electing Through a MedicarePlus product (as defined coverage under this section during the tran- Sec. 15631. Recommendations for quality in paragraph (2)), which may be— sition period (as defined in subsection standards for durable medicare ‘‘(i) a high deductible/medisave product (e)(1)(B)) in such an expedited manner as will equipment. (and a contribution into a MedicarePlus permit such an election for MedicarePlus Subtitle H—Provisions Relating to Medicare medical savings account (MSA)), products in an area as soon as such products Parts A and B ‘‘(ii) a product offered by a provider-spon- become available in that area. PART 1—PAYMENT FOR HOME HEALTH sored organization, ‘‘(3) COORDINATION THROUGH MEDICAREPLUS SERVICES ‘‘(iii) a product offered by an organization ORGANIZATIONS.— Sec. 15701. Payment for home health serv- that is a union, Taft-Hartley plan, or asso- ‘‘(A) ENROLLMENT.—Such process shall per- ices. ciation, or mit an individual who wishes to elect a Sec. 15702. Maintaining savings resulting ‘‘(iv) a product providing for benefits on a MedicarePlus product offered by a from temporary freeze on pay- fee-for-service or other basis. ment increases for home health ‘‘(2) MEDICAREPLUS PRODUCT DEFINED.—For MedicarePlus organization to make such services. purposes this section and part C, the term election through the filing of an appropriate Sec. 15703. Extension of waiver of presump- ‘MedicarePlus product’ means health bene- election form with the organization. tion of lack of knowledge of ex- fits coverage offered under a policy, con- ‘‘(B) DISENROLLMENT.—Such process shall clusion from coverage for home tract, or plan by a MedicarePlus organiza- permit an individual, who has elected a health agencies. tion (as defined in section 1851(a)) pursuant MedicarePlus product offered by a Sec. 15704. Report on recommendations for to and in accordance with a contract under MedicarePlus organization and who wishes payments and certification for section 1858. to terminate such election, to terminate home health services of Chris- ‘‘(3) TERMINOLOGY RELATING TO OPTIONS.— such election through the filing of an appro- tian Science providers. For purposes of this section and part C— priate election form with the organization. Sec. 15705. Extension of period of home ‘‘(A) NON-MEDICAREPLUS OPTION.—An indi- ‘‘(4) DEFAULT.— health agency certification. vidual who has made the election described ‘‘(A) INITIAL ELECTION.— October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10391

‘‘(i) IN GENERAL.—Subject to clause (ii), an ‘‘(C) GENERAL INFORMATION IN MEDICARE filing of an appropriate notice during the 90- individual who fails to make an election dur- HANDBOOK.—The Secretary shall include in- day period beginning on the first day on ing an initial election period under sub- formation about the MedicarePlus option which the individual’s coverage under the section (e)(1) is deemed to have chosen the provided under this section in the annual no- MedicarePlus product under such option be- Non-MedicarePlus option. tice of medicare benefits under section 1804. comes effective. ‘‘(ii) SEAMLESS CONTINUATION OF COV- ‘‘(e) COVERAGE ELECTION PERIODS.— ‘‘(B) EFFECT OF DISCONTINUATION OF ELEC- ERAGE.—The Secretary shall establish proce- ‘‘(1) INITIAL CHOICE UPON ELIGIBILITY TO TION.—An individual who discontinues an dures under which individuals who are en- MAKE ELECTION.— election under this paragraph shall be rolled with a MedicarePlus organization at ‘‘(A) IN GENERAL.—In the case of an indi- deemed at the time of such discontinuation the time of the initial election period and vidual who first becomes entitled to benefits to have elected the Non-MedicarePlus op- who fail to elect to receive coverage other under part A and enrolled under part B after tion. than through the organization are deemed to the beginning of the transition period (as de- ‘‘(5) SPECIAL ELECTION PERIODS.—An indi- have elected an appropriate MedicarePlus fined in subparagraph (B)), the individual vidual may discontinue an election of a product offered by the organization. shall make the election under this section MedicarePlus product offered by a ‘‘(B) CONTINUING PERIODS.—An individual during a period (of a duration and beginning MedicarePlus organization other than during who has made (or deemed to have made) an at a time specified by the Secretary) at the an annual, coordinated election period and election under this section is considered to first time the individual both is entitled to make a new election under this section if— have continued to make such election until benefits under part A and enrolled under ‘‘(A) the organization’s or product’s certifi- such time as— part B. Such period shall be specified in a cation under part C has been terminated or ‘‘(i) the individual changes the election manner so that, in the case of an individual the organization has terminated or other- under this section, or who elects a MedicarePlus product during wise discontinued providing the product; ‘‘(ii) a MedicarePlus product is discon- the period, coverage under the product be- ‘‘(B) in the case of an individual who has tinued, if the individual had elected such comes effective as of the first date on which elected a MedicarePlus product offered by a product at the time of the discontinuation. the individual may receive such coverage. MedicarePlus organization, the individual is ‘‘(5) AGREEMENTS WITH COMMISSIONER OF SO- ‘‘(B) TRANSITION PERIOD DEFINED.—In this no longer eligible to elect the product be- CIAL SECURITY TO PROMOTE EFFICIENT ADMIN- subsection, the term ‘transition period’ cause of a change in the individual’s place of ISTRATION.—In order to promote the efficient means, with respect to an individual in an residence or other change in circumstances administration of this section and the area, the period beginning on the first day of (specified by the Secretary, but not includ- the first month in which a MedicarePlus MedicarePlus program under part C, the Sec- ing termination of membership in a qualified product is first made available to individuals retary may enter into an agreement with the association in the case of a product offered in the area and ending with the month pre- Commissioner of Social Security under by a qualified association or termination of ceding the beginning of the first annual, co- which the Commissioner performs adminis- the individual’s enrollment on the basis de- ordinated election period under paragraph trative responsibilities relating to enroll- scribed in clause (i) or (ii) section (3). ment and disenrollment in MedicarePlus 1852(c)(3)(B)); ‘‘(2) DURING TRANSITION PERIOD.—Subject products under this section. ‘‘(C) the individual demonstrates (in ac- ‘‘(d) PROVISION OF BENEFICIARY INFORMA- to paragraph (6)— cordance with guidelines established by the TION TO PROMOTE INFORMED CHOICE.— ‘‘(A) CONTINUOUS OPEN ENROLLMENT INTO A Secretary) that— ‘‘(1) IN GENERAL.—The Secretary shall pro- MEDICARE-PLUS OPTION.—During the transi- vide for activities under this subsection to tion period, an individual who is eligible to ‘‘(i) the organization offering the product disseminate broadly information to medicare make an election under this section and who substantially violated a material provision beneficiaries (and prospective medicare has elected the non-MedicarePlus option of the organization’s contract under part C beneficiaries) on the coverage options pro- may change such election to a MedicarePlus in relation to the individual and the product; vided under this section in order to promote option at any time. or ‘‘(ii) the organization (or an agent or other an active, informed selection among such op- ‘‘(B) OPEN DISENROLLMENT BEFORE END OF tions. Such information shall be made avail- TRANSITION PERIOD.— entity acting on the organization’s behalf) able on such a timely basis (such as 6 months ‘‘(i) IN GENERAL.—During the transition pe- materially misrepresented the product’s pro- before the date an individual would first at- riod, an individual who has elected a visions in marketing the product to the indi- tain eligibility for medicare on the basis of MedicarePlus option for a MedicarePlus vidual; or age) as to permit individuals to elect the product may change such election to another ‘‘(D) the individual meets such other condi- MedicarePlus option during the initial elec- MedicarePlus product or to the non- tions as the Secretary may provide. tion period described in subsection (e)(1). MedicarePlus option. ‘‘(6) SPECIAL RULE FOR HIGH DEDUCTIBLE/ ‘‘(2) USE OF NONFEDERAL ENTITIES.—The ‘‘(ii) SPECIAL RULE.—During the transition MEDISAVE PRODUCTS.—Notwithstanding the Secretary shall, to the maximum extent fea- period, an individual who has elected a high previous provisions of this subsection, an in- sible, enter into contracts with appropriate deductible/medisave product may not change dividual may elect a high deductible/ non-Federal entities to carry out activities such election to a MedicarePlus product that medisave product only during an annual, co- under this subsection. is not a high deductible/medisave product ordinated election period described in para- ‘‘(3) SPECIFIC ACTIVITIES.—In carrying out unless the individual has had such election graph (3)(B) or during the month of October, this subsection, the Secretary shall provide in effect for 12 months. 1996. for at least the following activities in all ‘‘(3) ANNUAL, COORDINATED ELECTION PE- ‘‘(f) EFFECTIVENESS OF ELECTIONS.— areas in which MedicarePlus products are of- RIOD.— ‘‘(1) DURING INITIAL COVERAGE ELECTION PE- fered: ‘‘(A) IN GENERAL.—Subject to paragraph RIOD.—An election of coverage made during ‘‘(A) INFORMATION BOOKLET.— (5), each individual who is eligible to make the initial coverage election period under ‘‘(i) IN GENERAL.—The Secretary shall pub- an election under this section may change subsection (e)(1)(A) shall take effect upon lish an information booklet and disseminate such election during annual, coordinated the date the individual becomes entitled to the booklet to all individuals eligible to election periods. benefits under part A and enrolled under elect the MedicarePlus option under this sec- ‘‘(B) ANNUAL, COORDINATED ELECTION PE- part B, except as the Secretary may provide tion during coverage election periods. RIOD.—For purposes of this section, the term (consistent with section 1838) in order to pre- ‘‘(ii) INFORMATION INCLUDED.—The booklet ‘annual, coordinated election period’ means, vent retroactive coverage. shall include information presented in plain with respect to a calendar year (beginning ‘‘(2) DURING TRANSITION; 90-DAY English and in a standardized format regard- with 1998), the month of October before such DISENROLLMENT OPTION.—An election of cov- ing— year. erage made under subsection (e)(2) and an ‘‘(I) the benefits (including cost-sharing) ‘‘(C) MEDICAREPLUS HEALTH FAIR DURING OC- election to discontinue a MedicarePlus op- and premiums for the various MedicarePlus TOBER, 1996.—In the month of October, 1996, tion under subsection (e)(4) at any time shall products in the areas involved; the Secretary shall provide for a nationally take effect with the first calendar month fol- ‘‘(II) the quality of such products, includ- coordinated educational and publicity cam- lowing the date on which the election is ing consumer satisfaction information; and paign to inform individuals, who are eligible made. ‘‘(III) rights and responsibilities of medi- to elect MedicarePlus products, about such ‘‘(3) ANNUAL, COORDINATED ELECTION PERIOD care beneficiaries under such products. products and the election process provided AND MEDISAVE ELECTION.—An election of cov- ‘‘(iii) PERIODIC UPDATING.—The booklet under this section (including the annual, co- erage made during an annual, coordinated shall be updated on a regular basis (not less ordinated election periods that occur in sub- election period (as defined in subsection often than once every 12 months) to reflect sequent years). (e)(3)(B)) in a year or for a high deductible/ changes in the availability of MedicarePlus ‘‘(4) SPECIAL 90-DAY DISENROLLMENT OP- medisave product shall take effect as of the products and the benefits and premiums for TION.— first day of the following year. such products. ‘‘(A) IN GENERAL.—In the case of the first ‘‘(4) OTHER PERIODS.—An election of cov- ‘‘(B) TOLL-FREE NUMBER.—The Secretary time an individual elects a MedicarePlus op- erage made during any other period under shall maintain a toll-free number for inquir- tion (other than a high deductible/medisave subsection (e)(5) shall take effect in such ies regarding MedicarePlus options and the product) under this section, the individual manner as the Secretary provides in a man- operation of part C. may discontinue such election through the ner consistent (to the extent practicable) H 10392 CONGRESSIONAL RECORD — HOUSE October 19, 1995 with protecting continuity of health benefit assume full financial risk on a prospective deductibles or coinsurance) under parts A coverage. basis for the provision of the health care and B with respect to such expenses, ‘‘(g) EFFECT OF ELECTION OF MEDICAREPLUS services (other than hospice care) for which whichever is less. Such term does not include OPTION.—Subject to the provisions of section benefits are required to be provided under the MedicarePlus MSA itself or any con- 1855(f), payments under a contract with a section 1852(a)(1), except that the organiza- tribution into such account. MedicarePlus organization under section tion— ‘‘(2) DEDUCTIBLE.—The amount of deduct- 1858(a) with respect to an individual electing ‘‘(1) may obtain insurance or make other ible under a high deductible/medisave prod- a MedicarePlus product offered by the orga- arrangements for the cost of providing to uct— nization shall be instead of the amounts any enrolled member such services the ag- ‘‘(A) for contract year 1997 shall be not which (in the absence of the contract) would gregate value of which exceeds $5,000 in any more than $10,000; and otherwise be payable under parts A and B for year, ‘‘(B) for a subsequent contract year shall items and services furnished to the individ- ‘‘(2) may obtain insurance or make other be not more than the maximum amount of ual. arrangements for the cost of such services such deductible for the previous contract ‘‘(h) ADMINISTRATION.— provided to its enrolled members other than year under this paragraph increased by the ‘‘(1) IN GENERAL.—This part and sections through the organization because medical national average per capita growth rate 1805 and 1876 shall be administered through necessity required their provision before under section 1855(c)(3) for the year. an operating division (A) that is established they could be secured through the organiza- If the amount of the deductible under sub- or identified by the Secretary in the Depart- tion, paragraph (B) is not a multiple of $50, the ment of Health and Human Services, (B) that ‘‘(3) may obtain insurance or make other amount shall be rounded to the nearest mul- is separate from the Health Care Financing arrangements for not more than 90 percent tiple of $50. Administration, and (C) the primary func- of the amount by which its costs for any of ‘‘(g) ORGANIZATIONS TREATED AS tion of which is the administration of this its fiscal years exceed 115 percent of its in- MEDICAREPLUS ORGANIZATIONS DURING TRAN- part and such sections. The director of such come for such fiscal year, and SITION.—Any of the following organizations division shall be of equal pay and rank to ‘‘(4) may make arrangements with physi- shall be considered to qualify as a that of the individual responsible for overall cians or other health professionals, health MedicarePlus organization for contract administration of parts A and B. care institutions, or any combination of such years beginning before January 1, 1998: ‘‘(2) TRANSFER AUTHORITY.—The Secretary individuals or institutions to assume all or ‘‘(1) HEALTH MAINTENANCE ORGANIZA- shall transfer such personnel, administrative part of the financial risk on a prospective TIONS.—An organization that is organized support systems, assets, records, funds, and basis for the provision of basic health serv- under the laws of any State and that is a other resources in the Health Care Financing ices by the physicians or other health profes- qualified health maintenance organization Administration to the operating division re- sionals or through the institutions. (as defined in section 1310(d) of the Public ferred to in paragraph (1) as are used in the In the case of a MedicarePlus organization Health Service Act), an organization recog- administration of section 1876 and as may be that is a union sponsor (as defined in section nized under State law as a health mainte- required to implement the provisions re- 1852(c)(4)(A)), Taft-Hartley sponsor (as de- nance organization, or a similar organization fined in section 1852(c)(4)(B)), a qualified as- ferred to in such paragraph promptly and ef- regulated under State law for solvency in the sociation (as defined in section 1852(c)(4)(C)), ficiently.’’. same manner and to the same extent as such this subsection shall not apply with respect SEC. 15002. MEDICAREPLUS PROGRAM. a health maintenance organization. to MedicarePlus products offered by such or- (a) IN GENERAL.—Title XVIII is amended by ‘‘(2) LICENSED INSURERS.—An organization ganization and issued by an organization to redesignating part C as part D and by insert- that is organized under the laws of any State which subsection (b)(1) applies or by a pro- ing after part B the following new part: and— vider-sponsored organization (as defined in ‘‘(A) is licensed by a State agency as an in- ‘‘PART C—PROVISIONS RELATING TO section 1854(a)). surer for the offering of health benefit cov- MEDICAREPLUS ‘‘(e) PROVISION AGAINST RISK OF INSOL- erage, or ‘‘REQUIREMENTS FOR MEDICAREPLUS ORGANIZATIONSVENCY; HIGH.— DEDUCTIBLE/MEDISAVE PRODUCTS ‘‘(B) is licensed by a State agency as a II is amended by redesignating part C as part D and by‘‘(1) inserting IN GENERAL after part.—Each B the following MedicarePlus new part: orga- service benefit plan, ‘‘SEC. 1851. (a) MEDICAREPLUS ORGANIZA- nization shall meet standards under section but only for individuals residing in an area TION DEFINED.—In this part, subject to the 1856 relating to the financial solvency and in which the organization is licensed to offer succeeding provisions of this section, the capital adequacy of the organization. Such health insurance coverage. term ‘MedicarePlus organization’ means a standards shall take into account the nature ‘‘(3) CURRENT RISK-CONTRACTORS.—An orga- public or private entity that is certified and type of MedicarePlus products offered by nization that is an eligible organization (as under section 1857 as meeting the require- the organization. defined in section 1876(b)) and that has a ments and standards of this part for such an ‘‘(2) TREATMENT OF UNION AND TAFT-HART- risk-sharing contract in effect under section organization. LEY SPONSORS.—An entity that is a union 1876 as of the date of the enactment of this ‘‘(b) ORGANIZED AND LICENSED UNDER STATE sponsor or a Taft-Hartley sponsor is deemed section. LAW.— to meet the requirement of paragraph (1). ‘‘(h) MEDIGRANT DEMONSTRATION ‘‘(1) IN GENERAL.—A MedicarePlus organi- ‘‘(3) TREATMENT OF CERTAIN QUALIFIED AS- PROJECTS.—The Secretary shall provide, in zation shall be organized and licensed under SOCIATIONS.—An entity that is a qualified as- at least 10 States, for demonstration projects State law to offer health insurance or health sociation is deemed to meet the requirement which would permit MediGrant programs benefits coverage in each State in which it of paragraph (1) with respect to under title XXI to be treated as offers a MedicarePlus product. MedicarePlus products offered by such asso- MedicarePlus organizations under this part ‘‘(2) EXCEPTION FOR UNION AND TAFT-HART- ciation and issued by an organization to for individuals who are qualified to elect the LEY SPONSORS.—Paragraph (1) shall not apply which subsection (b)(1) applies or by a pro- MedicarePlus option and who eligible to re- to an MedicarePlus organization that is a vider-sponsored organization. ceive medical assistance under the union sponsor or a Taft-Hartley sponsor (as ‘‘(f) HIGH DEDUCTIBLE/MEDISAVE PRODUCT MediGrant program, for the purpose of dem- defined in section 1852(c)(4)). DEFINED.— onstrating the delivery of primary, acute, ‘‘(3) EXCEPTION FOR PROVIDER-SPONSORED ‘‘(1) IN GENERAL.—In this part, the term and long-term care through an integrated de- ORGANIZATIONS.—Paragraph (1) shall not ‘high deductible/medisave product’ means a livery network which emphasizes apply to a MedicarePlus organization that is MedicarePlus product that— noninstitutional care. a provider-sponsored organization (as defined ‘‘(A) provides reimbursement for at least in section 1854(a)) except to the extent pro- the items and services described in section ‘‘REQUIREMENTS RELATING TO BENEFITS, PRO- vided under section 1857(c). 1852(a)(1) in a year but only after the en- VISION OF SERVICES, ENROLLMENT, AND PRE- ‘‘(4) EXCEPTION FOR QUALIFIED ASSOCIA- rollee incurs countable expenses (as specified MIUMS TIONS.—Paragraph (1) shall not apply to a under the product) equal to the amount of a ‘‘SEC. 1852. (a) BENEFITS COVERED.— MedicarePlus organization that is a qualified deductible (described in paragraph (2)); ‘‘(1) IN GENERAL.—Except as provided in association (as defined in section ‘‘(B) counts as such expenses (for purposes section 1851(f)(1) with respect to high deduct- 1852(c)(4)(C)). of such deductible) at least all amounts that ible/medisave products, each MedicarePlus ‘‘(c) PREPAID PAYMENT.—A MedicarePlus would have been payable under parts A and product offered under this part shall provide organization shall be compensated (except B or by the enrollee if the enrollee had elect- benefits for at least the items and services for deductibles, coinsurance, and ed to receive benefits through the provisions for which benefits are available under parts copayments) for the provision of health care of such parts; and A and B consistent with the standards for services to enrolled members by a payment ‘‘(C) provides, after such deductible is met coverage of such items and services applica- which is paid on a periodic basis without re- for a year and for all subsequent expenses for ble under this title. gard to the date the health care services are benefits referred to in subparagraph (A) in ‘‘(2) ORGANIZATION AS SECONDARY PAYER.— provided and which is fixed without regard the year, for a level of reimbursement that is Notwithstanding any other provision of law, to the frequency, extent, or kind of health not less than— a MedicarePlus organization may (in the care service actually provided to a member. ‘‘(i) 100 percent of such expenses, or case of the provision of items and services to ‘‘(d) ASSUMPTION OF FULL FINANCIAL ‘‘(ii) 100 percent of the amounts that would an individual under this part under cir- RISK.—The MedicarePlus organization shall have been paid (without regard to any cumstances in which payment under this October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10393 title is made secondary pursuant to section with respect to a MedicarePlus product it of- ‘‘(I) has been formed for purposes other 1862(b)(2)) charge or authorize the provider of fers if— than the sale of any health insurance and such services to charge, in accordance with ‘‘(i) any premiums required with respect to does not restrict membership based on the the charges allowed under such law or pol- such product are not paid on a timely basis health status, claims experience, receipt of icy— (consistent with standards under section 1856 health care, medical history, or lack of evi- ‘‘(A) the insurance carrier, employer, or that provide for a grace period for late pay- dence of insurability, of an individual, other entity which under such law, plan, or ment of premiums), ‘‘(II) does not exist solely or principally for policy is to pay for the provision of such ‘‘(ii) the individual has engaged in disrup- the purpose of selling insurance, and services, or tive behavior (as specified in such stand- ‘‘(III) has at least 1,000 individual members ‘‘(B) such individual to the extent that the ards), or or 200 employer members. individual has been paid under such law, ‘‘(iii) the product is terminated with re- Such term includes a subsidiary or corpora- plan, or policy for such services. spect to all individuals under this part. tion that is wholly owned by one or more ‘‘(3) SATISFACTION OF REQUIREMENT.—A Any individual whose election is so termi- qualified organizations. MedicarePlus product (other than a high de- nated is deemed to have elected the Non- ‘‘(D) LIMITATION.—Rules of eligibility to ductible/medisave product) offered by a MedicarePlus option (as defined in section carry out the previous subparagraphs of this MedicarePlus organization satisfies para- 1805(a)(3)(A)). paragraph shall not have the effect of deny- graph (1) with respect to benefits for items ‘‘(C) ORGANIZATION OBLIGATION WITH RE- ing eligibility to individuals on the basis of and services if the following requirements SPECT TO ELECTION FORMS.—Pursuant to a health status, claims experience, receipt of are met: contract under section 1858, each health care, medical history, or lack of evi- ‘‘(A) FEE FOR SERVICE PROVIDERS.—In the MedicarePlus organization receiving an elec- dence of insurability. case of benefits furnished through a provider tion form under section 1805(c)(2) shall trans- ‘‘(E) LIMITED ENROLLMENT MEDICARE- that does not have a contract with the orga- mit to the Secretary (at such time and in PLUS ORGANIZATION.—In this part and section nization, the product provides for at least such manner as the Secretary may specify) a 1805, the term ‘limited enrollment the dollar amount of payment for such items copy of such form or such other information MedicarePlus organization’ means a and services as would otherwise be provided respecting the election as the Secretary may MedicarePlus organization that is a union under parts A and B. specify. sponsor, a Taft-Hartley sponsor, or a quali- ‘‘(B) PARTICIPATING PROVIDERS.—In the ‘‘(4) SPECIAL RULES FOR LIMITED ENROLL- fied association. case of benefits furnished through a provider MENT MEDICAREPLUS ORGANIZATIONS.— ‘‘(F) EMPLOYER, ETC.—In this paragraph, that has such a contract, the individual’s li- ‘‘(A) UNIONS.— the terms ‘employer’, ‘employee organiza- ability for payment for such items and serv- ‘‘(i) IN GENERAL.—Subject to subparagraph tion’, and ‘group health plan’ have the mean- ices does not exceed (after taking into ac- (D), a union sponsor (as defined in clause (ii)) ings given such terms for purposes of part 6 count any deductible, which does not exceed shall limit eligibility of enrollees under this of subtitle B of title I of the Employee Re- any deductible under parts A and B) the less- part for MedicarePlus products it offers to tirement Income Security Act of 1974. er of the following: individuals who are members of the sponsor and affiliated with the sponsor through an ‘‘(d) SUBMISSION AND CHARGING OF PRE- ‘‘(i) NON-MEDICAREPLUS LIABILITY.—The MIUMS.— amount of the liability that the individual employment relationship with any employer or are the spouses of such members. ‘‘(1) IN GENERAL.—Each MedicarePlus orga- would have had (based on the provider being ‘‘(ii) UNION SPONSOR.—In this part and sec- nization shall file with the Secretary each a participating provider) if the individual tion 1805, the term ‘union sponsor’ means an year, in a form and manner and at a time had elected the non-MedicarePlus option. employee organization in relation to a group specified by the Secretary— ‘‘(ii) MEDICARE COINSURANCE APPLIED TO health plan that is established or maintained ‘‘(A) the amount of the monthly premiums PRODUCT PAYMENT RATES.—The applicable co- by the organization other than pursuant to a for coverage under each MedicarePlus prod- insurance or copayment rate (that would collective bargaining agreement. uct it offers under this part in each payment have applied under the non-MedicarePlus op- ‘‘(B) TAFT-HARTLEY SPONSORS.— area (as determined for purposes of section tion) of the payment rate provided under the ‘‘(i) IN GENERAL.—Subject to subparagraph 1855) in which the product is being offered; contract. (D), a MedicarePlus organization that is a and ‘‘(b) ANTIDISCRIMINATION.—A MedicarePlus Taft-Hartley sponsor (as defined in clause ‘‘(B) the enrollment capacity in relation to organization may not deny, limit, or condi- (ii)) shall limit eligibility of enrollees under the product in each such area. tion the coverage or provision of benefits this part for MedicarePlus products it offers ‘‘(2) AMOUNTS OF PREMIUMS CHARGED.—The under this part based on the health status, to individuals who are entitled to obtain amount of the monthly premium charged by claims experience, receipt of health care, benefits through such products under the a MedicarePlus organization for a medical history, or lack of evidence of insur- terms of an applicable collective bargaining MedicarePlus product offered in a payment ability, of an individual. agreement. area to an individual under this part shall be ‘‘(c) GUARANTEED ISSUE AND RENEWAL.— ‘‘(ii) TAFT-HARTLEY SPONSOR.—In this part equal to the amount (if any) by which— ‘‘(1) IN GENERAL.—Except as provided in and section 1805, the term ‘Taft-Hartley ‘‘(A) the amount of the monthly premium this subsection, a MedicarePlus organization sponsor’ means, in relation to a group health for the product for the period involved, as es- shall provide that at any time during which plan that is established or maintained by tablished under paragraph (3) and submitted elections are accepted under section 1805 two or more employers or jointly by one or under paragraph (1), exceeds with respect to a MedicarePlus product of- more employers and one or more employee ‘‘(B)(i) 1⁄12 of the annual MedicarePlus capi- fered by the organization, the organization organizations, the association, committee, tation rate specified in section 1855(b)(2) for will accept without restrictions individuals joint board of trustees, or other similar the area and period involved, or (ii) in the who are eligible to make such election. group of representatives of parties who es- case of a high deductible/medisave product, ‘‘(2) PRIORITY.—If the Secretary determines tablish or maintain the plan. the monthly adjusted MedicarePlus capita- that a MedicarePlus organization, in rela- ‘‘(C) QUALIFIED ASSOCIATIONS.— tion rate specified in section 1855(b)(1) for tion to a MedicarePlus product it offers, has ‘‘(i) IN GENERAL.—Subject to subparagraph the individual and period involved. a capacity limit and the number of eligible (D), a MedicarePlus organization that is a ‘‘(3) UNIFORM PREMIUM.— individuals who elect the product under sec- qualified association (as defined in clause ‘‘(A) IN GENERAL.—Except as provided in tion 1805 exceeds the capacity limit, the or- (iii)) shall limit eligibility of individuals subparagraph (B), the premiums charged by ganization may limit the election of individ- under this part for products it offers to indi- a MedicarePlus organization under this part uals of the product under such section but viduals who are members of the association may not vary among individuals who reside only if priority in election is provided— (or who are spouses of such individuals). in the same payment area. ‘‘(A) first to such individuals as have elect- ‘‘(ii) LIMITATION ON TERMINATION OF COV- ‘‘(B) EXCEPTION FOR HIGH DEDUCTIBLE/ ed the product at the time of the determina- ERAGE.—Such a qualifying association offer- MEDISAVE PRODUCTS.—A MedicarePlus orga- tion, and ing a MedicarePlus product to an individual nization shall establish premiums for any ‘‘(B) then to other such individuals in such may not terminate coverage of the individ- high deductible/medisave product it offers in a manner that does not discriminate among ual on the basis that the individual is no a payment area based on each of the risk ad- the individuals (who seek to elect the prod- longer a member of the association except justment categories established for purposes uct) on a basis described in subsection (b). pursuant to a change of election during an of determining the amount of the payment ‘‘(3) LIMITATION ON TERMINATION OF ELEC- open election period occurring on or after to MedicarePlus organizations under section TION.— the date of the termination of membership. 1855(b)(1) and using the identical demo- ‘‘(A) IN GENERAL.—Subject to subparagraph ‘‘(iii) QUALIFIED ASSOCIATION.—In this part graphic and other adjustments among such (B), a MedicarePlus organization may not for and section 1805, the term ‘qualified associa- categories as are used for such purposes. any reason terminate the election of any in- tion’ means an association, religious frater- ‘‘(4) TERMS AND CONDITIONS OF IMPOSING dividual under section 1805 for a nal organization, or other organization PREMIUMS.—Each MedicarePlus organization MedicarePlus product it offers. (which may be a trade, industry, or profes- shall permit the payment of monthly pre- ‘‘(B) BASIS FOR TERMINATION OF ELECTION.— sional association, a chamber of commerce, miums on a monthly basis and may termi- A MedicarePlus organization may terminate or a public entity association) that the Sec- nate election of individuals for a an individual’s election under section 1805 retary finds— MedicarePlus product for failure to make H 10394 CONGRESSIONAL RECORD — HOUSE October 19, 1995

premium payments only in accordance with testing)), for the individual for the month. ‘‘(1) PROCEDURES.—Each MedicarePlus or- subsection (c)(3)(B). Except as provided in the previous sentence, ganization shall establish reasonable proce- ‘‘(5) RELATION OF PREMIUMS AND COST-SHAR- a MedicarePlus organization is not author- dures relating to the participation (under an ING TO BENEFITS.—In no case may the portion ized to provide for cash or other monetary agreement between a physician and the orga- of a MedicarePlus organization’s premium rebates as an inducement for enrollment or nization) of physicians under MedicarePlus rate and the actuarial value of its otherwise. products offered by the organization under deductibles, coinsurance, and copayments ‘‘(3) STABILIZATION FUND.—A MedicarePlus this part. Such procedures shall include— charged (to the extent attributable to the organization may provide that a part of the ‘‘(A) providing notice of the rules regard- minimum benefits described in subsection value of an excess actuarial amount de- ing participation, (a)(1) and not counting any amount attrib- scribed in paragraph (1) be withheld and re- ‘‘(B) providing written notice of participa- utable to balance billing) to individuals who served in the Federal Hospital Insurance tion decisions that are adverse to physicians, are enrolled under this part with the organi- Trust Fund and in the Federal Supple- and zation exceed the actuarial value of the coin- mentary Medical Insurance Trust Fund (in ‘‘(C) providing a process within the organi- surance and deductibles that would be appli- such proportions as the Secretary deter- zation for appealing adverse decisions, in- cable on the average to individuals enrolled mines to be appropriate) by the Secretary for cluding the presentation of information and under this part with the organization (or, if subsequent annual contract periods, to the views of the physician regarding such deci- the Secretary finds that adequate data are extent required to stabilize and prevent sion. not available to determine that actuarial undue fluctuations in the additional benefits ‘‘(2) CONSULTATION IN MEDICAL POLICIES.—A value, the actuarial value of the coinsurance and rebates offered in those subsequent peri- MedicarePlus organization shall consult and deductibles applicable on the average to ods by the organization in accordance with with physicians who have entered into par- individuals in the area, in the State, or in such paragraph. Any of such value of amount ticipation agreements with the organization the United States, eligible to enroll under reserved which is not provided as additional regarding the organization’s medical policy, this part with the organization, or other ap- benefits described in paragraph (1)(A) to in- quality, and medical management proce- propriate data) and entitled to benefits dividuals electing the MedicarePlus product dures. under part A and enrolled under part B if in accordance with such paragraph prior to ‘‘(3) LIMITATIONS ON PHYSICIAN INCENTIVE they were not members of a MedicarePlus or- the end of such periods, shall revert for the PLANS.— ganization. use of such trust funds. ‘‘(A) IN GENERAL.—Each MedicarePlus or- ‘‘(e) REQUIREMENT FOR ADDITIONAL BENE- ‘‘(4) DETERMINATION BASED ON INSUFFICIENT ganization may not operate any physician FITS, PART B PREMIUM DISCOUNT REBATES, OR DATA.—For purposes of this subsection, if the incentive plan (as defined in subparagraph BOTH.— Secretary finds that there is insufficient en- (B)) unless the following requirements are ‘‘(1) REQUIREMENT.— rollment experience (including no enroll- met: ‘‘(A) IN GENERAL.—Each MedicarePlus or- ment experience in the case of a provider- ‘‘(i) No specific payment is made directly ganization (in relation to a MedicarePlus sponsored organization) to determine an av- or indirectly under the plan to a physician or product it offers) shall provide that if there erage of the capitation payments to be made physician group as an inducement to reduce is an excess amount (as defined in subpara- under this part at the beginning of a con- or limit medically necessary services pro- graph (B)) for the product for a contract vided with respect to a specific individual tract period, the Secretary may determine year, subject to the succeeding provisions of enrolled with the organization. such an average based on the enrollment ex- this subsection, the organization shall pro- ‘‘(ii) If the plan places a physician or phy- perience of other contracts entered into vide to individuals such additional benefits sician group at substantial financial risk (as under this part. (as the organization may specify), a mone- determined by the Secretary) for services ‘‘(5) ADJUSTED COMMUNITY RATE.— tary rebate (paid on a monthly basis) of the not provided by the physician or physician ‘‘(A) IN GENERAL.—For purposes of this sub- part B monthly premium, or a combination group, the organization— section, subject to subparagraph (B), the thereof, in a total value which is at least ‘‘(I) provides stop-loss protection for the term ‘adjusted community rate’ for a service equal to the adjusted excess amount (as de- physician or group that is adequate and ap- or services means, at the election of a fined in subparagraph (C)). propriate, based on standards developed by MedicarePlus organization, either— ‘‘(B) EXCESS AMOUNT.—For purposes of this the Secretary that take into account the paragraph, the ‘excess amount’, for an orga- ‘‘(i) the rate of payment for that service or number of physicians placed at such substan- nization for a product, is the amount (if any) services which the Secretary annually deter- tial financial risk in the group or under the by which— mines would apply to an individual electing plan and the number of individuals enrolled ‘‘(i) the average of the capitation payments a MedicarePlus product under this part if the with the organization who receive services made to the organization under this part for rate of payment were determined under a from the physician or the physician group, the product at the beginning of contract ‘community rating system’ (as defined in and year, exceeds section 1302(8) of the Public Health Service ‘‘(II) conducts periodic surveys of both in- ‘‘(ii) the actuarial value of the minimum Act, other than subparagraph (C)), or dividuals enrolled and individuals previously benefits described in subsection (a)(1) under ‘‘(ii) such portion of the weighted aggre- enrolled with the organization to determine the product for individuals under this part, gate premium, which the Secretary annually the degree of access of such individuals to as determined based upon an adjusted com- estimates would apply to such an individual, services provided by the organization and munity rate described in paragraph (5) (as re- as the Secretary annually estimates is at- satisfaction with the quality of such serv- duced for the actuarial value of the coinsur- tributable to that service or services, ices. ance and deductibles under parts A and B). but adjusted for differences between the uti- ‘‘(iii) The organization provides the Sec- ‘‘(C) ADJUSTED EXCESS AMOUNT.—For pur- lization characteristics of the individuals retary with descriptive information regard- poses of this paragraph, the ‘adjusted excess electing coverage under this part and the ing the plan, sufficient to permit the Sec- amount’, for an organization for a product, is utilization characteristics of the other en- retary to determine whether the plan is in the excess amount reduced to reflect any rollees with the organization (or, if the Sec- compliance with the requirements of this amount withheld and reserved for the orga- retary finds that adequate data are not subparagraph. nization for the year under paragraph (3). available to adjust for those differences, the ‘‘(B) PHYSICIAN INCENTIVE PLAN DEFINED.— ‘‘(D) NO APPLICATION TO HIGH DEDUCTIBLE/ differences between the utilization charac- In this paragraph, the term ‘physician incen- MEDISAVE PRODUCT.—Subparagraph (A) shall teristics of individuals selecting other tive plan’ means any compensation arrange- not apply to a high deductible/medisave MedicarePlus coverage, or individuals in the ment between a MedicarePlus organization product. area, in the State, or in the United States, and a physician or physician group that may ‘‘(E) UNIFORM APPLICATION.—This para- eligible to elect MedicarePlus coverage directly or indirectly have the effect of re- graph shall be applied uniformly for all en- under this part and the utilization charac- ducing or limiting services provided with re- rollees for a product in a service area. teristics of the rest of the population in the spect to individuals enrolled with the organi- ‘‘(F) CONSTRUCTION.—Nothing in this sub- area, in the State, or in the United States, zation under this part. section shall be construed as preventing a respectively). ‘‘(4) LIMITATION ON PROVIDER INDEMNIFICA- MedicarePlus organization from providing ‘‘(B) SPECIAL RULE FOR PROVIDER-SPON- TION.—A MedicarePlus organization may not health care benefits that are in addition to SORED ORGANIZATIONS.—In the case of a provide (directly or indirectly) for a provider the benefits otherwise required to be pro- MedicarePlus organization that is a pro- (or group of providers) to indemnify the or- vided under this paragraph and from impos- vider-sponsored organization, the adjusted ganization against any liability resulting ing a premium for such additional benefits. community rate under subparagraph (A) for from a civil action brought by or on behalf of ‘‘(2) LIMITATION ON AMOUNT OF PART B PRE- a MedicarePlus product may be computed (in an enrollee under this part for any damage MIUM DISCOUNT REBATE.—In no case shall the a manner specified by the Secretary) using caused to the enrollee by the organization’s amount of a part B premium discount rebate data in the general commercial marketplace denial of medically necessary care. under paragraph (1)(A) exceed, with respect or (during a transition period) based on the ‘‘(5) EXCEPTION FOR CERTAIN FEE-FOR-SERV- to a month, the amount of premiums im- costs incurred by the organization in provid- ICE PLANS.—The previous provisions of this posed under part B (not taking into account ing such a product. subsection shall not apply in the case of a section 1839(b) (relating to penalty for late ‘‘(f) RULES REGARDING PHYSICIAN PARTICI- MedicarePlus organization in relation to a enrollment) or 1839(h) (relating to affluence PATION.— MedicarePlus product if the organization October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10395 does not have agreements between physi- ‘‘(b) ACCESS TO SERVICES.— ‘‘(D) EXCEPTION FOR CERTAIN FEE-FOR-SERV- cians and the organization for the provision ‘‘(1) IN GENERAL.—A MedicarePlus organi- ICE PLANS.—The previous provisions of this of benefits under the product. zation offering a MedicarePlus product may paragraph shall not apply in the case of a ‘‘(g) PROVISION OF INFORMATION.—A restrict the providers from whom the bene- MedicarePlus organization in relation to a MedicarePlus organization shall provide the fits under the product are provided so long MedicarePlus product if the organization Secretary with such information on the or- as— does not have agreements between physi- ganization and each MedicarePlus product it ‘‘(A) the organization makes such benefits cians and the organization for the provision offers as may be required for the preparation available and accessible to each individual of benefits under the product. of the information booklet described in sec- electing the product within the product serv- ‘‘(4) DEFINITION OF EMERGENCY SERVICES.— tion 1805(d)(3)(A). ice area with reasonable promptness and in a In this subsection, the term ‘emergency serv- ‘‘(h) COORDINATED ACUTE AND LONG-TERM manner which assures continuity in the pro- ices’ means, with respect to an individual en- CARE BENEFITS UNDER A MEDICAREPLUS vision of benefits; rolled with an organization, covered inpa- PRODUCT.—Nothing in this part shall be con- ‘‘(B) when medically necessary the organi- tient and outpatient services that— strued as preventing a State from coordinat- zation makes such benefits available and ac- ‘‘(A) are furnished by an appropriate ing benefits under its MediGrant program cessible 24 hours a day and 7 days a week; source other than the organization, under title XXI with those provided under a ‘‘(C) the product provides for reimburse- ‘‘(B) are needed immediately because of an MedicarePlus product in a manner that ment with respect to services which are cov- injury or sudden illness, and assures continuity of a full-range of acute ered under subparagraphs (A) and (B) and ‘‘(C) are needed because the time required care and long-term care services to poor el- which are provided to such an individual to reach the organization’s providers or sup- derly or disabled individuals eligible for ben- other than through the organization, if— pliers would have meant risk of serious dam- efits under this title and under such pro- ‘‘(i) the services were medically necessary age to the patient’s health. gram. and immediately required because of an un- ‘‘(c) CONFIDENTIALITY AND ACCURACY OF EN- ‘‘(i) TRANSITIONAL FILE AND USE FOR CER- foreseen illness, injury, or condition, and ROLLEE RECORDS.—Each MedicarePlus orga- TAIN REQUIREMENTS.— ‘‘(ii) it was not reasonable given the cir- nization shall establish procedures— ‘‘(1) IN GENERAL.—In the case of a cumstances to obtain the services through ‘‘(1) to safeguard the privacy of individ- MedicarePlus product proposed to be offered the organization; and ually identifiable enrollee information, and before the end of the transition period (as de- ‘‘(D) coverage is provided for emergency ‘‘(2) to maintain accurate and timely medi- fined in section 1805(e)(1)(B)), by a services (as defined in paragraph (4)) without cal records for enrollees. MedicarePlus organization described in sec- regard to prior authorization or the emer- ‘‘(d) QUALITY ASSURANCE PROGRAM.— tion 1851(g)(3) or by a MedicarePlus organiza- gency care provider’s contractual relation- ‘‘(1) IN GENERAL.—Each MedicarePlus orga- tion with a contract in effect under section ship with the organization. nization must have arrangements, estab- 1858, if the organization submits complete in- ‘‘(2) MINIMUM PAYMENT LEVELS WHERE PRO- lished in accordance with regulations of the formation to the Secretary regarding the VIDING POINT-OF-SERVICE COVERAGE.—If a Secretary, for an ongoing quality assurance product demonstrating that the product MedicarePlus product provides benefits for program for health care services it provides meets the requirements and standards under items and services (not described in para- to such individuals. subsections (a), (d), and (e) (relating to bene- graph (1)(C)) through a network of providers ‘‘(2) ELEMENTS OF PROGRAM.—The quality fits and premiums), the product shall be and also permits payment to be made under assurance program shall— deemed as meeting such requirements and the product for such items and services not ‘‘(A) stress health outcomes; standards under such subsections unless the provided through such a network, the pay- ‘‘(B) provide for the establishment of writ- Secretary disapproves the product within 60 ment level under the product with respect to ten protocols for utilization review, based on days after the date of submission of the com- such items and services furnished outside the current standards of medical practice; plete information. network shall be at least 70 percent (or, if ‘‘(C) provide review by physicians and ‘‘(2) CONSTRUCTION.—Nothing in paragraph the effective cost-sharing rate is 50 percent, other health care professionals of the process (1) shall be construed as waiving the require- at least 40 percent) of the lesser of— followed in the provision of such health care ment of a contract under section 1858 or ‘‘(A) the payment basis (determined with- services; waiving requirements and standards not re- out regard to deductibles and cost-sharing) ‘‘(D) monitors and evaluates high volume ferred to in paragraph (1). that would have applied for such items and and high risk services and the care of acute ‘‘PATIENT PROTECTION STANDARDS services under parts A and B, or and chronic conditions; ‘‘SEC. 1853. (a) DISCLOSURE TO ENROLLEES.— ‘‘(B) the amount charged by the entity fur- ‘‘(E) evaluates the continuity and coordi- A MedicarePlus organization shall disclose nishing such items and services. nation of care that enrollees receive; in clear, accurate, and standardized form, in- ‘‘(3) PROTECTION OF ENROLLEES FOR CERTAIN ‘‘(F) has mechanisms to detect both under- formation regarding all of the following for EMERGENCY SERVICES.— utilization and overutilization of services; each MedicarePlus product it offers: ‘‘(A) PARTICIPATING PROVIDERS.—In the ‘‘(G) after identifying areas for improve- ‘‘(1) Benefits under the MedicarePlus prod- case of emergency services described in sub- ment, establishes or alters practice param- uct offered, including exclusions from cov- paragraph (C) which are furnished by a par- eters; erage and, if it is a high deductible/medisave ticipating physician or provider of services ‘‘(H) takes action to improve quality and product, a comparison of benefits under such to an individual enrolled with a assesses the effectiveness of such action a product with benefits under other MedicarePlus organization under this sec- through systematic follow-up; MedicarePlus products. tion, the applicable participation agreement ‘‘(I) makes available information on qual- ‘‘(2) Rules regarding prior authorization or is deemed to provide that the physician or ity and outcomes measures to facilitate ben- other review requirements that could result provider of services will accept as payment eficiary comparison and choice of health in nonpayment. in full from the organization for such emer- coverage options (in such form and on such ‘‘(3) Potential liability for cost-sharing for gency services described in subparagraph (C) quality and outcomes measures as the Sec- out-of-network services. the amount that would be payable to the retary determines to be appropriate); ‘‘(4) The number, mix, and distribution of physician or provider of services under part ‘‘(J) is evaluated on an ongoing basis as to participating providers. B and from the individual under such part, if its effectiveness; and ‘‘(5) The financial obligations of the en- the individual were not enrolled with such ‘‘(K) provide for external accreditation or rollee, including premiums, deductibles, co- an organization under this part. review, by a utilization and quality control payments, and maximum limits on out-of- ‘‘(B) NONPARTICIPATING PROVIDERS.—In the peer review organization under part B of pocket losses for items and services (both in case of emergency services described in sub- title XI or other qualified independent re- and out of network). paragraph (C) which are furnished by a view organization, of the quality of services ‘‘(6) Statistics on enrollee satisfaction with nonparticipating physician, the limitations furnished by the organization meets profes- the product and organization, including on actual charges for such services otherwise sionally recognized standards of health care rates of reenrollment. applicable under part B (to services fur- (including providing adequate access of en- ‘‘(7) Enrollee rights and responsibilities, nished by individuals not enrolled with a rollees to services). including the grievance process provided MedicarePlus organization under this sec- ‘‘(3) EXCEPTION FOR CERTAIN FEE-FOR-SERV- under subsection (f). tion) shall apply in the same manner as such ICE PLANS.—Paragraph (1) and subsection ‘‘(8) A statement that the use of the 911 limitations apply to services furnished to in- (c)(2) shall not apply in the case of a emergency telephone number is appropriate dividuals not enrolled with such an organiza- MedicarePlus organization in relation to a in emergency situations and an explanation tion. MedicarePlus product to the extent the orga- of what constitutes an emergency situation. ‘‘(C) EMERGENCY SERVICES DESCRIBED.—The nization provides for coverage of benefits ‘‘(9) A description of the organization’s emergency services described in this sub- without restrictions relating to utilization quality assurance program under subsection paragraph are emergency services which are and without regard to whether the provider (d). furnished to an enrollee of a MedicarePlus has a contract or other arrangement with Such information shall be disclosed to each organization under this part by a physician the plan for the provision of such benefits. enrollee under this part at the time of en- or provider of services that is not under a ‘‘(4) TREATMENT OF ACCREDITATION.—The rollment and at least annually thereafter. contract with the organization. Secretary shall provide that a MedicarePlus H 10396 CONGRESSIONAL RECORD — HOUSE October 19, 1995

organization is deemed to meet the require- ‘‘(h) APPROVAL OF MARKETING MATE- directly or indirectly, owns, controls, or ments of paragraphs (1) and (2) of this sub- RIALS.— holds the power to vote, or proxies for, not section and subsection (c) if the organization ‘‘(1) SUBMISSION.—Each MedicarePlus orga- less than 51 percent of the voting rights or is accredited (and periodically reaccredited) nization may not distribute marketing mate- governance rights of another. by a private organization under a process rials unless— ‘‘(b) PROCESS FOR ESTABLISHING STANDARDS that the Secretary has determined assures ‘‘(A) at least 45 days before the date of dis- FOR PROVIDER-SPONSORED ORGANIZATIONS.— that the organization meets standards that tribution the organization has submitted the For process of establishing of standards for are no less stringent than the standards es- material to the Secretary for review, and provider-sponsored organizations, see section tablished under section 1856 to carry out this ‘‘(B) the Secretary has not disapproved the 1856(c). subsection and subsection (c). distribution of such material. ‘‘(c) PROCESS FOR STATE CERTIFICATION OF ‘‘(e) COVERAGE DETERMINATIONS.— ‘‘(2) REVIEW.—The standards established PROVIDER-SPONSORED ORGANIZATIONS.—For ‘‘(1) DECISIONS ON NONEMERGENCY CARE.—A under section 1856 shall include guidelines process of State certification of provider- MedicarePlus organization shall make deter- for the review of all such material submitted sponsored organizations, see section 1857(c). minations regarding authorization requests and under such guidelines the Secretary ‘‘(d) PREEMPTION OF STATE INSURANCE LI- for nonemergency care on a timely basis, de- shall disapprove such material if the mate- CENSING REQUIREMENTS.— pending on the urgency of the situation. rial is materially inaccurate or misleading ‘‘(1) IN GENERAL.—This section supersedes ‘‘(2) APPEALS.— or otherwise makes a material misrepresen- any State law which— ‘‘(A) IN GENERAL.—Appeals from a deter- tation. ‘‘(A) requires that a provider-sponsored or- mination of an organization denying cov- ‘‘(3) DEEMED APPROVAL (1-STOP SHOPPING).— ganization meet requirements for insurers of erage shall be decided within 30 days of the In the case of material that is submitted health services or health maintenance orga- date of receipt of medical information, but under paragraph (1)(A) to the Secretary or a nizations doing business in the State with not later than 60 days after the date of the regional office of the Department of Health respect to initial capitalization and estab- decision. and Human Services and the Secretary or lishment of financial reserves against insol- ‘‘(B) PHYSICIAN DECISION ON CERTAIN AP- the office has not disapproved the distribu- vency, or PEALS.—Appeal decisions relating to a deter- tion of marketing materials under paragraph ‘‘(B) imposes requirements that would have mination to deny coverage based on a lack of (1)(B) with respect to a MedicarePlus prod- the effect of prohibiting the organization medical necessity shall be made only by a uct in an area, the Secretary is deemed not from complying with the applicable require- physician. to have disapproved such distribution in all ments of this part, ‘‘(C) EMERGENCY CASES.—Appeals from other areas covered by the product and orga- insofar as such the law applies to individuals such a determination involving a life-threat- nization. enrolled with the organization under this ening or emergency situation shall be de- ‘‘(4) PROHIBITION OF CERTAIN MARKETING part. cided on an expedited basis. PRACTICES.—Each MedicarePlus organization ‘‘(2) EXCEPTION.—Paragraph (1) shall not ‘‘(f) GRIEVANCES AND APPEALS.— shall conform to fair marketing standards in apply with respect to any State law to the ‘‘(1) GRIEVANCE MECHANISM.—Each relation to MedicarePlus products offered extent that such law provides standards or MedicarePlus organization must provide under this part, included in the standards es- requirements, or provides for enforcement meaningful procedures for hearing and re- tablished under section 1856. Such standards solving grievances between the organization thereof, so as to meet the requirements of shall include a prohibition against an organi- section 1857(c)(2) with respect to approval by (including any entity or individual through zation (or agent of such an organization) which the organization provides health care the Secretary of State certification require- completing any portion of any election form ments thereunder. services) and enrollees under this part. under section 1805 on behalf of any individ- ‘‘(3) CONSTRUCTION.—Nothing in this sub- ‘‘(2) APPEALS.—An enrollee with an organi- ual. section shall be construed as affecting the zation under this part who is dissatisfied by ‘‘PROVIDER-SPONSORED ORGANIZATIONS reason of the enrollee’s failure to receive any operation of section 514 of the Employee Re- ‘‘SEC. 1854. (a) PROVIDER-SPONSORED ORGA- health service to which the enrollee believes tirement Income Security Act of 1974. NIZATION DEFINED.— the enrollee is entitled and at no greater ‘‘PAYMENTS TO MEDICAREPLUS ORGANIZATIONS ‘‘(1) IN GENERAL.—In this part, the term ‘‘SEC. 1855. (a) PAYMENTS.— charge than the enrollee believes the en- ‘provider-sponsored organization’ means a ‘‘(1) IN GENERAL.—Under a contract under rollee is required to pay is entitled, if the public or private entity that (in accordance section 1858 the Secretary shall pay to each amount in controversy is $100 or more, to a with standards established under subsection MedicarePlus organization, with respect to hearing before the Secretary to the same ex- (b)) is a provider, or group of affiliated pro- coverage of an individual under this part in tent as is provided in section 205(b), and in viders, that provides a substantial propor- a payment area for a month, an amount any such hearing the Secretary shall make tion (as defined by the Secretary under such the organization a party. If the amount in standards) of the health care items and serv- equal to the monthly adjusted MedicarePlus controversy is $1,000 or more, the individual ices under the contract under this part di- capitation rate (as provided under subsection or organization shall, upon notifying the rectly through the provider or affiliated (b)) with respect to that individual for that other party, be entitled to judicial review of group of providers. area. ‘‘(2) ANNUAL ANNOUNCEMENT.—The Sec- the Secretary’s final decision as provided in ‘‘(2) SUBSTANTIAL PROPORTION.—In defining section 205(g), and both the individual and what is a ‘substantial proportion’ for pur- retary shall annually determine, and shall the organization shall be entitled to be par- poses of paragraph (1), the Secretary— announce (in a manner intended to provide ties to that judicial review. In applying sec- ‘‘(A) shall take into account the need for notice to interested parties) not later than tions 205(b) and 205(g) as provided in this sub- such an organization to assume responsibil- September 7 before the calendar year con- paragraph, and in applying section 205(l) ity for a substantial proportion of services in cerned— thereto, any reference therein to the Com- order to assure financial stability and the ‘‘(A) the annual MedicarePlus capitation missioner of Social Security or the Social practical difficulties in such an organization rate for each payment area for the year, and Security Administration shall be considered integrating a very wide range of service pro- ‘‘(B) the factors to be used in adjusting a reference to the Secretary or the Depart- viders; and such rates under subsection (b) for payments ment of Health and Human Services, respec- ‘‘(B) may vary such proportion based upon for months in that year. tively. relevant differences among organizations, ‘‘(3) ADVANCE NOTICE OF METHODOLOGICAL ‘‘(3) INDEPENDENT REVIEW OF CERTAIN COV- such as their location in an urban or rural CHANGES.—At least 45 days before making ERAGE DENIALS.—The Secretary shall con- area. the announcement under paragraph (2) for a tract with an independent, outside entity to ‘‘(3) AFFILIATION.—For purposes of this year, the Secretary shall provide for notice review and resolve appeals of denials of cov- subsection, a provider is ‘affiliated’ with an- to MedicarePlus organizations of proposed erage related to urgent or emergency serv- other provider if, through contract, owner- changes to be made in the methodology or ices with respect to MedicarePlus products. ship, or otherwise— benefit coverage assumptions from the meth- ‘‘(4) COORDINATION WITH SECRETARY OF ‘‘(A) one provider, directly or indirectly, odology and assumptions used in the pre- LABOR.—The Secretary shall consult with the controls, is controlled by, or is under com- vious announcement and shall provide such Secretary of Labor so as to ensure that the mon control with the other, organizations an opportunity to comment on requirements of this subsection, as they ‘‘(B) each provider is a participant in a such proposed changes. apply in the case of grievances referred to in lawful combination under which each pro- ‘‘(4) EXPLANATION OF ASSUMPTIONS.—In paragraph (1) to which section 503 of the Em- vider shares, directly or indirectly, substan- each announcement made under paragraph ployee Retirement Income Security Act of tial financial risk in connection with their (2) for a year, the Secretary shall include an 1974 applies, are applied in a manner consist- operations, explanation of the assumptions (including ent with the requirements of such section ‘‘(C) both providers are part of a controlled any benefit coverage assumptions) and 503. group of corporations under section 1563 of changes in methodology used in the an- ‘‘(g) INFORMATION ON ADVANCE DIREC- the Internal Revenue Code of 1986, or nouncement in sufficient detail so that TIVES.—Each MedicarePlus organization ‘‘(D) both providers are part of an affiliated MedicarePlus organizations can compute shall meet the requirement of section 1866(f) service group under section 414 of such Code. monthly adjusted MedicarePlus capitation (relating to maintaining written policies and ‘‘(4) CONTROL.—For purposes of paragraph rates for classes of individuals located in procedures respecting advance directives). (3), control is presumed to exist if one party, each payment area which is in whole or in October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10397

part within the service area of such an orga- ‘‘(iv) HIGHER SERVICE UTILIZATION COHORT.— growth rate, as the Secretary may determine nization. For areas assigned to the higher service uti- consistent with subparagraph (B). lization cohort, 4.7 percent. ‘‘(B) AVERAGE PER CAPITA GROWTH RATE AT ‘‘(b) MONTHLY ADJUSTED MEDICAREPLUS ‘‘(v) HIGHEST SERVICE UTILIZATION CO- NATIONAL AVERAGE TO ASSURE BUDGET NEU- CAPITATION RATE.— HORT.—For areas assigned to the highest TRALITY.—The Secretary shall compute per ‘‘(1) IN GENERAL.—For purposes of this sec- service utilization cohort, 4.0 percent. capita growth rates for a year under sub- tion, the ‘monthly adjusted MedicarePlus ‘‘(B) BUDGET NEUTRAL ADJUSTMENT.—In paragraph (A) (before the application of sub- capitation rate’ under this subsection, for a order to assure that the total capitation pay- paragraph (C)) in a manner so that the month in a year for an individual in a pay- ments under this section during 1996 are the weighted average per capita growth rate for ment area (specified under paragraph (3)) and same as the amount such payments would all areas for the year (weighted to reflect the in a class (established under paragraph (4)), have been if the per capita growth rate for number of medicare beneficiaries in each 1 is ⁄12 of the annual MedicarePlus capitation all such areas for 1996 were equal to the na- area) is equal to the national average per rate specified in paragraph (2) for that area tional average per capita growth rate, speci- capita growth rate under paragraph (3) for for the year, adjusted to reflect the actuarial fied in paragraph (3) for 1996, the Secretary the year. value of benefits under this title with respect shall adjust the per capita growth rates for ‘‘(C) FINAL ADJUSTMENT OF GROWTH to individuals in such class compared to the payment areas as follows: RATES.—After computing per capita growth national average for individuals in all class- ‘‘(i) INCREASE UP TO FLOOR.—First, such ad- rates under the previous provisions of this es. ditional percent increase as may be nec- paragraph for a year, the Secretary shall— ‘‘(2) ANNUAL MEDICAREPLUS CAPITATION essary to assure that the annual ‘‘(i) reduce the per capita growth rate for RATES.—For purposes of this section, the an- MedicarePlus capitation rate for each pay- areas assigned to the median service utiliza- nual MedicarePlus capitation rate for a pay- ment area is at least 12 times $300 for 1996. tion cohort by the ratio of .1 to 5.3; ment area for a year is equal to the annual ‘‘(ii) RESIDUAL INCREASE TO LOWEST SERVICE ‘‘(ii) if the year is 1997, increase per capita MedicarePlus capitation rate for the area for UTILIZATION COHORT.—Next, for payment growth rates for payment areas to the extent the previous year (or, in the case of 1996, the areas assigned to the lowest service utiliza- necessary to assure that the annual average annual per capita rate of payment tion cohort, such additional percent increase MedicarePlus capitation rate for each pay- described in section 1876(a)(1)(C) for the area as will assure that the total capitation pay- ment area for such year is at least 12 times for 1995) increased by the per capita growth ments under this section during 1996 are the $320; and rate for that area and year (as determined same as the amount such payments would ‘‘(iii) adjust (consistent with clause (ii)) under subsection (c)). have been if the per capita growth rate for the per capita growth rate for areas assigned ‘‘(3) PAYMENT AREA DEFINED.—In this sec- all such areas for 1996 were equal to the na- to the lowest service utilization cohort by tion, the term ‘payment area’ means a coun- tional average per capita growth rate. The such proportion as the Secretary determines ty (or equivalent area specified by the Sec- increase under this clause may apply to a will result in no net increase in outlays re- retary), except that in the case of the popu- payment area described in clause (i) and sulting from the application of this subpara- lation group described in paragraph (5)(C), shall be applied after the increase provided graph for the year involved.’’; and the payment area shall be each State. under such clause. ‘‘(3) NATIONAL AVERAGE PER CAPITA GROWTH ‘‘(4) CLASSES.— ‘‘(2) FOR SUBSEQUENT YEARS.— RATES.—In this subsection, the ‘national av- ‘‘(A) IN GENERAL.—For purposes of this sec- ‘‘(A) IN GENERAL.—For purposes of this sec- erage per capita growth rate’ for— tion, the Secretary shall define appropriate tion and subject to subparagraphs (B) and ‘‘(A) 1996 is 5.3 percent, classes of enrollees, consistent with para- (C), the Secretary shall compute a per capita ‘‘(B) 1997 is 3.8 percent, graph (5), based on age, gender, welfare sta- growth rate for each year after 1996, for each ‘‘(C) 1998 is 4.6 percent, tus, institutionalization, and such other fac- payment area as assigned to a service utili- ‘‘(D) 1999 is 4.3 percent, tors as the Secretary determines to be appro- zation cohort under subsection (d), consist- ‘‘(E) 2000 is 3.8 percent, priate, so as to ensure actuarial equivalence. ent with the following rules: ‘‘(F) 2001 is 5.5 percent, The Secretary may add to, modify, or sub- ‘‘(i) MEDIAN SERVICE UTILIZATION COHORT ‘‘(G) 2002 is 5.6 percent, and stitute for such classes, if such changes will SET AT NATIONAL AVERAGE PER CAPITA ‘‘(H) each subsequent year is 5.0 percent. ‘‘(d) ASSIGNMENT OF PAYMENT AREAS TO improve the determination of actuarial GROWTH RATE.—The per capita growth rate SERVICE UTILIZATION COHORTS.— equivalence. for areas assigned to the median service uti- lization cohort for the year shall be the na- ‘‘(1) IN GENERAL.—For purposes of deter- ‘‘(B) RESEARCH.—The Secretary shall con- tional average per capita growth rate for the mining per capita growth rates under sub- duct such research as may be necessary to year (as specified under paragraph (3)), sub- section (c) for areas for a year, the Secretary provide for greater accuracy in the adjust- ject to subparagraph (C). shall assign each payment area to a service ment of capitation rates under this sub- ‘‘(ii) HIGHEST SERVICE UTILIZATION COHORT utilization cohort (based on the service utili- section. Such research may include research SET AT 75 PERCENT OF NATIONAL AVERAGE PER zation index value for that area determined into the addition or modification of classes CAPITA GROWTH RATE.—The per capita growth under paragraph (2)) as follows: under subparagraph (A). The Secretary shall rate for areas assigned to the highest service ‘‘(A) LOWEST SERVICE UTILIZATION CO- submit to Congress a report on such research utilization cohort for the year shall be 75 HORT.—Areas with a service utilization index by not later than January 1, 1997. percent of the national average per capita value of less than .80 shall be assigned to the ‘‘(5) DIVISION OF MEDICARE POPULATION.—In growth rate for the year. lowest service utilization cohort. carrying out paragraph (4) and this section, ‘‘(iii) LOWEST SERVICE UTILIZATION COHORT ‘‘(B) LOWER SERVICE UTILIZATION COHORT.— the Secretary shall recognize the following SET AT 187.5 PERCENT OF NATIONAL AVERAGE Areas with a service utilization index value separate population groups: PER CAPITA GROWTH RATE.—The per capita of at least .80 but less than .90 shall be as- ‘‘(A) AGED.—Individuals 65 years of age or growth rate for areas assigned to the lowest signed to the lower service utilization co- older who are not described in subparagraph service utilization cohort for the year shall hort. (C). be 187.5 percent of the national average per ‘‘(C) MEDIAN SERVICE UTILIZATION COHORT.— ‘‘(B) DISABLED.—Disabled individuals who capita growth rate for the year, subject to Areas with a service utilization index value are under 65 years of age and not described in subparagraph (C). of at least .90 but less than 1.10 shall be as- subparagraph (C). ‘‘(iv) LOWER SERVICE UTILIZATION COHORT signed to the median service utilization co- ‘‘(C) INDIVIDUALS WITH END STAGE RENAL SET AT 150 PERCENT OF NATIONAL AVERAGE PER hort. DISEASE.—Individuals who are determined to CAPITA GROWTH RATE.— ‘‘(D) HIGHER SERVICE UTILIZATION COHORT.— have end stage renal disease. ‘‘(I) IN GENERAL.—Subject to subclause (II), Areas with a service utilization index value ‘‘(c) PER CAPITA GROWTH RATES.— the per capita growth rate for areas assigned of at least 1.10 but less than 1.20 shall be as- ‘‘(1) FOR 1996.— to the lower service utilization cohort for signed to the higher service utilization co- ‘‘(A) IN GENERAL.—For purposes of this sec- the year shall be 150 percent of the national hort. tion and subject to subparagraph (B), the per average per capita growth rate for the year. ‘‘(E) HIGHEST SERVICE UTILIZATION CO- capita growth rates for 1996, for a payment ‘‘(II) ADJUSTMENT.—If the Secretary has es- HORT.—Areas with a service utilization index area assigned to a service utilization cohort tablished under clause (v) the per capita value of at least 1.20 shall be assigned to the under subsection (d), shall be the following: growth rate for areas assigned to the higher highest service utilization cohort. ‘‘(i) LOWEST SERVICE UTILIZATION COHORT.— service utilization cohort for the year at 75 ‘‘(2) DETERMINATION OF SERVICE UTILIZATION For areas assigned to the lowest service uti- percent of the national average per capita INDEX VALUES.—In order to determine the per lization cohort, 9.0 percent plus the addi- growth rate, the Secretary may provide for a capita growth rate for a payment area for tional percent provided under subparagraph reduced per capita growth rate under each year (beginning with 1996), the Sec- (B)(ii). subclause (I) to the extent necessary to com- retary shall determine for such area and ‘‘(ii) LOWER SERVICE UTILIZATION COHORT.— ply with subparagraph (B). year a service utilization index value, which For areas assigned to the lower service utili- ‘‘(v) HIGHER SERVICE UTILIZATION COHORT.— is equal to— zation cohort, 8.0 percent. The per capita growth rate for areas assigned ‘‘(A) the annual MedicarePlus capitation ‘‘(iii) MEDIAN SERVICE UTILIZATION CO- to the higher service utilization cohort for rate under this section for the area for the HORT.—For areas assigned to the median the year shall be such percent (not less than year in which the determination is made (or, service utilization cohort, 5.1 percent. 75 percent) of the national average per capita in the case of 1996, the average annual per H 10398 CONGRESSIONAL RECORD — HOUSE October 19, 1995

capita rate of payment (described in section ‘‘(1) IN GENERAL.—Subject to subsection (f), in the year shall be deposited during that 1876(a)(1)(C)) for the area for 1995); divided by the Secretary shall make monthly payments first month. In the case of a termination of ‘‘(B) the input-price-adjusted annual na- under this section in advance and in accord- such an election as of a month before the end tional MedicarePlus capitation rate (as de- ance with the rate determined under sub- of a year, the Secretary shall provide for a termined under paragraph (3)) for that area section (a) to the plan for each individual en- procedure for the recovery of deposits attrib- for the year in which the determination is rolled with a MedicarePlus organization utable to the remaining months in the year. made. under this part. ‘‘(g) PAYMENTS FROM TRUST FUND.—The ‘‘(3) DETERMINATION OF INPUT-PRICE-AD- ‘‘(2) ADJUSTMENT TO REFLECT NUMBER OF payment to a MedicarePlus organization JUSTED RATES.— ENROLLEES.— under this section for individuals enrolled ‘‘(A) IN GENERAL.—For purposes of para- ‘‘(A) IN GENERAL.—The amount of payment under this part with the organization, and graph (2), the ‘input-price-adjusted annual under this subsection may be retroactively payments to a MedicarePlus MSA under sub- national MedicarePlus capitation rate’ for a adjusted to take into account any difference section (f)(1)(B), shall be made from the Fed- payment area for a year is equal to the sum, between the actual number of individuals en- eral Hospital Insurance Trust Fund and the for all the types of medicare services (as rolled with an organization under this part Federal Supplementary Medical Insurance classified by the Secretary), of the product and the number of such individuals esti- Trust Fund in such proportion as the Sec- (for each such type) of— mated to be so enrolled in determining the retary determines reflects the relative ‘‘(i) the national standardized amount of the advance payment. weight that benefits under part A and under MedicarePlus capitation rate (determined ‘‘(B) SPECIAL RULE FOR CERTAIN ENROLL- part B represents of the actuarial value of under subparagraph (B)) for the year, EES.— the total benefits under this title. ‘‘(ii) the proportion of such rate for the ‘‘(i) IN GENERAL.—Subject to clause (ii), the ‘‘(h) SPECIAL RULE FOR CERTAIN INPATIENT year which is attributable to such type of Secretary may make retroactive adjust- HOSPITAL STAYS.—In the case of an individ- services, and ments under subparagraph (A) to take into ual who is receiving inpatient hospital serv- ‘‘(iii) an index that reflects (for that year account individuals enrolled during the pe- ices from a subsection (d) hospital (as de- and that type of services) the relative input riod beginning on the date on which the indi- fined in section 1886(d)(1)(B)) as of the effec- price of such services in the area compared vidual enrolls with a MedicarePlus organiza- tive date of the individual’s— to the national average input price of such tion under a product operated, sponsored, or ‘‘(1) election under this part of a MedicarePlus product offered by a services. contributed to by the individual’s employer or former employer (or the employer or MedicarePlus organization— In applying clause (iii), the Secretary shall, former employer of the individual’s spouse) ‘‘(A) payment for such services until the subject to subparagraph (C), apply those in- and ending on the date on which the individ- date of the individual’s discharge shall be dices under this title that are used in apply- ual is enrolled in the organization under this made under this title through the ing (or updating) national payment rates for part, except that for purposes of making MedicarePlus product or Non-MedicarePlus specific areas and localities. such retroactive adjustments under this sub- option (as the case may be) elected before ‘‘(B) NATIONAL STANDARDIZED paragraph, such period may not exceed 90 the election with such organization, MEDICAREPLUS CAPITATION RATE.—In this days. ‘‘(B) the elected organization shall not be paragraph, the ‘national standardized ‘‘(ii) EXCEPTION.—No adjustment may be financially responsible for payment for such MedicarePlus capitation rate’ for a year is made under clause (i) with respect to any in- services until the date after the date of the equal to— dividual who does not certify that the orga- individual’s discharge, and ‘‘(i) the sum (for all payment areas) of the nization provided the individual with the dis- ‘‘(C) the organization shall nonetheless be product of (I) the annual MedicarePlus capi- closure statement described in section paid the full amount otherwise payable to tation rate for that year for the area under 1853(a) at the time the individual enrolled the organization under this part; or subsection (b)(2), and (II) the average num- with the organization. ‘‘(2) termination of election with respect to ber of medicare beneficiaries residing in that ‘‘(f) SPECIAL RULES FOR INDIVIDUALS ELECT- a MedicarePlus organization under this area in the year; divided by ING HIGH DEDUCTIBLE/MEDISAVE PRODUCT.— part— ‘‘(ii) the total average number of medicare ‘‘(1) IN GENERAL.—In the case of an individ- ‘‘(A) the organization shall be financially beneficiaries residing in all the payment ual who has elected a high deductible/ responsible for payment for such services areas for that year. medisave product, notwithstanding the pre- after such date and until the date of the indi- ‘‘(C) SPECIAL RULES FOR 1996.—In applying ceding provisions of this section— vidual’s discharge, this paragraph for 1996— ‘‘(A) the amount of the payment to the ‘‘(B) payment for such services during the ‘‘(i) medicare services shall be divided into MedicarePlus organization offering the high stay shall not be made under section 1886(d) 2 types of services: part A services and part deductible/medisave product shall not exceed or by any succeeding MedicarePlus organiza- B services; the premium for the product, and tion, and ‘‘(ii) the proportions described in subpara- ‘‘(B) subject to paragraph (2), the dif- ‘‘(C) the terminated organization shall not graph (A)(ii) for such types of services shall ference between the amount of payment that receive any payment with respect to the in- be— would otherwise be made and the amount of dividual under this part during the period ‘‘(I) for part A services, the ratio (ex- payment to such organization shall be made the individual is not enrolled. pressed as a percentage) of the average an- directly into a MedicarePlus MSA estab- ‘‘ESTABLISHMENT OF STANDARDS FOR nual per capita rate of payment for the area lished (and, if applicable, designated) by the MEDICARE-PLUS ORGANIZATIONS AND PRODUCTS for part A for 1995 to the total average an- individual under paragraph (2). nual per capita rate of payment for the area ‘‘SEC. 1856. (a) STANDARDS APPLICABLE TO ‘‘(2) ESTABLISHMENT AND DESIGNATION OF for parts A and B for 1995, and STATE-REGULATED ORGANIZATIONS AND PROD- MEDICAREPLUS MEDICAL SAVINGS ACCOUNT AS ‘‘(II) for part B services, 100 percent minus UCTS.— REQUIREMENT FOR PAYMENT OF CONTRIBU- the ratio described in subclause (I); ‘‘(1) RECOMMENDATIONS OF NAIC.—The Sec- TION.—In the case of an individual who has retary shall request the National Associa- ‘‘(iii) for the part A services, 70 percent of elected coverage under a high deductible/ payments attributable to such services shall tion of Insurance Commissioners to develop medisave product, no payment shall be made and submit to the Secretary, not later than be adjusted by the index used under section under paragraph (1)(B) on behalf of an indi- 1886(d)(3)(E) to adjust payment rates for rel- 12 months after the date of the enactment of vidual for a month unless the individual— the Medicare Preservation Act of 1995, pro- ative hospital wage levels for hospitals lo- ‘‘(A) has established before the beginning cated in the payment area involved; posed standards consistent with the require- of the month (or by such other deadline as ments of this part for MedicarePlus organi- ‘‘(iv) for part B services— the Secretary may specify) a MedicarePlus ‘‘(I) 66 percent of payments attributable to zations (other than union sponsors, Taft- MSA (as defined in section 137(b) of the In- Hartley sponsors, and provider-sponsored or- such services shall be adjusted by the index ternal Revenue Code of 1986), and of the geographic area factors under section ganizations) and MedicarePlus products of- ‘‘(B) if the individual has established more fered by such organizations, except that 1848(e) used to adjust payment rates for phy- than one MedicarePlus MSA, has designated sicians’ services furnished in the payment such proposed standards may relate to one of such accounts as the individual’s MedicarePlus organizations that are quali- area, and MedicarePlus MSA for purposes of this part. ‘‘(II) of the remaining 34 percent of the fied associations only with respect to amount of such payments, 70 percent shall be Under rules under this section, such an indi- MedicarePlus products offered by them and adjusted by the index described in clause vidual may change the designation of such only if such products are issued by organiza- (iii); account under subparagraph (B) for purposes tions to which section 1851(b)(1) applies. ‘‘(v) the index values shall be computed of this part. ‘‘(2) REVIEW.—If the Association submits based only on the beneficiary population de- ‘‘(3) LUMP SUM DEPOSIT OF MEDICAL SAVINGS such standards on a timely basis, the Sec- scribed in subsection (b)(5)(A). ACCOUNT CONTRIBUTION.—In the case of an in- retary shall review such standards to deter- dividual electing a high deductible/medisave mine if the standards meet the requirements The Secretary may continue to apply the product effective beginning with a month in of the part. The Secretary shall complete the rules described in this subparagraph (or simi- a year, the amount of the contribution to the review of the standards not later than 90 lar rules) for 1997. MedicarePlus MSA on behalf of the individ- days after the date of their submission. The ‘‘(e) PAYMENT PROCESS.— ual for that month and all successive months Secretary shall promulgate such proposed October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10399

standards to apply to organizations and ‘‘(6) PRELIMINARY COMMITTEE REPORT.—The this section are changed, the organization products described in paragraph (1) except to negotiated rulemaking committee appointed may elect not to have such changes apply to the extent that the Secretary modifies such under paragraph (5) shall report to the Sec- the organization until the end of the current proposed standards because they do not meet retary, by not later than June 1, 1996, regard- contract year (or, if there is less than 6 such requirements. ing the committee’s progress on achieving a months remaining in the contract year, until ‘‘(3) FAILURE TO SUBMIT.—If the Associa- concensus with regard to the rulemaking 1 year after the end of the current contract tion does not submit such standards on a proceeding and whether such consensus is year). timely basis, the Secretary shall promulgate likely to occur before one month before the ‘‘(g) RELATION TO STATE LAWS.—The stand- such standards by not later than the date the target date for publication of the rule. If the ards established under this section shall su- Secretary would otherwise have been re- committee reports that the committee has persede any State law or regulation with re- quired to promulgate standards under para- failed to make significant progress towards spect to MedicarePlus products which are of- graph (2). such consensus or is unlikely to reach such fered by MedicarePlus organizations and are ‘‘(4) USE OF INTERIM RULES.—For the period consensus by the target date, the Secretary issued by organizations to which section in which this part is in effect and standards may terminate such process and provide for 1851(b)(1) applies, to the extent such law or are being developed and established under the publication of a rule under this sub- regulation is inconsistent with such stand- the preceding provisions of this subsection, section through such other methods as the ards. the Secretary shall provide by not later than Secretary may provide. ‘‘MEDICARE-PLUS CERTIFICATION June 1, 1996, for the application of such in- ‘‘(7) FINAL COMMITTEE REPORT.—If the com- ‘‘SEC. 1857. (a) STATE CERTIFICATION PROC- terim standards (without regard to any re- mittee is not terminated under paragraph ESS FOR STATE-REGULATED ORGANIZATIONS.— quirements for notice and public comment) (6), the rulemaking committee shall submit ‘‘(1) APPROVAL OF STATE PROCESS.—The as may be appropriate to provide for the ex- a report containing a proposed rule by not Secretary shall approve a MedicarePlus cer- pedited implementation of this part. Such later than one month before the target publi- tification and enforcement program estab- interim standards shall not apply after the cation date. lished by a State for applying the standards date standards are established under the pre- ‘‘(8) INTERIM, FINAL EFFECT.—The Secretary established under section 1856 to ceding provisions of this subsection. shall publish a rule under this subsection in MedicarePlus organizations (other than ‘‘(b) UNION AND TAFT-HARTLEY SPONSORS, the Federal Register by not later than the union sponsors, Taft-Hartley sponsors, and QUALIFIED ASSOCIATIONS, AND PRODUCTS.— target publication date. Such rule shall be provider-sponsored organizations) and ‘‘(1) IN GENERAL.—The Secretary shall de- effective and final immediately on an in- velop and promulgate by regulation stand- terim basis, but is subject to change and re- MedicarePlus products offered by such orga- ards consistent with the requirements of this vision after public notice and opportunity nizations if the Secretary determines that part for union and Taft-Hartley sponsors, for for a period (of not less than 60 days) for pub- the program effectively provides for the ap- qualified associations, and for MedicarePlus lic comment. In connection with such rule, plication and enforcement of such standards products offered by such organizations (other the Secretary shall specify the process for in the State with respect to such organiza- than MedicarePlus products offered by quali- the timely review and approval of applica- tions and products. Such program shall pro- fied associations that are issued by organiza- tions of entities to be certified as provider- vide for certification of compliance of tions to which section 1851(b)(1) applies). sponsored organizations pursuant to such MedicarePlus organizations and products ‘‘(2) CONSULTATION WITH LABOR.—The Sec- rules and consistent with this subsection. with the applicable requirements of this part retary shall consult with the Secretary of ‘‘(9) PUBLICATION OF RULE AFTER PUBLIC not less often than once every 3 years. Labor with respect to such standards for COMMENT.—The Secretary shall provide for ‘‘(2) EFFECT OF CERTIFICATION UNDER STATE such sponsors and products. consideration of such comments and republi- PROCESS.—A MedicarePlus organization and ‘‘(3) TIMING.—Standards under this sub- cation of such rule by not later than 1 year MedicarePlus product offered by such an or- section shall be promulgated at or about the after the target publication date. ganization that is certified under such pro- time standards are promulgated under sub- ‘‘(10) PROCESS FOR APPROVAL OF APPLICA- gram is considered to have been certified section (a). TIONS FOR CERTIFICATION.— under this subsection with respect to the of- ‘‘(c) ESTABLISHMENT OF STANDARDS FOR ‘‘(A) IN GENERAL.—The Secretary shall es- fering of the product to individuals residing PROVIDER-SPONSORED ORGANIZATIONS.— tablish a process for the receipt and approval in the State. ‘‘(1) IN GENERAL.—The Secretary shall es- of applications of entities for certification as ‘‘(3) USER FEES.—The State may impose tablish, on an expedited basis and using a ne- provider-sponsored organizations under this user fees on organizations seeking certifi- gotiated rulemaking process under sub- part. Under such process, the Secretary shall cation under this subsection in such chapter 3 of chapter 5 of title 5, United act upon a complete application submitted amounts as the State deems sufficient to fi- States Code, standards that entities must within 60 days after the date it is received. nance the costs of such certification. Noth- meet to qualify as provider-sponsored orga- ‘‘(B) CIRCULATION OF PROPOSED APPLICATION ing in this paragraph shall be construed as nizations under this part. FORM.—By March 1, 1996, the Secretary, after restricting a State’s authority to impose ‘‘(2) PUBLICATION OF NOTICE.—In carrying consultation with the negotiated rulemaking premium taxes, other taxes, or other levies. out the rulemaking process under this sub- committee, shall circulate a proposed appli- ‘‘(4) REVIEW.—The Secretary periodically section, the Secretary, after consultation cation form that could be used by entities shall review State programs approved under with the National Association of Insurance considering becoming certified as a provider- paragraph (1) to determine if they continue Commissioners, the American Academy of sponsored organization under this part. to provide for certification and enforcement Actuaries, organizations representative of ‘‘(d) COORDINATION AMONG FINAL STAND- described in such paragraph. If the Secretary medicare beneficiaries, and other interested ARDS.—In establishing standards (other than finds that a State program no longer so pro- parties, shall publish the notice provided for on an interim basis) under the previous pro- vides, before making a final determination, under section 564(a) of title 5, United States visions of this section, the Secretary shall the Secretary shall provide the State an op- Code, by not later than 45 days after the date seek to provide for consistency (as appro- portunity to adopt such a plan of correction of the enactment of Medicare Preservation priate) across the different types of as would permit the State program to meet Act of 1995. MedicarePlus organizations, in order to pro- the requirements of paragraph (1). If the Sec- ‘‘(3) TARGET DATE FOR PUBLICATION OF mote equitable treatment of different types retary makes a final determination that the RULE.—As part of the notice under paragraph of organizations and consistent protection State program, after such an opportunity, (2), and for purposes of this subsection, the for individuals who elect products offered by fails to meet such requirements, the provi- ‘target date for publication’ (referred to in the different types of MedicarePlus organiza- sions of subsection (b) shall apply to section 564(a)(5) of such title) shall be Sep- tions. MedicarePlus organizations and products in tember 1, 1996. ‘‘(e) USE OF CURRENT STANDARDS FOR IN- the State. ‘‘(4) ABBREVIATED PERIOD FOR SUBMISSION TERIM STANDARDS.—To the extent prac- ‘‘(5) EFFECT OF NO STATE PROGRAM.—Begin- OF COMMENTS.—In applying section 564(c) of ticable and consistent with the requirements ning on the date standards are established such title under this subsection, ‘15 days’ of this part, standards established on an in- under section 1856, in the case of organiza- shall be substituted for ‘30 days’. terim basis to carry out requirements of this tions and products in States in which a cer- ‘‘(5) APPOINTMENT OF NEGOTIATED RULE- part may be based on currently applicable tification program has not been approved MAKING COMMITTEE AND FACILITATOR.—The standards, such as the rules established and in operation under paragraph (1), the Secretary shall provide for— under section 1876 (as in effect as of the date Secretary shall establish a process for the ‘‘(A) the appointment of a negotiated rule- of the enactment of this section) to carry certification of MedicarePlus organizations making committee under section 565(a) of out analogous provisions of such section or (other than union sponsors, Taft-Hartley such title by not later than 30 days after the standards established or developed for appli- sponsors, and provider-sponsored organiza- end of the comment period provided for cation in the private health insurance mar- tions) and products of such organizations as under section 564(c) of such title (as short- ket. meeting such standards. ened under paragraph (4)), and ‘‘(f) APPLICATION OF NEW STANDARDS TO EN- ‘‘(6) PUBLICATION OF LIST OF APPROVED ‘‘(B) the nomination of a facilitator under TITIES WITH A CONTRACT.—In the case of a STATE PROGRAMS.—The Secretary shall pub- section 566(c) of such title by not later than MedicarePlus organization with a contract lish (and periodically update) a list of those 10 days after the date of appointment of the in effect under this part at the time stand- State programs which are approved for pur- committee. ards applicable to the organization under poses of this subsection. H 10400 CONGRESSIONAL RECORD — HOUSE October 19, 1995

‘‘(b) FEDERAL CERTIFICATION PROCESS FOR comply with the applicable requirements and retary, or any person or organization des- UNION SPONSORS, TAFT-HARTLEY SPONSORS, standards of this part and the terms and con- ignated by the Secretary— AND PROVIDER-SPONSORED ORGANIZATIONS.— ditions of payment as provided for in this ‘‘(A) shall have the right to inspect or oth- ‘‘(1) ESTABLISHMENT.—The Secretary shall part. erwise evaluate (i) the quality, appropriate- establish a process for the certification of ‘‘(b) MINIMUM ENROLLMENT REQUIRE- ness, and timeliness of services performed union sponsors, Taft-Hartley sponsors, and MENTS.— under the contract and (ii) the facilities of provider-sponsored organizations and ‘‘(1) IN GENERAL.—Subject to paragraphs (1) the organization when there is reasonable MedicarePlus products offered by such spon- and (2), the Secretary may not enter into a evidence of some need for such inspection, sors and organizations as meeting the appli- contract under this section with a and cable standards established under section MedicarePlus organization (other than a ‘‘(B) shall have the right to audit and in- 1856. union sponsor or Taft-Hartley sponsor) un- spect any books and records of the ‘‘(2) INVOLVEMENT OF SECRETARY OF less the organization has at least 5,000 indi- MedicarePlus organization that pertain (i) to LABOR.—Such process shall be established viduals (or 1,500 individuals in the case of an the ability of the organization to bear the and operated in cooperation with the Sec- organization that is a provider-sponsored or- risk of potential financial losses, or (ii) to retary of Labor with respect to union spon- ganization) who are receiving health benefits services performed or determinations of through the organization, except that the sors and Taft-Hartley sponsors. amounts payable under the contract. standards under section 1856 may permit the ‘‘(3) USE OF STATE LICENSING AND PRIVATE ‘‘(2) ENROLLEE NOTICE AT TIME OF TERMI- organization to have a lesser number of ACCREDITATION PROCESSES.— NATION.—Each contract under this section beneficiaries (but not less than 500 in the ‘‘(A) IN GENERAL.—The process under this shall require the organization to provide subsection shall, to the maximum extent case of an organization that is a provider- sponsored organization) if the organization (and pay for) written notice in advance of practicable, provide that MedicarePlus orga- the contract’s termination, as well as a de- nizations and products that are licensed or primarily serves individuals residing outside of urbanized areas. scription of alternatives for obtaining bene- certified through a qualified private accredi- fits under this title, to each individual en- tation process that the Secretary finds ap- ‘‘(2) EXCEPTION FOR HIGH DEDUCTIBLE/ MEDISAVE PRODUCT.—Paragraph (1) shall not rolled with the organization under this part. plies standards that are no less stringent ‘‘(3) DISCLOSURE.— than the requirements of this part are apply with respect to a contract that relates only to a high deductible/medisave product. ‘‘(A) IN GENERAL.—Each MedicarePlus or- deemed to meet the corresponding require- ganization shall, in accordance with regula- ments of this part for such an organization ‘‘(3) ALLOWING TRANSITION.—The Secretary may waive the requirement of paragraph (1) tions of the Secretary, report to the Sec- or product. during the first 3 contract years with respect retary financial information which shall in- ‘‘(B) PERIODIC ACCREDITATION.—The use of to an organization. clude the following: an accreditation under subparagraph (A) ‘‘(c) CONTRACT PERIOD AND EFFECTIVE- ‘‘(i) Such information as the Secretary shall be valid only for such period as the Sec- NESS.— may require demonstrating that the organi- retary specifies. ‘‘(1) PERIOD.—Each contract under this sec- zation has a fiscally sound operation. ‘‘(4) USER FEES.—The Secretary may im- tion shall be for a term of at least one year, ‘‘(ii) A copy of the report, if any, filed with pose user fees on entities seeking certifi- as determined by the Secretary, and may be the Health Care Financing Administration cation under this subsection in such made automatically renewable from term to containing the information required to be re- amounts as the Secretary deems sufficient to term in the absence of notice by either party ported under section 1124 by disclosing enti- finance the costs of such certification. of intention to terminate at the end of the ties. ‘‘(c) CERTIFICATION OF PROVIDER-SPON- current term. ‘‘(iii) A description of transactions, as SORED ORGANIZATIONS BY STATES.— ‘‘(2) TERMINATION AUTHORITY.—In accord- specified by the Secretary, between the orga- ‘‘(1) IN GENERAL.—The Secretary shall es- ance with procedures established under sub- nization and a party in interest. Such trans- tablish a process under which a State may section (h), the Secretary may at any time actions shall include— propose to provide for certification of enti- terminate any such contract or may impose ‘‘(I) any sale or exchange, or leasing of any ties as meeting the requirements of this part the intermediate sanctions described in an property between the organization and a to be provider-sponsored organizations. applicable paragraph of subsection (g) on the party in interest; ‘‘(2) CONDITIONS FOR APPROVAL.—The Sec- MedicarePlus organization if the Secretary ‘‘(II) any furnishing for consideration of retary may not approve a State program for determines that the organization— goods, services (including management serv- certification under paragraph (1) unless the ‘‘(A) has failed substantially to carry out ices), or facilities between the organization Secretary determines that the certification the contract; and a party in interest, but not including program applies standards and requirements ‘‘(B) is carrying out the contract in a man- salaries paid to employees for services pro- that are identical to the standards and re- ner inconsistent with the efficient and effec- vided in the normal course of their employ- quirements of this part and the applicable tive administration of this part; ment and health services provided to mem- provisions for enforcement of such standards ‘‘(C) is operating in a manner that is not in bers by hospitals and other providers and by and requirements do not result in a lower the best interests of the individuals covered staff, medical group (or groups), individual level or quality of enforcement than that under the contract; or practice association (or associations), or any which is otherwise applicable under this ‘‘(D) no longer substantially meets the ap- combination thereof; and title. plicable conditions of this part. ‘‘(III) any lending of money or other exten- ‘‘(d) NOTICE TO ENROLLEES IN CASE OF DE- ‘‘(3) EFFECTIVE DATE OF CONTRACTS.—The sion of credit between an organization and a CERTIFICATION.—If a MedicarePlus organiza- effective date of any contract executed pur- party in interest. tion or product is decertified under this sec- suant to this section shall be specified in the The Secretary may require that information tion, the organization shall notify each en- contract, except that in no case shall a con- reported respecting an organization which rollee with the organization and product tract under this section which provides for controls, is controlled by, or is under com- under this part of such decertification. coverage under a high deductible/medisave mon control with, another entity be in the ‘‘(e) QUALIFIED ASSOCIATIONS.—In the case account be effective before January 1997 with form of a consolidated financial statement of MedicarePlus products offered by a respect to such coverage. for the organization and such entity. MedicarePlus organization that is a qualified ‘‘(4) PREVIOUS TERMINATIONS.—The Sec- ‘‘(B) PARTY IN INTEREST DEFINED.—For the association (as defined in section retary may not enter into a contract with a purposes of this paragraph, the term ‘party 1854(c)(4)(C)) and issued by an organization MedicarePlus organization if a previous con- in interest’ means— to which section 1851(b)(1) applies or by a tract with that organization under this sec- ‘‘(i) any director, officer, partner, or em- provider-sponsored organization (as defined tion was terminated at the request of the or- ployee responsible for management or ad- in section 1854(a)), nothing in this section ganization within the preceding five-year pe- ministration of a MedicarePlus organization, shall be construed as limiting the authority riod, except in circumstances which warrant any person who is directly or indirectly the of States to regulate such products. special consideration, as determined by the beneficial owner of more than 5 percent of ‘‘CONTRACTS WITH MEDICAREPLUS Secretary. the equity of the organization, any person ORGANIZATIONS ‘‘(5) NO CONTRACTING AUTHORITY.—The au- who is the beneficial owner of a mortgage, ‘‘SEC. 1858. (a) IN GENERAL.—The Secretary thority vested in the Secretary by this part deed of trust, note, or other interest secured shall not permit the election under section may be performed without regard to such by, and valuing more than 5 percent of the 1805 of a MedicarePlus product offered by a provisions of law or regulations relating to organization, and, in the case of a MedicarePlus organization under this part, the making, performance, amendment, or MedicarePlus organization organized as a and no payment shall be made under section modification of contracts of the United nonprofit corporation, an incorporator or 1856 to an organization, unless the Secretary States as the Secretary may determine to be member of such corporation under applicable has entered into a contract under this sec- inconsistent with the furtherance of the pur- State corporation law; tion with an organization with respect to the pose of this title. ‘‘(ii) any entity in which a person described offering of such product. Such a contract ‘‘(d) PROTECTIONS AGAINST FRAUD AND BEN- in clause (i)— with an organization may cover more than EFICIARY PROTECTIONS.— ‘‘(I) is an officer or director; one MedicarePlus product. Such contract ‘‘(1) INSPECTION AND AUDIT.—Each contract ‘‘(II) is a partner (if such entity is orga- shall provide that the organization agrees to under this section shall provide that the Sec- nized as a partnership); October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10401 ‘‘(III) has directly or indirectly a beneficial each individual not enrolled as a result of on an interim basis, after notice and pending interest of more than 5 percent of the equity; the practice involved, opportunity for public comment. or ‘‘(B) suspension of enrollment of individ- (d) ADVANCE DIRECTIVES.—Section 1866(f) ‘‘(IV) has a mortgage, deed of trust, note, uals under this part after the date the Sec- (42 U.S.C. 1395cc(f)) is amended— or other interest valuing more than 5 per- retary notifies the organization of a deter- (1) in paragraph (1)— cent of the assets of such entity; mination under paragraph (1) and until the (A) by inserting ‘‘1853(g),’’ after ‘‘1833(s),’’, ‘‘(iii) any person directly or indirectly con- Secretary is satisfied that the basis for such and trolling, controlled by, or under common determination has been corrected and is not (B) by inserting ‘‘, MedicarePlus organiza- control with an organization; and likely to recur, or tion,’’ after ‘‘provider of services’’, and ‘‘(iv) any spouse, child, or parent of an in- ‘‘(C) suspension of payment to the organi- (2) by adding at the end the following new dividual described in clause (i). zation under this part for individuals en- paragraph: ‘‘(C) ACCESS TO INFORMATION.—Each rolled after the date the Secretary notifies ‘‘(4) Nothing in this subsection shall be MedicarePlus organization shall make the the organization of a determination under construed to require the provision of infor- information reported pursuant to subpara- paragraph (1) and until the Secretary is sat- mation regarding assisted suicide, eutha- graph (A) available to its enrollees upon rea- isfied that the basis for such determination nasia, or mercy killing.’’. sonable request. has been corrected and is not likely to recur. (e) CONFORMING AMENDMENT.—Section ‘‘(4) LOAN INFORMATION.—The contract ‘‘(3) OTHER INTERMEDIATE SANCTIONS.—In 1866(a)(1)(O) (42 U.S.C. 1395cc(a)(1)(O)) is shall require the organization to notify the the case of a MedicarePlus organization for amended by inserting before the semicolon Secretary of loans and other special finan- which the Secretary makes a determination at the end the following: ‘‘and in the case of cial arrangements which are made between under subsection (c)(2) the basis of which is hospitals to accept as payment in full for in- the organization and subcontractors, affili- not described in paragraph (1), the Secretary patient hospital services that are emergency ates, and related parties. may apply the following intermediate sanc- services (as defined in section 1853(b)(4)) that ‘‘(e) ADDITIONAL CONTRACT TERMS.—The tions: are covered under this title and are furnished contract shall contain such other terms and ‘‘(A) civil money penalties of not more to any individual enrolled under part C with conditions not inconsistent with this part than $25,000 for each determination under a MedicarePlus organization which does not (including requiring the organization to pro- subsection (c)(2) if the deficiency that is the have a contract establishing payment vide the Secretary with such information) as basis of the determination has directly ad- amounts for services furnished to members the Secretary may find necessary and appro- versely affected (or has the substantial like- of the organization the amounts that would priate. lihood of adversely affecting) an individual be made as a payment in full under this title ‘‘(f) INTERMEDIATE SANCTIONS.— covered under the organization’s contract; if the individuals were not so enrolled’’. ‘‘(1) IN GENERAL.—If the Secretary deter- ‘‘(B) civil money penalties of not more mines that a MedicarePlus organization with than $10,000 for each week beginning after SEC. 15003. DUPLICATION AND COORDINATION OF MEDICARE-RELATED PRODUCTS. a contract under this section— the initiation of procedures by the Secretary ‘‘(A) fails substantially to provide medi- under subsection (h) during which the defi- (a) TREATMENT OF CERTAIN HEALTH INSUR- cally necessary items and services that are ciency that is the basis of a determination ANCE POLICIES AS NONDUPLICATIVE.— required (under law or under the contract) to under subsection (c)(2) exists; and (1) IN GENERAL.—Effective as if included in be provided to an individual covered under ‘‘(C) suspension of enrollment of individ- the enactment of section 4354 of the Omnibus the contract, if the failure has adversely af- uals under this part after the date the Sec- Budget Reconciliation Act of 1990, section fected (or has substantial likelihood of ad- retary notifies the organization of a deter- 1882(d)(3)(A) (42 U.S.C. 1395ss(d)(3)(A)) is versely affecting) the individual; mination under subsection (c)(2) and until amended— ‘‘(B) imposes premiums on individuals en- the Secretary is satisfied that the deficiency (A) by amending clause (i) to read as fol- rolled under this part in excess of the pre- that is the basis for the determination has lows: miums permitted; been corrected and is not likely to recur. ‘‘(i) It is unlawful for a person to sell or ‘‘(C) acts to expel or to refuse to re-enroll ‘‘(4) PROCEDURES FOR IMPOSING SANC- issue to an individual entitled to benefits an individual in violation of the provisions of TIONS.—The provisions of section 1128A under part A or enrolled under part B of this this part; (other than subsections (a) and (b)) shall title or electing a MedicarePlus product ‘‘(D) engages in any practice that would apply to a civil money penalty under para- under section 1805— reasonably be expected to have the effect of graph (1) or (2) in the same manner as they ‘‘(I) a health insurance policy (other than a denying or discouraging enrollment (except apply to a civil money penalty or proceeding medicare supplemental policy) with knowl- as permitted by this part) by eligible individ- under section 1128A(a). edge that the policy duplicates health bene- uals with the organization whose medical ‘‘(g) PROCEDURES FOR IMPOSING SANC- fits to which the individual is otherwise enti- condition or history indicates a need for sub- TIONS.—The Secretary may terminate a con- tled under this title or title XIX, stantial future medical services; tract with a MedicarePlus organization ‘‘(II) in the case of an individual not elect- ‘‘(E) misrepresents or falsifies information under this section or may impose the inter- ing a MedicarePlus product, a medicare sup- that is furnished— mediate sanctions described in subsection (f) plemental policy with knowledge that the in- ‘‘(i) to the Secretary under this part, or on the organization in accordance with for- dividual is entitled to benefits under another ‘‘(ii) to an individual or to any other entity mal investigation and compliance procedures medicare supplemental policy, or under this part; established by the Secretary under which— ‘‘(III) in the case of an individual electing ‘‘(F) fails to comply with the requirements ‘‘(1) the Secretary provides the organiza- a MedicarePlus product, a medicare supple- of section 1852(f)(3); or tion with the opportunity to develop and im- mental policy with knowledge that the pol- ‘‘(G) employs or contracts with any indi- plement a corrective action plan to correct icy duplicates health benefits to which the vidual or entity that is excluded from par- the deficiencies that were the basis of the individual is otherwise entitled under this ticipation under this title under section 1128 Secretary’s determination under subsection title or under another medicare supple- or 1128A for the provision of health care, uti- (c)(2); mental policy.’’; lization review, medical social work, or ad- ‘‘(2) the Secretary shall impose more se- (B) in clause (iii), by striking ‘‘clause (i)’’ ministrative services or employs or con- vere sanctions on organizations that have a and inserting ‘‘clause (i)(II)’’; and tracts with any entity for the provision (di- history of deficiencies or that have not (C) by adding at the end the following new rectly or indirectly) through such an ex- taken steps to correct deficiencies the Sec- clauses: cluded individual or entity of such services; retary has brought to their attention; ‘‘(iv) For purposes of this subparagraph a the Secretary may provide, in addition to ‘‘(3) there are no unreasonable or unneces- health insurance policy shall be considered any other remedies authorized by law, for sary delays between the finding of a defi- to ‘duplicate’ benefits under this title only any of the remedies described in paragraph ciency and the imposition of sanctions; and when, under its terms, the policy provides (2). ‘‘(4) the Secretary provides the organiza- specific reimbursement for identical items ‘‘(2) REMEDIES.—The remedies described in tion with reasonable notice and opportunity and services to the extent paid for under this this paragraph are— for hearing (including the right to appeal an title, and a health insurance policy providing ‘‘(A) civil money penalties of not more initial decision) before imposing any sanc- for benefits which are payable to or on behalf than $25,000 for each determination under tion or terminating the contract.’’. of an individual without regard to other paragraph (1) or, with respect to a deter- (b) CONFORMING REFERENCES TO PREVIOUS health benefit coverage of such individual is mination under subparagraph (D) or (E)(i) of PART C.—Any reference in law (in effect be- not considered to ‘duplicate’ any health ben- such paragraph, of not more than $100,000 for fore the date of the enactment of this Act) to efits under this title. each such determination, plus, with respect part C of title XVIII of the Social Security ‘‘(v) For purposes of this subparagraph, a to a determination under paragraph (1)(B), Act is deemed a reference to part D of such health insurance policy (or a rider to an in- double the excess amount charged in viola- title (as in effect after such date). surance contract which is not a health insur- tion of such paragraph (and the excess (c) USE OF INTERIM, FINAL REGULATIONS.— ance policy), including a policy (such as a amount charged shall be deducted from the In order to carry out the amendment made long-term care insurance contract described penalty and returned to the individual con- by subsection (a) in a timely manner, the in section 7702B(b) of the Internal Revenue cerned), and plus, with respect to a deter- Secretary of Health and Human Services Code of 1986, as added by the Contract with mination under paragraph (1)(D), $15,000 for may promulgate regulations that take effect America Tax Relief Act of 1995 (H.R. 1215)) H 10402 CONGRESSIONAL RECORD — HOUSE October 19, 1995 providing benefits for long-term care, nurs- relate to limitations on benefits or groups of specified in such section) in as timely a man- ing home care, home health care, or commu- benefits that may be offered). ner as possible and may (to the extent nec- nity-based care, that coordinates against or ‘‘(B) Subsection (r) (relating to loss-ra- essary) provide for retroactive adjustment in excludes items and services available or paid tios). payments made not in accordance with such for under this title and (for policies sold or ‘‘(2)(A) It is unlawful for a person to sell or rates. issued after January 1, 1996) that discloses issue a policy described in subparagraph (B) (2) COST CONTRACTS.—Notwithstanding any such coordination or exclusion in the pol- to an individual with knowledge that the in- other provision of law, the Secretary shall icy’s outline of coverage, is not considered to dividual has in effect under section 1805 an provide that payment amounts under cost ‘duplicate’ health benefits under this title. election of a high deductible/medisave prod- reimbursement contracts under section For purposes of this clause, the terms ‘co- uct. 1876(a) of the Social Security Act shall take ordinates’ and ‘coordination’ mean, with re- ‘‘(B) A policy described in this subpara- into account adjustments in payment spect to a policy in relation to health bene- graph is a health insurance policy that pro- amounts made in parts A and B of title XVIII fits under this title, that the policy under its vides for coverage of expenses that are other- of such Act pursuant to the amendments terms is secondary to, or excludes from pay- wise required to be counted toward meeting made by this title. ment, items and services to the extent avail- the annual deductible amount provided (c) ELIMINATION OF 50:50 RULE.— able or paid for under this title. under the high deductible/medisave prod- (1) IN GENERAL.—Section 1876 (42 U.S.C. ‘‘(vi) Notwithstanding any other provision uct.’’. 1395mm) is amended by striking subsection of law, no criminal or civil penalty may be SEC. 15004. TRANSITIONAL RULES FOR CURRENT (f). imposed at any time under this subpara- MEDICARE HMO PROGRAM. (2) CONFORMING AMENDMENTS.—Section 1876 graph and no legal action may be brought or (a) TRANSITION FROM CURRENT CON- is further amended— continued at any time in any Federal or TRACTS.— (A) in subsection (c)(3)(A)(i), by striking State court if the penalty or action is based (1) LIMITATION ON NEW CONTRACTS.— ‘‘would result in failure to meet the require- on an act or omission that occurred after No- (A) NO NEW RISK-SHARING CONTRACTS AFTER ments of subsection (f) or’’, and vember 5, 1991, and before the date of the en- NEW STANDARDS ESTABLISHED.—The Sec- (B) in subsection (i)(1)(C), by striking ‘‘(e), actment of this clause, and relates to the retary of Health and Human Services (in this and (f)’’ and inserting ‘‘and (e)’’. section referred to as the ‘‘Secretary’’) shall sale, issuance, or renewal of any health in- (3) EFFECTIVE DATE.—The amendments not enter into any risk-sharing contract surance policy during such period, if such made by this section shall apply to contract under section 1876 of the Social Security Act policy meets the requirements of clause (iv) years beginning on or after January 1, 1996. or (v). with an eligible organization for any con- ‘‘(vii) A State may not impose, with re- tract year beginning on or after the date PART 2—SPECIAL RULES FOR spect to the sale or issuance of a policy (or standards for MedicarePlus organizations MEDICAREPLUS MEDICAL SAVINGS AC- rider) that meets the requirements of this and products are first established under sec- COUNTS title pursuant to clause (iv) or (v) to an indi- tion 1856(a) of such Act with respect to SEC. 15011. MEDICAREPLUS MSA’S. vidual entitled to benefits under part A or MedicarePlus organizations that are insurers (a) IN GENERAL.—Part III of subchapter B enrolled under part B or enrolled under a or health maintenance organizations unless of chapter 1 of the Internal Revenue Code of MedicarePlus product under part C, any re- such a contract had been in effect under sec- 1986 (relating to amounts specifically ex- quirement based on the premise that such a tion 1876 of such Act for the organization for cluded from gross income) is amended by re- policy or rider duplicates health benefits to the previous contract year. designating section 137 as section 138 and by which the individual is otherwise entitled (B) NO NEW COST REIMBURSEMENT CON- inserting after section 136 the following new under this title.’’. TRACTS.—The Secretary shall not enter into section: (2) CONFORMING AMENDMENTS.—Section any cost reimbursement contract under sec- ‘‘SEC. 137. MEDICAREPLUS MSA’S. 1882(d)(3) (42 U.S.C. 1395ss(d)(3)) is amended— tion 1876 of the Social Security Act begin- ‘‘(a) EXCLUSION.—Gross income shall not (A) in subparagraph (B), by inserting ‘‘(in- ning for any contract year beginning on or include any payment to the MedicarePlus cluding any MedicarePlus product)’’ after after the date of the enactment of this Act. MSA of an individual by the Secretary of ‘‘health insurance policies’’; (2) TERMINATION OF CURRENT CONTRACTS.— Health and Human Services under section (B) in subparagraph (C)— (A) RISK-SHARING CONTRACTS.—Notwith- 1855(f)(1)(B) of the Social Security Act. (i) by striking ‘‘with respect to (i)’’ and in- standing any other provision of law, the Sec- ‘‘(b) MEDICAREPLUS MSA.—For purposes of serting ‘‘with respect to’’, and retary shall not extend or continue any risk- this section— (ii) by striking ‘‘, (ii) the sale’’ and all that sharing contract with an eligible organiza- ‘‘(1) MEDICAREPLUS MSA.—The term follows up to the period at the end; and tion under section 1876 of the Social Security ‘MedicarePlus MSA’ means a trust created (C) by striking subparagraph (D). Act (for which a contract was entered into or organized in the United States exclusively (3) MEDICAREPLUS PRODUCTS NOT TREATED consistent with paragraph (1)(A)) for any for the purpose of paying the qualified medi- AS MEDICARE SUPPLEMENTARY POLICIES.—Sec- contract year beginning on or after 1 year cal expenses of the account holder, but only tion 1882(g) (42 U.S.C. 1395ss(g)) is amended after the date standards described in para- if the written governing instrument creating by inserting ‘‘a MedicarePlus product or’’ graph (1)(A) are established. the trust meets the following requirements: after ‘‘and does not include’’ (B) COST REIMBURSEMENT CONTRACTS.—The ‘‘(A) Except in the case of a trustee-to- (4) REPORT ON DUPLICATION AND COORDINA- Secretary shall not extend or continue any trustee transfer described in subsection TION OF HEALTH INSURANCE POLICIES THAT ARE reasonable cost reimbursement contract (d)(4), no contribution will be accepted un- NOT MEDICARE SUPPLEMENTAL POLICIES.—Not with an eligible organization under section less it is made by the Secretary of Health later than 3 years after the date of the enact- 1876 of the Social Security Act for any con- and Human Services under section ment of this Act, the Secretary of Health tract year beginning on or after January 1, 1855(f)(1)(B) of the Social Security Act. and Human Services shall prepare and sub- 1998. ‘‘(B) The trustee is a bank (as defined in mit to Congress a report on the advisability (b) CONFORMING PAYMENT RATES.— section 408(n)), an insurance company (as de- and feasibility of restricting the sale to med- (1) RISK-SHARING CONTRACTS.—Notwith- fined in section 816), or another person who icare beneficiaries of health insurance poli- standing any other provision of law, the Sec- demonstrates to the satisfaction of the Sec- cies that duplicate (within the meaning of retary shall provide that payment amounts retary that the manner in which such person section 1882(d)(3)(A) of the Social Security under risk-sharing contracts under section will administer the trust will be consistent Act) other health insurance policies that 1876(a) of the Social Security Act for months with the requirements of this section. such a beneficiary may have. In preparing in a year (beginning with January 1996) shall ‘‘(C) No part of the trust assets will be in- such report, the Secretary shall seek the ad- be computed— vested in life insurance contracts. vice of the National Association of Insurance (A) with respect to individuals entitled to ‘‘(D) The assets of the trust will not be Commissioners and shall take into account benefits under both parts A and B of title commingled with other property except in a the standards established under section 1807 XVIII of such Act, by substituting payment common trust fund or common investment of the Social Security Act for the electronic rates under section 1855(a) of such Act for fund. coordination of benefits. the payment rates otherwise established ‘‘(E) The interest of an individual in the (b) ADDITIONAL RULES RELATING TO INDIVID- under section 1876(a) of such Act, and balance in his account is nonforfeitable. UALS ENROLLED IN MEDICAREPLUS PROD- (B) with respect to individuals only enti- ‘‘(F) Trustee-to-trustee transfers described UCTS.—Section 1882 (42 U.S.C. 1395ss) is fur- tled to benefits under part B of such title, by in subsection (d)(4) may be made to and from ther amended by adding at the end the fol- substituting an appropriate proportion of the trust. lowing new subsection: such rates (reflecting the relative proportion ‘‘(2) QUALIFIED MEDICAL EXPENSES.— ‘‘(u)(1) Notwithstanding the previous provi- of payments under such title attributable to ‘‘(A) IN GENERAL.—The term ‘qualified sions of this section, the following provisions such part) for the payment rates otherwise medical expenses’ means, with respect to an shall not apply to a health insurance policy established under section 1876(a) of such Act. account holder, amounts paid by such hold- (other than a medicare supplemental policy) For purposes of carrying out this paragraph er— provided to an individual who has elected the for payment for months in 1996, the Sec- ‘‘(i) for medical care (as defined in section MedicarePlus option under section 1805: retary shall compute, announce, and apply 213(d)) for the account holder, but only to ‘‘(A) Subsections (o)(1), (o)(2), (p)(1)(A)(i), the payment rates under section 1855(a) of the extent such amounts are not com- (p)(2), (p)(3), (p)(8), and (p)(9) (insofar as they such Act (notwithstanding any deadlines pensated for by insurance or otherwise, or October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10403 ‘‘(ii) for long-term care insurance for the MedicarePlus MSA to the Secretary of of chapter 11 of such Code is amended by add- account holder. Health and Human Services of an erroneous ing at the end the following new section: ‘‘(B) HEALTH INSURANCE MAY NOT BE PUR- contribution to such MSA and of the net in- ‘‘SEC. 2057. MEDICAREPLUS MSA’S. CHASED FROM ACCOUNT.—Subparagraph (A)(i) come attributable to such contribution. ‘‘For purposes of the tax imposed by sec- shall not apply to any payment for insur- ‘‘(4) TRUSTEE-TO-TRUSTEE TRANSFERS.— tion 2001, the value of the taxable estate ance. Paragraphs (1) and (2) shall not apply to any shall be determined by deducting from the ‘‘(3) ACCOUNT HOLDER.—The term ‘account trustee-to-trustee transfer from a value of the gross estate an amount equal to holder’ means the individual on whose behalf MedicarePlus MSA of an account holder to the value of any MedicarePlus MSA (as de- the MedicarePlus MSA is maintained. another MedicarePlus MSA of such account fined in section 137(b)) included in the gross ‘‘(4) CERTAIN RULES TO APPLY.—Rules simi- holder. estate.’’ lar to the rules of subsections (g) and (h) of ‘‘(5) COORDINATION WITH MEDICAL EXPENSE (c) TAX ON PROHIBITED TRANSACTIONS.— section 408 shall apply for purposes of this DEDUCTION.—For purposes of section 213, any (1) Section 4975 of such Code (relating to section. payment or distribution out of a tax on prohibited transactions) is amended ‘‘(c) TAX TREATMENT OF ACCOUNTS.— MedicarePlus MSA for qualified medical ex- by adding at the end of subsection (c) the fol- ‘‘(1) IN GENERAL.—A MedicarePlus MSA is penses shall not be treated as an expense lowing new paragraph: exempt from taxation under this subtitle un- paid for medical care. PECIAL RULE FOR MEDICAREPLUS less such MSA has ceased to be a ‘‘(e) TREATMENT OF ACCOUNT AFTER DEATH ‘‘(4) S MedicarePlus MSA by reason of paragraph OF ACCOUNT HOLDER.— MSA’S.—An individual for whose benefit a (2). Notwithstanding the preceding sentence, ‘‘(1) TREATMENT IF DESIGNATED BENEFICIARY MedicarePlus MSA (within the meaning of any such MSA is subject to the taxes im- IS SPOUSE.— section 137(b)) is established shall be exempt posed by section 511 (relating to imposition ‘‘(A) IN GENERAL.—In the case of an ac- from the tax imposed by this section with re- of tax on unrelated business income of chari- count holder’s interest in a MedicarePlus spect to any transaction concerning such ac- table, etc. organizations). MSA which is payable to (or for the benefit count (which would otherwise be taxable ‘‘(2) ACCOUNT ASSETS TREATED AS DISTRIB- of) such holder’s spouse upon the death of under this section) if, with respect to such UTED IN THE CASE OF PROHIBITED TRANS- such holder, such MedicarePlus MSA shall be transaction, the account ceases to be a ACTIONS OR ACCOUNT PLEDGED AS SECURITY treated as a MedicarePlus MSA of such MedicarePlus MSA by reason of the applica- FOR LOAN.—Rules similar to the rules of spouse as of the date of such death. tion of section 137(c)(2) to such account.’’ paragraphs (2) and (4) of section 408(e) shall ‘‘(B) SPECIAL RULES IF SPOUSE NOT MEDI- (2) Paragraph (1) of section 4975(e) of such apply to MedicarePlus MSA’s, and any CARE ELIGIBLE.—If, as of the date of such Code is amended to read as follows: amount treated as distributed under such death, such spouse is not entitled to benefits ‘‘(1) PLAN.—For purposes of this section, rules shall be treated as not used to pay under title XVIII of the Social Security Act, the term ‘plan’ means— qualified medical expenses. then after the date of such death— ‘‘(A) a trust described in section 401(a) ‘‘(d) TAX TREATMENT OF DISTRIBUTIONS.— ‘‘(i) the Secretary of Health and Human which forms a part of a plan, or a plan de- ‘‘(1) INCLUSION OF AMOUNTS NOT USED FOR Services may not make any payments to scribed in section 403(a), which trust or plan QUALIFIED MEDICAL EXPENSES.—No amount such MedicarePlus MSA, other than pay- is exempt from tax under section 501(a), shall be included in the gross income of the ments attributable to periods before such ‘‘(B) an individual retirement account de- account holder by reason of a payment or date, scribed in section 408(a), distribution from a MedicarePlus MSA ‘‘(ii) in applying subsection (b)(2) with re- ‘‘(C) an individual retirement annuity de- which is used exclusively to pay the qualified spect to such MedicarePlus MSA, references scribed in section 408(b), medical expenses of the account holder. Any to the account holder shall be treated as in- ‘‘(D) a medical savings account described amount paid or distributed from a cluding references to any dependent (as de- in section 220(d), MedicarePlus MSA which is not so used shall fined in section 152) of such spouse and any ‘‘(E) a MedicarePlus MSA described in sec- be included in the gross income of such hold- subsequent spouse of such spouse, and tion 137(b), or er. ‘‘(iii) in lieu of applying subsection (d)(2), ‘‘(F) a trust, plan, account, or annuity ‘‘(2) PENALTY FOR DISTRIBUTIONS NOT USED the rules of section 220(f)(2) shall apply. which, at any time, has been determined by FOR QUALIFIED MEDICAL EXPENSES IF MINIMUM ‘‘(2) TREATMENT IF DESIGNATED BENEFICIARY the Secretary to be described in any preced- BALANCE NOT MAINTAINED.— IS NOT SPOUSE.—In the case of an account ing subparagraph of this paragraph.’’ ‘‘(A) IN GENERAL.—The tax imposed by this holder’s interest in a MedicarePlus MSA (d) FAILURE TO PROVIDE REPORTS ON chapter for any taxable year in which there which is payable to (or for the benefit of) any MEDICAREPLUS MSA’S.— is a payment or distribution from a person other than such holder’s spouse upon (1) Subsection (a) of section 6693 of such MedicarePlus MSA which is not used exclu- the death of such holder— Code (relating to failure to provide reports sively to pay the qualified medical expenses ‘‘(A) such account shall cease to be a on individual retirement accounts or annu- of the account holder shall be increased by 50 MedicarePlus MSA as of the date of death, ities) is amended to read as follows: percent of the excess (if any) of— and ‘‘(a) REPORTS.— ‘‘(i) the amount of such payment or dis- ‘‘(B) an amount equal to the fair market ‘‘(1) IN GENERAL.—If a person required to tribution, over value of the assets in such account on such file a report under a provision referred to in ‘‘(ii) the excess (if any) of— date shall be includible— paragraph (2) fails to file such report at the ‘‘(I) the fair market value of the assets in ‘‘(i) if such person is not the estate of such time and in the manner required by such the MedicarePlus MSA as of the close of the holder, in such person’s gross income for the provision, such person shall pay a penalty of calendar year preceding the calendar year in taxable year which includes such date, or $50 for each failure unless it is shown that which the taxable year begins, over ‘‘(ii) if such person is the estate of such such failure is due to reasonable cause. ‘‘(II) an amount equal to 60 percent of the holder, in such holder’s gross income for last ‘‘(2) PROVISIONS.—The provisions referred deductible under the high deductible/ taxable year of such holder. to in this paragraph are— medisave product covering the account hold- ‘‘(f) REPORTS.— ‘‘(A) subsections (i) and (l) of section 408 er as of January 1 of the calendar year in ‘‘(1) IN GENERAL.—The trustee of a (relating to individual retirement plans), which the taxable year begins. MedicarePlus MSA shall make such reports ‘‘(B) section 220(h) (relating to medical ‘‘(B) EXCEPTIONS.—Subparagraph (A) shall regarding such account to the Secretary and savings accounts), and not apply if the payment or distribution is to the account holder with respect to— ‘‘(C) section 137(f) (relating to made on or after the date the account hold- ‘‘(A) the fair market value of the assets in MedicarePlus MSA’s).’’ er— such MedicarePlus MSA as of the close of (2) The section heading for section 6693 of ‘‘(i) becomes disabled within the meaning each calendar year, and such Code is amended to read as follows: of section 72(m)(7), or ‘‘(B) contributions, distributions, and ‘‘SEC. 6693. FAILURE TO FILE REPORTS ON INDI- ‘‘(ii) dies. other matters, VIDUAL RETIREMENT PLANS AND ‘‘(C) SPECIAL RULES.—For purposes of sub- as the Secretary may require by regulations. CERTAIN OTHER TAX-FAVORED AC- paragraph (A)— ‘‘(2) TIME AND MANNER OF REPORTS.—The COUNTS; PENALTIES RELATING TO ‘‘(i) all MedicarePlus MSA’s of the account reports required by this subsection— DESIGNATED NONDEDUCTIBLE CON- holder shall be treated as 1 account, ‘‘(A) shall be filed at such time and in such TRIBUTIONS.’’ ‘‘(ii) all payments and distributions not manner as the Secretary prescribes in such (e) CLERICAL AMENDMENTS.— used exclusively to pay the qualified medical regulations, and (1) The table of sections for part III of sub- expenses of the account holder during any ‘‘(B) shall be furnished to the account hold- chapter B of chapter 1 of such Code is amend- taxable year shall be treated as 1 distribu- er— ed by striking the last item and inserting tion, and ‘‘(i) not later than January 31 of the cal- the following: ‘‘(iii) any distribution of property shall be endar year following the calendar year to ‘‘Sec. 137. MedicarePlus MSA’s. taken into account at its fair market value which such reports relate, and ‘‘Sec. 138. Cross references to other Acts.’’ on the date of the distribution. ‘‘(ii) in such manner as the Secretary pre- ‘‘(3) WITHDRAWAL OF ERRONEOUS CONTRIBU- scribes in such regulations.’’ (2) The table of sections for part 1 of sub- TIONS.—Paragraphs (1) and (2) shall not apply (b) EXCLUSION OF MEDICAREPLUS MSA’S chapter B of chapter 68 of such Code is to any payment or distribution from a FROM ESTATE TAX.—Part IV of subchapter A amended by striking the item relating to H 10404 CONGRESSIONAL RECORD — HOUSE October 19, 1995

section 6693 and inserting the following new (5) MEDICAREPLUS PSO PRODUCT.—The term PART 4—COMMISSIONS item: ‘‘MedicarePlus PSO product’’ means a SEC. 15031. MEDICARE PAYMENT REVIEW COM- ‘‘Sec. 6693. Failure to file reports on individ- MedicarePlus product offered by a provider- MISSION. ual retirement plans and cer- sponsored organization under part C of title (a) IN GENERAL.—Title XVIII, as amended tain other tax-favored ac- XVIII of the Social Security Act. by section 15001(a), is amended by inserting counts; penalties relating to (6) PROVIDER SERVICE NETWORK.—The term after section 1805 the following new section: designated nondeductible con- ‘‘provider service network’’ means an organi- ‘‘MEDICARE PAYMENT REVIEW COMMISSION tributions.’’ zation that— ‘‘SEC. 1806. (a) ESTABLISHMENT.—There is (3) The table of sections for part IV of sub- (A) is organized by, operated by, and com- hereby established the Medicare Payment chapter A of chapter 11 of such Code is posed of members who are health care pro- Review Commission (in this section referred amended by adding at the end the following viders and for purposes that include provid- to as the ‘Commission’). ‘‘(b) DUTIES.— new item: ing health care services, (B) is funded in part by capital contribu- ‘‘(1) GENERAL DUTIES AND REPORTS.— ‘‘Sec. 2057. MedicarePlus MSA’s.’’ tions made by the members of such organiza- ‘‘(A) IN GENERAL.—The Commission shall review, and make recommendations to Con- (f) EFFECTIVE DATE.—The amendments tion, gress concerning, payment policies under made by this section shall apply to taxable (C) with respect to each contract made by this title. years beginning after December 31, 1996. such organization for the purpose of provid- ‘‘(B) ANNUAL REPORTS.—By not later than SEC. 15012. CERTAIN REBATES EXCLUDED FROM ing a type of health care service to individ- GROSS June 1 of each year, the Commission shall INCOME. uals under the terms of a MedicarePlus PSO submit a report to Congress containing an (a) IN GENERAL.—Section 105 of the Inter- product— examination of issues affecting the medicare nal Revenue Code of 1986 (relating to (i) requires all members of such organiza- program, including the implications of amounts received under accident and health tion who engage in providing such type of changes in health care delivery in the United plans) is amended by adding at the end the health care service to agree to provide States and in the market for health care following new subsection: health care services of such type under such services on the medicare program. ‘‘(j) CERTAIN REBATES UNDER SOCIAL SECU- contract, ‘‘(C) ADDITIONAL REPORTS.—The Commis- RITY ACT.—Gross income does not include (ii) receives the compensation paid for the sion may submit to Congress from time to any rebate received under section health care services of such type provided time such other reports as the Commission 1852(e)(1)(A) of the Social Security Act dur- under such contract by such members, and deems appropriate. By not later than May 1, ing the taxable year.’’ (iii) provides for the distribution of such 1997, the Commission shall submit to Con- (b) EFFECTIVE DATE.—The amendment compensation, gress a report on the matter described in made by subsection (a) shall apply to paragraph (2)(G). amounts received after the date of the enact- (D) has established, consistent with the re- ‘‘(D) SECRETARIAL RESPONSE IN RULE- ment of this Act. quirements of the MedicarePlus program for MAKING.—The Secretary shall respond to rec- PART 3—SPECIAL ANTITRUST RULE FOR provider-sponsored organizations, a program to review, pursuant to written guidelines, ommendations of the Commission in notices PROVIDER SERVICE NETWORKS of rulemaking proceedings under this title. the quality, efficiency, and appropriateness SEC. 15021. APPLICATION OF ANTITRUST RULE ‘‘(2) SPECIFIC DUTIES RELATING TO of treatment methods and setting of services OF REASON TO PROVIDER SERVICE MEDICAREPLUS PROGRAM.—Specifically, the for all health care providers and all patients NETWORKS. Commission shall review, with respect to the (a) RULE OF REASON STANDARD.—In any ac- participating in such product, along with in- MedicarePlus program under part C— tion under the antitrust laws, or under any ternal procedures to correct identified defi- ‘‘(A) the appropriateness of the methodol- State law similar to the antitrust laws— ciencies relating to such methods and such ogy for making payment to plans under such (1) the conduct of a provider service net- services, program, including the making of differen- work in negotiating, making, or performing (E) has established, consistent with the re- tial payments and the distribution of dif- a contract (including the establishment and quirements of the MedicarePlus program for ferential updates among different payment modification of a fee schedule and the devel- provider-sponsored organizations, a program areas); opment of a panel of physicians), to the ex- to monitor and control utilization of health ‘‘(B) the appropriateness of the mecha- tent such contract is for the purpose of pro- care services provided under such product, nisms used to adjust payments for risk and viding health care services to individuals the need to adjust such mechanisms to take under the terms of a MedicarePlus PSO prod- for the purpose of improving efficient, appro- into account health status of beneficiaries; uct, and priate care and eliminating the provision of (2) the conduct of any member of such net- unnecessary health care services, ‘‘(C) the implications of risk selection both work for the purpose of providing such (F) has established a management program among MedicarePlus organizations and be- health care services under such contract to to coordinate the delivery of health care tween the MedicarePlus option and the non- such extent, services for all health care providers and all MedicarePlus option; shall not be deemed illegal per se. Such con- patients participating in such product, for ‘‘(D) in relation to payment under part C, duct shall be judged on the basis of its rea- the purpose of achieving efficiencies and en- the development and implementation of mechanisms to assure the quality of care for sonableness, taking into account all relevant hancing the quality of health care services those enrolled with MedicarePlus organiza- factors affecting competition, including the provided, and tions; effects on competition in properly defined (G) has established, consistent with the re- ‘‘(E) the impact of the MedicarePlus pro- markets. quirements of the MedicarePlus program for (b) DEFINITIONS.—For purposes of sub- gram on access to care for medicare bene- provider-sponsored organizations, a griev- section (a): ficiaries; ance and appeal process for such organiza- (1) ANTITRUST LAWS.—The term ‘‘antitrust ‘‘(F) the feasibility and desirability of ex- laws’’ has the meaning given it in subsection tion designed to review and promptly resolve tending the rules for open enrollment that (a) of the first section of the Clayton Act (15 beneficiary or patient grievances and com- apply during the transition period to apply U.S.C. 12), except that such term includes plaints. in each county during the first 2 years in section 5 of the Federal Trade Commission Such term may include a provider-sponsored which MedicarePlus products are made Act (15 U.S.C. 45) to the extent that such sec- organization. available to individuals residing in the coun- tion 5 applies to unfair methods of competi- (7) PROVIDER-SPONSORED ORGANIZATION.— ty; and tion. The term ‘‘provider-sponsored organization’’ ‘‘(G) other major issues in implementation (2) HEALTH CARE PROVIDER.—The term means a MedicarePlus organization under and further development of the MedicarePlus ‘‘health care provider’’ means any individual the MedicarePlus program that is a provider- program. or entity that is engaged in the delivery of sponsored organization (as defined in section ‘‘(3) SPECIFIC DUTIES RELATING TO THE health care services in a State and that is re- ll of the Social Security Act). FAILSAFE BUDGET MECHANISM.—Specifically, quired by State law or regulation to be li- (8) STATE.—The term ‘‘State’’ has the the Commission shall review, with respect to censed or certified by the State to engage in meaning given it in section 4G(2) of the Clay- the failsafe budget mechanism described in the delivery of such services in the State. ton Act (15 U.S.C. 15g(2)). section 1895— (3) HEALTH CARE SERVICE.—The term ‘‘(A) the appropriateness of the expendi- ‘‘health care service’’ means any service for (c) ISSUANCE OF GUIDELINES.—Not later ture projections by the Secretary under sec- which payment may be made under a than 120 days after the date of the enactment tion 1895(c) for each medicare sector; MedicarePlus PSO product including serv- of this Act, the Attorney General and the ‘‘(B) the appropriateness of the growth fac- ices related to the delivery or administra- Federal Trade Commission shall issue joint- tors for each sector and the ability to take tion of such service. ly guidelines specifying the enforcement into account substitution across sectors; (4) MEDICAREPLUS PROGRAM.—The term policies and analytical principles that will ‘‘(C) the appropriateness of the mecha- ‘‘MedicarePlus program’’ means the program be applied by the Department of Justice and nisms for implementing reductions in pay- under part C of title XVIII of the Social Se- the Commission with respect to the oper- ment amounts for different sectors, includ- curity Act. ation of subsection (a). ing any adjustments to reflect changes in October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10405

volume or intensity resulting for any pay- lar place of business, a member may be al- ‘‘(4) PERIODIC AUDIT.—The Commission ment reductions; lowed travel expenses, as authorized by the shall be subject to periodic audit by the Gen- ‘‘(D) the impact of the mechanism on pro- Chairman of the Commission. Physicians eral Accounting Office. vider participation in parts A and B and in serving as personnel of the Commission may ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— the MedicarePlus program; and be provided a physician comparability allow- ‘‘(1) REQUEST FOR APPROPRIATIONS.—The ‘‘(E) the appropriateness of the medicare ance by the Commission in the same manner Commission shall submit requests for appro- benefit budget (under section 1895(c)(2)(C) of as Government physicians may be provided priations in the same manner as the Comp- the Social Security Act), particularly for fis- such an allowance by an agency under sec- troller General submits requests for appro- cal years after fiscal year 2002. tion 5948 of title 5, United States Code, and priations, but amounts appropriated for the ‘‘(4) SPECIFIC DUTIES RELATING TO THE FEE- for such purpose subsection (i) of such sec- Commission shall be separate from amounts FOR-SERVICE SYSTEM.—Specifically, the Com- tion shall apply to the Commission in the appropriated for the Comptroller General. mission shall review payment policies under same manner as it applies to the Tennessee ‘‘(2) AUTHORIZATION.—There are authorized parts A and B, including— Valley Authority. For purposes of pay (other to be appropriated such sums as may be nec- ‘‘(A) the factors affecting expenditures for than pay of members of the Commission) and essary to carry out the provisions of this sec- services in different sectors, including the employment benefits, rights, and privileges, tion. 60 percent of such appropriation shall process for updating hospital, physician, and all personnel of the Commission shall be be payable from the Federal Hospital Insur- other fees, treated as if they were employees of the ance Trust Fund, and 40 percent of such ap- ‘‘(B) payment methodologies; and United States Senate. propriation shall be payable from the Fed- ‘‘(C) the impact of payment policies on ac- ‘‘(6) CHAIRMAN; VICE CHAIRMAN.—The Comp- eral Supplementary Medical Insurance Trust cess and quality of care for medicare bene- troller General shall designate a member of Fund.’’. ficiaries. the Commission, at the time of appointment (b) ABOLITION OF PROPAC AND PPRC.— (1) PROPAC.— ‘‘(5) SPECIFIC DUTIES RELATING TO INTER- of the member, as Chairman and a member (A) IN GENERAL.—Section 1886(e) (42 U.S.C. ACTION OF PAYMENT POLICIES WITH HEALTH as Vice Chairman for that term of appoint- 1395ww(e)) is amended— CARE DELIVERY GENERALLY.—Specifically the ment. (i) by striking paragraphs (2) and (6); and Commission shall review the effect of pay- ‘‘(7) MEETINGS.—The Commission shall (ii) in paragraph (3), by striking ‘‘(A) The ment policies under this title on the delivery meet at the call of the Chairman. of health care services under this title and Commission’’ and all that follows through ‘‘(d) DIRECTOR AND STAFF; EXPERTS AND assess the implications of changes in the ‘‘(B)’’. CONSULTANTS.—Subject to such review as the health services market on the medicare pro- (B) CONFORMING AMENDMENT.—Section 1862 Comptroller General deems necessary to as- gram. (42 U.S.C. 1395y) is amended by striking sure the efficient administration of the Com- ‘‘(c) MEMBERSHIP.— ‘‘Prospective Payment Assessment Commis- mission, the Commission may— ‘‘(1) NUMBER AND APPOINTMENT.—The Com- sion’’ each place it appears in subsection mission shall be composed of 15 members ap- ‘‘(1) employ and fix the compensation of an (a)(1)(D) and subsection (i) and inserting pointed by the Comptroller General. Executive Director (subject to the approval ‘‘Medicare Payment Review Commission’’. ‘‘(2) QUALIFICATIONS.—The membership of of the Comptroller General) and such other (2) PPRC.— the Commission shall include individuals personnel as may be necessary to carry out (A) IN GENERAL.—Title XVIII is amended with national recognition for their expertise its duties (without regard to the provisions by striking section 1845 (42 U.S.C. 1395w–1). in health finance and economics, actuarial of title 5, United States Code, governing ap- (B) CONFORMING AMENDMENTS.— science, health facility management, health pointments in the competitive service); (i) Section 1834(b)(2) (42 U.S.C. 1395m(b)(2)) plans and integrated delivery systems, reim- ‘‘(2) seek such assistance and support as is amended by striking ‘‘Physician Payment bursement of health facilities, allopathic and may be required in the performance of its du- Review Commission’’ and inserting ‘‘Medi- osteopathic physicians, and other providers ties from appropriate Federal departments care Payment Review Commission’’. of services, and other related fields, who pro- and agencies; (ii) Section 1842(b) (42 U.S.C. 1395u(b)) is vide a mix of different professionals, broad ‘‘(3) enter into contracts or make other ar- amended by striking ‘‘Physician Payment geographic representation, and a balance be- rangements, as may be necessary for the Review Commission’’ each place it appears tween urban and rural representatives, in- conduct of the work of the Commission in paragraphs (9)(D) and (14)(C)(i) and insert- cluding physicians and other health profes- (without regard to section 3709 of the Re- ing ‘‘Medicare Payment Review Commis- sionals, employers, third party payors, indi- vised Statutes (41 U.S.C. 5)); sion’’. viduals skilled in the conduct and interpre- ‘‘(4) make advance, progress, and other (iii) Section 1848 (42 U.S.C. 1395w–4) is tation of biomedical, health services, and payments which relate to the work of the amended by striking ‘‘Physician Payment health economics research and expertise in Commission; Review Commission’’ and inserting ‘‘Medi- outcomes and effectiveness research and ‘‘(5) provide transportation and subsistence care Payment Review Commission’’ each technology assessment. Such membership for persons serving without compensation; place it appears in paragraph (2)(A)(ii), shall also include representatives of consum- and (2)(B)(iii), and (5) of subsection (c), sub- ers and the elderly. ‘‘(6) prescribe such rules and regulations as section (d)(2)(F), paragraphs (1)(B), (3), and ‘‘(3) CONSIDERATIONS IN INITIAL APPOINT- it deems necessary with respect to the inter- (4)(A) of subsection (f), and paragraphs (6)(C) MENT.—To the extent possible, in first ap- nal organization and operation of the Com- and (7)(C) of subsection (g). pointing members to the Commission the mission. (c) EFFECTIVE DATE; TRANSITION.— Comptroller General shall consider appoint- ‘‘(e) POWERS.— (1) IN GENERAL.—The Comptroller General ing individuals who (as of the date of the en- ‘‘(1) OBTAINING OFFICIAL DATA.—The Com- shall first provide for appointment of mem- actment of this section) were serving on the mission may secure directly from any de- bers to the Medicare Payment Review Com- Prospective Payment Assessment Commis- partment or agency of the United States in- mission (in this subsection referred to as sion or the Physician Payment Review Com- formation necessary to enable it to carry out ‘‘MPRC’’) by not later than March 31, 1996. mission. this section. Upon request of the Chairman, (2) TRANSITION.—Effective on a date (not ‘‘(4) TERMS.— the head of that department or agency shall later than 30 days after the date a majority ‘‘(A) IN GENERAL.—The terms of members furnish that information to the Commission of members of the MPRC have first been ap- of the Commission shall be for 3 years except on an agreed upon schedule. pointed, the Prospective Payment Assess- that the Comptroller General shall designate ‘‘(2) DATA COLLECTION.—In order to carry ment Commission (in this subsection re- staggered terms for the members first ap- out its functions, the Commission shall col- ferred to as ‘‘ProPAC’’) and the Physician pointed. lect and assess information to— Payment Review Commission (in this sub- ‘‘(B) VACANCIES.—Any member appointed ‘‘(A) utilize existing information, both pub- section referred to as ‘‘PPRC’’), and amend- to fill a vacancy occurring before the expira- lished and unpublished, where possible, col- ments made by subsection (b), are termi- tion of the term for which the member’s lected and assessed either by its own staff or nated. The Comptroller General, to the max- predecessor was appointed shall be appointed under other arrangements made in accord- imum extent feasible, shall provide for the only for the remainder of that term. A mem- ance with this section, transfer to the MPRC of assets and staff of ber may serve after the expiration of that ‘‘(B) carry out, or award grants or con- ProPAC and PPRC, without any loss of bene- member’s term until a successor has taken tracts for, original research and experimen- fits or seniority by virtue of such transfers. office. A vacancy in the Commission shall be tation, where existing information is inad- Fund balances available to the ProPAC or filled in the manner in which the original ap- equate, and PPRC for any period shall be available to the pointment was made. ‘‘(C) adopt procedures allowing any inter- MPRC for such period for like purposes. ‘‘(5) COMPENSATION.—While serving on the ested party to submit information for the (3) CONTINUING RESPONSIBILITY FOR RE- business of the Commission (including trav- Commission’s use in making reports and rec- PORTS.—The MPRC shall be responsible for eltime), a member of the Commission shall ommendations. the preparation and submission of reports re- be entitled to compensation at the per diem ‘‘(3) ACCESS OF GAO TO INFORMATION.—The quired by law to be submitted (and which equivalent of the rate provided for level IV of Comptroller General shall have unrestricted have not been submitted by the date of es- the Executive Schedule under section 5315 of access to all deliberations, records, and data tablishment of the MPRC) by the ProPAC title 5, United States Code; and while so of the Commission, immediately upon re- and PPRC, and, for this purpose, any ref- serving away from home and member’s regu- quest. erence in law to either such Commission is H 10406 CONGRESSIONAL RECORD — HOUSE October 19, 1995 deemed, after the appointment of the MPRC, necessary expenses incurred in carrying out cost of personnel detailed from the Govern- to refer to the MPRC. the duties of the Commission. ment Printing Office, the Commission shall SEC. 15032. COMMISSION ON THE EFFECT OF THE (d) STAFF AND CONSULTANTS.— be deemed to be a committee of the Con- BABY BOOM GENERATION ON THE (1) STAFF.—The Commission may appoint gress. MEDICARE PROGRAM. and determine the compensation of such (f) REPORT.—Not later than May 1, 1997, the (a) ESTABLISHMENT.—There is established a staff as may be necessary to carry out the Commission shall submit to Congress a re- commission to be known as the Commission duties of the Commission. Such appoint- port containing its findings and rec- on the Effect of the Baby Boom Generation ments and compensation may be made with- ommendations regarding how to protect and on the Medicare Program (in this section re- out regard to the provisions of title 5, United preserve the medicare program in a finan- ferred to as the ‘‘Commission’’). States Code, that govern appointments in cially solvent manner until 2030 (or, if later, (b) DUTIES.— the competitive services, and the provisions throughout the period of projected solvency (1) IN GENERAL.—The Commission shall— of chapter 51 and subchapter III of chapter 53 of the Federal Old-Age and Survivors Insur- (A) examine the financial impact on the of such title that relate to classifications ance Trust Fund). The report shall include medicare program of the significant increase and the General Schedule pay rates. detailed recommendations for appropriate in the number of medicare eligible individ- (2) CONSULTANTS.—The Commission may legislative initiatives respecting how to ac- uals which will occur beginning approxi- procure such temporary and intermittent complish this objective. mately during 2010 and lasting for approxi- services of consultants under section 3109(b) (g) TERMINATION.—The Commission shall mately 25 years, and of title 5, United States Code, as the Com- terminate 60 days after the date of submis- (B) make specific recommendations to the mission determines to be necessary to carry sion of the report required in subsection (f). Congress respecting a comprehensive ap- out the duties of the Commission. proach to preserve the medicare program for (e) POWERS.— (h) AUTHORIZATION OF APPROPRIATIONS.— the period during which such individuals are (1) HEARINGS AND OTHER ACTIVITIES.—For There are authorized to be appropriated eligible for medicare. the purpose of carrying out its duties, the $1,500,000 to carry out this section. Amounts (2) CONSIDERATIONS IN MAKING REC- Commission may hold such hearings and un- appropriated to carry out this section shall OMMENDATIONS.—In making its recommenda- dertake such other activities as the Commis- remain available until expended. tions, the Commission shall consider the fol- sion determines to be necessary to carry out SEC. 15033. CHANGE IN APPOINTMENT OF ADMIN- lowing: its duties. ISTRATOR OF HCFA. (A) The amount and sources of Federal (2) STUDIES BY GAO.—Upon the request of (a) IN GENERAL.—Section 1117 (42 U.S.C. funds to finance the medicare program, in- the Commission, the Comptroller General 1317) is amended by striking ‘‘President by cluding the potential use of innovative fi- shall conduct such studies or investigations and with the advice and consent of the Sen- nancing methods. as the Commission determines to be nec- ate’’ and inserting ‘‘Secretary of Health and (B) The most efficient and effective man- essary to carry out its duties. Human Services’’. ner of administering the program, including (3) COST ESTIMATES BY CONGRESSIONAL (b) EFFECTIVE DATE.—The amendment the appropriateness of continuing the appli- BUDGET OFFICE.— made by subsection (a) shall take effect on cation of the failsafe budget mechanism (A) Upon the request of the Commission, the date of the enactment of this Act and under section 1895 of the Social Security Act the Director of the Congressional Budget Of- shall apply to Administrators appointed on for fiscal years after fiscal year 2002 and the fice shall provide to the Commission such or after the date of the enactment of this appropriate long-term growth rates for con- cost estimates as the Commission deter- Act. tributions electing coverage under mines to be necessary to carry out its duties. MedicarePlus under part C of title XVIII of (B) The Commission shall reimburse the PART 5—TREATMENT OF HOSPITALS such Act. Director of the Congressional Budget Office WHICH PARTICIPATE IN PROVIDER- (C) Methods used by other nations to re- for expenses relating to the employment in SPONSORED ORGANIZATIONS spond to comparable demographic patterns the office of the Director of such additional SEC. 15041. TREATMENT OF HOSPITALS WHICH in eligibility for health care benefits for el- staff as may be necessary for the Director to PARTICIPATE IN PROVIDER-SPON- derly and disabled individuals. comply with requests by the Commission SORED ORGANIZATIONS. (D) Modifying age-based eligibility to cor- under subparagraph (A). (a) IN GENERAL.—Section 501 of the Inter- respond to changes in age-based eligibility (4) DETAIL OF FEDERAL EMPLOYEES.—Upon nal Revenue Code of 1986 (relating to exemp- under the OASDI program. the request of the Commission, the head of tion from tax on corporations, certain (E) Trends in employment-related health any Federal agency is authorized to detail, trusts, etc.) is amended by redesignating care for retirees, including the use of medi- without reimbursement, any of the personnel subsection (n) as subsection (o) and by in- cal savings accounts and similar financing of such agency to the Commission to assist serting after subsection (m) the following devices. the Commission in carrying out its duties. new subsection: (c) MEMBERSHIP.— Any such detail shall not interrupt or other- ‘‘(n) TREATMENT OF HOSPITALS PARTICIPAT- (1) APPOINTMENT.—The Commission shall wise affect the civil service status or privi- ING IN PROVIDER-SPONSORED ORGANIZA- be composed of 15 members appointed as fol- leges of the Federal employee. TIONS.—An organization shall not fail to be lows: (5) TECHNICAL ASSISTANCE.—Upon the re- treated as organized and operated exclu- (A) The President shall appoint 3 members. quest of the Commission, the head of a Fed- sively for a charitable purpose for purposes (B) The Majority Leader of the Senate eral agency shall provide such technical as- of subsection (c)(3) solely because a hospital shall appoint, after consultation with the sistance to the Commission as the Commis- which is owned and operated by such organi- minority leader of the Senate, 6 members, of sion determines to be necessary to carry out zation participates in a provider-sponsored whom not more than 4 may be of the same its duties. organization (as defined in section 1854(a)(1) political party. (6) USE OF MAILS.—The Commission may of the Social Security Act), whether or not (C) The Speaker of the House of Represent- use the United States mails in the same the provider-sponsored organization is ex- atives shall appoint, after consultation with manner and under the same conditions as empt from tax. For purposes of subsection the minority leader of the House of Rep- Federal agencies and shall, for purposes of (c)(3), any person with a material financial resentatives, 6 members, of whom not more the frank, be considered a commission of interest in such a provider-sponsored organi- than 4 may be of the same political party. Congress as described in section 3215 of title zation shall be treated as a private share- (2) CHAIRMAN AND VICE CHAIRMAN.—The 39, United States Code. holder or individual with respect to the hos- Commission shall elect a Chairman and Vice (7) OBTAINING INFORMATION.—The Commis- pital.’’ Chairman from among its members. sion may secure directly from any Federal (b) EFFECTIVE DATE.—The amendment (3) VACANCIES.—Any vacancy in the mem- agency information necessary to enable it to made by subsection (a) shall take effect on bership of the Commission shall be filled in carry out its duties, if the information may the date of the enactment of this Act. the manner in which the original appoint- be disclosed under section 552 of title 5, Unit- Subtitle B—Preventing Fraud and Abuse ment was made and shall not affect the ed States Code. Upon request of the Chair- power of the remaining members to execute man of the Commission, the head of such PART 1—GENERAL PROVISIONS the duties of the Commission. agency shall furnish such information to the SEC. 15101. INCREASING AWARENESS OF FRAUD (4) QUORUM.—A quorum shall consist of 8 Commission. AND ABUSE. members of the Commission, except that 4 (8) ADMINISTRATIVE SUPPORT SERVICES.— (a) BENEFICIARY OUTREACH EFFORTS.—The members may conduct a hearing under sub- Upon the request of the Commission, the Ad- Secretary of Health and Human Services section (e). ministrator of General Services shall provide (acting through the Administrator of the (5) MEETINGS.—The Commission shall meet to the Commission on a reimbursable basis Health Care Financing Administration and at the call of its Chairman or a majority of such administrative support services as the the Inspector General of the Department of its members. Commission may request. Health and Human Services) shall make on- (6) COMPENSATION AND REIMBURSEMENT OF (9) ACCEPTANCE OF DONATIONS.—The Com- going efforts (through public service an- EXPENSES.—Members of the Commission are mission may accept, use, and dispose of gifts nouncements, publications, and other appro- not entitled to receive compensation for or donations of services or property. priate methods) to alert individuals entitled service on the Commission. Members may be (10) PRINTING.—For purposes of costs relat- to benefits under the medicare program of reimbursed for travel, subsistence, and other ing to printing and binding, including the the existence of fraud and abuse committed October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10407 against the program and the costs to the pro- shall discourage provision of, and not con- ciency that is the basis of a determination gram of such fraud and abuse, and of the ex- sider, information which is frivolous or oth- under paragraph (1) exists; and istence of the toll-free telephone line oper- erwise not relevant or material to the impo- ‘‘(iii) suspension of enrollment of individ- ated by the Secretary to receive information sition of such a sanction. uals under this section after the date the on fraud and abuse committed against the (2) PAYMENT OF PORTION OF AMOUNTS COL- Secretary notifies the organization of a de- program. LECTED.—If an individual reports informa- termination under paragraph (1) and until (b) CLARIFICATION OF REQUIREMENT TO PRO- tion to the Secretary under the program es- the Secretary is satisfied that the deficiency VIDE EXPLANATION OF MEDICARE BENEFITS.— tablished under paragraph (1) which serves as that is the basis for the determination has The Secretary shall provide an explanation the basis for the collection by the Secretary been corrected and is not likely to recur.’’. of benefits under the medicare program with or the Attorney General of any amount of at (3) PROCEDURES FOR IMPOSING SANCTIONS.— respect to each item or service for which least $100 (other than any amount paid as a Section 1876(i) (42 U.S.C. 1395mm(i)) is payment may be made under the program penalty under section 1128B of the Social Se- amended by adding at the end the following which is furnished to an individual, without curity Act), the Secretary may pay a portion new paragraph: regard to whether or not a deductible or co- of the amount collected to the individual ‘‘(9) The Secretary may terminate a con- insurance may be imposed against the indi- (under procedures similar to those applicable tract with an eligible organization under vidual with respect to the item or service. under section 7623 of the Internal Revenue this section or may impose the intermediate (c) PROVIDER OUTREACH EFFORTS; PUBLICA- Code of 1986 to payments to individuals pro- sanctions described in paragraph (6) on the TION OF FRAUD ALERTS.— viding information on violations of such organization in accordance with formal in- (1) SPECIAL FRAUD ALERTS.— Code). vestigation and compliance procedures es- (A) IN GENERAL.— (b) PROGRAM TO COLLECT INFORMATION ON tablished by the Secretary under which— (i) REQUEST FOR SPECIAL FRAUD ALERTS.— PROGRAM EFFICIENCY.— ‘‘(A) the Secretary provides the organiza- Any person may present, at any time, a re- (1) ESTABLISHMENT OF PROGRAM.—Not later tion with the opportunity to develop and im- quest to the Secretary to issue and publish a than 3 months after the date of the enact- plement a corrective action plan to correct special fraud alert. ment of this Act, the Secretary shall estab- the deficiencies that were the basis of the lish a program under which the Secretary (ii) SPECIAL FRAUD ALERT DEFINED.—In this Secretary’s determination under paragraph section, a ‘‘special fraud alert’’ is a notice shall encourage individuals to submit to the (1); which informs the public of practices which Secretary suggestions on methods to im- ‘‘(B) the Secretary shall impose more se- the Secretary considers to be suspect or of prove the efficiency of the medicare pro- vere sanctions on organizations that have a gram. particular concern under the medicare pro- history of deficiencies or that have not (2) PAYMENT OF PORTION OF PROGRAM SAV- gram or a State health care program (as de- taken steps to correct deficiencies the Sec- INGS.—If an individual submits a suggestion fined in section 1128(h) of the Social Security retary has brought to their attention; to the Secretary under the program estab- Act). ‘‘(C) there are no unreasonable or unneces- lished under paragraph (1) which is adopted (B) ISSUANCE AND PUBLICATION OF SPECIAL sary delays between the finding of a defi- by the Secretary and which results in sav- FRAUD ALERTS.— ciency and the imposition of sanctions; and ings to the program, the Secretary may (i) INVESTIGATION.—Upon receipt of a re- ‘‘(D) the Secretary provides the organiza- make a payment to the individual of such quest for a special fraud alert under subpara- tion with reasonable notice and opportunity amount as the Secretary considers appro- graph (A), the Secretary shall investigate for hearing (including the right to appeal an priate. the subject matter of the request to deter- initial decision) before imposing any sanc- mine whether a special fraud alert should be SEC. 15103. INTERMEDIATE SANCTIONS FOR MED- tion or terminating the contract.’’. ICARE HEALTH MAINTENANCE OR- (4) CONFORMING AMENDMENTS.—(A) Section issued. If appropriate, the Secretary (in con- GANIZATIONS. 1876(i)(6)(B) (42 U.S.C. 1395mm(i)(6)(B)) is sultation with the Attorney General) shall (a) APPLICATION OF INTERMEDIATE SANC- amended by striking the second sentence. issue a special fraud alert in response to the TIONS FOR ANY PROGRAM VIOLATIONS.— (B) Section 1876(i)(6) (42 U.S.C. request. All special fraud alerts issued pursu- (1) IN GENERAL.—Section 1876(i)(1) (42 ant to this subparagraph shall be published U.S.C. 1395mm(i)(1)) is amended by striking 1395mm(i)(6)) is further amended by adding in the Federal Register. ‘‘the Secretary may terminate’’ and all that at the end the following new subparagraph: ‘‘(D) The provisions of section 1128A (other (ii) CRITERIA FOR ISSUANCE.—In determin- follows and inserting the following: ‘‘in ac- than subsections (a) and (b)) shall apply to a ing whether to issue a special fraud alert cordance with procedures established under civil money penalty under subparagraph (A) upon a request under subparagraph (A), the paragraph (9), the Secretary may at any or (B) in the same manner as they apply to Secretary may consider— time terminate any such contract or may a civil money penalty or proceeding under (I) whether and to what extent the prac- impose the intermediate sanctions described section 1128A(a).’’. tices that would be identified in the special in paragraph (6)(B) or (6)(C) (whichever is ap- (b) EFFECTIVE DATE.—The amendments fraud alert may result in any of the con- plicable) on the eligible organization if the made by this section shall apply with respect sequences described in 15214(b); and Secretary determines that the organiza- to contract years beginning on or after Janu- (II) the extent and frequency of the con- tion— ary 1, 1996. duct that would be identified in the special ‘‘(A) has failed substantially to carry out fraud alert. the contract; SEC. 15104. VOLUNTARY DISCLOSURE PROGRAM. (2) PUBLICATION OF ALL HCFA FRAUD ALERTS ‘‘(B) is carrying out the contract in a man- Title XI (42 U.S.C. 1301 et seq.) is amended IN FEDERAL REGISTER.—Each notice issued by ner inconsistent with the efficient and effec- by inserting after section 1128B the following the Health Care Financing Administration tive administration of this section; new section: which informs the public of practices which ‘‘(C) is operating in a manner that is not in ‘‘VOLUNTARY DISCLOSURE OF ACTS OR the Secretary considers to be suspect or of the best interests of the individuals covered OMISSIONS particular concern under the medicare pro- under the contract; or ‘‘SEC. 1129. (a) ESTABLISHMENT OF VOL- gram or a State health care program (as de- ‘‘(D) no longer substantially meets the ap- UNTARY DISCLOSURE PROGRAM.—Not later fined in section 1128(h) of the Social Security plicable conditions of subsections (b), (c), than 3 months after the date of the enact- Act) shall be published in the Federal Reg- and (e).’’. ment of this section, the Secretary shall es- ister, without regard to whether or not the (2) OTHER INTERMEDIATE SANCTIONS FOR tablish a program to encourage individuals notice is issued by a regional office of the MISCELLANEOUS PROGRAM VIOLATIONS.—Sec- and entities to voluntarily disclose to the Health Care Financing Administration. tion 1876(i)(6) (42 U.S.C. 1395mm(i)(6)) is Secretary information on acts or omissions SEC. 15102. BENEFICIARY INCENTIVE PROGRAMS. amended by adding at the end the following of the individual or entity which constitute (a) PROGRAM TO COLLECT INFORMATION ON new subparagraph: grounds for the imposition of a sanction de- FRAUD AND ABUSE.— ‘‘(C) In the case of an eligible organization scribed in section 1128, 1128A, or 1128B. (1) ESTABLISHMENT OF PROGRAM.—Not later for which the Secretary makes a determina- ‘‘(b) EFFECT OF VOLUNTARY DISCLOSURE.—If than 3 months after the date of the enact- tion under paragraph (1) the basis of which is an individual or entity voluntarily discloses ment of this Act, the Secretary of Health not described in subparagraph (A), the Sec- information with respect to an act or omis- and Human Services (hereinafter in this sub- retary may apply the following intermediate sion to the Secretary under subsection (a), title referred to as the ‘‘Secretary’’) shall es- sanctions: the following rules shall apply: tablish a program under which the Secretary ‘‘(i) civil money penalties of not more than ‘‘(1) The Secretary may waive, reduce, or shall encourage individuals to report to the $25,000 for each determination under para- otherwise mitigate any sanction which Secretary information on individuals and en- graph (1) if the deficiency that is the basis of would otherwise be applicable to the individ- tities who are engaging or who have engaged the determination has directly adversely af- ual or entity under section 1128, 1128A, or in acts or omissions which constitute fected (or has the substantial likelihood of 1128B as a result of the act or omission in- grounds for the imposition of a sanction adversely affecting) an individual covered volved. under section 1128, section 1128A, or section under the organization’s contract; ‘‘(2) No qui tam action may be brought 1128B of the Social Security Act, or who have ‘‘(ii) civil money penalties of not more pursuant to chapter 37 of title 31, United otherwise engaged in fraud and abuse against than $10,000 for each week beginning after States Code, against the individual or entity the medicare program for which there is a the initiation of procedures by the Secretary with respect to the act or omission in- sanction provided under law. The program under paragraph (9) during which the defi- volved.’’. H 10408 CONGRESSIONAL RECORD — HOUSE October 19, 1995 SEC. 15105. REVISIONS TO CURRENT SANCTIONS. ‘‘(1) the entity has demonstrated capabil- Fund as such Secretary determines are not (a) DOUBLING THE AMOUNT OF CIVIL MONE- ity to carry out such activities; required to meet current withdrawals from TARY PENALTIES.—The maximum amount of ‘‘(2) in carrying out such activities, the en- the Fund in government account serial secu- civil monetary penalties specified in section tity agrees to cooperate with the Inspector rities. 1128A of the Social Security Act or under General of the Department of Health and ‘‘(B) USE OF INCOME.—Any interest derived title XVIII of such Act (as in effect on the Human Services, the Attorney General of the from investments under subparagraph (A) day before the date of the enactment of this United States, and other law enforcement shall be credited to the Fund. Act) shall, effective for violations occurring agencies, as appropriate, in the investigation ‘‘(3) AMOUNTS DEPOSITED INTO TRUST after the date of the enactment of this Act, and deterrence of fraud and abuse in relation FUND.—In addition to amounts transferred be double the amount otherwise provided as to this title and in other cases arising out of under subsection (f), there shall be deposited of such date. such activities; in the Trust Fund— (b) ESTABLISHMENT OF MINIMUM PERIOD OF ‘‘(3) the entity’s financial holdings, inter- ‘‘(A) that portion of amounts recovered in EXCLUSION FOR CERTAIN INDIVIDUALS AND EN- ests, or relationships will not interfere with relation to section 1128A arising out of a TITIES SUBJECT TO PERMISSIVE EXCLUSION.— its ability to perform the functions to be re- claim under title XVIII as remains after ap- Section 1128(c)(3) (42 U.S.C. 1320a–7(c)(3)) is quired by the contract in an effective and plication of subsection (f)(2) (relating to re- amended by adding at the end the following impartial manner; and payment of the Federal Hospital Insurance new subparagraphs: ‘‘(4) the entity meets such other require- Trust Fund or the Federal Supplementary ‘‘(D) In the case of an exclusion of an indi- ments as the Secretary may impose. Medical Insurance Trust Fund) of that sec- vidual or entity under paragraph (1), (2), or ‘‘(d) PROCESS FOR ENTERING INTO CON- tion, as may be applicable, (3) of subsection (b), the period of the exclu- TRACTS.—The Secretary shall enter into con- ‘‘(B) fines imposed under section 1128B sion shall be 3 years, unless the Secretary tracts under the Program in accordance with arising out of a claim under this title, and determines in accordance with regulations such procedures as the Secretary may by ‘‘(C) penalties and damages imposed (other that a shorter period is appropriate because regulation establish, except that such proce- than funds awarded to a relator or for res- of mitigating circumstances or that a longer dures shall include the following: titution) under sections 3729 through 3732 of period is appropriate because of aggravating ‘‘(1) The Secretary shall determine the ap- title 31, United States Code (pertaining to circumstances. propriate number of separate contracts false claims) in cases involving claims relat- ‘‘(E) In the case of an exclusion of an indi- which are necessary to carry out the Pro- ing to programs under title XVIII, XIX, or vidual or entity under subsection (b)(4) or gram and the appropriate times at which the XXI. (b)(5), the period of the exclusion shall not be Secretary shall enter into such contracts. ‘‘(4) DIRECT APPROPRIATION OF FUNDS TO less than the period during which the indi- ‘‘(2) The provisions of section 1153(e)(1) CARRY OUT PROGRAM.— vidual’s or entity’s license to provide health shall apply to contracts and contracting au- ‘‘(A) IN GENERAL.—There are appropriated care is revoked, suspended, or surrendered, thority under this section, except that com- from the Trust Fund for each fiscal year or the individual or the entity is excluded or petitive procedures must be used when enter- such amounts as are necessary to carry out suspended from a Federal or State health ing into new contracts under this section, or the Medicare Integrity Program under this care program. at any other time considered appropriate by section, subject to subparagraph (B). ‘‘(F) In the case of an exclusion of an indi- the Secretary. ‘‘(B) AMOUNTS SPECIFIED.—The amount ap- vidual or entity under subsection (b)(6)(B), ‘‘(3) A contract under this section may be propriated under subparagraph (A) for a fis- the period of the exclusion shall be not less renewed without regard to any provision of cal year is as follows: than 1 year.’’. law requiring competition if the contractor ‘‘(i) For fiscal year 1996, such amount shall (c) EFFECTIVE DATE.—The amendments has met or exceeded the performance re- be not less than $430,000,000 and not more made by this section shall apply with respect quirements established in the current con- than $440,000,000. to acts or omissions occurring on or after tract. ‘‘(ii) For fiscal year 1997, such amount January 1, 1996. ‘‘(e) LIMITATION ON CONTRACTOR LIABIL- shall be not less than $490,000,000 and not SEC. 15106. DIRECT SPENDING FOR ANTI-FRAUD ITY.—The Secretary shall by regulation pro- more than $500,000,000. ACTIVITIES UNDER MEDICARE. vide for the limitation of a contractor’s li- ‘‘(iii) For fiscal year 1998, such amount (a) ESTABLISHMENT OF MEDICARE INTEGRITY ability for actions taken to carry out a con- shall be not less than $550,000,000 and not PROGRAM.—Title XVIII is amended by adding tract under the Program, and such regula- more than $560,000,000. at the end the following new section: tion shall, to the extent the Secretary finds ‘‘(iv) For fiscal year 1999, such amount ‘‘MEDICARE INTEGRITY PROGRAM appropriate, employ the same or comparable shall be not less than $620,000,000 and not ‘‘SEC. 1893. (a) ESTABLISHMENT OF PRO- standards and other substantive and proce- more than $630,000,000. GRAM.—There is hereby established the Medi- dural provisions as are contained in section ‘‘(v) For fiscal year 2000, such amount shall care Integrity Program (hereafter in this 1157. be not less than $670,000,000 and not more section referred to as the ‘Program’) under ‘‘(f) TRANSFER OF AMOUNTS TO MEDICARE than $680,000,000. which the Secretary shall promote the integ- ANTI-FRAUD AND ABUSE TRUST FUND.—For ‘‘(vi) For fiscal year 2001, such amount rity of the medicare program by entering each fiscal year, the Secretary shall transfer shall be not less than $690,000,000 and not into contracts in accordance with this sec- from the Federal Hospital Insurance Trust more than $700,000,000. tion with eligible private entities to carry Fund and the Federal Supplementary Medi- ‘‘(vii) For fiscal year 2002, such amount out the activities described in subsection (b). cal Insurance Trust Fund to the Medicare shall be not less than $710,000,000 and not ‘‘(b) ACTIVITIES DESCRIBED.—The activities Anti-Fraud and Abuse Trust Fund under sub- more than $720,000,000. described in this subsection are as follows: section (g) such amounts as are necessary to ‘‘(5) ANNUAL REPORT.—The Secretary shall ‘‘(1) Review of activities of providers of carry out the activities described in sub- submit an annual report to Congress on the services or other individuals and entities fur- section (b). Such transfer shall be in an allo- amount of revenue which is generated and nishing items and services for which pay- cation as reasonably reflects the proportion disbursed by the Trust Fund in each fiscal ment may be made under this title (includ- of such expenditures associated with part A year.’’. ing skilled nursing facilities and home and part B. (b) ELIMINATION OF FI AND CARRIER RE- health agencies), including medical and uti- ‘‘(g) MEDICARE ANTI-FRAUD AND ABUSE SPONSIBILITY FOR CARRYING OUT ACTIVITIES lization review and fraud review (employing TRUST FUND.— SUBJECT TO PROGRAM.— similar standards, processes, and tech- ‘‘(1) ESTABLISHMENT.— (1) RESPONSIBILITIES OF FISCAL nologies used by private health plans, includ- ‘‘(A) IN GENERAL.—There is hereby estab- INTERMEDIARIES UNDER PART A.—Section 1816 ing equipment and software technologies lished in the Treasury of the United States (42 U.S.C. 1395h) is amended by adding at the which surpass the capability of the equip- the Anti-Fraud and Abuse Trust Fund (here- end the following new subsection: ment and technologies used in the review of after in this subsection referred to as the ‘‘(l) No agency or organization may carry claims under this title as of the date of the ‘Trust Fund’). The Trust Fund shall consist out (or receive payment for carrying out) enactment of this section). of such gifts and bequests as may be made as any activity pursuant to an agreement under ‘‘(2) Audit of cost reports. provided in subparagraph (B) and such this section to the extent that the activity is ‘‘(3) Determinations as to whether pay- amounts as may be deposited in the Trust carried out pursuant to a contract under the ment should not be, or should not have been, Fund as provided in subsection (f), paragraph Medicare Integrity Program under section made under this title by reason of section (3), and title XI. 1893.’’. 1862(b), and recovery of payments that ‘‘(B) AUTHORIZATION TO ACCEPT GIFTS AND (2) RESPONSIBILITIES OF CARRIERS UNDER should not have been made. BEQUESTS.—The Trust Fund is authorized to PART B.—Section 1842(c) (42 U.S.C. 1395u(c)) is ‘‘(4) Education of providers of services, accept on behalf of the United States money amended by adding at the end the following beneficiaries, and other persons with respect gifts and bequests made unconditionally to new paragraph: to payment integrity and benefit quality as- the Trust Fund, for the benefit of the Trust ‘‘(6) No carrier may carry out (or receive surance issues. Fund or any activity financed through the payment for carrying out) any activity pur- ‘‘(c) ELIGIBILITY OF ENTITIES.—An entity is Trust Fund. suant to a contract under this subsection to eligible to enter into a contract under the ‘‘(2) INVESTMENT.— the extent that the activity is carried out Program to carry out any of the activities ‘‘(A) IN GENERAL.—The Secretary of the pursuant to a contract under the Medicare described in subsection (b) if— Treasury shall invest such amounts of the Integrity Program under section 1893.’’. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10409

(c) CONFORMING AMENDMENT.—Section (b) EFFECTIVE DATE.—The amendment ‘‘(3)(A) Any physician who executes a docu- 1128A(f)(3) (42 U.S.C. 1320a–7a(f)(3)) is amend- made by subsection (a) shall take effect as if ment described in subparagraph (B) with re- ed by striking ‘‘as miscellaneous receipts of included in the enactment of the Social Se- spect to an individual knowing that all of the Treasury of the United States’’ and in- curity Act Amendments of 1994. the requirements referred to in such sub- serting ‘‘in the Anti-Fraud and Abuse Trust SEC. 15108. NATIONAL HEALTH CARE ANTI- paragraph are not met with respect to the Fund established under section 1893(g)’’. FRAUD TASK FORCE. individual shall be subject to a civil mone- (d) DIRECT SPENDING FOR MEDICARE-RELAT- (a) ESTABLISHMENT.—The Attorney Gen- tary penalty of not more than the greater ED ACTIVITIES OF INSPECTOR GENERAL.—Sec- eral, in consultation with the Secretary of of— tion 1893, as added by subsection (a), is Health and Human Services, shall establish a ‘‘(i) $5,000, or amended by adding at the end the following national health care anti-fraud task force (in ‘‘(ii) three times the amount of the pay- new subsection: this section referred to as the ‘‘task force’’). ments under title XVIII for home health ‘‘(h) DIRECT SPENDING FOR MEDICARE-RE- The Attorney General shall establish the services which are made pursuant to such LATED ACTIVITIES OF INSPECTOR GENERAL.— task force within 120 days after the date of certification. ‘‘(1) IN GENERAL.—There are appropriated the enactment of this Act. ‘‘(B) A document described in this subpara- from the Federal Hospital Insurance Trust (b) COMPOSITION.—The task force shall in- graph is any document that certifies, for Fund and the Federal Supplementary Medi- clude representatives of Federal agencies in- purposes of title XVIII, that an individual cal Insurance Trust Fund to the Inspector volved in the investigation and prosecution meets the requirements of section General of the Department of Health and of persons violating laws relating to health 1814(a)(2)(C) or 1835(a)(2)(A) in the case of Human Services for each fiscal year such care fraud and abuse, including at least one home health services furnished to the indi- amounts as are necessary to enable the In- representative from each of the following vidual.’’. spector General to carry out activities relat- agencies: (b) EFFECTIVE DATE.—The amendment ing to the medicare program (as described in (1) The Department of Justice and the Fed- made by subsection (a) shall apply to certifi- paragraph (2)), subject to paragraph (3). eral Bureau of Investigation. cations made on or after the date of the en- ‘‘(2) ACTIVITIES DESCRIBED.—The activities (2) The Department of Health and Human actment of this Act. described in this paragraph are as follows: Services and the Office of the Inspector Gen- SEC. 15111. PILOT PROJECTS. ‘‘(A) Prosecuting medicare-related matters eral within the Department. The Secretary of Health and Human Serv- through criminal, civil, and administrative (3) The office in the Department of Defense ices shall establish and operate 5 pilot proceedings. responsible for administration of the projects (in various geographic regions of the ‘‘(B) Conducting investigations relating to CHAMPUS program. United States) under which the Secretary the medicare program. (4) The Department of Veterans’ Affairs. shall implement innovative approaches to ‘‘(C) Performing financial and performance (5) The United States Postal Inspection monitor payment claims under the medicare audits of programs and operations relating Service. program to detect those claims that are to the medicare program. (6) The Internal Revenue Service. wasteful or fraudulent. ‘‘(D) Performing inspections and other The Attorney General (or the designee of the PART 2—REVISIONS TO CRIMINAL LAW evaluations relating to the medicare pro- Attorney General) shall serve as chair of the SEC. 15121. DEFINITION OF FEDERAL HEALTH gram. task force. CARE OFFENSE. ‘‘(E) Conducting provider and conumer (c) DUTIES.—The task force shall coordi- (a) IN GENERAL.—Chapter 2 of title 18, education activities regarding the require- nate Federal law enforcement activities re- United States Code, is amended by adding at ments of this title. lating to health care fraud and abuse in the end the following: ‘‘(3) AMOUNTS SPECIFIED.—The amount ap- order to better control fraud and abuse in ‘‘§ 24. Definition of Federal health care of- propriated under paragraph (1) for a fiscal the delivery of health care in the United fense year is as follows: States. Specifically, the task force shall co- ‘‘(a) As used in this title, the term ‘Federal ‘‘(A) For fiscal year 1996, such amount ordinate activities— health care offense’ means— shall be $130,000,000. (1) in order to assure the effective ‘‘(1) a violation of, or criminal conspiracy ‘‘(B) For fiscal year 1997, such amount targeting and investigation of persons who to violate section 226, 227, 669, 1035, 1347, or shall be $181,000,000. organize, direct, finance, or otherwise know- 1518 of this title; ‘‘(C) For fiscal year 1998, such amount shall ingly engage in health care fraud, and ‘‘(2) a violation of, or criminal conspiracy be $204,000,000. (2) in order to assure full and effective co- to violate section 1128B of the Social Secu- ‘‘(D) For each subsequent fiscal year, the operation between Federal and State agen- rity Act (42 U.S.C. 1320a–7b); amount appropriated for the previous fiscal cies involved in health care fraud investiga- ‘‘(3) a violation of, or criminal conspiracy year, increased by the percentage increase in tions. to violate section 201, 287, 371, 664, 666, 1001, aggregate expenditures under this title for (d) STAFF.—Each member of the task force 1027, 1341, 1343, or 1954 of this title, if the vio- the fiscal year involved over the previous fis- who represents an agency shall be respon- lation or conspiracy relates to a health care cal year. sible for providing for the detail (from the benefit program; ‘‘(4) ALLOCATION OF PAYMENTS AMONG TRUST agency) of at least one full-time staff person ‘‘(4) a violation of, or criminal conspiracy FUNDS.—The appropriations made under to staff the task force. Such detail shall be to violate section 501 or 511 of the Employee paragraph (1) shall be in an allocation as rea- without change in salary, compensation, Retirement Income Security Act of 1974 (29 sonably reflects the proportion of such ex- benefits, and other employment-related mat- U.S.C. 1131 or 29 U.S.C. 1141), if the violation penditures associated with part A and part ters. or conspiracy relates to a health care benefit B.’’. SEC. 15109. STUDY OF ADEQUACY OF PRIVATE program; SEC. 15107. PERMITTING CARRIERS TO CARRY QUALITY ASSURANCE PROGRAMS. ‘‘(5) the commission of, or attempt to com- OUT PRIOR AUTHORIZATION FOR (a) IN GENERAL.—The Administrator of the mit, an act which constitutes grounds for CERTAIN ITEMS OF DURABLE MEDI- Health Care Financing Administration (act- the imposition of a penalty under section 303 CAL EQUIPMENT. ing through the Director of the Office of Re- of the Federal Food, Drug, and Cosmetic Act, (a) IN GENERAL.—Section 1834(a)(15) (42 search and Demonstrations) shall enter into if the act or attempt relates to a health care U.S.C. 1395m(a)(15)), as amended by section an agreement with a private entity to con- benefit program; or 135(b) of the Social Security Act Amend- duct a study during the 5-year period begin- ‘‘(6) a violation of, or criminal conspiracy ments of 1994, is amended by adding at the ning on the date of the enactment of this Act to violate, section 3 of the Anti-Kickback end the following new subparagraphs: of the adequacy of the quality assurance pro- Act of 1986 (41 U.S.C. 53), if the violation or ‘‘(D) APPLICATION BY CARRIERS.—A carrier grams and consumer protections used by the conspiracy relates to a health care benefit may develop (and periodically update) a list MedicarePlus program under part C of title program. ‘‘(b) As used in this title, the term ‘health of items under subparagraph (A) and a list of XVIII of the Social Security Act (as inserted care benefit program’ has the meaning given suppliers under subparagraph (B) in the same by section 15002(a)), and shall include in the such term in section 1347(b) of this title.’’. manner as the Secretary may develop (and study an analysis of the effectiveness of such periodically update) such lists. (b) CLERICAL AMENDMENT.—The table of programs in protecting plan enrollees sections at the beginning of chapter 2 of title ‘‘(E) WAIVER OF PUBLICATION REQUIRE- against the risk of insufficient provision of 18, United States Code, is amended by insert- MENT.—A carrier may make an advance de- benefits which may result from utilization ing after the item relating to section 23 the termination under subparagraph (C) with re- controls. following new item: spect to an item or supplier on a list devel- (b) REPORT.—Not later than 6 months after oped by the Secretary or the carrier without the conclusion of the 5-year period described ‘‘24. Definition relating to Federal health regard to whether or not the Secretary has in subsection (a), the Administrator shall care offense defined.’’. promulgated a regulation with respect to the submit a report to Congress on the study SEC. 15122. HEALTH CARE FRAUD. list, except that the carrier may not make conducted under subsection (a). (a) IN GENERAL.—Chapter 63 of title 18, United States Code, is amended by adding at such an advance determination with respect SEC. 15110. PENALTY FOR FALSE CERTIFICATION to an item or supplier on a list until the ex- FOR HOME HEALTH SERVICES. the end the following: piration of the 30-day period beginning on (a) IN GENERAL.—Section 1128A(b) (42 ‘‘§ 1347. Health care fraud the date the Secretary or the carrier places U.S.C. 1320a–7a(b)) is amended by adding at ‘‘(a) Whoever, having devised or intending the item or supplier on the list.’’. the end the following new paragraph: to devise a scheme or artifice, commits or H 10410 CONGRESSIONAL RECORD — HOUSE October 19, 1995 attempts to commit an act in furtherance of SEC. 15125. BRIBERY AND GRAFT. ‘‘(1) in return for referring any individual or for the purpose of executing such scheme (a) IN GENERAL.—Chapter 11 of title 18, to a person for the furnishing or arranging or artifice— United States Code, is amended by adding at for the furnishing of any item or service for ‘‘(1) to defraud any health care benefit pro- the end the following: which payment may be made in whole or in gram; or ‘‘§ 226. Bribery and graft in connection with part by any health care benefit program; or ‘‘(2) to obtain, by means of false or fraudu- health care ‘‘(2) in return for purchasing, leasing, or- lent pretenses, representations, or promises, ‘‘(a) Whoever— dering, or arranging for or recommending any of the money or property owned by, or ‘‘(1) directly or indirectly, corruptly gives, purchasing, leasing, or ordering any good, fa- under the custody or control of, any health offers, or promises anything of value to a cility, service, or item for which payment care benefit program, health care official, or offers or promises to may be made in whole or in part by any shall be fined under this title or imprisoned give anything of value to any other person, health care benefit program, or attempting not more than 10 years, or both. If the viola- or attempts to violate this subsection, with to do so, tion results in serious bodily injury (as de- intent— shall be fined under this title or imprisoned fined in section 1365 of this title), such per- ‘‘(A) to influence any of the health care of- for not more than 5 years, or both. son shall be fined under this title or impris- ficial’s actions, decisions, or duties relating ‘‘(b) Whoever knowingly and willfully of- oned not more than 20 years, or both; and if to a health care benefit program; fers or pays any remuneration (including any the violation results in death, such person ‘‘(B) to influence such an official to com- kickback, bribe, or rebate) directly or indi- shall be fined under this title, or imprisoned mit or aid in the committing, or collude in rectly, overtly, or covertly, in cash or in for any term of years or for life, or both. or allow, any fraud, or make opportunity for kind to any person to induce such person— ‘‘(b) As used in this section, the term the commission of any fraud, on a health ‘‘(1) to refer an individual to a person for ‘health care benefit program’ means any care benefit program; or the furnishing or arranging for the furnish- public or private plan or contract under ‘‘(C) to induce such an official to engage in ing of any item or service for which payment which any medical benefit, item, or service any conduct in violation of the lawful duty may be made in whole or in part by any is provided to any individual, and includes of such official; or health benefit program; or any individual or entity who is providing a ‘‘(2) being a health care official, directly or ‘‘(2) to purchase, lease, order, or arrange medical benefit, item, or service for which indirectly, corruptly demands, seeks, re- for or recommend purchasing, leasing, or or- payment may be made under the plan or con- ceives, accepts, or agrees to accept anything dering any good, facility, service, or item for tract.’’. of value personally or for any other person which payment may be made in whole or in (b) CLERICAL AMENDMENT.—The table of or entity, the giving of which violates para- part by any health benefit program or at- sections at the beginning of chapter 63 of graph (1) of this subsection, or attempts to tempts to do so, violate this subsection, title 18, United States Code, is amended by shall be fined under this title or imprisoned adding at the end the following: shall be fined under this title or imprisoned for not more than 5 years, or both. ‘‘1347. Health care fraud.’’ not more than 15 years, or both. ‘‘(c) Subsections (a) and (b) shall not apply SEC. 15123. THEFT OR EMBEZZLEMENT. ‘‘(b) Whoever— to— ‘‘(1) otherwise than as provided by law for (a) IN GENERAL.—Chapter 31 of title 18, ‘‘(1) a discount or other reduction in price United States Code, is amended by adding at the proper discharge of any duty, directly or obtained by a provider of services or other the end the following: indirectly gives, offers, or promises anything entity under a health care benefit program if of value to a health care official, for or be- ‘‘§ 669. Theft or embezzlement in connection the reduction in price is properly disclosed cause of any of the health care official’s ac- with health care and appropriately reflected in the costs tions, decisions, or duties relating to a claimed or charges made by the provider or ‘‘(a) Whoever embezzles, steals, or other- health care benefit program, or attempts to wise without authority willfully and unlaw- entity under a health care benefit program; violate this subsection; or ‘‘(2) any amount paid by an employer to an fully converts to the use of any person other ‘‘(2) being a health care official, otherwise employee (who has a bona fide employment than the rightful owner, or intentionally than as provided by law for the proper dis- relationship with such employer) for employ- misapplies any of the moneys, funds, securi- charge of any duty, directly or indirectly, ment in the provision of covered items or ties, premiums, credits, property, or other demands, seeks, receives, accepts or agrees services if the amount of the remuneration assets of a health care benefit program, shall to accept anything of value personally or for under the arrangement is consistent with be fined under this title or imprisoned not any other person or entity, the giving of the fair market value of the services and is more than 10 years, or both. which violates paragraph (1) of this sub- not determined in a manner that takes into ‘‘(b) As used in this section, the term section, or attempts to violate this sub- account (directly or indirectly) the volume ‘health care benefit program’ has the mean- section. ing given such term in section 1347(b) of this or value of any referrals; shall be fined under this title, or imprisoned title.’’. ‘‘(3) any amount paid by a vendor of goods not more than 2 years, or both. (b) CLERICAL AMENDMENT.—The table of or services to a person authorized to act as ‘‘(c) As used in this section— a purchasing agent for a group of individuals sections at the beginning of chapter 31 of ‘‘(1) the term ‘health care official’’ means— or entities who are furnishing services reim- title 18, United States Code, is amended by ‘‘(A) an administrator, officer, trustee, fi- bursed under a health care benefit program adding at the end the following: duciary, custodian, counsel, agent, or em- if— ‘‘669. Theft or embezzlement in connection ployee of any health care benefit program; ‘‘(A) the person has a written contract, with health care.’’. ‘‘(B) an officer, counsel, agent, or em- with each such individual or entity, which SEC. 15124. FALSE STATEMENTS. ployee, of an organization that provides serv- specifies the amount to be paid the person, (a) IN GENERAL.—Chapter 47 of title 18, ices under contract to any health care bene- which amount may be a fixed amount or a United States Code, is amended by adding at fit program; or percentage of the value of the purchases the end the following: ‘‘(C) an official, employee, or agent of an entity having regulatory authority over any made by each such individual or entity under ‘‘§ 1035. False statements relating to health the contract, and care matters health care benefit program; and ‘‘(2) the term ‘health care benefit program’ ‘‘(B) in the case of an entity that is a pro- ‘‘(a) Whoever, in any matter involving a has the meaning given such term in section vider of services (as defined in section 1861(u) health care benefit program, knowingly and 1347(b) of this title.’’. of the Social Security Act, the person dis- willfully falsifies, conceals, or covers up by (b) CLERICAL AMENDMENT.—The table of closes (in such form and manner as the Sec- any trick, scheme, or device a material fact, chapters at the beginning of chapter 11 of retary of Health and Human Services re- or makes any false, fictitious, or fraudulent title 18, United States Code, is amended by quires) to the entity and, upon request, to statements or representations, or makes or adding at the end the following new item: the Secretary the amount received from uses any false writing or document knowing each such vendor with respect to purchases ‘‘226. Bribery and graft in connection with the same to contain any false, fictitious, or made by or on behalf of the entity; health care.’’. fraudulent statement or entry, shall be fined ‘‘(4) a waiver of any coinsurance under part under this title or imprisoned not more than SEC. 15126. ILLEGAL REMUNERATION WITH RE- B of title XVIII of the Social Security Act by 5 years, or both. SPECT TO HEALTH CARE BENEFIT a federally qualified health care center with ‘‘(b) As used in this section, the term PROGRAMS. respect to an individual who qualifies for ‘health care benefit program’ has the mean- (a) IN GENERAL.—Chapter 11 of title 18, subsidized services under a provision of the ing given such term in section 1347(b) of this United States Code, is amended by adding at Public Health Service Act; and title.’’. the end the following: ‘‘(5) any payment practice specified by the ‘‘(b) CLERICAL AMENDMENT.—The table of ‘‘§ 227. Illegal remuneration with respect to Secretary of Health and Human Services in sections at the beginning of chapter 47 of health care benefit programs regulations promulgated pursuant to section title 18, United States Code, is amended by ‘‘(a) Whoever knowingly and willfully so- 14(a) of the Medicare and Medicaid Patient adding at the end the following new item: licits or receives any remuneration (includ- and Program Protection Act of 1987. ‘‘1035. False statements relating to health ing any kickback, bribe, or rebate) directly ‘‘(d) Any person injured in his business or care matters.’’. or indirectly, overtly or covertly, in cash or property by reason of a violation of this sec- in kind— tion or section 226 of this title may sue there October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10411 for in any appropriate United States district (2) by inserting ‘‘or’’ at the end of subpara- matter under investigation. Any failure to court and shall recover threefold the dam- graph (B); and obey the order of the court may be punished ages such person sustains and the cost of the (3) by adding at the end the following: by the court as a contempt thereof. All proc- suit, including a reasonable attorney’s fee. ‘‘(C) committing or about to commit a ess in any such case may be served in any ju- ‘‘(e) As used in this section, ‘health care Federal health care offense (as defined in dicial district in which such person may be benefit program’ has the meaning given such section 24 of this title).’’. found. term in section 1347(b) of this title.’’. SEC. 15130. AUTHORIZED INVESTIGATIVE DE- ‘‘(d) IMMUNITY FROM CIVIL LIABILITY.—Not- ‘‘(b) CLERICAL AMENDMENT.—The table of MAND PROCEDURES. withstanding any Federal, State, or local sections at the beginning of chapter 11 of (a) IN GENERAL.—Chapter 233 of title 18, law, any person, including officers, agents, title 18, United States Code, is amended by United States Code, is amended by adding and employees, receiving a summons under adding at the end the following: after section 3485 the following: this section, who complies in good faith with the summons and thus produces the mate- ‘‘227. Illegal remuneration with respect to ‘‘§ 3486. Authorized investigative demand pro- rials sought, shall not be liable in any court health care benefit programs.’’. cedures of any State or the United States to any cus- (c) CONFORMING AMENDMENT.—Section ‘‘(a) AUTHORIZATION.—(1) In any investiga- tomer or other person for such production or 1128B of the Social Security Act (42 U.S.C. tion relating to functions set forth in para- for nondisclosure of that production to the 1320a—7b) is amended by striking subsection graph (2), the Attorney General or the Direc- customer.’’. (b). tor of the Federal Bureau of Investigation or (b) CLERICAL AMENDMENT.—The table of SEC. 15127. OBSTRUCTION OF CRIMINAL INVES- their designees may issue in writing and sections at the beginning of chapter 223 of TIGATIONS OF HEALTH CARE OF- cause to be served a summons compelling the title 18, United States Code, is amended by FENSES. attendance and testimony of witnesses and inserting after the item relating to section ‘‘(a) IN GENERAL.—Chapter 73 of title 18, requiring the production of any records (in- 3485 the following new item: United States Code, is amended by adding at cluding any books, papers, documents, elec- ‘‘3486. Authorized investigative demand pro- the end the following: tronic media, or other objects or tangible cedures.’’. things), which may be relevant to an author- ‘‘§ 1518. Obstruction of criminal investiga- (c) CONFORMING AMENDMENT.—Section ized law enforcement inquiry, that a person tions of health care offenses 1510(b)(3)(B) of title 18, United States Code, is ‘‘(a) Whoever willfully prevents, obstructs, or legal entity may possess or have care, cus- amended by inserting ‘‘or a Federal Bureau misleads, delays or attempts to prevent, ob- tody, or control. The attendance of witnesses of Investigation summons (issued under sec- struct, mislead, or delay the communication and the production of records may be re- tion 3486 of title 18),’’ after ‘‘subpoena’’. quired from any place in any State or in any of information or records relating to a viola- SEC. 15131. GRAND JURY DISCLOSURE. territory or other place subject to the juris- tion of a health care offense to a criminal in- Section 3322 of title 18, United States Code, diction of the United States at any des- vestigator shall be fined under this title or is amended— imprisoned not more than 5 years, or both. ignated place of hearing; except that a wit- (1) by redesignating subsections (c) and (d) ‘‘(b) As used in this section the term ness shall not be required to appear at any as subsection (d) and (e), respectively; and ‘health care offense’ has the meaning given hearing more than 500 miles distant from the (2) by inseritng after subsection (b) the fol- such term in section 24 of this title. place where he was served with a subpoena. lowing: ‘‘(c) As used in this section the term Witnesses summoned under this section shall ‘‘(c) A person who is privy to grand jury in- ‘criminal investigator’ means any individual be paid the same fees and mileage that are formation concerning a health care offense— duly authorized by a department, agency, or paid witnesses in the courts of the United ‘‘(1) received in the course of duty as an at- armed force of the United States to conduct States. A summons requiring the production torney for the Government; or ‘‘(2) disclosed under rule 6(e)(3)(A)(ii) of the or engage in investigations for prosecutions of records shall describe the objects required Federal Rules of Criminal Procedure; for violations of health care offenses.’’. to be produced and prescribe a return date ‘‘(b) ‘‘CLERICAL AMENDMENT.—The table of within a reasonable period of time within may disclose that information to an attor- sections at the beginning of chapter 73 of which the objects can be assembled and made ney for the Government to use in any civil title 18, United States Code, is amended by available. investigation or proceeding related to a Fed- adding at the end the following new item: ‘‘(2) Investigative demands utilizing an ad- eral health care offense (as defined in section ministrative summons are authorized for: 24 of this title).’’. ‘‘1518. Obstruction of criminal investigations ‘‘(A) Any investigation with respect to any SEC. 15132. MISCELLANEOUS AMENDMENTS TO of health care offenses.’’. act or activity constituting an offense in- TITLE 18, UNITED STATES CODE. SEC. 15128. CIVIL PENALTIES FOR VIOLATIONS volving a Federal health care offense as that (a) LAUNDERING OF MONETARY INSTRU- OF FEDERAL HEALTH CARE OF- term is defined in section 24 of title 18, Unit- MENTS.—Section 1956(c)(7) of title 18, United FENSES. ed States Code. States Code, is amended by adding at the end (a) IN GENERAL.—Chapter 63 of title 18, ‘‘(B) Any investigation, with respect to thereof the following: United States Code, is amended by adding at violations of sections 1073 and 1074 of title 18, ‘‘(F) Any act or activity constituting an the end the following: United States Code, or in which an individ- offense involving a Federal health care of- ‘‘§ 1348. Civil penalties for violations of Fed- ual has been lawfully charged with a Federal fense as that term is defined in section 24 of eral health care offenses offense and such individual is avoiding pros- title 18, United States Code.’’. (b) ENHANCED PENALTIES.—Section 2326(2) ‘‘The Attorney General may bring a civil ecution or custody or confinement after con- viction of such offense or attempt. of title 18, United States Code, is amended by action in the appropriate United States dis- striking ‘‘sections that—’’ and inserting ‘‘or trict court against any person who engages ‘‘(b) SERVICE.—A subpoena issued under this section may be served by any person in the case of a Federal health care offense in conduct constituting a violation of Fed- as that term is defined in section 24 of this eral health care offense, as that term is de- designated in the subpoena to serve it. Serv- ice upon a natural person may be made by title, that—’’. fined in section 24 of this title and, upon (c) AUTHORIZATION FOR INTERCEPTION OF proof of such conduct by a preponderance of personal delivery of the subpoena to him. Service may be made upon a domestic or for- WIRE, ORAL, OR ELECTRONIC COMMUNICA- the evidence, such person shall be subject to TIONS.—Section 2516(1)(c) of title 18, United a civil penalty of not more than $50,000 for eign corporation or upon a partnership or other unincorporated association which is States Code is amended— each violation or the amount of compensa- (1) by inserting ‘‘section 226 (bribery and subject to suit under a common name, by de- tion or proceeds which the person received or graft in connection with health care), sec- livering the subpoena to an officer, to a man- offered for the prohibited conduct, whichever tion 227 (illegal remunerations)’’ after ‘‘sec- aging or general agent, or to any other agent amount is greater. The imposition of a civil tion 224 (bribery in sporting contests),’’; and penalty under this section does not preclude authorized by appointment or by law to re- (2) by inserting ‘‘section 1347 (health care any other criminal or civil statutory, com- ceive service to process. The affidavit of the fraud)’’ after ‘‘section 1344 (relating to bank mon law, or administrative remedy, which is person serving the subpoena entered on a fraud),’’. available by law to the United States or any true copy thereof by the person serving it (d) DEFINITIONS.—Section 1961(1) of title 18, other person.’’. shall be proof of service. United States Code, is amended— ‘‘(c) ENFORCEMENT.—In the case of contu- (b) CLERICAL AMENDMENT.—The table of (1) by inserting ‘‘sections 226 and 227 (relat- sections for chapter 63 of title 18, United macy by or refusal to obey a subpoena issued ing to bribery and graft, and illegal remu- States Code, is amended by adding at the end to any person, the Attorney General may in- neration in connection with health care)’’ the following item: voke the aid of any court of the United after ‘‘section 224 (relating to sports brib- States within the jurisdiction of which the ery),’’; ‘‘1348. Civil penalties for violations of Fed- investigation is carried on or of which the (2) by inserting ‘‘section 669 (relating to eral health care offenses.’’. subpoenaed person is an inhabitant, or in theft or embezzlement in connection with SEC. 15129. INJUNCTIVE RELIEF RELATING TO which he carries on business or may be health care)’’ after ‘‘section 664 (relating to HEALTH CARE OFFENSES. found, to compel compliance with the sub- embezzlement from pension and welfare Section 1345(a)(1) of title 18, United States poena. The court may issue an order requir- funds),’’; and Code, is amended— ing the subpoenaed person to appear before (3) by inserting ‘‘section 1347 (relating to (1) by striking ‘‘or’’ at the end of subpara- the Attorney General to produce records, if health care fraud)’’ after ‘‘section 1344 (relat- graph (A); so ordered, or to give testimony touching the ing to financial institution fraud),’’. H 10412 CONGRESSIONAL RECORD — HOUSE October 19, 1995

(e) CRIMINAL FORFEITURE.—Section 982(a) SEC. 15202. REVISION OF DESIGNATED HEALTH ‘‘ANCILLARY SERVICES FURNISHED PERSONALLY of title 18, United States Code, is amended by SERVICES SUBJECT TO PROHIBI- OR THROUGH GROUP PRACTICE.—’’. TION. adding at the end the following new para- (b) CLARIFICATION OF EXCEPTION FOR SERV- (a) IN GENERAL.—Section 1877(h)(6) (42 graph: ICES FURNISHED IN A RURAL AREA.—Para- U.S.C. 1395nn(h)(6)) is amended by striking ‘‘(6) The court in imposing sentence on a graph (5) of section 1877(b) (42 U.S.C. subparagraphs (B) through (K) and inserting person convicted of a Federal health care of- 1395nn(b)), as transferred by section the following: fense as defined in section 24 of this title, 15201(b)(3)(C), is amended by striking ‘‘sub- ‘‘(B) Parenteral and enteral nutrients, shall order that the offender forfeit to the stantially all’’ and inserting ‘‘not less than equipment, and supplies. United States any real or personal property 75 percent’’. ‘‘(C) Magnetic resonance imaging and com- constituting or derived from proceeds that puterized tomography services. (c) REVISION OF EXCEPTION FOR CERTAIN the offender obtained directly or indirectly ‘‘(D) Outpatient physical or occupational MANAGED CARE ARRANGEMENTS.—Section as the result of the offense.’’. therapy services.’’. 1877(b)(3) (42 U.S.C. 1395nn(b)(3)) is amended— (f) REWARDS FOR INFORMATION LEADING TO (b) CONFORMING AMENDMENTS.— (1) in the heading by inserting ‘‘MANAGED PROSECUTION AND CONVICTION.—Section (1) Section 1877(b)(2) (42 U.S.C. 1395nn(b)(2)) CARE ARRANGEMENTS’’ after ‘‘PREPAID 3059(c)(1) of title 18, United States Code, is is amended in the matter preceding subpara- PLANS’’; amended by inserting ‘‘or furnishes informa- graph (A) by striking ‘‘services’’ and all that (2) in the matter preceding subparagraph tion unknown to the Government relating to follows through ‘‘supplies)—’’ and inserting (A), by striking ‘‘organization—’’ and insert- a possible prosecution of a Federal health ‘‘services—’’. ing ‘‘organization, directly or through con- care offense as defined in section 24 of this (2) Section 1877(h)(5)(C) (42 U.S.C. tractual arrangements with other entities, title, which results in a conviction’’ before 1395nn(h)(5)(C)) is amended— to individuals enrolled with the organiza- the period at the end. (A) by striking ‘‘, a request by a radiolo- tion—’’; Subtitle C—Regulatory Relief gist for diagnostic radiology services, and a (3) in subparagraph (A), by inserting ‘‘or request by a radiation oncologist for radi- part C’’ after ‘‘section 1876’’; PART 1—PHYSICIAN OWNERSHIP (4) by striking ‘‘or’’ at the end of subpara- REFERRAL REFORM ation therapy,’’ and inserting ‘‘and a request by a radiologist for magnetic resonance im- graph (C); SEC. 15201. REPEAL OF PROHIBITIONS BASED ON aging or for computerized tomography’’, and (5) by striking the period at the end of sub- COMPENSATION ARRANGEMENTS. (B) by striking ‘‘radiologist, or radiation paragraph (D) and inserting a comma; and (a) IN GENERAL.—Section 1877(a)(2) (42 oncologist’’ and inserting ‘‘or radiologist’’. (6) by adding at the end the following new U.S.C. 1395nn(a)(2)) is amended by striking SEC. 15203. DELAY IN IMPLEMENTATION UNTIL subparagraphs: ‘‘is—’’ and all that follows through ‘‘equity,’’ PROMULGATION OF REGULATIONS. ‘‘(E) with a contract with a State to pro- and inserting the following: ‘‘is (except as (a) IN GENERAL.—Section 13562(b) of OBRA– vide services under the State plan under title provided in subsection (c)) an ownership or 1993 (42 U.S.C. 1395nn note) is amended— XIX (in accordance with section 1903(m)) or a investment interest in the entity through (1) in paragraph (1), by striking ‘‘paragraph State MediGrant plan under title XXI; or equity,’’. (2)’’ and inserting ‘‘paragraphs (2) and (3)’’; ‘‘(F) which is a MedicarePlus organization (b) CONFORMING AMENDMENTS.—Section and under part C or which provides or arranges 1877 (42 U.S.C. 1395nn) is amended as follows: (2) by adding at the end the following new for the provision of health care items or (1) In subsection (b)— paragraph: services pursuant to a written agreement be- (A) in the heading, by striking ‘‘TO BOTH ‘‘(3) PROMULGATION OF REGULATIONS.—Not- tween the organization and an individual or OWNERSHIP AND COMPENSATION ARRANGEMENT withstanding paragraphs (1) and (2), the entity if the written agreement places the PROHIBITIONS’’ and inserting ‘‘WHERE FINAN- amendments made by this section shall not individual or entity at substantial financial CIAL RELATIONSHIP EXISTS’’; and apply to any referrals made before the effec- risk for the cost or utilization of the items (B) by redesignating paragraph (4) as para- tive date of final regulations promulgated by or services which the individual or entity is graph (7). the Secretary of Health and Human Services obligated to provide, whether through a (2) In subsection (c)— to carry out such amendments.’’. withhold, capitation, incentive pool, per (A) by amending the heading to read as fol- (b) EFFECTIVE DATE.—The amendments diem payment, or any other similar risk ar- lows: ‘‘EXCEPTION FOR OWNERSHIP OR INVEST- made by subsection (a) shall take effect as if rangement which places the individual or en- MENT INTEREST IN PUBLICLY TRADED SECURI- included in the enactment of OBRA–1993. tity at substantial financial risk.’’. TIES AND MUTUAL FUNDS’’; and SEC. 15204. EXCEPTIONS TO PROHIBITION. (d) NEW EXCEPTION FOR SHARED FACILITY (B) in the matter preceding paragraph (1), (a) REVISIONS TO EXCEPTION FOR IN-OFFICE SERVICES.— by striking ‘‘subsection (a)(2)(A)’’ and insert- ANCILLARY SERVICES.— (1) IN GENERAL.—Section 1877(b) (42 U.S.C. ing ‘‘subsection (a)(2)’’. (1) REPEAL OF SITE-OF-SERVICE REQUIRE- 1395nn(b)), as amended by section (3) In subsection (d)— MENT.—Section 1877 (42 U.S.C. 1395nn) is 15201(b)(3)(C), is amended— (A) by striking the matter preceding para- amended— (A) by redesignating paragraphs (4) graph (1); (A) by amending subparagraph (A) of sub- through (7) as paragraphs (5) through (8); and (B) in paragraph (3), by striking ‘‘para- section (b)(2) to read as follows: (B) by inserting after paragraph (3) the fol- graph (1)’’ and inserting ‘‘paragraph (4)’’; and ‘‘(A) that are furnished personally by the lowing new paragraph: (C) by redesignating paragraphs (1), (2), and referring physician, personally by a physi- ‘‘(4) SHARED FACILITY SERVICES.—In the (3) as paragraphs (4), (5), and (6), and by cian who is a member of the same group case of a designated health service consist- transferring and inserting such paragraphs practice as the referring physician, or per- ing of a shared facility service of a shared fa- after paragraph (3) of subsection (b). sonally by individuals who are under the cility— (4) By striking subsection (e). general supervision of the physician or of an- ‘‘(A) that is furnished— (5) In subsection (f)(2)— other physician in the group practice, and’’, ‘‘(i) personally by the referring physician (A) in the matter preceding paragraph (1), and who is a shared facility physician or person- by striking ‘‘ownership, investment, and (B) by adding at the end of subsection (h) ally by an individual directly employed or compensation’’ and inserting ‘‘ownership and the following new paragraph: under the general supervision of such a phy- investment’’; ‘‘(7) GENERAL SUPERVISION.—An individual sician, (B) in paragraph (2), by striking ‘‘sub- is considered to be under the ‘general super- ‘‘(ii) by a shared facility in a building in section (a)(2)(A)’’ and all that follows vision’ of a physician if the physician (or which the referring physician furnishes sub- through ‘‘subsection (a)(2)(B)),’’ and insert- group practice of which the physician is a stantially all of the services of the physician ing ‘‘subsection (a)(2),’’; and member) is legally responsible for the serv- that are unrelated to the furnishing of (C) in paragraph (2), by striking ‘‘or who ices performed by the individual and for en- shared facility services, and have such a compensation relationship with suring that the individual meets licensure ‘‘(iii) to a patient of a shared facility phy- the entity’’. and certification requirements, if any, appli- sician; and (6) In subsection (h)— cable under other provisions of law, regard- ‘‘(B) that is billed by the referring physi- (A) by striking paragraphs (1), (2), and (3); less of whether or not the physician is phys- cian or a group practice of which the physi- (B) in paragraph (4)(A), by striking clauses ically present when the individual furnishes cian is a member.’’. (iv) and (vi); an item or service.’’. (2) DEFINITIONS.—Section 1877(h) (42 U.S.C. (C) in paragraph (4)(B), by striking (2) CLARIFICATION OF TREATMENT OF PHYSI- 1395nn(h)), as amended by section 15201(b)(6), ‘‘RULES.—’’ and all that follows through ‘‘(ii) CIAN OWNERS OF GROUP PRACTICE.—Section is amended by inserting before paragraph (4) FACULTY’’ and inserting ‘‘RULES FOR FAC- 1877(b)(2)(B) (42 U.S.C. 1395nn(b)(2)(B)) is the following new paragraph: ULTY’’; and amended by striking ‘‘physician or such ‘‘(1) SHARED FACILITY RELATED DEFINI- (D) by adding at the end of paragraph (4) group practice’’ and inserting ‘‘physician, TIONS.— the following new subparagraph: such group practice, or the physician owners ‘‘(A) SHARED FACILITY SERVICE.—The term ‘‘(C) MEMBER OF A GROUP.—A physician is a of such group practice’’. ‘shared facility service’ means, with respect ‘member’ of a group if the physician is an (3) CONFORMING AMENDMENT.—Section to a shared facility, a designated health serv- owner or a bona fide employee, or both, of 1877(b)(2) (42 U.S.C. 1395nn(b)(2)) is amended ice furnished by the facility to patients of the group.’’. by amending the heading to read as follows: shared facility physicians. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10413

‘‘(B) SHARED FACILITY.—The term ‘shared HABILITATION FACILITY.—Section 1877(b) (42 ‘‘(6) The term ‘should know’ means that a facility’ means an entity that furnishes U.S.C. 1395nn(b)), as amended by section person, with respect to information— shared facility services under a shared facil- 15201(b)(3)(C), subsection (d)(1), subsection ‘‘(A) acts in deliberate ignorance of the ity arrangement. (e)(1), subsection (f), subsection (g), and sub- truth or falsity of the information; or ‘‘(C) SHARED FACILITY PHYSICIAN.—The section (h), is amended— ‘‘(B) acts in reckless disregard of the truth term ‘shared facility physician’ means, with (1) by redesignating paragraphs (9) through or falsity of the information, respect to a shared facility, a physician (or a (12) as paragraphs (10) through (13); and and no proof of specific intent to defraud is group practice of which the physician is a (2) by inserting after paragraph (8) the fol- required.’’. member) who has a financial relationship lowing new paragraph: (b) CLARIFICATION OF EFFECT AND APPLICA- under a shared facility arrangement with the ‘‘(9) SERVICES FURNISHED IN A COMPREHEN- TION OF SAFE HARBOR EXCEPTIONS.—For pur- facility. SIVE OUTPATIENT REHABILITATION FACILITY.— poses of section 1128B(b)(3) of the Social Se- ‘‘(D) SHARED FACILITY ARRANGEMENT.—The In the case of a designated health service curity Act, the specification of any payment term ‘shared facility arrangement’ means, furnished in a comprehensive outpatient re- practice in regulations promulgated pursu- with respect to the provision of shared facil- habilitation facility (as defined in section ant to section 14(a) of the Medicare and Med- ity services in a building, a financial ar- 1861(cc)(2)).’’. icaid Program and Patient Protection Act of rangement— (i) DEFINITION OF REFERRAL.—Section 1987 is— ‘‘(i) which is only between physicians who 1877(h)(5)(A) (42 U.S.C. 1395nn(h)(5)(A)) is (1) solely for the purpose of adding addi- are providing services (unrelated to shared amended— tional exceptions to the types of conduct facility services) in the same building, (1) by striking ‘‘an item or service’’ and in- which are not subject to an anti-kickback ‘‘(ii) in which the overhead expenses of the serting ‘‘a designated health service’’, and penalty under such section and not for the facility are shared, in accordance with meth- (2) by striking ‘‘the item or service’’ and purpose of limiting the scope of such excep- ods previously determined by the physicians inserting ‘‘the designated health service’’. tions; and in the arrangement, among the physicians in SEC. 15205. REPEAL OF REPORTING REQUIRE- (2) for the purpose of prescribing criteria the arrangement, and MENTS. for qualifying for such an exception notwith- ‘‘(iii) which, in the case of a corporation, is Section 1877 (42 U.S.C. 1395nn) is amended— standing the intent of the party involved. wholly owned and controlled by shared facil- (1) by striking subsection (f); and (c) LIMITING IMPOSITION OF ANTI-KICKBACK ity physicians.’’. (2) by striking subsection (g)(5). PENALTIES TO ACTIONS WITH SIGNIFICANT (e) NEW EXCEPTION FOR SERVICES FUR- SEC. 15206. PREEMPTION OF STATE LAW. PURPOSE TO INDUCE REFERRALS.—Section NISHED IN COMMUNITIES WITH NO ALTER- Section 1877 (42 U.S.C. 1395nn) is amended 1128B(b)(2) (42 U.S.C. 1320a–7b(b)(2)) is amend- NATIVE PROVIDERS.—Section 1877(b) (42 by adding at the end the following new sub- ed in the matter preceding subparagraph (A) U.S.C. 1395nn(b)), as amended by section section: by striking ‘‘to induce’’ and inserting ‘‘for 15201(b)(3)(C) and subsection (d)(1), is amend- ‘‘(i) PREEMPTION OF STATE LAW.—This sec- the significant purpose of inducing’’. ed— tion preempts State law to the extent State (d) EFFECTIVE DATE.—The amendments (1) by redesignating paragraphs (5) through law is inconsistent with this section.’’. made by this section shall apply to acts or (8) as paragraphs (6) through (9); and SEC. 15207. EFFECTIVE DATE. omissions occurring on or after January 1, (2) by inserting after paragraph (4) the fol- Except as provided in section 15203(b), the 1996. lowing new paragraph: amendments made by this part shall apply to SEC. 15213. ADDITIONAL EXCEPTION TO ANTI- ‘‘(5) NO ALTERNATIVE PROVIDERS IN AREA.— referrals made on or after August 14, 1995, re- KICKBACK PENALTIES FOR MAN- In the case of a designated health service gardless of whether or not regulations are AGED CARE ARRANGEMENTS. furnished in any area with respect to which promulgated to carry out such amendments. (a) IN GENERAL.—Section 1128B(b)(3) (42 the Secretary determines that individuals PART 2—OTHER MEDICARE REGULATORY U.S.C. 1320a–7b(b)(3)) is amended— residing in the area do not have reasonable RELIEF (1) by striking ‘‘and’’ at the end of subpara- access to such a designated health service for SEC. 15211. REPEAL OF MEDICARE AND MEDIC- graph (D); which subsection (a)(1) does not apply.’’. AID COVERAGE DATA BANK. (2) by striking the period at the end of sub- (f) NEW EXCEPTION FOR SERVICES FUR- (a) IN GENERAL.—Section 1144 (42 U.S.C. paragraph (E) and inserting ‘‘; and’’; and NISHED IN AMBULATORY SURGICAL CENTERS.— 1320b–14) is repealed. (3) by adding at the end the following new Section 1877(b) (42 U.S.C. 1395nn(b)), as (b) CONFORMING AMENDMENTS.— subparagraph: amended by section 15201(b)(3)(C), subsection (1) MEDICARE.—Section 1862(b)(5) (42 U.S.C. ‘‘(F) any remuneration between an organi- (d)(1), and subsection (e)(1), is amended— 1395y(b)(5)) is amended— zation and an individual or entity providing (1) by redesignating paragraphs (6) through (A) in subparagraph (B), by striking services pursuant to a written agreement be- (9) as paragraphs (7) through (10); and ‘‘under—’’ and all that follows through the tween the organization and the individual or (2) by inserting after paragraph (5) the fol- end and inserting ‘‘subparagraph (A) for pur- entity if the organization is a MedicarePlus lowing new paragraph: poses of carrying out this subsection.’’, and organization under part C of title XVIII or if ‘‘(6) SERVICES FURNISHED IN AMBULATORY (B) in subparagraph (C)(i), by striking the written agreement places the individual SURGICAL CENTERS.—In the case of a des- ‘‘subparagraph (B)(i)’’ and inserting ‘‘sub- or entity at substantial financial risk for the ignated health service furnished in an ambu- paragraph (B)’’. cost or utilization of the items or services latory surgical center described in section (2) MEDICAID.—Section 1902(a)(25)(A)(i) (42 which the individual or entity is obligated to 1832(a)(2)(F)(i).’’. U.S.C. 1396a(a)(25)(A)(i)) is amended by strik- provide, whether through a withhold, capita- (g) NEW EXCEPTION FOR SERVICES FUR- ing ‘‘including the use of’’ and all that fol- tion, incentive pool, per diem payment, or NISHED IN RENAL DIALYSIS FACILITIES.—Sec- lows through ‘‘any additional measures’’. any other similar risk arrangement which tion 1877(b) (42 U.S.C. 1395nn(b)), as amended (3) ERISA.—Section 101(f) of the Employee places the individual or entity at substantial by section 15201(b)(3)(C), subsection (d)(1), Retirement Income Security Act of 1974 (29 financial risk.’’. subsection (e)(1), and subsection (f), is U.S.C. 1021(f)) is repealed. (b) EFFECTIVE DATE.—The amendment amended— (4) DATA MATCHES.—Section 552a(a)(8)(B) of made by subsection (a) shall apply to acts or (1) by redesignating paragraphs (7) through title 5, United States Code, is amended— omissions occurring on or after January 1, (10) as paragraphs (8) through (11); and (A) by adding ‘‘; or’’ at the end of clause 1996. (2) by inserting after paragraph (6) the fol- (v), SEC. 15214. SOLICITATION AND PUBLICATION OF lowing new paragraph: (B) by striking ‘‘or’’ at the end of clause MODIFICATIONS TO EXISTING SAFE ‘‘(7) SERVICES FURNISHED IN RENAL DIALYSIS (vi), and HARBORS AND NEW SAFE HARBORS. FACILITIES.—In the case of a designated (C) by striking clause (vii). (a) IN GENERAL.— health service furnished in a renal dialysis SEC. 15212. CLARIFICATION OF LEVEL OF INTENT (1) SOLICITATIONS.—Not later than January facility under section 1881.’’. REQUIRED FOR IMPOSITION OF 1, 1996, and not less than annually thereafter, (h) NEW EXCEPTION FOR SERVICES FUR- SANCTIONS. the Secretary of Health and Human Services NISHED IN A HOSPICE.—Section 1877(b) (42 (a) CLARIFICATION OF LEVEL OF KNOWLEDGE shall publish a notice in the Federal Register U.S.C. 1395nn(b)), as amended by section REQUIRED FOR IMPOSITION OF CIVIL MONETARY soliciting proposals, which will be accepted 15201(b)(3)(C), subsection (d)(1), subsection PENALTIES.— during a 60-day period, for— (e)(1), subsection (f), and subsection (g), is (1) IN GENERAL.—Section 1128A(a) (42 U.S.C. (A) modifications to existing safe harbors amended— 1320a–7a(a)) is amended— issued pursuant to section 14(a) of the Medi- (1) by redesignating paragraphs (8) through (A) in paragraphs (1) and (2), by inserting care and Medicaid Patient and Program Pro- (11) as paragraphs (9) through (12); and ‘‘knowingly’’ before ‘‘presents’’ each place it tection Act of 1987; (2) by inserting after paragraph (7) the fol- appears; and (B) additional safe harbors specifying pay- lowing new paragraph: (B) in paragraph (3), by striking ‘‘gives’’ ment practices that shall not be treated as a ‘‘(8) SERVICES FURNISHED BY A HOSPICE PRO- and inserting ‘‘knowingly gives or causes to criminal offense under section 1128B(b) of the GRAM.—In the case of a designated health be given’’. Social Security Act and shall not serve as service furnished by a hospice program under (2) DEFINITION OF STANDARD.—Section the basis for an exclusion under section section 1861(dd)(2).’’. 1128A(i) (42 U.S.C. 1320a–7a(i)) is amended by 1128(b)(7) of such Act; and (i) NEW EXCEPTION FOR SERVICES FUR- adding at the end the following new para- (C) special fraud alerts to be issued pursu- NISHED IN A COMPREHENSIVE OUTPATIENT RE- graph: ant to section 15101(c). H 10414 CONGRESSIONAL RECORD — HOUSE October 19, 1995

(2) PUBLICATION OF PROPOSED MODIFICA- ‘‘(1) Whether the fair market value shall under the safe harbor established under para- TIONS AND PROPOSED ADDITIONAL SAFE HAR- be, or was paid or received for any goods, graph (1) if the activity— BORS.—Not later than 120 days after receiv- services or property. (A) is conducted for purposes of financial ing the proposals described in subparagraphs ‘‘(2) Whether an individual is a bona fide gain, or (A) and (B) of paragraph (1), the Secretary, employee within the requirements of section (B) interferes with the provision of health after considering such proposals in consulta- 3121(d)(2) of the Internal Revenue Code of care services by any health care provider tion with the Attorney General, shall pub- 1986. who is not a member of the specific profes- lish in the Federal Register proposed modi- ‘‘(d) EFFECT OF ADVISORY OPINIONS.— sion which is subject to the authority of the fications to existing safe harbors and pro- ‘‘(1) BINDING AS TO SECRETARY AND PARTIES medical self-regulatory entity. posed additional safe harbors, if appropriate, INVOLVED.—Each advisory opinion issued by (c) DEFINITIONS.—For purposes of this sec- with a 60-day comment period. After consid- the Secretary shall be binding as to the Sec- tion: ering any public comments received during retary and the party or parties requesting (1) ANTITRUST LAWS.—The term ‘‘antitrust this period, the Secretary shall issue final the opinion. laws’’ has the meaning given it in subsection rules modifying the existing safe harbors and ‘‘(2) FAILURE TO SEEK OPINION.—The failure (a) of the first section of the Clayton Act (15 establishing new safe harbors, as appro- of a party to seek an advisory opinion may U.S.C. 12(a)), except that such term includes priate. not be introduced into evidence to prove that section 5 of the Federal Trade Commission (3) REPORT.—The Inspector General shall, the party intended to violate the provisions Act (15 U.S.C. 45) to the extent such section in an annual report to Congress or as part of of sections 1128, 1128A, or 1128B. applies to unfair methods of competition. the year-end semiannual report required by ‘‘(e) REGULATIONS.— (2) HEALTH BENEFIT PLAN.—The term section 5 of the Inspector General Act of ‘‘(1) IN GENERAL.—Not later than 180 days ‘‘health benefit plan’’ means— 1978, describe the proposals received under after the date of the enactment of this sec- (A) a hospital or medical expense incurred subparagraphs (A) and (B) of paragraph (1) tion, the Secretary shall issue regulations to policy or certificate, and explain which proposals were included in carry out this section. Such regulations (B) a hospital or medical service plan con- the publication described in paragraph (2), shall provide for— tract, which proposals were not included in that ‘‘(A) the procedure to be followed by a (C) a health maintenance subscriber con- publication, and the reasons for the rejection party applying for an advisory opinion; tract, of the proposals that were not included. ‘‘(B) the procedure to be followed by the (D) a multiple employer welfare arrange- (b) CRITERIA FOR MODIFYING AND ESTAB- Secretary in responding to a request for an ment or employee benefit plan (as defined LISHING SAFE HARBORS.—In modifying and advisory opinion; under the Employee Retirement Income Se- establishing safe harbors under subsection ‘‘(C) the interval in which the Secretary curity Act of 1974), or (a)(2), the Secretary may consider the extent shall respond; (E) a MedicarePlus product (offered under to which providing a safe harbor for the spec- ‘‘(D) the reasonable fee to be charged to part C of title XVIII of the Social Security ified payment practice may result in any of the party requesting an advisory opinion; Act), the following: and that provides benefits with respect to health (1) An increase or decrease in access to ‘‘(E) the manner in which advisory opin- care services. health care services. ions will be made available to the public. (3) HEALTH CARE SERVICE.—The term (2) An increase or decrease in the quality ‘‘(2) SPECIFIC CONTENTS.—Under the regula- ‘‘health care service’’ means any service for of health care services. tions promulgated pursuant to paragraph which payment may be made under a health (3) An increase or decrease in patient free- (1)— benefit plan including services related to the dom of choice among health care providers. ‘‘(A) the Secretary shall be required to re- delivery or administration of such service. (4) An increase or decrease in competition spond to a party requesting an advisory (4) MEDICAL SELF-REGULATORY ENTITY.— among health care providers. opinion by not later than 30 days after the The term ‘‘medical self-regulatory entity’’ (5) An increase or decrease in the cost to request is received; and means a medical society or association, a health care programs of the Federal Govern- ‘‘(B) the fee charged to the party request- specialty board, a recognized accrediting ment. ing an advisory opinion shall be equal to the agency, or a hospital medical staff, and in- (6) An increase or decrease in the potential costs incurred by the Secretary in respond- cludes the members, officers, employees, overutilization of health care services. ing to the request.’’. consultants, and volunteers or committees of (7) Any other factors the Secretary deems (b) EFFECTIVE DATE.—The amendment such an entity. appropriate in the interest of preventing made by subsection (a) shall apply to re- (5) HEALTH CARE PROVIDER.—The term fraud and abuse in health care programs of quests for advisory opinions made on or after ‘‘health care provider’’ means any individual the Federal Government. January 1, 1996. or entity that is engaged in the delivery of SEC. 15215. ISSUANCE OF ADVISORY OPINIONS SEC. 15216. PRIOR NOTICE OF CHANGES IN BILL- health care services in a State and that is re- UNDER TITLE XI. ING AND CLAIMS PROCESSING RE- quired by State law or regulation to be li- (a) IN GENERAL.—Title XI (42 U.S.C. 1301 et QUIREMENTS FOR PHYSICIANS’ censed or certified by the State to engage in SERVICES. seq.), as amended by section 15104(a), is the delivery of such services in the State. Except as may be specifically provided by amended by inserting after section 1129 the (6) STANDARD SETTING OR STANDARD EN- Congress, the Secretary of Health and following new section: FORCEMENT ACTIVITIES.—The term ‘‘standard ‘‘ADVISORY OPINIONS Human Services may not implement any setting or standard enforcement activities’’ change in the requirements imposed on the ‘‘SEC. 1130. (a) ISSUANCE OF ADVISORY OPIN- means— billing and processing of claims for payment IONS.—The Secretary shall issue written ad- (A) accreditation of health care practition- for physicians’ services under part B of the visory opinions as provided in this section. ers, health care providers, medical education medicare program unless the Secretary noti- ‘‘(b) MATTERS SUBJECT TO ADVISORY OPIN- institutions, or medical education programs, fies the individuals furnishing such services IONS.—The Secretary shall issue advisory (B) technology assessment and risk man- opinions as to the following matters: of the change not later than 120 days before agement activities, ‘‘(1) What constitutes prohibited remunera- the effective date of the change. (C) the development and implementation tion within the meaning of section 1128B(b). PART 3—PROMOTING PHYSICIAN SELF- of practice guidelines or practice param- ‘‘(2) Whether an arrangement or proposed POLICING eters, or arrangement satisfies the criteria set forth SEC. 15221. EXEMPTION FROM ANTITRUST LAWS (D) official peer review proceedings under- in section 1128B(b)(3) for activities which do FOR CERTAIN ACTIVITIES OF MEDI- taken by a hospital medical staff (or com- not result in prohibited remuneration. CAL SELF-REGULATORY ENTITIES. mittee thereof) or a medical society or asso- ‘‘(3) Whether an arrangement or proposed (a) EXEMPTION DESCRIBED.—An activity re- ciation for purposes of evaluating the profes- arrangement satisfies the criteria which the lating to the provision of health care serv- sional conduct or quality of health care pro- Secretary has established, or shall establish ices shall be exempt from the antitrust laws, vided by a medical professional. by regulation for activities which do not re- and any State law similar to the antitrust Subtitle D—Medical Liability Reform sult in prohibited remuneration. laws, if the activity is within the safe harbor ‘‘(4) What constitutes an inducement to re- described in subsection (b). PART 1—GENERAL PROVISIONS duce or limit services to individuals entitled (b) SAFE HARBOR FOR ACTIVITIES OF MEDI- SEC. 15301. FEDERAL REFORM OF HEALTH CARE to benefits under title XVIII or title XIX or CAL SELF-REGULATORY ENTITIES.— LIABILITY ACTIONS. title XXI within the meaning of section (1) IN GENERAL.—The safe harbor referred (a) APPLICABILITY.—This subtitle shall 1128B(b). to in subsection (a) is, subject to paragraph apply with respect to any health care liabil- ‘‘(5) Whether any activity or proposed ac- (2), any activity of a medical self-regulatory ity action brought in any State or Federal tivity constitutes grounds for the imposition entity relating to standard setting or stand- court, except that this subtitle shall not of a sanction under section 1128, 1128A, or ard enforcement activities that are designed apply to— 1128B. to promote the quality of health care serv- (1) an action for damages arising from a ‘‘(c) MATTERS NOT SUBJECT TO ADVISORY ices provided to patients. vaccine-related injury or death to the extent OPINIONS.—Such advisory opinions shall not (2) EXCEPTION.—No activity of a medical that title XXI of the Public Health Service address the following matters: self-regulatory entity may be deemed to fall Act applies to the action, or October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10415 (2) an action under the Employee Retire- (A) any State or Federal health, sickness, utation, humiliation, and other ment Income Security Act of 1974 (29 U.S.C. income-disability, accident or workers’ com- nonpecuniary losses. 1001 et seq.). pensation Act; (16) PERSON.—The term ‘‘person’’ means (b) PREEMPTION.—This subtitle shall pre- (B) any health, sickness, income-disability, any individual, corporation, company, asso- empt any State law to the extent such law is or accident insurance that provides health ciation, firm, partnership, society, joint inconsistent with the limitations contained benefits or income-disability coverage; stock company, or any other entity, includ- in this subtitle. This subtitle shall not pre- (C) any contract or agreement of any ing any governmental entity. empt any State law that provides for de- group, organization, partnership, or corpora- (17) PRODUCT SELLER.— fenses or places limitations on a person’s li- tion to provide, pay for, or reimburse the (A) IN GENERAL.—Subject to subparagraph ability in addition to those contained in this cost of medical, hospital, dental, or income (B), the term ‘‘product seller’’ means a per- subtitle or otherwise imposes greater restric- disability benefits; and son who, in the course of a business con- tions than those provided in this subtitle. (D) any other publicly or privately funded ducted for that purpose— program. (c) EFFECT ON SOVEREIGN IMMUNITY AND (i) sells, distributes, rents, leases, prepares, (6) DRUG.—The term ‘‘drug’’ has the mean- CHOICE OF LAW OR VENUE.—Nothing in sub- blends, packages, labels, or is otherwise in- ing given such term in section 201(g)(1) of the section (b) shall be construed to— volved in placing, a product in the stream of Federal Food, Drug, and Cosmetic Act (21 (1) waive or affect any defense of sovereign commerce, or U.S.C. 321(g)(1)). immunity asserted by any State under any (ii) installs, repairs, or maintains the (7) ECONOMIC LOSS.—The term ‘‘economic harm-causing aspect of a product. provision of law; loss’’ means any pecuniary loss resulting (2) waive or affect any defense of sovereign (B) EXCLUSION.—Such term does not in- from injury (including the loss of earnings or clude— immunity asserted by the United States; other benefits related to employment, medi- (3) affect the applicability of any provision (i) a seller or lessor of real property; cal expense loss, replacement services loss, (ii) a provider of professional services in of the Foreign Sovereign Immunities Act of loss due to death, burial costs, and loss of 1976; any case in which the sale or use of a prod- business or employment opportunities), to uct is incidental to the transaction and the (4) preempt State choice-of-law rules with the extent recovery for such loss is allowed respect to claims brought by a foreign nation essence of the transaction is the furnishing under applicable State law. of judgment, skill, or services; or or a citizen of a foreign nation; or (8) HARM.—The term ‘‘harm’’ means any le- (5) affect the right of any court to transfer (iii) any person who— gally cognizable wrong or injury for which (I) acts in only a financial capacity with venue or to apply the law of a foreign nation punitive damages may be imposed. or to dismiss a claim of a foreign nation or respect to the sale of a product; or (9) HEALTH BENEFIT PLAN.—The term (II) leases a product under a lease arrange- of a citizen of a foreign nation on the ground ‘‘health benefit plan’’ means— of inconvenient forum. ment in which the selection, possession, (A) a hospital or medical expense incurred maintenance, and operation of the product (d) AMOUNT IN CONTROVERSY.—In an action policy or certificate, are controlled by a person other than the les- to which this subtitle applies and which is (B) a hospital or medical service plan con- sor. brought under section 1332 of title 28, United tract, (18) PUNITIVE DAMAGES.—The term ‘‘puni- States Code, the amount of noneconomic (C) a health maintenance subscriber con- tive damages’’ means damages awarded damages or punitive damages, and attorneys’ tract, or against any person not to compensate for ac- fees or costs, shall not be included in deter- (D) a MedicarePlus product (offered under tual injury suffered, but to punish or deter mining whether the matter in controversy part C of title XVIII of the Social Security such person or others from engaging in simi- exceeds the sum or value of $50,000. Act), lar behavior in the future. that provides benefits with respect to health (e) FEDERAL COURT JURISDICTION NOT ES- (19) STATE.—The term ‘‘State’’ means each care services. TABLISHED ON FEDERAL QUESTION GROUNDS.— of the several States, the District of Colum- (10) HEALTH CARE LIABILITY ACTION.—The Nothing in this subtitle shall be construed to bia, Puerto Rico, the Virgin Islands, Guam, term ‘‘health care liability action’’ means a establish any jurisdiction in the district American Samoa, the Northern Mariana Is- courts of the United States over health care civil action brought in a State or Federal court against a health care provider, an en- lands, and any other territory or possession liability actions on the basis of section 1331 of the United States. or 1337 of title 28, United States Code. tity which is obligated to provide or pay for health benefits under any health benefit plan SEC. 15303. EFFECTIVE DATE. SEC. 15302. DEFINITIONS. (including any person or entity acting under This subtitle will apply to any health care As used in this subtitle: a contract or arrangement to provide or ad- liability action brought in a Federal or State (1) ACTUAL DAMAGES.—The term ‘‘actual minister any health benefit), or the manu- court and to any health care liability claim damages’’ means damages awarded to pay for facturer, distributor, supplier, marketer, subject to an alternative dispute resolution economic loss. promoter, or seller of a medical product, in system, that is initiated on or after the date (2) ALTERNATIVE DISPUTE RESOLUTION SYS- which the claimant alleges a claim (includ- of enactment of this subtitle, except that TEM; ADR.—The term ‘‘alternative dispute ing third party claims, cross claims, counter any health care liability claim or action resolution system’’ or ‘‘ADR’’ means a sys- claims, or distribution claims) based upon arising from an injury occurring prior to the tem established under Federal or State law the provision of (or the failure to provide or date of enactment of this subtitle shall be that provides for the resolution of health pay for) health care services or the use of a governed by the applicable statute of limita- care liability claims in a manner other than medical product, regardless of the theory of tions provisions in effect at the time the in- through health care liability actions. liability on which the claim is based or the jury occurred. (3) CLAIMANT.—The term ‘‘claimant’’ number of plaintiffs, defendants, or causes of PART 2—UNIFORM STANDARDS FOR means any person who brings a health care action. HEALTH CARE LIABILITY ACTIONS liability action and any person on whose be- (11) HEALTH CARE LIABILITY CLAIM.—The half such an action is brought. If such action term ‘‘health care liability claim’’ means a SEC. 15311. STATUTE OF LIMITATIONS. is brought through or on behalf of an estate, claim in which the claimant alleges that in- A health care liability action may not be the term includes the claimant’s decedent. If jury was caused by the provision of (or the brought after the expiration of the 2-year pe- such action is brought through or on behalf failure to provide) health care services. riod that begins on the date on which the al- of a minor or incompetent, the term includes (12) HEALTH CARE PROVIDER.—The term leged injury that is the subject of the action the claimant’s legal guardian. ‘‘health care provider’’ means any person was discovered or should reasonably have (4) CLEAR AND CONVINCING EVIDENCE.—The that is engaged in the delivery of health care been discovered, but in no case after the ex- term ‘‘clear and convincing evidence’’ is that services in a State and that is required by piration of the 5-year period that begins on measure or degree of proof that will produce the laws or regulations of the State to be li- the date the alleged injury occurred. in the mind of the trier of fact a firm belief censed or certified by the State to engage in SEC. 15312. CALCULATION AND PAYMENT OF or conviction as to the truth of the allega- the delivery of such services in the State. DAMAGES. tions sought to be established. Such measure (13) HEALTH CARE SERVICE.—The term (a) TREATMENT OF NONECONOMIC DAM- or degree of proof is more than that required ‘‘health care service’’ means any service for AGES.— under preponderance of the evidence but less which payment may be made under a health (1) LIMITATION ON NONECONOMIC DAMAGES.— than that required for proof beyond a reason- benefit plan including services related to the The total amount of noneconomic damages able doubt. delivery or administration of such service. that may be awarded to a claimant for losses (5) COLLATERAL SOURCE PAYMENTS.—The (14) MEDICAL DEVICE.—The term ‘‘medical resulting from the injury which is the sub- term ‘‘collateral source payments’’ means device’’ has the meaning given such term in ject of a health care liability action may not any amount paid or reasonably likely to be section 201(h) of the Federal Food, Drug, and exceed $250,000, regardless of the number of paid in the future to or on behalf of a claim- Cosmetic Act (21 U.S.C. 321(h)). parties against whom the action is brought ant, or any service, product, or other benefit (15) NONECONOMIC DAMAGES.—The term or the number of actions brought with re- provided or reasonably likely to be provided ‘‘noneconomic damages’’ means damages spect to the injury. in the future to or on behalf of a claimant, paid to an individual for pain and suffering, (2) JOINT AND SEVERAL LIABILITY.—In any as a result of an injury or wrongful death, inconvenience, emotional distress, mental health care liability action brought in State pursuant to— anguish, loss of consortium, injury to rep- or Federal court, a defendant shall be liable H 10416 CONGRESSIONAL RECORD — HOUSE October 19, 1995 only for the amount of noneconomic dam- the adequacy of the packaging or labeling of transferred to the Fund under section 1886(j), ages attributable to such defendant in direct a drug which is required to have tamper-re- and such gifts and bequests as may be depos- proportion to such defendant’s share of fault sistant packaging under regulations of the ited in the Fund pursuant to subsection (f). or responsibility for the claimant’s actual Secretary of Health and Human Services (in- Amounts in the Fund are available until ex- damages, as determined by the trier of fact. cluding labeling regulations related to such pended. In all such cases, the liability of a defendant packaging), the manufacturer or product ‘‘(b) EXPENDITURES FROM FUND.—Amounts for noneconomic damages shall be several seller of the drug shall not be held liable for in the Fund are available to the Secretary and not joint. punitive damages unless such packaging or for making payments under section 2211. (b) TREATMENT OF PUNITIVE DAMAGES.— labeling is found by the court by clear and ‘‘(c) ACCOUNTS IN FUND.—There are estab- (1) GENERAL RULE.—Punitive damages may, convincing evidence to be substantially out lished within the Fund the following ac- to the extent permitted by applicable State of compliance with such regulations. counts: law, be awarded in any health care liability (c) PERIODIC PAYMENTS FOR FUTURE ‘‘(1) The Indirect-Costs Medical Education action for harm in any Federal or State LOSSES.— Account. court against a defendant if the claimant es- (1) GENERAL RULE.—In any health care li- ‘‘(2) The Medicare Direct-Costs Medical tablishes by clear and convincing evidence ability action in which the damages awarded Education Account. that the harm suffered was the result of con- for future economic and noneconomic loss ‘‘(3) The General Direct-Costs Medical Edu- duct— exceeds $50,000, a person shall not be required cation Account. (A) specifically intended to cause harm, or to pay such damages in a single, lump-sum ‘‘(d) GENERAL TRANSFERS TO FUND.— (B) conduct manifesting a conscious, fla- payment, but shall be permitted to make ‘‘(1) IN GENERAL.—For fiscal year 1997 and each subsequent fiscal year, there are appro- grant indifference to the rights or safety of such payments periodically based on when priated to the Fund (effective on the applica- others. the damages are found likely to occur, as ble date under paragraph (2)), out of any (2) PROPORTIONAL AWARDS.—The amount of such payments are determined by the court. money in the Treasury not otherwise appro- punitive damages that may be awarded in (2) FINALITY OF JUDGMENT.—The judgment priated, the following amounts (as applicable any health care liability action subject to of the court awarding periodic payments to the fiscal year involved): this subtitle shall not exceed 3 times the under this subsection may not, in the ab- ‘‘(A) For fiscal year 1997, $1,300,000,000. amount of damages awarded to the claimant sence of fraud, be reopened at any time to ‘‘(B) For fiscal year 1998, $1,500,000,000. for economic loss, or $250,000, whichever is contest, amend, or modify the schedule or ‘‘(C) For fiscal year 1999, $2,300,000,000. greater. This paragraph shall be applied by amount of the payments. the court and shall not be disclosed to the ‘‘(D) For fiscal year 2000, $3,100,000,000. (3) LUMP-SUM SETTLEMENTS.—This sub- jury. ‘‘(E) For fiscal year 2001, $3,600,000,000. section shall not be construed to preclude a ‘‘(F) For fiscal year 2002, $4,000,000,000. (3) APPLICABILITY.—This subsection shall settlement providing for a single, lump-sum apply to any health care liability action ‘‘(G) For fiscal year 2003 and each subse- payment. quent fiscal year, the greater of the amount brought in any Federal or State court on any (d) TREATMENT OF COLLATERAL SOURCE theory where punitive damages are sought. appropriated for the preceding fiscal year or PAYMENTS.— This subsection does not create a cause of an amount equal to the product of— (1) INTRODUCTION INTO EVIDENCE.—In any ‘‘(i) the amount appropriated for the pre- action for punitive damages. This subsection health care liability action, any defendant ceding fiscal year; and does not preempt or supersede any State or may introduce evidence of collateral source ‘‘(ii) 1 plus the percentage increase in the Federal law to the extent that such law payments. If any defendant elects to intro- would further limit the award of punitive nominal gross domestic product for the one- duce such evidence, the claimant may intro- damages. year period ending upon July 1 of such pre- duce evidence of any amount paid or contrib- (4) BIFURCATION.—At the request of any ceding fiscal year. uted or reasonably likely to be paid or con- party, the trier of fact shall consider in a ‘‘(2) EFFECTIVE DATE FOR ANNUAL APPRO- tributed in the future by or on behalf of the separate proceeding whether punitive dam- PRIATION.—For purposes of paragraph (1) (and claimant to secure the right to such collat- ages are to be awarded and the amount of for purposes of section 2221(a)(1), and sub- eral source payments. such award. If a separate proceeding is re- sections (b)(1)(A) and (c)(1)(A) of section (2) NO SUBROGATION.—No provider of collat- quested, evidence relevant only to the claim 2231)), the applicable date for a fiscal year is eral source payments shall recover any of punitive damages, as determined by appli- the first day of the fiscal year, exclusive of amount against the claimant or receive any cable State law, shall be inadmissible in any Saturdays, Sundays, and Federal holidays. lien or credit against the claimant’s recov- proceeding to determine whether actual ‘‘(3) ALLOCATION AMONG CERTAIN AC- ery or be equitably or legally subrogated the damages are to be awarded. COUNTS.—Of the amount appropriated in right of the claimant in a health care liabil- (5) DRUGS AND DEVICES.— paragraph (1) for a fiscal year— ity action. (A) IN GENERAL.—(i) Punitive damages ‘‘(A) there shall be allocated to the Indi- (3) APPLICATION TO SETTLEMENTS.—This shall not be awarded against a manufacturer rect-Costs Medical Education Account the subsection shall apply to an action that is or product seller of a drug or medical device percentage determined under paragraph settled as well as an action that is resolved which caused the claimant’s harm where— (4)(B); and by a fact finder. (I) such drug or device was subject to pre- ‘‘(B) there shall be allocated to the General market approval by the Food and Drug Ad- SEC. 15313. ALTERNATIVE DISPUTE RESOLUTION. Direct-Costs Medical Education Account the ministration with respect to the safety of Any ADR used to resolve a health care li- percentage determined under paragraph the formulation or performance of the aspect ability action or claim shall contain provi- (4)(C). of such drug or device which caused the sions relating to statute of limitations, non- ‘‘(4) DETERMINATION OF PERCENTAGES.—The claimant’s harm, or the adequacy of the economic damages, joint and several liabil- Secretary of Health and Human Services, packaging or labeling of such drug or device ity, punitive damages, collateral source rule, acting through the Administrator of the which caused the harm, and such drug, de- and periodic payments which are identical to Health Care Financing Administration, shall vice, packaging, or labeling was approved by the provisions relating to such matters in determine the following: the Food and Drug Administration; or this subtitle. ‘‘(A) The total amount of payments that (II) the drug is generally recognized as safe Subtitle E—Teaching Hospitals and Graduate were made under subsections (d)(5)(B) and (h) and effective pursuant to conditions estab- Medical Education of section 1886 for fiscal year 1994. lished by the Food and Drug Administration PART 1—TEACHING HOSPITAL AND GRAD- ‘‘(B) The percentage of such total that was and applicable regulations, including pack- UATE MEDICAL EDUCATION TRUST constituted by payments under subsection aging and labeling regulations. FUND (d)(5)(B) of such section. (ii) Clause (i) shall not apply in any case in SEC. 15401. ESTABLISHMENT OF FUND; PAY- ‘‘(C) The percentage of such total that was which the defendant, before or after pre- MENTS TO TEACHING HOSPITALS. constituted by payments under subsection market approval of a drug or device— The Social Security Act (42 U.S.C. 300 et (h) of such section. (I) intentionally and wrongfully withheld seq.) is amended by adding after title XXI ‘‘(e) INVESTMENT.— from or misrepresented to the Food and Drug the following title: ‘‘(1) IN GENERAL.—The Secretary of the Administration information concerning such Treasury shall invest such amounts of the ‘‘TITLE XXII—TEACHING HOSPITAL AND drug or device required to be submitted Fund as such Secretary determines are not GRADUATE MEDICAL EDUCATION under the Federal Food, Drug, and Cosmetic required to meet current withdrawals from TRUST FUND Act (21 U.S.C. 301 et seq.) or section 351 of the the Fund. Such investments may be made Public Health Service Act (42 U.S.C. 262) that ‘‘PART A—ESTABLISHMENT OF FUND only in interest-bearing obligations of the is material and relevant to the harm suffered ‘‘SEC. 2201. ESTABLISHMENT OF FUND. United States. For such purpose, such obli- by the claimant, or ‘‘(a) IN GENERAL.—There is established in gations may be acquired on original issue at (II) made an illegal payment to an official the Treasury of the United States a fund to the issue price, or by purchase of outstand- or employee of the Food and Drug Adminis- be known as the Teaching Hospital and ing obligations at the market price. tration for the purpose of securing or main- Graduate Medical Education Trust Fund (in ‘‘(2) SALE OF OBLIGATIONS.—Any obligation taining approval of such drug or device. this title referred to as the ‘Fund’), consist- acquired by the Fund may be sold by the (B) PACKAGING.—In a health care liability ing of amounts appropriated to the Fund in Secretary of the Treasury at the market action for harm which is alleged to relate to subsection (d) and subsection (e)(3), amounts price. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10417

‘‘(3) AVAILABILITY OF INCOME.—Any interest ‘‘(1) the amount in the Indirect-Costs Medi- total amount of payments that would have derived from obligations acquired by the cal Education Account on the applicable been paid to the hospital under section Fund, and proceeds from any sale or redemp- date under section 2201(d) (once the appro- 1886(d)(5)(B) for discharges occurring during tion of such obligations, are hereby appro- priation under such section is made); and fiscal year 1995 if such section, as in effect priated to the Fund. ‘‘(2) the percentage determined for the hos- for fiscal year 1996, had applied to the hos- ‘‘(f) ACCEPTANCE OF GIFTS AND BEQUESTS.— pital under subsection (b). pital for discharges occurring during fiscal The Fund may accept on behalf of the United ‘‘(b) HOSPITAL-SPECIFIC PERCENTAGE.— year 1995. ‘‘(1) IN GENERAL.—For purposes of sub- States money gifts and bequests made un- ‘‘(B)(i) If the first payment year for the section (a)(2), the percentage determined conditionally to the Fund for the benefit of hospital is fiscal year 1995, the amount deter- under this subsection for a teaching hospital the Fund or any activity financed through mined under this subparagraph is the aggre- the Fund. is the mean average of the respective per- centages determined under paragraph (3) for gate total of the payments received by ‘‘PART B—PAYMENTS TO TEACHING HOSPITALS each fiscal year of the applicable period (as teaching hospitals under section 1886(d)(5)(B) ‘‘Subpart 1—Requirement of Payments defined in paragraph (2)), adjusted by the for discharges occurring during fiscal year ‘‘SEC. 2211. FORMULA PAYMENTS TO TEACHING Secretary (upward or downward, as the case 1995. HOSPITALS. may be) on a pro rata basis to the extent ‘‘(ii) If the first payment year for the hos- ‘‘(a) IN GENERAL.—Subject to subsection necessary to ensure that the sum of the per- pital is fiscal year 1996— (d), in the case of each teaching hospital that centages determined under this paragraph ‘‘(I) the Secretary shall make an estimate in accordance with subsection (b) submits to for all teaching hospitals is equal to 100 per- in accordance with subparagraph (A)(ii) for the Secretary a payment document for fiscal cent. The preceding sentence is subject to all teaching hospitals; and year 1997 or any subsequent fiscal year, the sections 2222 and 2223. ‘‘(II) the amount determined under this Secretary shall make payments for the year ‘‘(2) APPLICABLE PERIOD REGARDING REL- subparagraph is the sum of the estimates to the teaching hospital for the costs of oper- EVANT DATA; FISCAL YEARS 1992 THROUGH 1994.— made by the Secretary under subclause (I). ating approved medical residency training For purposes of this part, the term ‘applica- ‘‘(b) NEW TEACHING HOSPITALS.— programs. Such payments shall be made ble period’ means the period beginning on ‘‘(1) IN GENERAL.—Subject to paragraph (4), from the Fund, and the total of the pay- the first day of fiscal year 1992 and continu- in the case of a teaching hospital that did ments to the hospital for the fiscal year ing through the end of fiscal year 1994. not receive payments under section shall equal the sum of the following: ‘‘(3) RESPECTIVE DETERMINATIONS FOR FIS- ‘‘(1) An amount determined under section CAL YEARS OF APPLICABLE PERIOD.—For pur- 1886(d)(5)(B) for any of the fiscal years 1992 2221 (relating to the indirect costs of grad- poses of paragraph (1), the percentage deter- through 1996, the percentage determined uate medical education). mined under this paragraph for a teaching under paragraph (3) for the hospital is ‘‘(2) An amount determined under section hospital for a fiscal year of the applicable pe- deemed to be the percentage applicable 2231 (relating to the direct costs of graduate riod is the percentage constituted by the under section 2221(b) to the hospital, except medical education). ratio of— that the percentage under paragraph (3) shall ‘‘(b) PAYMENT DOCUMENT.—For purposes of ‘‘(A) the total amount of payments re- be adjusted in accordance with section subsection (a), a payment document is a doc- ceived by the hospital under section 2221(b)(1) to the extent determined by the ument containing such information as may 1886(d)(5)(B) for discharges occurring during Secretary to be necessary with respect to a be necessary for the Secretary to make pay- the fiscal year involved; to sum that equals 100 percent. ments under such subsection to a teaching ‘‘(B) the sum of the respective amounts de- ‘‘(2) DESIGNATED FISCAL YEAR REGARDING hospital for a fiscal year. The document is termined under subparagraph (A) for the fis- DATA.—The determination under paragraph submitted in accordance with this subsection cal year for all teaching hospitals. (3) of a percentage for a teaching hospital de- if the document is submitted not later than ‘‘(c) AVAILABILITY OF DATA.—If a teaching scribed in paragraph (1) shall be made for the the date specified by the Secretary, and the hospital received the payments specified in most recent fiscal year for which the Sec- document is in such form and is made in subsection (b)(3)(A) during the applicable pe- retary has sufficient data to make the deter- such manner as the Secretary may require. riod but a complete set of the relevant data mination (referred to in this subsection as The Secretary may require that information is not available to the Secretary for purposes the ‘designated fiscal year’). of determining an amount under such sub- under this subsection be submitted to the ‘‘(3) DETERMINATION OF PERCENTAGE.—For section for the fiscal year involved, the Sec- Secretary in periodic reports. purposes of paragraph (1), the percentage de- retary shall for purposes of such subsection ‘‘(c) ADMINISTRATOR OF PROGRAMS.—This termined under this paragraph for the teach- make an estimate on the basis of such data part, and the subsequent parts of this title, ing hospital involved is the percentage con- as are available to the Secretary for the ap- shall be carried out by the Secretary acting stituted by the ratio of the amount deter- plicable period. through the Administrator of the Health mined under subparagraph (A) to the amount Care Financing Administration. ‘‘SEC. 2222. INDIRECT COSTS; SPECIAL RULES RE- GARDING DETERMINATION OF HOS- determined under subparagraph (B), as fol- ‘‘(d) SPECIAL RULES.— PITAL-SPECIFIC PERCENTAGE. lows: ‘‘(1) AUTHORITY REGARDING PAYMENTS TO ‘‘(a) SPECIAL RULE REGARDING FISCAL ‘‘(A) The amount determined under this CONSORTIA OF PROVIDERS.—In the case of pay- YEARS 1995 AND 1996.— subparagraph is an amount equal to an esti- ments under subsection (a) that are deter- ‘‘(1) IN GENERAL.—In the case of a teaching mate by the Secretary of the total amount of mined under section 2231: hospital whose first payments under section payments that would have been paid to the ‘‘(A) The requirement under such sub- 1886(d)(5)(B) were for discharges occurring in hospital under section 1886(d)(5)(B) for the section to make the payments to teaching fiscal year 1995 or in fiscal year 1996 (referred designated fiscal year if such section, as in hospitals is subject to the authority of the to in this subsection individually as a ‘first effect for the first fiscal year for which pay- Secretary under section 2233(a) to make pay- payment year’), the percentage determined ments pursuant to this subsection are to be ments to qualifying consortia. under paragraph (2) for the hospital is made to the hospital, had applied to the hos- ‘‘(B) If the Secretary authorizes such a deemed to be the percentage applicable consortium for purposes of section 2233(a), pital for the designated fiscal year. under section 2221(b) to the hospital, except subsections (a) and (b) of this section apply ‘‘(B) The Secretary shall make an estimate that the percentage under paragraph (2) shall to the consortium to the same extent and in in accordance with subparagraph (A) for all be adjusted in accordance with section the same manner as the subsections apply to teaching hospitals. The amount determined 2221(b)(1) to the extent determined by the teaching hospitals. under this subparagraph is the sum of the es- Secretary to be necessary with respect to a ‘‘(2) CERTAIN HOSPITALS.—Paragraph (1) of timates made by the Secretary under the sum that equals 100 percent. subsection (a) is subject to sections 2222 and preceding sentence. ‘‘(2) DETERMINATION OF PERCENTAGE.—For 2223 of subpart 2. Paragraph (2) of subsection ‘‘(4) LIMITATION.—This subsection does not purposes of paragraph (1), the percentage de- (a) is subject to sections 2232 through 2234 of apply to a teaching hospital described in termined under this paragraph for a teaching subpart 3. paragraph (1) if the hospital is in a State for hospital is the percentage constituted by the ‘‘(e) APPROVED MEDICAL RESIDENCY TRAIN- which a demonstration project under section ratio of the amount determined under sub- ING PROGRAM.—For purposes of this title, the 1814(b)(3) is in effect. paragraph (A) to the amount determined term ‘approved medical residency training under subparagraph (B), as follows: ‘‘(c) CONSOLIDATIONS AND MERGERS.—In the program’ has the meaning given such term ‘‘(A)(i) If the first payment year for the case of two or more teaching hospitals that in section 1886(h)(5)(A). hospital is fiscal year 1995, the amount deter- have each received payments pursuant to ‘‘Subpart 2—Amount Relating to Indirect mined under this subparagraph is the total section 2221 for one or more fiscal years and Costs of Graduate Medical Education amount of payments received by the hospital that undergo a consolidation or merger, the ‘‘SEC. 2221. DETERMINATION OF AMOUNT RELAT- under section 1886(d)(5)(B) for discharges oc- percentage applicable to the resulting teach- ING TO INDIRECT COSTS. curring during fiscal year 1995. ing hospital for purposes of section 2221(b) is ‘‘(a) IN GENERAL.—For purposes of section ‘‘(ii) If the first payment year for the hos- the sum of the respective percentages that 2211(a)(1), the amount determined under this pital is fiscal year 1996, the amount deter- would have applied pursuant to such section section for a teaching hospital for a fiscal mined under this subparagraph is an amount if the hospitals had not undergone the con- year is the product of— equal to an estimate by the Secretary of the solidation or merger. H 10418 CONGRESSIONAL RECORD — HOUSE October 19, 1995

‘‘SEC. 2223. INDIRECT COSTS; ALTERNATIVE PAY- ‘‘(b) PAYMENT FROM GENERAL ACCOUNT.— hospital is deemed to be the percentage ap- MENTS REGARDING TEACHING HOS- ‘‘(1) IN GENERAL.—For purposes of sub- plicable under section 2231(b)(2) to the hos- PITALS IN CERTAIN STATES. section (a)(1), the amount determined under pital, except that the percentage under para- ‘‘(a) IN GENERAL.—In the case of a teaching this subsection for a teaching hospital for a graph (2) shall be adjusted in accordance hospital in a State for which a demonstra- fiscal year is the product of— with section 2231(b)(2)(A) to the extent deter- tion project under section 1814(b)(3) is in ef- ‘‘(A) the amount in the General Direct- mined by the Secretary to be necessary with fect, this section applies in lieu of section Costs Medical Education Account on the ap- respect to a sum that equals 100 percent. 2221. For purposes of section 2211(a)(1), the plicable date under section 2201(d) (once the ‘‘(2) DETERMINATION OF PERCENTAGE.—For amount determined for such a teaching hos- appropriation under such section is made); purposes of paragraph (1), the percentage de- pital for a fiscal year is the product of— and termined under this paragraph for a teaching ‘‘(1) the amount in the Indirect-Costs Medi- ‘‘(B) the percentage determined for the hospital is the percentage constituted by the cal Education Account for the fiscal year hospital under paragraph (2). ratio of the amount determined under sub- pursuant to the allocation under section ‘‘(2) HOSPITAL-SPECIFIC PERCENTAGE.— paragraph (A) to the amount determined 2201(d)(3)(A) for the year; and ‘‘(A) IN GENERAL.—For purposes of para- under subparagraph (B), as follows: ‘‘(2) the percentage determined under sub- graph (1)(B), the percentage determined ‘‘(A)(i) If the first payment year for the section (b) for the hospital. under this paragraph for a teaching hospital hospital is fiscal year 1995, the amount deter- ‘‘(b) DETERMINATION OF PERCENTAGE.—For is the mean average of the respective per- mined under this subparagraph is the total purposes of subsection (a)(2): centages determined under subparagraph (B) amount of payments received by the hospital ‘‘(1) The Secretary shall make an estimate for each fiscal year of the applicable period under section 1886(h) for cost reporting peri- of the total amount of payments that would (as defined in section 2221(b)(2)), adjusted by ods beginning in fiscal year 1995. have been received under section 1886(d)(5)(B) the Secretary (upward or downward, as the ‘‘(ii) If the first payment year for the hos- by the hospital involved with respect to each case may be) on a pro rata basis to the ex- pital is fiscal year 1996, the amount deter- of the fiscal years of the applicable period if tent necessary to ensure that the sum of the mined under this subparagraph is an amount such section (as in effect for such fiscal percentages determined under this subpara- equal to an estimate by the Secretary of the years) had applied to the hospital for such graph for all teaching hospitals is equal to total amount of payments that would have years. 100 percent. The preceding sentence is sub- been paid to the hospital under section ‘‘(2) The percentage determined under this ject to sections 2232 through 2234. 1886(h) for cost reporting periods beginning subsection for the hospital for a fiscal year is ‘‘(B) RESPECTIVE DETERMINATIONS FOR FIS- in fiscal year 1995 if such section, as in effect a mean average percentage determined for CAL YEARS OF APPLICABLE PERIOD.—For pur- for fiscal year 1996, had applied to the hos- the hospital in accordance with the meth- poses of subparagraph (A), the percentage de- pital for fiscal year 1995. odology of section 2221(b)(1), except that the termined under this subparagraph for a ‘‘(B)(i) If the first payment year for the estimate made by the Secretary under para- teaching hospital for a fiscal year of the ap- hospital is fiscal year 1995, the amount deter- graph (1) of this subsection for a fiscal year plicable period is the percentage constituted mined under this subparagraph is the aggre- of the applicable period is deemed to be the by the ratio of— gate total of the payments received by amount that applies for purposes of section ‘‘(i) the total amount of payments received teaching hospitals under section 1886(h) for 2221(b)(3)(A) for such year. by the hospital under section 1886(h) for cost cost reporting periods beginning in fiscal ‘‘(c) RULE REGARDING PAYMENTS FROM CER- reporting periods beginning during the fiscal year 1995. TAIN AMOUNTS.—In the case of a teaching year involved; to ‘‘(ii) If the first payment year for the hos- hospital described in subsection (a), this sec- ‘‘(ii) the sum of the respective amounts de- pital is fiscal year 1996— tion does not authorize any payment to the termined under clause (i) for the fiscal year ‘‘(I) the Secretary shall make an estimate hospital from amounts transferred to the for all teaching hospitals. in accordance with subparagraph (A)(ii) for Fund under section 1886(j). ‘‘(3) AVAILABILITY OF DATA.—If a teaching all teaching hospitals; and ‘‘(d) ADJUSTMENT REGARDING PAYMENTS TO hospital received the payments specified in ‘‘(II) the amount determined under this OTHER HOSPITALS.—In the case of a fiscal paragraph (2)(B)(i) during the applicable pe- subparagraph is the sum of the estimates year for which payments pursuant to sub- riod but a complete set of the relevant data made by the Secretary under subclause (I). section (a) are made to one or more teaching is not available to the Secretary for purposes ‘‘(b) NEW TEACHING HOSPITALS.— hospitals, the following applies: of determining an amount under such para- ‘‘(1) IN GENERAL.—Subject to paragraph (4), ‘‘(1) The Secretary shall determine a per- graph for the fiscal year involved, the Sec- in the case of a teaching hospital that did not receive payments under section 1886(h) centage equal to the sum of the respective retary shall for purposes of such paragraph for any of the fiscal years 1992 through 1996, percentages determined for the hospitals make an estimate on the basis of such data the percentage determined under paragraph under subsection (b). as are available to the Secretary for the ap- (3) for the hospital is deemed to be the per- ‘‘(2) The Secretary shall determine an plicable period. centage applicable under section 2231(b)(2) to amount equal to the product of— ‘‘(c) PAYMENT FROM MEDICARE ACCOUNT.— the hospital, except that the percentage ‘‘(A) the percentage determined under ‘‘(1) IN GENERAL.—For purposes of sub- under paragraph (3) shall be adjusted in ac- paragraph (1); and section (a)(2), the amount determined under cordance with section 2231(b)(2)(A) to the ex- ‘‘(B) the amount in the Indirect-Costs Med- this subsection for a teaching hospital for a tent determined by the Secretary to be nec- ical Education Account for the fiscal year fiscal year is the product of— essary with respect to a sum that equals 100 pursuant to the transfer under section ‘‘(A) the amount in the Medicare Direct- percent. 1886(j)(1). Costs Medical Education Account on the ap- ‘‘(2) DESIGNATED FISCAL YEAR REGARDING ‘‘(3) The Secretary shall, for each hospital plicable date under section 2201(d) (once the DATA.—The determination under paragraph (other than hospitals described in subsection appropriation under such section is made); (3) of a percentage for a teaching hospital de- (a)), make payments to the hospital in and scribed in paragraph (1) shall be made for the amounts whose sum for the fiscal year is ‘‘(B) the percentage determined for the most recent fiscal year for which the Sec- equal to the product of— hospital under paragraph (2) for the fiscal retary has sufficient data to make the deter- ‘‘(A) the amount determined under para- year. mination (referred to in this subsection as graph (2); and ‘‘(2) HOSPITAL-SPECIFIC PERCENTAGE.—For the ‘designated fiscal year’). ‘‘(B) the percentage that applies to the purposes of paragraph (1)(B), the percentage ‘‘(3) DETERMINATION OF PERCENTAGE.—For hospital for purposes of section 2221(b), ex- determined under this subsection for a purposes of paragraph (1), the percentage de- cept that such percentage shall be adjusted teaching hospital for a fiscal year is the per- termined under this paragraph for the teach- in accordance with the methodology of sec- centage constituted by the ratio of— ing hospital involved is the percentage con- tion 2221(b)(1) to the extent determined by ‘‘(A) the estimate made by the Secretary stituted by the ratio of the amount deter- the Secretary to be necessary with respect to for the hospital for the fiscal year under sec- mined under subparagraph (A) to the amount a sum that equals 100 percent. tion 1886(j)(2)(B); to ‘‘(B) the sum of the respective estimates determined under subparagraph (B), as fol- ‘‘Subpart 3—Amount Relating to Direct referred to in subparagraph (A) for all teach- lows: Costs of Graduate Medical Education ing hospitals. ‘‘(A) The amount determined under this ‘‘SEC. 2231. DETERMINATION OF AMOUNT RELAT- ‘‘SEC. 2232. DIRECT COSTS; SPECIAL RULES RE- subparagraph is an amount equal to an esti- ING TO DIRECT COSTS. GARDING DETERMINATION OF HOS- mate by the Secretary of the total amount of ‘‘(a) IN GENERAL.—For purposes of section PITAL-SPECIFIC PERCENTAGE. payments that would have been paid to the 2211(a)(2), the amount determined under this ‘‘(a) SPECIAL RULE REGARDING FISCAL hospital under section 1886(h) for the des- section for a teaching hospital for a fiscal YEARS 1995 AND 1996.— ignated fiscal year if such section, as in ef- year is the sum of— ‘‘(1) IN GENERAL.—In the case of a teaching fect for the first fiscal year for which pay- ‘‘(1) the amount determined under sub- hospital whose first payments under section ments pursuant to this subsection are to be section (b) (relating to the General Direct- 1886(h) were for the cost reporting period be- made to the hospital, had applied to the hos- Costs Medical Education Account); and ginning in fiscal year 1995 or in fiscal year pital for cost reporting periods beginning in ‘‘(2) the amount determined under sub- 1996 (referred to in this subsection individ- the designated fiscal year. section (c) (relating to the Medicare Direct- ually as a ‘first payment year’), the percent- ‘‘(B) The Secretary shall make an estimate Costs Medical Education Account). age determined under paragraph (2) for the in accordance with subparagraph (A) for all October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10419 teaching hospitals. The amount determined ‘‘(2) an amount equal to 1 percent of the (2) in subsection (h)— under this subparagraph is the sum of the es- amount that applies under section (A) in paragraph (1), in the first sentence, timates made by the Secretary under the 2231(c)(1)(A) for the fiscal year (relating to by striking ‘‘the Secretary shall provide’’ preceding sentence. the Medicare Direct-Costs Medical Edu- and inserting ‘‘the Secretary shall, subject ‘‘(4) LIMITATION.—This subsection does not cation Account). to paragraph (6), provide’’; and apply to a teaching hospital described in ‘‘(e) DEFINITION.—For purposes of this title, (B) by adding at the end the following paragraph (1) if the hospital is in a State for the term ‘qualifying consortium’ means a paragraph: which a demonstration project under section consortium that meets the requirements of ‘‘(6) LIMITATION.— 1814(b)(3) is in effect. subsection (b). ‘‘(A) IN GENERAL.—The authority to make ‘‘(c) CONSOLIDATIONS AND MERGERS.—In the ‘‘SEC. 2234. DIRECT COSTS; ALTERNATIVE PAY- payments under this subsection applies only case of two or more teaching hospitals that MENTS REGARDING TEACHING HOS- with respect to cost reporting periods ending have each received payments pursuant to PITALS IN CERTAIN STATES. on or before September 30, 1996, except as section 2231 for one or more fiscal years and ‘‘(a) IN GENERAL.—In the case of a teaching provided in subparagraph (B). that undergo a consolidation or merger, the hospital in a State for which a demonstra- ‘‘(B) RULE REGARDING PORTION OF LAST COST percentage applicable to the resulting teach- tion project under section 1814(b)(3) is in ef- REPORTING PERIOD.—In the case of a cost re- ing hospital for purposes of section 2231(b) is fect, this section applies in lieu of section porting period that extends beyond Septem- the sum of the respective percentages that 2231. For purposes of section 2211(a)(2), the ber 30, 1996, payments under this subsection would have applied pursuant to such section amount determined for a teaching hospital shall be made with respect to such portion of if the hospitals had not undergone the con- for a fiscal year is the product of— the period as has lapsed as of such date. solidation or merger. ‘‘(1) the amount in the General Direct- ‘‘(C) RULE OF CONSTRUCTION.—This para- Costs Medical Education Account on the ap- graph may not be construed as authorizing ‘‘SEC. 2233. DIRECT COSTS; AUTHORITY FOR PAY- any payment under section 1861(v) with re- MENTS TO CONSORTIA OF PROVID- plicable date under section 2201(d) (once the ERS. appropriation under such section is made); spect to graduate medical education.’’; and (3) by adding at the end the following sub- ‘‘(a) IN GENERAL.—In lieu of making pay- and ments to teaching hospitals pursuant to sec- ‘‘(2) the percentage determined under sub- section: ‘‘(j) TRANSFERS TO TEACHING HOSPITAL AND tion 2231, the Secretary may make payments section (b) for the hospital. GRADUATE MEDICAL EDUCATION TRUST under this section to consortia that meet the ‘‘(b) DETERMINATION OF PERCENTAGE.—For FUND.— requirements of subsection (b). purposes of subsection (a)(2): ‘‘(1) The Secretary shall make an estimate ‘‘(1) INDIRECT COSTS OF MEDICAL EDU- ‘‘(b) QUALIFYING CONSORTIUM.—For pur- of the total amount of payments that would CATION.— poses of subsection (a), a consortium meets ‘‘(A) IN GENERAL.—From the Federal Hos- the requirements of this subsection if the have been received under section 1886(h) by the hospital involved with respect to each of pital Insurance Trust Fund, the Secretary consortium is in compliance with the follow- shall, for fiscal year 1997 and each subse- ing: the fiscal years of the applicable period if such section (as in effect for such fiscal quent fiscal year, transfer to the Indirect- ‘‘(1) The consortium consists of an ap- Costs Medical Education Account (under sec- proved medical residency training program years) had applied to the hospital for such years. tion 2201) an amount determined by the Sec- and one or more of the following entities: retary in accordance with subparagraph (B). ‘‘(A) Schools of allopathic medicine or os- ‘‘(2) The percentage determined under this subsection for the hospital for a fiscal year is ‘‘(B) DETERMINATION OF AMOUNTS.—The teopathic medicine. Secretary shall make an estimate for the fis- ‘‘(B) Teaching hospitals. a mean average percentage determined for the hospital in accordance with the meth- cal year involved of the nationwide total of ‘‘(C) Other approved medical residency the amounts that would have been paid training programs. odology of section 2231(b)(2)(A), except that the estimate made by the Secretary under under subsection (d)(5)(B) to hospitals during ‘‘(D) Federally qualified health centers. the fiscal year if such payments had not been ‘‘(E) Medical group practices. paragraph (1) of this subsection for a fiscal year of the applicable period is deemed to be terminated for discharges occurring after ‘‘(F) Managed care entities. September 30, 1996. For purposes of subpara- ‘‘(G) Entities furnishing outpatient serv- the amount that applies for purposes of sec- tion 2231(b)(2)(B)(i) for such year. graph (A), the amount determined under this ices. subparagraph for the fiscal year is the esti- ‘‘(c) RULE REGARDING PAYMENTS FROM CER- ‘‘(H) Such other entities as the Secretary mate made by the Secretary under the pre- TAIN AMOUNTS.—In the case of a teaching determines to be appropriate. hospital described in subsection (a), this sec- ceding sentence. ‘‘(2) The members of the consortium have tion does not authorize any payment to the ‘‘(2) DIRECT COSTS OF MEDICAL EDUCATION.— agreed to participate in the programs of ‘‘(A) IN GENERAL.—From the Federal Hos- hospital from amounts transferred to the graduate medical education that are oper- pital Insurance Trust Fund and the Federal Fund under section 1886(j). ated by the entities in the consortium. Supplementary Medical Insurance Trust ‘‘(3) With respect to the receipt by the con- ‘‘Subpart 4—General Provisions Fund, the Secretary shall, for fiscal year 1997 sortium of payments made pursuant to this ‘‘SEC. 2241. ADJUSTMENTS IN PAYMENT and each subsequent fiscal year, transfer to section, the members of the consortium have AMOUNTS. the Medicare Direct-Costs Medical Edu- agreed on a method for allocating the pay- ‘‘(a) COLLECTION OF DATA ON ACCURACY OF cation Account (under section 2201) the sum ments among the members. ESTIMATES.—The Secretary shall collect of— ‘‘(4) The consortium meets such additional data on whether the estimates made by the ‘‘(i) an amount determined by the Sec- requirements as the Secretary may estab- Secretary under section 1886(j) for a fiscal retary in accordance with subparagraph (B); lish. year were substantially accurate. and ‘‘(c) PAYMENTS FROM ACCOUNTS.— ‘‘(b) ADJUSTMENTS.—If the Secretary deter- ‘‘(ii) as applicable, an amount determined ‘‘(1) IN GENERAL.—Subject to subsection mines under subsection (a) that an estimate by the Secretary in accordance with sub- (d), the total of payments to a qualifying for a fiscal year was not substantially accu- paragraph (C)(ii). consortium for a fiscal year pursuant to sub- rate, the Secretary shall, for the first fiscal ‘‘(B) DETERMINATION OF AMOUNTS.—For section (a) shall be the sum of— year beginning after the Secretary makes each hospital (other than a hospital that is a ‘‘(1) the aggregate amount determined for the determination— member of a qualifying consortium referred the teaching hospitals of the consortium ‘‘(1) make adjustments accordingly in to in subparagraph (C)), the Secretary shall pursuant to paragraph (1) of section 2231(a); transfers to the Fund under section 1886(j); make an estimate for the fiscal year in- and and volved of the amount that would have been ‘‘(2) an amount determined in accordance ‘‘(2) make adjustments accordingly in the paid under subsection (h) to the hospital dur- with the methodology that applies pursuant amount of payments to teaching hospitals ing the fiscal year if such payments had not to paragraph (2) of such section, except that pursuant to 2231(c) (or, as applicable, to been terminated for cost reporting periods the estimate used for purposes of subsection qualifying consortia pursuant to section ending on or before September 30, 1996. For (c)(2)(A) of such section shall be the estimate 2233(c)(2)).’’. purposes of subparagraph (A)(i), the amount made for the consortium under section PART 2—AMENDMENTS TO MEDICARE determined under this subparagraph for the 1886(j)(2)(C)(ii). PROGRAM fiscal year is the sum of all estimates made ‘‘(d) LIMITATION ON AGGREGATE TOTAL OF SEC. 15411. TRANSFERS TO TEACHING HOSPITAL by the Secretary under the preceding sen- PAYMENTS TO CONSORTIA.—The aggregate AND GRADUATE MEDICAL EDU- tence. total of the amounts paid under subsection CATION TRUST FUND. ‘‘(C) ESTIMATES REGARDING QUALIFYING CON- (c)(2) to qualifying consortia for a fiscal year Section 1886 (42 U.S.C. 1395ww) is amend- SORTIA.—If the Secretary elects to authorize may not exceed the sum of— ed— one or more qualifying consortia for pur- ‘‘(1) the aggregate total of the amounts (1) in subsection (d)(5)(B), in the matter poses of section 2233(a), the Secretary shall that would have been paid under section preceding clause (i), by striking ‘‘The Sec- carry out the following: 2231(c) for the fiscal year to the teaching retary shall provide’’ and inserting the fol- ‘‘(i) The Secretary shall establish a meth- hospitals of the consortia if the hospitals lowing: ‘‘For discharges occurring on or be- odology for making payments to qualifying had not been participants in the consortia; fore September 30, 1996, the Secretary shall consortia with respect to the reasonable di- and provide’’; rect costs of such consortia in carrying out H 10420 CONGRESSIONAL RECORD — HOUSE October 19, 1995

programs of graduate medical education. (1) LIMITATION ON NUMBER OF FULL-TIME- cal year, for each such individual the Sec- The methodology shall be the methodology EQUIVALENT RESIDENTS.—Section 1886(h)(4) retary shall apply a weighting factor of .25.’’. established in subsection (h), modified to the (42 U.S.C. 1395ww(h)(4)) is amended by adding (4) EFFECTIVE DATE.—Except as provided extent necessary to take into account the at the end the following new subparagraph: otherwise in this subsection (or in the participation in such programs of entities ‘‘(F) LIMITATION ON NUMBER OF RESIDENTS amendments made by this subsection), the other than hospitals. FOR CERTAIN FISCAL YEARS.— amendments made by this subsection apply ‘‘(ii) For each qualifying consortium, the ‘‘(i) IN GENERAL.—Such rules shall provide to hospital cost reporting periods beginning Secretary shall make an estimate for the fis- that for purposes of a cost reporting period on or after October 1, 1995. cal year involved of the amount that would beginning on or after October 1, 1995, and on PART 3—REFORM OF FEDERAL POLICIES have been paid to the consortium during the or before September 30, 2002, the number of REGARDING TEACHING HOSPITALS AND fiscal year if, using the methodology under full-time-equivalent residents determined GRADUATE MEDICAL EDUCATION clause (i), payments had been made to the under this paragraph with respect to an ap- SEC. 15421. ESTABLISHMENT OF ADVISORY consortium for the fiscal year as reimburse- proved medical residency training program PANEL FOR RECOMMENDING POLI- ments with respect to cost reporting periods. may not exceed the number of full-time- CIES. For purposes of subparagraph (A)(ii), the equivalent residents with respect to the pro- Title XXII of the Social Security Act, as amount determined under this clause for the gram as of August 1, 1995 (except that this added by section 15401, is amended by adding fiscal year is the sum of all estimates made subparagraph applies only to approved medi- at the end the following part: by the Secretary under the preceding sen- cal residency training programs in the fields ‘‘PART C—OTHER MATTERS tence. of allopathic medicine and osteopathic medi- ‘‘SEC. 2251. ADVISORY PANEL ON REFORM IN FI- ‘‘(D) ALLOCATION BETWEEN FUNDS.—In pro- cine). NANCING OF TEACHING HOSPITALS viding for a transfer under subparagraph (A) ‘‘(ii) DISPOSITION OF UNUSED RESIDENCY PO- AND GRADUATE MEDICAL EDU- for a fiscal year, the Secretary shall provide SITIONS.—In the case of a cost reporting pe- CATION. for an allocation of the amounts involved be- riod to which the limitation under clause (i) ‘‘(a) ESTABLISHMENT.—The Chair of the tween part A and part B (and the trust funds applies, if for such a period the number of Medicare Payment Review Commission established under the respective parts) as full-time-equivalent residents determined under section 1806 shall establish a tem- reasonably reflects the proportion of direct under this paragraph with respect to an ap- porary advisory panel to be known as the graduate medical education costs of hos- proved medical residency training program Advisory Panel on Financing for Teaching pitals associated with the provision of serv- is less than the maximum number applicable Hospitals and Graduate Medical Education ices under each respective part. to the program under such clause, the Sec- (in this section referred to as the ‘Panel’). ‘‘(3) APPLICABILITY OF CERTAIN AMEND- retary may authorize for one or more other ‘‘(b) DUTIES.—The Panel shall develop rec- MENTS.—Amendments made to subsection approved medical residency training pro- ommendations on whether and to what ex- (d)(5)(B) and subsection (h) that are effective grams offsetting increases in the respective tent Federal policies regarding teaching hos- on or after October 1, 1996, apply only for maximum numbers that otherwise would be pitals and graduate medical education purposes of estimates under paragraphs (1) applicable under such clause to the pro- should be reformed, including recommenda- and (2) and for purposes of determining the grams. In authorizing such increases with re- tions regarding the following: amount of payments under 2211. Such spect to a cost reporting period, the Sec- ‘‘(1) The financing of graduate medical amendments do not require any adjustment retary shall ensure that the national total of education, including consideration of alter- to amounts paid under subsection (d)(5)(B) or the respective maximum numbers deter- native broad-based sources of funding for (h) with respect to fiscal year 1996 or any mined under such clause with respect to ap- such education. prior fiscal year. proved medical residency training programs ‘‘(2) The financing of teaching hospitals, ‘‘(4) RELATIONSHIP TO CERTAIN DEMONSTRA- is not exceeded.’’. including consideration of the difficulties en- TION PROJECTS.—In the case of a State for (2) EXCLUSION OF RESIDENTS AFTER INITIAL countered by such hospitals as competition which a demonstration project under section RESIDENCY PERIOD.—Section 1886(h)(4)(C) (42 among health care entities increases. Mat- 1814(b)(3) is in effect, the Secretary, in mak- U.S.C. 1395ww(h)(4)(C)) is amended to read as ters considered under this paragraph shall ing determinations of the rates of increase follows: include consideration of the effects on teach- under such section, shall include all amounts ‘‘(C) WEIGHTING FACTORS FOR RESIDENTS.— ing hospitals of the method of financing used transferred under this subsection. Such Effective for cost reporting periods begin- for the MedicarePlus program under part C amounts shall be so included to the same ex- ning on or after October 1, 1997, such rules of title XVIII. tent and in the same manner as amounts de- shall provide that, in the calculation of the ‘‘(3) The methodology for making pay- termined under subsections (d)(5)(B) and (h) number of full-time-equivalent residents in ments for graduate medical education, and were included in such determination under an approved residency program, the the selection of entities to receive the pay- the provisions of this title in effect on Sep- weighting factor for a resident who is in the ments. Matters considered under this para- tember 30, 1996.’’. initial residency period (as defined in para- graph shall include the following: SEC. 15412. MODIFICATION IN PAYMENT POLI- graph (5)(F)) is 1.0 and the weighting factor ‘‘(A) The methodology under part B for CIES REGARDING GRADUATE MEDI- for a resident who has completed such period making payments from the Fund, including CAL EDUCATION. is 0.0. (In the case of cost reporting periods the use of data from the fiscal years 1992 (a) INDIRECT COSTS OF MEDICAL EDUCATION; beginning before October 1, 1997, the through 1994, and including the methodology APPLICABLE PERCENTAGE.— weighting factors that apply in such calcula- that applies with respect to consolidations (1) MODIFICATION REGARDING 5.6 PERCENT.— tion are the weighting factors that were ap- and mergers of participants in the program Section 1886(d)(5)(B)(ii) (42 U.S.C. plicable under this subparagraph on the day under such part and with respect to the in- 1395ww(d)(5)(B)(ii)) is amended— before the date of the enactment of the Medi- clusion of additional participants in the pro- (A) by striking ‘‘on or after October 1, care Preservation Act of 1995.)’’. gram. 1988,’’ and inserting ‘‘on or after October 1, (3) REDUCTIONS IN PAYMENTS FOR ALIEN ‘‘(B) Issues regarding children’s hospitals, 1999,’’; and RESIDENTS.—Section 1886(h)(4) (42 U.S.C. and approved medical residency training pro- (B) by striking ‘‘1.89’’ and inserting ‘‘1.38’’. 1395ww(h)(4)), as amended by paragraph (1), grams in pediatrics. (2) SPECIAL RULE REGARDING FISCAL YEARS is amended by adding at the end the follow- ‘‘(C) Whether and to what extent payments 1996 THROUGH 1998; MODIFICATION REGARDING 6 ing new subparagraph: are being made (or should be made) for grad- PERCENT.—Section 1886(d)(5)(B)(ii), as amend- ‘‘(G) SPECIAL RULES FOR ALIEN RESIDENTS.— uate training in the various nonphysician ed by paragraph (1), is amended by adding at In the case of individuals who are not citi- health professions. the end the following: ‘‘In the case of dis- zens or nationals of the United States, aliens ‘‘(4) Federal policies regarding inter- charges occurring on or after October 1, 1995, lawfully admitted to the United States for national medical graduates. and before October 1, 1999, the preceding sen- permanent residence, aliens admitted to the ‘‘(5) The dependence of schools of medicine tence applies to the same extent and in the United States as refugees, or citizens of Can- on service-generated income. same manner as the sentence applies to dis- ada, in the calculation of the number of full- ‘‘(6) The effects of the amendments made charges occurring on or after October 1, 1999, time-equivalent residents in an approved by section 15412 of the Medicare Preservation except that the term ‘1.38’ is deemed to be medical residency program, the following Act of 1995, including adverse effects on ‘1.48’.’’. rules shall apply with respect to such indi- teaching hospitals that result from modifica- (3) CONFORMING AMENDMENT RELATING TO viduals who are residents in the program: tions in policies regarding international DETERMINATION OF STANDARDIZED AMOUNTS.— ‘‘(i) For a cost reporting period beginning medical graduates. Section 1886(d)(2)(C)(i) (42 U.S.C. during fiscal year 1996, for each such individ- ‘‘(7) Whether and to what extent the needs 1395ww(d)(2)(C)(i)) is amended by striking ual the Secretary shall apply a weighting of the United States regarding the supply of ‘‘1985’’ and inserting the following: ‘‘1985, but factor of .75. physicians will change during the 10-year pe- (for discharges occurring after September 30, ‘‘(ii) For a cost reporting period beginning riod beginning on October 1, 1995, and wheth- 1995) not taking into account any reductions during fiscal year 1997, for each such individ- er and to what extent any such changes will in such costs resulting from the amendments ual the Secretary shall apply a weighting have significant financial effects on teaching made by section 15412(a) of the Medicare factor of .50. hospitals. Preservation Act of 1995’’. ‘‘(iii) For a cost reporting period beginning ‘‘(8) The appropriate number and mix of (b) DIRECT COSTS OF MEDICAL EDUCATION.— during fiscal year 1998 or any subsequent fis- residents. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10421

‘‘(c) COMPOSITION.—Not later than three consultants under section 3109(b) of title 5, subclauses (XI), (XII), and (XIII) and insert- months after being designated as the initial United States Code, as the Panel may deter- ing the following: chair of the Medicare Payment Review Com- mine to be useful in carrying out the duties ‘‘(XI) for fiscal year 1996, the market bas- mission, the Chair of the Commission shall under subsection (b). The Panel may not pro- ket percentage increase minus 2.5 percentage appoint to the Panel 19 individuals who are cure services under this subsection at any points for hospitals in all areas, not members of the Commission, who are not rate in excess of the daily equivalent of the ‘‘(XII) for each of the fiscal years 1997 officers or employees of the United States, maximum annual rate of basic pay payable through 2002, the market basket percentage and who possess expertise on matters on under the General Schedule for positions increase minus 2.0 percentage points for hos- which the Panel is to make recommenda- above GS–15. Consultants under this sub- pitals in all areas, and tions under subsection (b). Such individuals section may, in accordance with chapter 57 ‘‘(XIII) for fiscal year 2003 and each subse- shall include the following: of title 5, United States Code, be reimbursed quent fiscal year, the market basket per- ‘‘(1) Deans from allopathic and osteopathic for travel, subsistence, and other necessary centage increase for hospitals in all areas.’’. schools of medicine. expenses incurred for activities carried out SEC. 15502. REDUCTIONS IN DISPROPORTIONATE ‘‘(2) Chief executive officers (or equivalent on behalf of the Panel pursuant to sub- SHARE PAYMENT ADJUSTMENTS. administrative heads) from academic health section (b). (a) IN GENERAL.—Section 1886(d)(5)(F) (42 centers, integrated health care systems, ap- ‘‘(k) POWERS.— U.S.C. 1395ww(d)(5)(F)) is amended— proved medical residency training programs, ‘‘(1) IN GENERAL.—For the purpose of carry- (1) in clause (ii), by striking ‘‘The amount’’ and teaching hospitals that sponsor approved ing out the duties of the Panel under sub- and inserting ‘‘Subject to clause (ix), the medical residency training programs. section (b), the Panel may hold such hear- amount’’; and ‘‘(3) Chairs of departments or divisions ings, sit and act at such times and places, (2) by adding at the end the following new from allopathic and osteopathic schools of take such testimony, and receive such evi- clause: medicine, schools of dentistry, and approved dence as the Panel considers appropriate. ‘‘(ix) In the case of discharges occurring on medical residency training programs in oral ‘‘(2) OBTAINING OFFICIAL INFORMATION.— or after October 1, 1995, the additional pay- surgery. Upon the request of the Panel, the heads of ment amount otherwise determined under ‘‘(4) Individuals with leadership experience Federal agencies shall furnish directly to the clause (ii) shall be reduced as follows: from each of the fields of advanced practice Panel information necessary for the Panel to ‘‘(I) For discharges occurring on or after ± nursing, physician assistants, and podiatric carry out the duties under subsection (b). October 1, 1995, and on or before September medicine. ‘‘(3) USE OF MAILS.—The Panel may use the 30, 1996, by 20 percent. ‘‘(5) Individuals with substantial experi- United States mails in the same manner and ‘‘(II) For discharges occurring on or after ence in the study of issues regarding the under the same conditions as Federal agen- October 1, 1996, and on or before September composition of the health care workforce of cies. 30, 1997, by 25 percent. ‘‘(l) REPORTS.— the United States. ‘‘(III) For discharges occurring on or after ‘‘(1) FIRST INTERIM REPORT.—Not later than ‘‘(6) Individuals with expertise on the fi- October 1, 1997, by 30 percent.’’. one year after the date of the enactment of nancing of health care. (b) CONFORMING AMENDMENT RELATING TO the Medicare Preservation Act of 1995, the ‘‘(7) Representatives from health insurance DETERMINATION OF STANDARDIZED Panel shall submit to the Congress a report AMOUNTS.—Section 1886(d)(2)(C)(iv) (42 U.S.C. organizations and health plan organizations. providing the recommendations of the Panel ‘‘(d) RELATIONSHIP OF PANEL TO MEDICARE 1395ww(d)(2)(C)(iv)) is amended by striking regarding the matters specified in para- PAYMENT REVIEW COMMISSION.—From the period at the end and inserting the fol- graphs (1) through (4) of subsection (b). amounts appropriated under subsection (n), lowing: ‘‘, and the Secretary shall not take ‘‘(2) SECOND INTERIM REPORT.—Not later the Medicare Payment Review Commission into account any reductions in the amount than 2 years after the date of enactment shall provide for the Panel such staff and ad- of such additional payments resulting from specified in paragraph (1), the Panel shall ministrative support (including quarters for the amendments made by section 15502(a) of submit to the Congress a report providing the Medicare Preservation Act of 1995.’’. the Panel) as may be necessary for the Panel the recommendations of the Panel regarding SEC. 15503. PAYMENTS FOR CAPITAL-RELATED to carry out the duties under subsection (b). the matters specified in paragraphs (5) and ‘‘(e) CHAIR.—The Panel shall designate a COSTS FOR INPATIENT HOSPITAL (6) of subsection (b). member of the Panel to serve as the Chair of SERVICES. ‘‘(3) FINAL REPORT.—Not later than 3 years the Panel. (a) REDUCTION IN PAYMENTS FOR PPS HOS- after the date of enactment specified in para- ‘‘(f) MEETINGS.—The Panel shall meet at PITALS.— the call of the Chair or a majority of the graph (1), the Panel shall submit to the Con- (1) CONTINUATION OF CURRENT REDUC- gress a final report providing the rec- members, except that the first meeting of TIONS.—Section 1886(g)(1)(A) (42 U.S.C. ommendations of the Panel under subsection the Panel shall be held not later than three 1395ww(g)(1)(A)) is amended in the second (b). months after the date on which appoint- sentence— ‘‘(m) DURATION.—The Panel terminates (A) by striking ‘‘through 1995’’ and insert- ments under subsection (c) are completed. upon the expiration of the 180-day period be- ‘‘(g) TERMS.—The term of a member of the ing ‘‘through 2002’’; and ginning on the date on which the final report Panel is the duration of the Panel. (B) by inserting after ‘‘10 percent reduc- under subsection (l)(3) is submitted to the ‘‘(h) VACANCIES.— tion’’ the following: ‘‘(or a 15 percent reduc- Congress. ‘‘(1) IN GENERAL.—A vacancy in the mem- tion in the case of payments during fiscal ‘‘(n) AUTHORIZATION OF APPROPRIATIONS.— bership of the Panel does not affect the years 1996 through 2002)’’. ‘‘(1) IN GENERAL.—Subject to paragraph (2), power of the remaining members to carry (2) REDUCTION IN BASE PAYMENT RATES.— for the purpose of carrying out this section, out the duties under subsection (b). A va- Section 1886(g)(1)(A) (42 U.S.C. there are authorized to be appropriated such cancy in the membership of the Panel shall sums as may be necessary for each of the fis- 1395ww(g)(1)(A)) is amended by adding at the be filled in the manner in which the original cal years 1996 through 1999. end the following new sentence: ‘‘In addition appointment was made. to the reduction described in the preceding ‘‘(2) LIMITATION.—The authorization of ap- ‘‘(2) INCOMPLETE TERM.—If a member of the propriations established in paragraph (1) is sentence, for discharges occurring after Sep- Panel does not serve the full term applicable effective only with respect to appropriations tember 30, 1995, the Secretary shall reduce by to the member, the individual appointed to made from allocations under section 302(b) of 7.47 percent the unadjusted standard Federal fill the resulting vacancy shall be appointed the Congressional Budget Act of 1974— capital payment rate (as described in 42 CFR for the remainder of the term of the prede- ‘‘(A) for the Subcommittee on Labor, 412.308(c), as in effect on the date of the en- cessor of the individual. Health and Human Services, and Education, actment of the Medicare Preservation Act of ‘‘(i) COMPENSATION; REIMBURSEMENT OF EX- Committee on Appropriations of the House 1995) and shall reduce by 8.27 percent the PENSES.— of Representatives, in the case of any bill, unadjusted hospital-specific rate (as de- ‘‘(1) COMPENSATION.—Members of the Panel resolution, or amendment considered in the scribed in 42 CFR 412.328(e)(1), as in effect on shall receive compensation for each day (in- House; and such date of enactment).’’. cluding traveltime) engaged in carrying out ‘‘(B) for the Subcommittee on Labor, (b) REDUCTION IN PAYMENTS FOR PPS-EX- the duties of the Committee. Such com- Health and Human Services, and Education, EMPT HOSPITALS.—Section 1886(g) (42 U.S.C. pensation may not be in an amount in excess Committee on Appropriations of the Senate, 1395ww(g)) is amended by adding at the end of the daily equivalent of the annual maxi- in the case of any bill, resolution, or amend- the following new paragraph: ‘‘(4)(A) Except as provided in subparagraph mum rate of basic pay payable under the ment considered in the Senate.’’. General Schedule (under title 5, United (B), in determining the amount of the pay- States Code) for positions above GS–15. Subtitle F—Provisions Relating to Medicare ments that may be made under this title Part A ‘‘(2) REIMBURSEMENT.—Members of the with respect to all the capital-related costs Panel may, in accordance with chapter 57 of PART 1—HOSPITALS of inpatient hospital services furnished dur- title 5, United States Code, be reimbursed for Subpart A—General Provisions Relating to ing fiscal years 1996 through 2002 of a hos- travel, subsistence, and other necessary ex- Hospitals pital which is not a subsection (d) hospital or penses incurred in carrying out the duties of SEC. 15501. REDUCTIONS IN INFLATION UPDATES a subsection (d) Puerto Rico hospital, the the Panel. FOR PPS HOSPITALS. Secretary shall reduce the amounts of such ‘‘(j) CONSULTANTS.—The Panel may procure Section 1886(b)(3)(B)(i) (42 U.S.C. payments otherwise determined under this such temporary and intermittent services of 1395ww(b)(3)(B)(i)) is amended by striking title by 15 percent. H 10422 CONGRESSIONAL RECORD — HOUSE October 19, 1995 ‘‘(B) Subparagraph (A) shall not apply to ‘‘(vi) The system shall provide that the ‘‘(II) with respect to a later cost reporting payments with respect to the capital-related Federal capital rate for any fiscal year after period, the target amount for the preceding costs of any hospital that is a sole commu- September 30, 1995, shall be reduced by a per- cost reporting period, increase by the appli- nity hospital (as defined in subsection centage sufficient to ensure that the adjust- cable percentage increase under subpara- (d)(5)(D)(iii) or a rural primary care hospital ments required to be paid under clause (i) for graph (B)(ii) for that later cost reporting pe- (as defined in section 1861(mm)(1)).’’. a fiscal year neither increase nor decrease riod. (c) HOSPITAL-SPECIFIC ADJUSTMENT FOR the total amount that would have been paid ‘‘(ii) In clause (i), a ‘qualified long-term CAPITAL-RELATED TAX COSTS.—Section under this system but for the payment of care hospital’ means, with respect to a cost 1886(g)(1) (42 U.S.C. 1395ww(g)(1)) is amend- such adjustments for such fiscal year.’’. reporting period, a hospital described in ed— (d) REVISION OF EXCEPTIONS PROCESS clause (iv) of subsection (d)(1)(B) during fis- (1) by redesignating subparagraph (C) as UNDER PROSPECTIVE PAYMENT SYSTEM FOR cal year 1995 for which the hospital’s allow- subparagraph (D), and CERTAIN PROJECTS.— able operating costs of inpatient hospital (2) by inserting after subparagraph (B) the (1) IN GENERAL.—Section 1886(g)(1) (42 services recognized under this title for each following: U.S.C. 1395ww(g)(1)), as amended by sub- of the two most recent previous 12-month ‘‘(C)(i) For discharges occurring after Sep- section (c), is amended— cost reporting periods exceeded the hos- tember 30, 1995, such system shall provide for (A) by redesignating subparagraph (D) as pital’s target amount determined under this an adjustment in an amount equal to the subparagraph (E), and paragraph for such cost reporting periods, if amount determined under clause (iv) for cap- (B) by inserting after subparagraph (C) the the hospital— ital-related tax costs for each hospital that following: ‘‘(I) has a disproportionate patient percent- ‘‘(D) The exceptions under the system pro- is eligible for such adjustment. age during such cost reporting period (as de- vided by the Secretary under subparagraph ‘‘(ii) Subject to clause (iii), a hospital is el- termined by the Secretary under subsection (B)(iii) shall include the provision of excep- igible for an adjustment under this subpara- (d)(5)(F)(vi) as if the hospital were a sub- tion payments under the special exceptions graph, with respect to discharges occurring section (d) hospital) of at least 25 percent, or process provided under 42 CFR 412.348(g) (as in a fiscal year, if the hospital— ‘‘(II) is located in a State for which no pay- in effect on September 1, 1995), except that ‘‘(I) is a hospital that may otherwise re- ment is made under the State plan under the Secretary shall revise such process as ceive payments under this subsection, title XIX for days of inpatient hospital serv- follows: ‘‘(II) is not a public hospital, and ices furnished to any individual in excess of ‘‘(i) A hospital with at least 100 beds which ‘‘(III) incurs capital-related tax costs for the limit on the number of days of such serv- is located in an urban area shall be eligible the fiscal year. ices furnished to the individual for which ‘‘(iii)(I) In the case of a hospital that first under such process without regard to its dis- payment may be made under this title.’’. incurs capital-related tax costs in a fiscal proportionate patient percentage under sub- (2) EFFECTIVE DATE.—The amendment year after fiscal year 1992 because of a section (d)(5)(F) or whether it qualifies for made by paragraph (1) shall apply to dis- change from nonproprietary to proprietary additional payment amounts under such sub- charges occurring during cost reporting peri- status or because the hospital commenced section. ods beginning on or after October 1, 1995. operation after such fiscal year, the first fis- ‘‘(ii) The minimum payment level for cal year for which the hospital shall be eligi- qualifying hospitals shall be 85 percent. (c) TREATMENT OF CERTAIN LONG-TERM ble for such adjustment is the second full fis- ‘‘(iii) A hospital shall be considered to CARE HOSPITALS LOCATED WITHIN OTHER HOS- cal year following the fiscal year in which meet the requirement that it completes the PITALS.— the hospital first incurs such costs. project involved no later than the end of the (1) IN GENERAL.—Section 1886(d)(1)(B) (42 ‘‘(II) In the case of a hospital that first in- hospital’s last cost reporting period begin- U.S.C. 1395ww(d)(1)(B)) is amended in the curs capital-related tax costs in a fiscal year ning after October 1, 2001, if— matter following clause (v) by striking the after fiscal year 1992 because of a change in ‘‘(I) the hospital has obtained a certificate period and inserting the following: ‘‘, or a State or local tax laws, the first fiscal year of need for the project approved by the State hospital classified by the Secretary as a for which the hospital shall be eligible for or a local planning authority, and long-term care hospital on or before Septem- such adjustment is the fourth full fiscal year ‘‘(II) by September 1, 1995, the hospital has ber 30, 1995, and located in the same building following the fiscal year in which the hos- expended on the project at least $750,000 or 10 as, or on the same campus as, another hos- pital first incurs such costs. percent of the estimated cost of the project. pital.’’. ‘‘(iv) The per discharge adjustment under ‘‘(iv) The amount of the exception payment (2) STUDY BY REVIEW COMMISSION.—Not this clause shall be equal to the hospital-spe- made shall not be reduced by any offsetting later than 12 months after the date a major- cific capital-related tax costs per discharge amounts.’’. ity of the members of the Medicare Payment Review Commission are first appointed, the of a hospital for fiscal year 1992 (or, in the (2) CONFORMING AMENDMENT.—Section case of a hospital that first incurs capital-re- 1886(g)(1)(B)(iii) (42 U.S.C. Commission shall submit a report to Con- lated tax costs for a fiscal year after fiscal 1395ww(g)(1)(B)(iii)) is amended by striking gress containing recommendations for appro- year 1992, for the first full fiscal year for ‘‘may provide’’ and inserting ‘‘shall provide priate revisions in the treatment of long- which such costs are incurred), updated to (in accordance with subparagraph (D))’’. term care hospitals located in the same building as or on the same campus as an- the fiscal year to which the adjustment ap- SEC. 15504. REDUCTION IN ADJUSTMENT FOR IN- plies. Such per discharge adjustment shall be DIRECT MEDICAL EDUCATION. other hospital for purposes of section 1886 of added to the Federal capital rate, after such For provisions modifying medicare pay- the Social Security Act. rate has been adjusted as described in 42 CFR ment policies regarding graduate medical (3) EFFECTIVE DATE.—The amendment 412.312 (as in effect on the date of the enact- education, see part 2 of subtitle E. made by paragraph (1) shall apply to dis- charges occurring on or after October 1, 1995. ment of the Medicare Preservation Act of SEC. 15505. TREATMENT OF PPS-EXEMPT HOS- 1995), and before such rate is multiplied by PITALS. (d) STUDY OF PROSPECTIVE PAYMENT SYS- the applicable Federal rate percentage. (a) UPDATES.—Section 1886(b)(3)(B)(ii)(V) TEM FOR REHABILITATION HOSPITALS AND ‘‘(v) For purposes of this subparagraph, (42 U.S.C. 1395ww(b)(3)(B)(ii)(V)) is amended UNITS.— capital-related tax costs include— by striking ‘‘thorugh 1997’’ and inserting (1) IN GENERAL.—After consultation with ‘‘(I) the costs of taxes on land and depre- ‘‘through 2002’’. the Prospective Payment Assessment Com- ciable assets owned by a hospital (or related (b) REBASING FOR CERTAIN LONG-TERM mission, providers of rehabilitation services, organization) and used for patient care, CARE HOSPITALS.— and other appropriate parties, the Secretary ‘‘(II) payments in lieu of such taxes (made (1) IN GENERAL.—Section 1886(b)(3) (42 of Health and Human Services shall submit by hospitals that are exempt from taxation), U.S.C. 1395ww(b)(3)) is amended— to Congress, by not later than June 1, 1996, a and (A) in subparagraph (A), by striking ‘‘and report on the advisability and feasibility of ‘‘(III) the costs of taxes paid by a hospital (E)’’ and inserting ‘‘(E), and (F)’’; providing for payment based on a prospective (or related organization) as lessee of land, (B) in subparagraph (B)(ii), by striking payment system for inpatient services of re- buildings, or fixed equipment from a lessor ‘‘(A) and (E)’’ and inserting ‘‘(A), (E), and habilitation hospitals and units under the that is unrelated to the hospital (or related (F)’’; and medicare program. organization) under the terms of a lease that (C) by adding at the end the following new (2) ITEMS INCLUDED.—The report shall in- requires the lessee to pay all expenses (in- subparagraph: clude the following: cluding mortgage, interest, and amortiza- ‘‘(F)(i) In the case of a qualified long-term (A) The available and preferred systems of tion) and leaves the lessor with an amount care hospital (as defined in clause (ii)), the classifying rehabilitation patients relative free of all claims (sometimes referred to as a term ‘target amount’ means— to duration and intensity of inpatient serv- ‘net net net’ or ‘triple net’ lease). ‘‘(I) with respect to the first 12-month cost ices, including the use of functional-related In determining the adjustment required reporting period in which this subparagraph groups (FRGs). under clause (i), the Secretary shall not take is applied to the hospital, the allowable oper- (B) The means of calculating medicare pro- into account any capital-related tax costs of ating costs of inpatient hospital services (as gram payments to reflect such patient re- a hospital to the extent that such costs are defined in subsection (a)(4)) recognized under quirements. based on tax rates and assessments that ex- this title for the hospital for the 12-month (C) Other appropriate adjustments which ceed those for similar commercial prop- cost reporting period beginning during fiscal should be made, such as for geographic vari- erties. year 1991; or ations in wages and other costs and outliers. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10423 (D) A timetable under which such a system port on the study conducted under paragraph ‘‘(2) The term ‘rural emergency access care might be introduced. (1). hospital services’ means the following serv- (E) Whether such a system should be ap- SEC. 15512. CLARIFICATION OF TREATMENT OF ices provided by a rural emergency access plied to other types of providers of inpatient EAC AND RPC HOSPITALS. care hospital and furnished to an individual rehabilitation services. Paragraphs (1)(A)(i) and (2)(A)(i) of section over a continuous period not to exceed 24 SEC. 15506. REDUCTION IN PAYMENTS TO HOS- 1820(i) (42 U.S.C. 1395i–4(i)) are each amended hours (except that such services may be fur- PITALS FOR ENROLLEES’ BAD by striking the semicolon at the end and in- nished over a longer period in the case of an DEBTS. serting the following: ‘‘, or in a State which individual who is unable to leave the hos- (a) IN GENERAL.—Section 1861(v)(1) (42 the Secretary finds would receive a grant pital because of inclement weather): U.S.C. 1395x(v)(1)) is amended by adding at under such subsection during a fiscal year if ‘‘(A) An appropriate medical screening ex- the end the following new subparagraph: funds were appropriated for grants under amination (as described in section 1867(a)). ‘‘(T)(i) In determining such reasonable such subsection for the fiscal year;’’. ‘‘(B) Necessary stabilizing examination and costs for hospitals, the amount of bad debts SEC. 15513. ESTABLISHMENT OF RURAL EMER- treatment services for an emergency medical otherwise treated as allowable costs which GENCY ACCESS CARE HOSPITALS. condition and labor (as described in section are attributable to the deductibles and coin- (a) IN GENERAL.—Section 1861 (42 U.S.C. 1867(b)).’’. surance amounts under this title shall be re- 1395x) is amended by adding at the end the (b) REQUIRING RURAL EMERGENCY ACCESS duced by— following new subsection: CARE HOSPITALS TO MEET HOSPITAL ANTI- ‘‘(I) 75 percent for cost reporting periods ‘‘Rural Emergency Access Care Hospital; DUMPING REQUIREMENTS.—Section 1867(e)(5) beginning during fiscal year 1996, Rural Emergency Access Care Hospital (42 U.S.C. 1395dd(e)(5)) is amended by strik- ‘‘(II) 60 percent for cost reporting periods Services ing ‘‘1861(mm)(1))’’ and inserting beginning during fiscal year 1997, and ‘‘1861(mm)(1)) and a rural emergency access ‘‘(oo)(1) The term ‘rural emergency access care hospital (as defined in section ‘‘(III) 50 percent for subsequent cost report- care hospital’ means, for a fiscal year, a fa- ing periods. 1861(oo)(1))’’. cility with respect to which the Secretary (c) REFERENCE TO PAYMENT PROVISIONS ‘‘(ii) Clause (i) shall not apply with respect finds the following: to bad debt of a hospital described in section UNDER PART B.—For provisions relating to ‘‘(A) The facility is located in a rural area payment for rural emergency access care 1886(d)(1)(B)(iv) if the debt is attributable to (as defined in section 1886(d)(2)(D)). uncollectable deductible and coinsurance hospital services under part B, see section ‘‘(B) The facility was a hospital under this 15607. payments owed by individuals enrolled in a title at any time during the 5-year period State plan under title XIX or under the (d) EFFECTIVE DATE.—The amendments that ends on the date of the enactment of made by this section shall apply to fiscal MediGrant program under title XXI.’’. this subsection. FFECTIVE DATE.—The amendment years beginning on or after October 1, 1995. (b) E ‘‘(C) The facility is in danger of closing due made by subsection (a) shall apply to hos- SEC. 15514. CLASSIFICATION OF RURAL REFER- to low inpatient utilization rates and operat- pital cost reporting periods beginning on or RAL CENTERS. ing losses, and the closure of the facility after October 1, 1995. (a) PROHIBITING DENIAL OF REQUEST FOR would limit the access to emergency services RECLASSIFICATION ON BASIS OF COMPARABIL- SEC. 15507. PERMANENT EXTENSION OF HEMO- of individuals residing in the facility’s serv- ITY OF WAGES.— PHILIA PASS-THROUGH. ice area. (1) IN GENERAL.—Section 1886(d)(10)(D) (42 Effective as if included in the enactment of ‘‘(D) The facility has entered into (or plans U.S.C. 1395ww(d)(10)(D)) is amended— OBRA–1989, section 6011(d) of such Act (as to enter into) an agreement with a hospital (A) by redesignating clause (iii) as clause amended by section 13505 of OBRA–1993) is with a participation agreement in effect (iv); and amended by striking ‘‘and shall expire Sep- under section 1866(a), and under such agree- (B) by inserting after clause (ii) the follow- tember 30, 1994’’. ment the hospital shall accept patients ing new clause: SEC. 15508. CONFORMING AMENDMENT TO CER- transferred to the hospital from the facility ‘‘(iii) Under the guidelines published by the TIFICATION OF CHRISTIAN SCIENCE and receive data from and transmit data to Secretary under clause (i), in the case of a PROVIDERS. the facility. hospital which is classified by the Secretary (a) HOSPITALS.—Section 1861(e) (42 U.S.C. ‘‘(E) There is a practitioner who is quali- as a rural referral center under paragraph 1395x(e)) is amended in the sixth sentence by fied to provide advanced cardiac life support (5)(C), the Board may not reject the applica- inserting after ‘‘Massachusetts,’’ the follow- services (as determined by the State in tion of the hospital under this paragraph on ing: ‘‘or by the Commission for Accredita- which the facility is located) on-site at the the basis of any comparison between the av- tion of Christian Science Nursing Organiza- facility on a 24-hour basis. erage hourly wage of the hospital and the av- tions/Facilities, Inc.,’’. ‘‘(F) A physician is available on-call to erage hourly wage of hospitals in the area in (b) SKILLED NURSING FACILITIES.—Section provide emergency medical services on a 24- which it is located.’’. 1861(y)(1) is amended by inserting after hour basis. (2) EFFECTIVE DATE.—Notwithstanding sec- ‘‘Massachusetts,’’ the following: ‘‘or by the ‘‘(G) The facility meets such staffing re- tion 1886(d)(10)(C)(ii) of the Social Security Commission for Accreditation of Christian quirements as would apply under section Act, a hospital may submit an application to Science Nursing Organizations/Facilities, 1861(e) to a hospital located in a rural area, the Medicare Geographic Classification Re- Inc.,’’. except that— view Board during the 30-day period begin- Subpart B—Provisions Relating to Rural ‘‘(i) the facility need not meet hospital ning on the date of the enactment of this Act Hospitals standards relating to the number of hours requesting a change in its classification for SEC. 15511. SOLE COMMUNITY HOSPITALS. during a day, or days during a week, in purposes of determining the area wage index (a) UPDATE.—Section 1886(b)(3)(B)(iv) (42 which the facility must be open, except inso- applicable to the hospital under section U.S.C. 1395ww(b)(3)(B)(iv)) is amended— far as the facility is required to provide 1886(d)(3)(D) of such Act for fiscal year 1997, (A) in subclause (III), by striking ‘‘and’’ at emergency care on a 24-hour basis under sub- if the hospital would be eligible for such a the end; and paragraphs (E) and (F); and change in its classification under the stand- (B) by striking subclause (IV) and inserting ‘‘(ii) the facility may provide any services ards described in section 1886(d)(10)(D) (as the following: otherwise required to be provided by a full- amended by paragraph (1)) but for its failure ‘‘(IV) for each of the fiscal years 1996 time, on-site dietitian, pharmacist, labora- to meet the deadline for applications under through 2000, the market basket percentage tory technician, medical technologist, or ra- section 1886(d)(10)(C)(ii). increase minus 1 percentage points, and diological technologist on a part-time, off- (b) CONTINUING TREATMENT OF PREVIOUSLY ‘‘(V) for fiscal year 2001 and each subse- site basis. DESIGNATED CENTERS.—Any hospital classi- quent fiscal year, the applicable percentage ‘‘(H) The facility meets the requirements fied as a rural referral center by the Sec- increase under clause (i).’’. applicable to clinics and facilities under sub- retary of Health and Human Services under (b) STUDY OF IMPACT OF SOLE COMMUNITY paragraphs (C) through (J) of paragraph (2) section 1886(d)(5)(C) of the Social Security HOSPITAL DESIGNATIONS.— of section 1861(aa) and of clauses (ii) and (iv) Act for fiscal year 1994 shall be classified as (1) STUDY.—The Medicare Payment Review of the second sentence of such paragraph (or, such a rural referral center for fiscal year Commission shall conduct a study of the im- in the case of the requirements of subpara- 1996 and each subsequent fiscal year. pact of the designation of hospitals as sole graph (E), (F), or (J) of such paragraph, SEC. 15515. FLOOR ON AREA WAGE INDEX. community hospitals under the medicare would meet the requirements if any ref- (a) IN GENERAL.—For purposes of section program on the delivery of health care serv- erence in such subparagraph to a ‘nurse prac- 1886(d)(3)(E) of the Social Security Act for ices to individuals in rural areas, and shall titioner’ or to ‘nurse practitioners’ were discharges occurring on or after October 1, include in the study an analysis of the char- deemed to be a reference to a ‘nurse practi- 1995, the area wage index applicable under acteristics of the hospitals designated as tioner or nurse’ or to ‘nurse practitioners or such section to any hospital which is not lo- such sole community hospitals under the nurses’); except that in determining whether cated in a rural area (as defined in section program. a facility meets the requirements of this sub- 1886(d)(2)(D) of such Act) may not be less (2) REPORT.—Not later than 12 months paragraph, subparagraphs (E) and (F) of that than the average of the area wage indices ap- after the date a majority of the members of paragraph shall be applied as if any reference plicable under such section to hospitals lo- the Commission are first appointed, the to a ‘physician’ is a reference to a physician cated in rural areas in the State in which the Commission shall submit to Congress a re- as defined in section 1861(r)(1). hospital is located. H 10424 CONGRESSIONAL RECORD — HOUSE October 19, 1995

(b) BUDGET-NEUTRALITY IN IMPLEMENTA- section 1861(v). The Secretary may adjust ing payments described in subparagraph (A), TION.—The Secretary of Health and Human such payments if the Secretary determines the Secretary may reduce payments made to Services shall adjust the area wage indices (on the basis of such estimated information a facility under this section during a cost re- referred to in subsection (a) for hospitals not as the Secretary considers appropriate) that porting period if the Secretary determines described in such subsection in a manner payments to the facility under this para- (on the basis of such estimated information which assures that the aggregate payments graph for a cost reporting period would sub- as the Secretary considers appropriate) that made under section 1886(d) of the Social Se- stantially exceed the cost reporting period payments to the facility under this section curity Act in a fiscal year for the operating limit determined under subsection (c)(1)(B). for the period will substantially exceed the costs of inpatient hospital services are not ‘‘(2) RESPONSIBILITY OF SKILLED NURSING cost reporting period limit for the period de- greater or less than those which would have FACILITY TO MANAGE BILLINGS.— termined under this paragraph. been made in the year if this section did not ‘‘(A) CLARIFICATION RELATING TO PART A ‘‘(2) INCENTIVE PAYMENTS.— apply. BILLING.—In the case of a covered non-rou- ‘‘(A) IN GENERAL.—If a skilled nursing fa- PART 2—PAYMENTS TO SKILLED NURSING tine service furnished to an individual who cility has received aggregate payments FACILITIES (at the time the service is furnished) is a under subsection (b) for covered non-routine resident of a skilled nursing facility who is services during a cost reporting period begin- SEC. 15521. PAYMENTS FOR ROUTINE SERVICE entitled to coverage under section 1812(a)(2) COSTS. ning during a fiscal year in an amount that for such service, the skilled nursing facility (a) CLARIFICATION OF DEFINITION OF ROU- is less than the amount determined under shall submit a claim for payment under this TINE SERVICE COSTS.—Section 1888 (42 U.S.C. paragraph (1)(B), the Secretary shall pay the title for such service under part A (without 1395yy) is amended by adding at the end the skilled nursing facility in the following fis- regard to whether or not the item or service following new subsection: cal year an incentive payment equal to 50 was furnished by the facility, by others ‘‘(e) For purposes of this section, the ‘rou- percent of the difference between such under arrangement with them made by the tine service costs’ of a skilled nursing facil- amounts, except that the incentive payment facility, under any other contracting or con- ity are all costs which are attributable to may not exceed 5 percent of the aggregate sulting arrangement, or otherwise). nursing services, room and board, adminis- payments made to the facility under sub- ‘‘(B) PART B BILLING.—In the case of a cov- trative costs, other overhead costs, and all ered non-routine service (other than a port- section (b) for the previous fiscal year (with- other ancillary services (including supplies able X-ray or portable electrocardiogram out regard to subparagraph (B)). and equipment), excluding costs attributable treated as a physician’s service for purposes ‘‘(B) INSTALLMENT INCENTIVE PAYMENTS.— to covered non-routine services subject to of section 1848(j)(3)) furnished to an individ- The Secretary may make installment pay- payment limits under section 1888A.’’. ual who (at the time the service is furnished) ments during a fiscal year to a skilled nurs- (b) CONFORMING AMENDMENT.—Section 1888 is a resident of a skilled nursing facility who ing facility based on the estimated incentive (42 U.S.C. 1395yy) is amended in the heading is not entitled to coverage under section payment that the facility would be eligible by inserting ‘‘AND CERTAIN ANCILLARY’’ after 1812(a)(2) for such service but is entitled to to receive with respect to such fiscal year. ‘‘SERVICE’’. coverage under part B for such service, the ‘‘(d) DETERMINATION OF FACILITY PER STAY SEC. 15522. INCENTIVES FOR COST EFFECTIVE skilled nursing facility shall submit a claim LIMIT.— MANAGEMENT OF COVERED NON- for payment under this title for such service ROUTINE SERVICES. ‘‘(1) LIMIT FOR FISCAL YEAR 1997.— under part B (without regard to whether or (a) IN GENERAL.—Title XVIII is amended by ‘‘(A) IN GENERAL.—Except as provided in inserting after section 1888 the following new not the item or service was furnished by the subparagraph (B), the Secretary shall estab- facility, by others under arrangement with section: lish separate per stay limits for hospital- them made by the facility, under any other ‘‘INCENTIVES FOR COST-EFFECTIVE MANAGE- based and freestanding skilled nursing facili- contracting or consulting arrangement, or ties for the 12-month cost reporting period MENT OF COVERED NON-ROUTINE SERVICES OF otherwise). SKILLED NURSING FACILITIES beginning during fiscal year 1997 that are ‘‘(C) MAINTAINING RECORDS ON SERVICES equal to the sum of— ‘‘SEC. 1888A. (a) DEFINITIONS.—For purposes FURNISHED TO RESIDENTS.—Each skilled nurs- ‘‘(i) 50 percent of the facility-specific stay of this section: ing facility receiving payments for extended amount for the facility (as determined under ‘‘(1) COVERED NON-ROUTINE SERVICES.—The care services under this title shall document subsection (e)) for the last 12-month cost re- term ‘covered non-routine services’ means on the facility’s cost report all covered non- porting period ending on or before Septem- post-hospital extended care services consist- routine services furnished to all residents of ber 30, 1994, increased (in a compounded man- ing of any of the following: the facility to whom the facility provided ex- ‘‘(A) Physical or occupational therapy or tended care services for which payment was ner) by the SNF market basket percentage speech-language pathology services, or res- made under part A during a fiscal year (be- increase for fiscal years 1995 through 1997; piratory therapy, including supplies and sup- ginning with fiscal year 1996) (without regard and port services incident to such services and to whether or not the services were furnished ‘‘(ii) 50 percent of the average of all facil- therapy. by the facility, by others under arrangement ity-specific stay amounts for all hospital- ‘‘(B) Prescription drugs. with them made by the facility, under any based facilities or all freestanding facilities ‘‘(C) Complex medical equipment. other contracting or consulting arrange- (whichever is applicable) during the cost re- ‘‘(D) Intravenous therapy and solutions ment, or otherwise). porting period described in clause (i), in- (including enteral and parenteral nutrients, ‘‘(c) RECONCILIATION OF AMOUNTS.— creased (in a compounded manner) by the supplies, and equipment). ‘‘(1) LIMIT BASED ON PER STAY LIMIT AND SNF market basket percentage increase for ‘‘(E) Radiation therapy. NUMBER OF STAYS.— fiscal years 1995 through 1997. ‘‘(F) Diagnostic services, including labora- ‘‘(A) IN GENERAL.—If a skilled nursing fa- ‘‘(B) FACILITIES NOT HAVING 1994 COST RE- tory, radiology (including computerized to- cility has received aggregate payments PORTING PERIOD.—In the case of a skilled mography services and imaging services), under subsection (b) for covered non-routine nursing facility for which payments were not and pulmonary services. services during a cost reporting period begin- made under this title for covered non-routine ‘‘(2) SNF MARKET BASKET PERCENTAGE IN- ning during a fiscal year in excess of an services for the last 12-month cost reporting CREASE.—The term ‘SNF market basket per- amount equal to the cost reporting period period ending on or before September 30, centage increase’ for a fiscal year means a limit determined under subparagraph (B), 1994, the per stay limit for the 12-month cost percentage equal to the percentage increase the Secretary shall reduce the payments reporting period beginning during fiscal year in routine service cost limits for the year made to the facility with respect to such 1997 shall be twice the amount determined under section 1888(a). services for cost reporting periods beginning under subparagraph (A)(ii). ‘‘(3) STAY.—The term ‘stay’ means, with during the following fiscal year in an ‘‘(2) LIMIT FOR SUBSEQUENT FISCAL YEARS.— respect to an individual who is a resident of amount equal to such excess. The Secretary The per stay limit for a skilled nursing facil- a skilled nursing facility, a period of contin- shall reduce payments under this subpara- ity for a 12-month cost reporting period be- uous days during which the facility provides graph at such times and in such manner dur- ginning during a fiscal year after fiscal year extended care services for which payment ing a fiscal year as the Secretary finds nec- 1997 is equal to the per stay limit established may be made under this title with respect to essary to meet the requirement of this sub- under this subsection for the 12-month cost the individual during the individual’s spell of paragraph. reporting period beginning during the pre- illness. ‘‘(B) COST REPORTING PERIOD LIMIT.—The vious fiscal year, increased by the SNF mar- ‘‘(b) NEW PAYMENT METHOD FOR COVERED cost reporting period limit determined under ket basket percentage increase for such sub- NON-ROUTINE SERVICES.— this subparagraph is an amount equal to the sequent fiscal year minus 2 percentage ‘‘(1) IN GENERAL.—Subject to subsection (c), product of— points. a skilled nursing facility shall receive in- ‘‘(i) the per stay limit applicable to the fa- ‘‘(3) REBASING OF AMOUNTS.— terim payments under this title for covered cility under subsection (d) for the period; and ‘‘(A) IN GENERAL.—The Secretary shall pro- non-routine services furnished to an individ- ‘‘(ii) the number of stays beginning during vide for an update to the facility-specific ual during a cost reporting period beginning the period for which payment was made to amounts used to determine the per stay lim- during a fiscal year (after fiscal year 1996) in the facility for such services. its under this subsection for cost reporting an amount equal to the reasonable cost of ‘‘(C) PROSPECTIVE REDUCTION IN PAY- periods beginning on or after October 1, 1999, providing such services in accordance with MENTS.—In addition to the process for reduc- and every 2 years thereafter. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10425

‘‘(B) TREATMENT OF FACILITIES NOT HAVING ‘‘(2) BUDGET NEUTRALITY.—The Secretary defined in section 1888A(e)(3)) for fiscal year REBASED COST REPORTING PERIODS.—Para- shall adjust payments under subsection (b) 1997; and graph (1)(B) shall apply with respect to a in a manner that ensures that total pay- ‘‘(B) for cost reporting periods beginning skilled nursing facility for which payments ments for covered non-routine services under during a subsequent fiscal year, the amount were not made under this title for covered this section are not greater or less than total determined under this paragraph for the pre- non-routine services for the 12-month cost payments for such services would have been vious fiscal year increased by the SNF mar- reporting period used by the Secretary to up- but for the application of paragraph (1). ket basket percentage increase for such sub- date facility-specific amounts under sub- ‘‘(i) SPECIAL RULE FOR X-RAY SERVICES.— sequent fiscal year.’’. paragraph (A) in the same manner as such Before furnishing a covered non-routine serv- (d) IMPOSITION OF LIMITS FOR ALL COST RE- paragraph applies with respect to a facility ice consisting of an X-ray service for which PORTING PERIODS.—Section 1888(a) (42 U.S.C. for which payments were not made under payment may be made under part A or part 1395yy(a)) is amended in the matter preced- this title for covered non-routine services for B to a resident, a skilled nursing facility ing paragraph (1) by inserting after ‘‘ex- the last 12-month cost reporting period end- shall consider whether furnishing the service tended care services’’ the following: ‘‘(for ing on or before September 30, 1994. through a provider of portable X-ray service any cost reporting period for which payment ‘‘(e) DETERMINATION OF FACILITY-SPECIFIC services would be appropriate, taking into is made under this title to the skilled nurs- account the cost effectiveness of the service STAY AMOUNTS.—The ‘facility-specific stay ing facility for such services)’’. amount’ for a skilled nursing facility for a and the convenience to the resident.’’. ONFORMING AMENDMENT.—Section SEC. 15524. REDUCTIONS IN PAYMENT FOR CAP- cost reporting period is the sum of— (b) C 1814(b) (42 U.S.C. 1395f(b)) is amended in the ITAL-RELATED COSTS. ‘‘(1) the average amount of payments made matter preceding paragraph (1) by striking Section 1861(v)(1) (42 U.S.C. 1395x(v)(1)), as to the facility under part A during the period ‘‘1813 and 1886’’ and inserting ‘‘1813, 1886, 1888, amended by section 15506, is amended by add- which are attributable to covered non-rou- and 1888A’’. ing at the end the following new subpara- tine services furnished during a stay; and graph: ‘‘(2) the Secretary’s best estimate of the SEC. 15523. PAYMENTS FOR ROUTINE SERVICE COSTS. ‘‘(U) Such regulations shall provide that, average amount of payments made under (a) MAINTAINING SAVINGS RESULTING FROM in determining the amount of the payments part B during the period for covered non-rou- TEMPORARY FREEZE ON PAYMENT IN- that may be made under this title with re- tine services furnished to all residents of the CREASES.— spect to all the capital-related costs of facility to whom the facility provided ex- (1) BASING UPDATES TO PER DIEM COST LIM- skilled nursing facilities, the Secretary shall tended care services for which payment was ITS ON LIMITS FOR FISCAL YEAR 1993.— reduce the amounts of such payments other- made under part A during the period (with- (A) IN GENERAL.—The last sentence of sec- wise established under this title by 15 per- out regard to whether or not the services tion 1888(a) (42 U.S.C. 1395yy(a)) is amended cent for payments attributable to portions of were furnished by the facility, by others by inserting before the period at the end the cost reporting periods occurring during fis- under arrangement with them made by the following: ‘‘(except that such updates may cal years 1996 through 2002.’’. facility, under any other contracting or con- not take into account any changes in the sulting arrangement, or otherwise), as esti- SEC. 15525. TREATMENT OF ITEMS AND SERVICES routine service costs of skilled nursing fa- mated by the Secretary. PAID FOR UNDER PART B. cilities occurring during cost reporting peri- (a) REQUIRING PAYMENT FOR ALL ITEMS AND ‘‘(f) INTENSIVE NURSING OR THERAPY ods which began during fiscal year 1994 or SERVICES TO BE MADE TO FACILITY.— NEEDS.— fiscal year 1995)’’. ‘‘(1) IN GENERAL.—In applying subsection (1) IN GENERAL.—The first sentence of sec- (B) NO EXCEPTIONS PERMITTED BASED ON (b) to covered non-routine services furnished tion 1842(b)(6) (42 U.S.C. 1395u(b)(6)) is AMENDMENT.—The Secretary of Health and amended— during a stay beginning during a cost report- Human Services shall not consider the (A) by striking ‘‘and (D)’’ and inserting ing period beginning during a fiscal year to amendment made by subparagraph (A) in ‘‘(D)’’; and a resident of a skilled nursing facility who making any adjustments pursuant to section (B) by striking the period at the end and requires intensive nursing or therapy serv- 1888(c) of the Social Security Act. ices, the per stay limit determined for the inserting the following: ‘‘, and (E) in the case (2) PAYMENTS DETERMINED ON PROSPECTIVE fiscal year under the methodology for such of an item or service (other than physicians’ BASIS.—Any change made by the Secretary of services and other than a portable X-ray or resident shall be the per stay limit developed Health and Human Services in the amount of portable electrocardiogram treated as a phy- under paragraph (2) instead of the per stay any prospective payment paid to a skilled sician’s service for purposes of section limit determined under subsection (d)(1)(A). nursing facility under section 1888(d) of the 1848(j)(3)) furnished to an individual who (at ‘‘(2) PER STAY LIMIT FOR INTENSIVE NEED Social Security Act for cost reporting peri- the time the item or service is furnished) is RESIDENTS.—Not later than June 30, 1996, the ods beginning on or after October 1, 1995, a resident of a skilled nursing facility, pay- Secretary, after consultation with the Medi- may not take into account any changes in ment shall be made to the facility (without care Payment Review Commission and the costs of services occurring during cost regard to whether or not the item or service skilled nursing facility experts, shall develop reporting periods which began during fiscal was furnished by the facility, by others and publish a methodology for determining year 1994 or fiscal year 1995. under arrangement with them made by the on an annual basis a per stay limit for resi- (b) ESTABLISHMENT OF SCHEDULE FOR MAK- facility, or otherwise).’’. dents of a skilled nursing facility who re- ING ADJUSTMENTS TO LIMITS.—Section 1888(c) (2) EXCLUSION FOR ITEMS AND SERVICES NOT quire intensive nursing or therapy services. (42 U.S.C. 1395yy(c)) is amended by striking BILLED BY FACILITY.—Section 1862(a) (42 ‘‘(3) BUDGET NEUTRALITY.—The Secretary the period at the end of the second sentence U.S.C. 1395y(a)) is amended— shall adjust payments under subsection (b) and inserting ‘‘, and may only make adjust- (A) by striking ‘‘or’’ at the end of para- in a manner that ensures that total pay- ments under this subsection with respect to graph (14); ments for covered non-routine services under a facility which applies for an adjustment (B) by striking the period at the end of this section are not greater or less than total during an annual application period estab- paragraph (15) and inserting ‘‘; or’’; and payments for such services would have been lished by the Secretary.’’. but for the application of paragraph (1). (c) LIMITATION ON AGGREGATE INCREASE IN (C) by inserting after paragraph (15) the ‘‘(g) SPECIAL TREATMENT FOR MEDICARE PAYMENTS RESULTING FROM ADJUSTMENTS TO following new paragraph: LOW VOLUME SKILLED NURSING FACILITIES.— LIMITS.—Section 1888(c) (42 U.S.C. 1395yy(c)) ‘‘(16) where such expenses are for covered This section shall not apply with respect to is amended— non-routine services (as defined in section a skilled nursing facility for which payment (1) by striking ‘‘(c) The Secretary’’ and in- 1888A(a)(1)) (other than a portable X-ray or is made for routine service costs during a serting ‘‘(c)(1) Subject to paragraph (2), the portable electrocardiogram treated as a phy- cost reporting period on the basis of prospec- Secretary’’; and sician’s service for purposes of section tive payments under section 1888(d). (2) by adding at the end the following new 1848(j)(3)) furnished to an individual who is a ‘‘(h) EXCEPTIONS AND ADJUSTMENTS TO LIM- paragraph: resident of a skilled nursing facility and for ITS.— ‘‘(2) The Secretary may not make any ad- which the claim for payment under this title ‘‘(1) IN GENERAL.—The Secretary may make justments under this subsection in the limits is not submitted by the facility.’’. exceptions and adjustments to the cost re- set forth in subsection (a) for a cost report- (3) CONFORMING AMENDMENT.—Section porting limits applicable to a skilled nursing ing period beginning during a fiscal year to 1832(a)(1) (42 U.S.C. 1395k(a)(1)) is amended by facility under subsection (c)(1)(B) for a cost the extent that the total amount of the addi- striking ‘‘(2);’’ and inserting ‘‘(2) and section reporting period, except that the total tional payments made under this title as a 1842(b)(6)(E);’’. amount of any additional payments made result of such adjustments is greater than an (b) REDUCTION IN PAYMENTS FOR ITEMS AND under this section for covered non-routine amount equal to— SERVICES FURNISHED BY OR UNDER ARRANGE- services during the cost reporting period as a ‘‘(A) for cost reporting periods beginning MENTS WITH FACILITIES.—Section 1861(v)(1) result of such exceptions and adjustments during fiscal year 1997, the total amount of (42 U.S.C. 1395x(v)(1)), as amended by sec- may not exceed 5 percent of the aggregate the additional payments made under this tions 15506 and 15524, is amended by adding at payments made to all skilled nursing facili- title as a result of adjustments under this the end the following new subparagraph: ties for covered non-routine services during subsection for cost reporting periods begin- ‘‘(V) In the case of an item or service fur- the cost reporting period (determined with- ning during fiscal year 1996 increased by the nished by a skilled nursing facility (or by out regard to this paragraph). SNF market basket percentage increase (as others under arrangement with them made H 10426 CONGRESSIONAL RECORD — HOUSE October 19, 1995

by a skilled nursing facility) for which pay- ‘‘(D) REQUIRING NOTICE AND COMMENT.—The terminate such facility’s certification for ment is made under part B in an amount de- standards established for facilities under this participation under this title effective with termined in accordance with section paragraph may only take effect after the the first day of the first month following the 1833(a)(2)(B), the Secretary shall reduce the Secretary has provided the public with no- month specified in such clause. reasonable cost for such item or service oth- tice and an opportunity for comment. ‘‘(d) STATE-CERTIFIED FACILITY DEFINED.— erwise determined under clause (i)(I) of such ‘‘(2) CERTIFICATION PROGRAM.— In subsection (a), a ‘State-certified facility’ section by 5.8 percent for payments attrib- ‘‘(A) IN GENERAL.—The Secretary shall pro- means a facility licensed or certified as a utable to portions of cost reporting periods vide for the establishment and operation of a skilled nursing facility by the State in which occurring during fiscal years 1996 through program consistent with the requirements of it is located, or a facility which otherwise 2002.’’. subparagraph (B) for the certification of meets the requirements applicable to provid- skilled nursing facilities which meet the SEC. 15526. CERTIFICATION OF FACILITIES MEET- ers of nursing facility services under the standards established under paragraph (1) ING REVISED NURSING HOME RE- State plan under title XIX or the MediGrant and the decertification of facilities which FORM STANDARDS. program under title XXI.’’. (a) IN GENERAL.—Section 1819(a)(3) (42 fail to meet such standards. (c) CONFORMING AMENDMENTS.—(1) Section U.S.C. 1395i–3(a)(3)) is amended to read as fol- ‘‘(B) REQUIREMENTS FOR PROGRAM.—In addi- 1861(v)(1)(E) (42 U.S.C. 1395x(v)(1)(E)) is lows: tion to any other requirements the Sec- amended by striking the second sentence. ‘‘(3)(A) is certified by the Secretary as retary may impose, in establishing and oper- meeting the standards established under sub- ating the certification program under sub- (2) Section 1864 (42 U.S.C. 1395aa) is amend- section (b), or (B) is a State-certified facility paragraph (A), the Secretary shall ensure the ed by striking subsection (d). following: (as defined in subsection (d)).’’. (3) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) ‘‘(i) The Secretary shall ensure public ac- (b) REQUIREMENTS DESCRIBED.—Section is amended by striking ‘‘1819(c)(2)(E),’’. cess (as defined by the Secretary) to the cer- 1819 (42 U.S.C. 1395i–3) is amended by striking tification program’s evaluations of partici- (4) Section 1883(f) (42 U.S.C. 1395tt(f)) is subsections (b) through (i) and inserting the pating facilities, including compliance amended— following: records and enforcement actions and other (A) in the second sentence, by striking ‘‘(b) STANDARDS FOR AND CERTIFICATION OF reports by the Secretary regarding the own- ‘‘such a hospital’’ and inserting ‘‘a hospital FACILITIES.— ership, compliance histories, and services which enters into an agreement with the ‘‘(1) STANDARDS FOR FACILITIES.— provided by certified facilities. Secretary under this section’’; and ‘‘(A) IN GENERAL.—The Secretary shall pro- ‘‘(ii) Not less often than every 4 years, the (B) by striking the first sentence. vide for the establishment and maintenance Secretary shall audit its expenditures under of standards consistent with the contents de- (d) EFFECTIVE DATE.—The amendments the program, through an entity designated made by this section shall apply with respect scribed in subparagraph (B) for skilled nurs- by the Secretary which is not affiliated with ing facilities which furnish services for to cost reporting periods beginning on or the program, as designated by the Secretary. after October 1, 1995. which payment may be made under this ‘‘(c) INTERMEDIATE SANCTION AUTHORITY.— title. ‘‘(1) AUTHORITY.—In addition to any other SEC. 15527. MEDICAL REVIEW PROCESS. ‘‘(B) CONTENTS OF STANDARDS.—The stand- authority, where the Secretary determines In order to ensure that medicare bene- ards established for facilities under this that a nursing facility which is certified for ficiaries are furnished appropriate extended paragraph shall contain provisions relating participation under this title (whether cer- care services, the Secretary of Health and to the following items: tified by the Secretary as meeting the stand- Human Services shall establish and imple- ‘‘(i) The treatment of resident medical ards established under subsection (b) or a ment a thorough medical review process to records. State-ceritified facility) no longer or does examine the effects of the amendments made ‘‘(ii) Policies, procedures, and bylaws for not substantially meet the requirements for by this part on the quality of extended care operation. such a facility under this title as specified services furnished to medicare beneficiaries. ‘‘(iii) Quality assurance systems. under subsection (b) and further determines In developing such a medical review process, ‘‘(iv) Resident assessment procedures, in- that the facility’s deficiencies— the Secretary shall place a particular em- cluding care planning and outcome evalua- ‘‘(A) immediately jeopardize the health phasis on the quality of non-routine covered tion. and safety of its residents, the Secretary services for which payment is made under ‘‘(v) The assurance of a safe and adequate shall at least provide for the termination of section 1888A of the Social Security Act. physical plant for the facility. the facility’s certification for participation ‘‘(vi) Qualifications for staff sufficient to under this title, or SEC. 15528. REPORT BY MEDICARE PAYMENT RE- provide adequate care. ‘‘(B) do not immediately jeopardize the VIEW COMMISSION. ‘‘(vii) Utilization review. health and safety of its residents, the Sec- Not later than October 1, 1997, the Medi- ‘‘(viii) The protection and enforcement of retary may, in lieu of providing for termi- care Payment Review Commission shall sub- resident rights described in subparagraph nating the facility’s certification for partici- mit to Congress a report on the system (C). pation under the plan, provide lesser sanc- under which payment is made under the ‘‘(C) RESIDENT RIGHTS DESCRIBED.—The tions including one that provides that no medicare program for extended care services resident rights described in this subpara- payment will be made under this title with furnished by skilled nursing facilities, and graph are the rights of residents to the fol- respect to any individual admitted to such shall include in the report the following: lowing: facility after a date specified by the Sec- (1) An analysis of the effect of the meth- ‘‘(i) To exercise the individual’s rights as a retary. odology established under section 1888A of resident of the facility and as a citizen or ‘‘(2) NOTICE.—The Secretary shall not the Social Security Act (as added by section resident of the United States. make such a decision with respect to a facil- 15522) on the payments for, and the quality ‘‘(ii) To receive notice of rights and serv- ity until the facility has had a reasonable of, extended care services under the medi- ices. opportunity, following the initial determina- care program. ‘‘(iii) To be protected against the misuse of tion that it no longer or does not substan- (2) An analysis of the advisability of deter- resident funds. tially meet the requirements for such a facil- mining the amount of payment for covered ‘‘(iv) To be provided privacy and confiden- ity under this title, to correct its defi- non-routine services of facilities (as de- tiality. ciencies, and, following this period, has been scribed in such section) on the basis of the ‘‘(v) To voice grievances. given reasonable notice and opportunity for amounts paid for such services when fur- ‘‘(vi) To examine the results of inspections a hearing. nished by suppliers under part B of the medi- under the certification program. ‘‘(3) EFFECTIVENESS.—The Secretary’s deci- care program. ‘‘(vii) To refuse to perform services for the sion to deny payment may be made effective (3) An analysis of the desirability of main- facility. only after such notice to the public and to taining separate limits for hospital-based ‘‘(viii) To be provided privacy in commu- the facility as may be provided for by the and freestanding facilities in the costs of ex- nications and to receive mail. Secretary, and its effectiveness shall termi- tended care services recognized as reasonable ‘‘(ix) To have the facility provide imme- nate (A) when the Secretary finds that the under the medicare program. diate access to any resident by any rep- facility is in substantial compliance (or is (4) An analysis of the quality of services resentative of the certification program, the making good faith efforts to achieve sub- furnished by skilled nursing facilities. resident’s individual physician, the State stantial compliance) with the requirements (5) An analysis of the adequacy of the proc- long term care ombudsman, and any person for such a facility under this title, or (B) in ess and standards used to provide exceptions the resident has designated as a visitor. the case described in paragraph (1)(B), with to the limits described in paragraph (3). ‘‘(x) To retain and use personal property. the end of the eleventh month following the ‘‘(xi) To be free from abuse, including month such decision is made effective, SEC. 15529. EFFECTIVE DATE. verbal, sexual, physical and mental abuse, whichever occurs first. If a facility to which Except as otherwise provided in this part, corporal punishment, and involuntary seclu- clause (B) of the previous sentence applies the amendments made by this part shall sion. still fails to substantially meet the provi- apply to services furnished during cost re- ‘‘(xii) To be provided with prior written no- sions of the respective section on the date porting periods (or portions of cost reporting tice of a pending transfer or discharge. specified in such clause, the Secretary shall periods) beginning on or after October 1, 1996. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10427 PART 3—CLARIFICATION OF CREDITS TO minus 1 and multiplied by 100. tence of section 1842(b)(3)) for the year (di- PART A TRUST FUND ‘‘(2) EXCLUSION OF SERVICES FURNISHED TO vided by 100). SEC. 15531. CLARIFICATION OF AMOUNT OF PRIVATE PLAN ENROLLEES.—In this sub- ‘‘(ii) APPLICABLE PERCENTAGE LIMIT.—In TAXES CREDITED TO FEDERAL HOS- section, the term ‘physicians’ services’ with clause (i)(II), the ‘applicable percentage PITAL INSURANCE TRUST FUND. respect to a fiscal year does not include serv- limit’ for a year is— Section 121(e)(1)(B) of the Social Security ices furnished to an individual enrolled ‘‘(I) for 1997, 93 percent; Amendments of 1983 (Public Law 98–21) is under this part who has elected to receive ‘‘(II) for 1998, 92.25 percent; and amended by adding at the end the following: benefits under this title for the fiscal year ‘‘(III) for 1999 and each succeeding year, 92 ‘‘The Secretary of the Treasury shall carry through a MedicarePlus product offered percent.’’; and out this subparagraph without regard to any under part C or through enrollment with an (C) by adding at the end the following new amendments to this subsection or to section eligible organization with a risk-sharing paragraph: 86 of the Internal Revenue Code of 1986 which contract under section 1876.’’. ‘‘(4) REPORTING REQUIREMENTS.— take effect on or after January 1, 1994.’’. (b) ESTABLISHING UPDATE TO CONVERSION ‘‘(A) IN GENERAL.—Not later than Novem- Subtitle G—Provisions Relating to Medicare FACTOR TO MATCH SPENDING UNDER SUSTAIN- ber 1 of each year (beginning with 1996), the Part B ABLE GROWTH RATE.— Secretary shall transmit to the Congress a PART 1—PAYMENT REFORMS (1) IN GENERAL.—Section 1848(d) (42 U.S.C. report that describes the update in the con- SEC. 15601. PAYMENTS FOR PHYSICIANS’ SERV- 1395w–4(d)) is amended— version factor for physicians’ services (as de- ICES. (A) by striking paragraph (2); fined in subsection (f)(3)(A)) in the following (a) REPLACEMENT OF VOLUME PERFORMANCE (B) by amending paragraph (3) to read as year. STANDARD WITH SUSTAINABLE GROWTH follows: ‘‘(B) COMMISSION REVIEW.—The Medicare RATE.—Section 1848(f) (42 U.S.C. 1395w–4(f)) is ‘‘(3) UPDATE.— Payment Review Commission shall review amended to read as follows: ‘‘(A) IN GENERAL.—Subject to subparagraph the report submitted under subparagraph (A) ‘‘(f) SUSTAINABLE GROWTH RATE.— (E), for purposes of this section the update for a year and shall submit to the Congress, ‘‘(1) SPECIFICATION OF GROWTH RATE.— for a year (beginning with 1997) is equal to by not later than December 1 of the year, a ‘‘(A) FISCAL YEAR 1996.—The sustainable the product of— report containing its analysis of the conver- growth rate for all physicians’ services for ‘‘(i) 1 plus the Secretary’s estimate of the sion factor for the following year.’’. fiscal year 1996 shall be equal to the product percentage increase in the medicare eco- (2) EFFECTIVE DATE.—The amendments of— nomic index (described in the fourth sen- made by this subsection shall apply to physi- ‘‘(i) 1 plus the Secretary’s estimate of the tence of section 1842(b)(3)) for the year (di- cians’ services furnished on or after January percentage change in the medicare economic vided by 100), and 1, 1996. index for 1996 (described in the fourth sen- ‘‘(ii) 1 plus the Secretary’s estimate of the (c) ESTABLISHMENT OF SINGLE CONVERSION tence of section 1842(b)(3)) (divided by 100), update adjustment factor for the year (di- FACTOR FOR 1996.— ‘‘(ii) 1 plus the Secretary’s estimate of the vided by 100), (1) IN GENERAL.—Section 1848(d)(1) (42 percentage change (divided by 100) in the av- minus 1 and multiplied by 100. U.S.C. 1395w–4(d)(1)) is amended— erage number of individuals enrolled under ‘‘(B) UPDATE ADJUSTMENT FACTOR.—The (A) by redesignating subparagraph (C) as this part (other than private plan enrollees) ‘update adjustment factor’ for a year is equal subparagraph (D); and from fiscal year 1995 to fiscal year 1996, to the quotient of— (B) by inserting after subparagraph (B) the ‘‘(iii) 1 plus the Secretary’s estimate of the ‘‘(i) the difference between (I) the sum of following new subparagraph: projected percentage growth in real gross do- the allowed expenditures for physicians’ ‘‘(C) SPECIAL RULE FOR 1996.—For 1996, the mestic product per capita (divided by 100) services furnished during each of the years conversion factor under this subsection shall from fiscal year 1995 to fiscal year 1996, plus 1995 through the year involved and (II) the be $35.42 for all physicians’ services.’’. 2 percentage points, and sum of the amount of actual expenditures for (2) CONFORMING AMENDMENTS.—Section 1848 ‘‘(iv) 1 plus the Secretary’s estimate of the physicians’ services furnished during each of (42 U.S.C. 1395w–4), as amended by paragraph percentage change (divided by 100) in expend- the years 1995 through the previous year; di- (1), is amended— itures for all physicians’ services in fiscal vided by (A) by striking ‘‘(or factors)’’ each place it year 1996 (compared with fiscal year 1995) ‘‘(ii) the Secretary’s estimate of allowed appears in subsection (d)(1)(A) and which will result from changes in law, deter- expenditures for physicians’ services fur- (d)(1)(D)(ii); mined without taking into account esti- nished during the year. (B) in subsection (d)(1)(A), by striking ‘‘or mated changes in expenditures due to ‘‘(C) DETERMINATION OF ALLOWED EXPENDI- updates’’; changes in the volume and intensity of phy- TURES.—For purposes of subparagraph (B), (C) in subsection (d)(1)(D)(ii), by striking sicians’ services or changes in expenditures allowed expenditures for physicians’ services ‘‘(or updates)’’; and resulting from changes in the update to the shall be determined as follows (as estimated (D) in subsection (i)(1)(C), by striking conversion factor under subsection (d), by the Secretary): ‘‘conversion factors’’ and inserting ‘‘the con- minus 1 and multiplied by 100. ‘‘(i) In the case of allowed expenditures for version factor’’. ‘‘(B) SUBSEQUENT FISCAL YEARS.—The sus- 1995, such expenditures shall be equal to ac- SEC. 15602. ELIMINATION OF FORMULA-DRIVEN tainable growth rate for all physicians’ serv- tual expenditures for services furnished dur- OVERPAYMENTS FOR CERTAIN OUT- ices for fiscal year 1997 and each subsequent ing the 12-month period ending with June of PATIENT HOSPITAL SERVICES. fiscal year shall be equal to the product of— 1995. (a) AMBULATORY SURGICAL CENTER PROCE- ‘‘(i) 1 plus the Secretary’s estimate of the ‘‘(ii) In the case of allowed expenditures for DURES.—Section 1833(i)(3)(B)(i)(II) (42 U.S.C. percentage change in the medicare economic 1996 and each subsequent year, such expendi- 1395l(i)(3)(B)(i)(II)) is amended— index for the fiscal year involved (described tures shall be equal to allowed expenditures (1) by striking ‘‘of 80 percent’’; and in the fourth sentence of section 1842(b)(3)) for the previous year, increased by the sus- (2) by striking the period at the end and in- (divided by 100), tainable growth rate under subsection (f) for serting the following: ‘‘, less the amount a ‘‘(ii) 1 plus the Secretary’s estimate of the the fiscal year which begins during the year. provider may charge as described in clause percentage change (divided by 100) in the av- ‘‘(D) DETERMINATION OF ACTUAL EXPENDI- (ii) of section 1866(a)(2)(A).’’. erage number of individuals enrolled under TURES.—For purposes of subparagraph (B), (b) RADIOLOGY SERVICES AND DIAGNOSTIC this part (other than private plan enrollees) the amount of actual expenditures for physi- PROCEDURES.—Section 1833(n)(1)(B)(i)(II) (42 from the previous fiscal year to the fiscal cians’ services furnished during a year shall U.S.C. 1395l(n)(1)(B)(i)(II)) is amended— year involved, be equal to the amount of expenditures for (1) by striking ‘‘of 80 percent’’; and ‘‘(iii) 1 plus the Secretary’s estimate of the such services during the 12-month period (2) by striking the period at the end and in- projected percentage growth in real gross do- ending with June of the previous year. serting the following: ‘‘, less the amount a mestic product per capita (divided by 100) ‘‘(E) RESTRICTION ON VARIATION FROM MEDI- provider may charge as described in clause from the previous fiscal year to the fiscal CARE ECONOMIC INDEX.— (ii) of section 1866(a)(2)(A).’’. year involved, plus 2 percentage points, and ‘‘(i) IN GENERAL.—Notwithstanding the (c) EFFECTIVE DATE.—The amendments ‘‘(iv) 1 plus the Secretary’s estimate of the amount of the update adjustment factor de- made by this section shall apply to services percentage change (divided by 100) in expend- termined under subparagraph (B) for a year, furnished during portions of cost reporting itures for all physicians’ services in the fis- the update in the conversion factor under periods occurring on or after October 1, 1995. cal year (compared with the previous fiscal this paragraph for the year may not be— SEC. 15603. PAYMENTS FOR DURABLE MEDICAL year) which will result from changes in law ‘‘(I) greater than 103 percent of 1 plus the EQUIPMENT. (including changes made by the Secretary in Secretary’s estimate of the percentage in- (a) REDUCTION IN PAYMENT AMOUNTS FOR response to section 1895), determined without crease in the medicare economic index (de- ITEMS OF DURABLE MEDICAL EQUIPMENT.— taking into account estimated changes in ex- scribed in the fourth sentence of section (1) FREEZE IN UPDATE FOR COVERED ITEMS.— penditures due to changes in the volume and 1842(b)(3)) for the year (divided by 100); or Section 1834(a)(14) (42 U.S.C. 1395m(a)(14)) is intensity of physicians’ services or changes ‘‘(II) less than the applicable percentage amended— in expenditures resulting from changes in limit of 1 plus the Secretary’s estimate of (A) by striking ‘‘and’’ at the end of sub- the update to the conversion factor under the percentage increase in the medicare eco- paragraph (A); subsection (d)(3), nomic index (described in the fourth sen- (B) in subparagraph (B)— H 10428 CONGRESSIONAL RECORD — HOUSE October 19, 1995 (i) by striking ‘‘a subsequent year’’ and in- ‘‘(iii) sanctions (including exclusion) of emergency access care hospital services pro- serting ‘‘1993, 1994, and 1995’’, and suppliers who are determined to have en- vided during a year shall be determined (ii) by striking the period at the end and gaged in coercive or abusive practices; and using the applicable method provided under inserting a semicolon; and ‘‘(iv) such other safeguards as the Sec- this subsection for determining payment for (C) by adding at the end the following: retary determines are necessary.’’. outpatient rural primary care hospital serv- ‘‘(C) for each of the years 1996 through 2002, (d) PAYMENT FREEZE FOR PARENTERAL AND ices during the year.’’. 0 percentage points; and ENTERAL NUTRIENTS, SUPPLIES, AND EQUIP- (c) EFFECTIVE DATE.—The amendments ‘‘(D) for a subsequent year, the percentage MENT.—In determining the amount of pay- made by this section shall apply to services increase in the consumer price index for all ment under part B of title XVIII of the So- furnished on or after October 1, 1995. urban consumers (U.S. urban average) for cial Security Act with respect to parenteral SEC. 15608. ENSURING PAYMENT FOR PHYSICIAN the 12-month period ending with June of the and enteral nutrients, supplies, and equip- AND NURSE FOR JOINTLY FUR- previous year.’’. ment during each of the years 1996 through NISHED ANESTHESIA SERVICES. (a) PAYMENT FOR JOINTLY FURNISHED SIN- (2) UPDATE FOR ORTHOTICS AND PROSTHET- 2002, the charges determined to be reasonable GLE CASE.— ICS.—Section 1834(h)(4)(A) (42 U.S.C. with respect to such nutrients, supplies, and (1) PAYMENT TO PHYSICIAN.—Section 1395m(h)(4)(A)) is amended— equipment may not exceed the charges de- 1848(a)(4) (42 U.S.C. 1395w–4(a)(4)) is amended (A) by striking ‘‘and’’ at the end of clause termined to be reasonable with respect to by adding at the end the following new sub- (iii); such nutrients, supplies, and equipment dur- paragraph: (B) by redesignating clause (iv) as clause ing 1993. ‘‘(C) PAYMENT FOR SINGLE CASE.—Notwith- (v); and SEC. 15604. REDUCTION IN UPDATES TO PAY- standing section 1862(a)(1)(A), with respect to (C) by inserting after clause (iii) the fol- MENT AMOUNTS FOR CLINICAL DI- physicians’ services consisting of the fur- lowing new clause: AGNOSTIC LABORATORY TESTS. nishing of anesthesia services for a single ‘‘(iv) for each of the years 1996 through (a) CHANGE IN UPDATE.—Section case that are furnished jointly with a cer- 2002, 1 percent, and’’. 1833(h)(2)(A)(ii)(IV) (42 U.S.C. 1395l(h)(2)(A)(ii)(IV)) is amended by striking tified registered nurse anesthetist, if the car- (b) OXYGEN AND OXYGEN EQUIPMENT.—Sec- ‘‘1994 and 1995’’ and inserting ‘‘1994 through rier determines that the use of both the phy- tion 1834(a)(9)(C) (42 U.S.C. 1395m(a)(9)(C)) is 2002’’. sician and the nurse anesthetist to furnish amended— (b) LOWERING CAP ON PAYMENT AMOUNTS.— the anesthesia service was not medically (1) by striking ‘‘and’’ at the end of clause Section 1833(h)(4)(B) (42 U.S.C. 1395l(h)(4)(B)) necessary, the fee schedule amount for the (iii); is amended— physicians’ services shall be equal to 50 per- (2) in clause (iv)— (1) in clause (vi), by striking ‘‘and’’ at the cent (or 55 percent, in the case of services (A) by striking ‘‘a subsequent year’’ and in- end; furnished during 1996 or 1997) of the fee serting ‘‘1993, 1994, and 1995’’, and (2) in clause (vii)— schedule amount applicable under this sec- (B) by striking the period at the end and (A) by inserting ‘‘and before January 1, tion for anesthesia services personally per- inserting a semicolon; and 1997,’’ after ‘‘1995,’’, and formed by the physician alone (without re- (3) by adding at the end the following new (B) by striking the period at the end and gard to this subparagraph). Nothing in this clauses: inserting ‘‘, and’’; and subparagraph may be construed to affect the ‘‘(v) in 1996, is 80 percent of the national (3) by adding at the end the following new application of any provision of law regarding limited monthly payment rate computed clause: balance billing.’’. under subparagraph (B) for the item for the ‘‘(viii) after December 31, 1996, is equal to (2) PAYMENT TO CRNA.—Section 1833(l)(4)(B) year; and 65 percent of such median.’’. (42 U.S.C. 1395l(l)(4)(B)) is amended by adding ‘‘(vi) in a subsequent year, is the national at the end the following new clause: SEC. 15605. EXTENSION OF REDUCTIONS IN PAY- ‘‘(iv) Notwithstanding section 1862(a)(1)(A), limited monthly payment rate computed MENTS FOR COSTS OF HOSPITAL under subparagraph (B) for the item for the OUTPATIENT SERVICES. in the case of services of a certified reg- istered nurse anesthetist consisting of the year.’’. (a) REDUCTION IN PAYMENTS FOR CAPITAL- furnishing of anesthesia services for a single (c) PAYMENT FOR UPGRADED DURABLE MEDI- RELATED COSTS.—Section 1861(v)(1)(S)(ii)(I) (42 U.S.C. 1395x(v)(1)(S)(ii)(I)) is amended by case that are furnished jointly with a physi- CAL EQUIPMENT.—Section 1834(a) (42 U.S.C. cian, if the carrier determines that the use of 1395m(a)) is amended by inserting after para- striking ‘‘through 1998’’ and inserting ‘‘through 2002’’. both the physician and the nurse anesthetist graph (15) the following new paragraph: to furnish the anesthesia service was not (b) REDUCTION IN PAYMENTS FOR OTHER ‘‘(16) PAYMENT FOR CERTAIN UPGRADED medically necessary, the fee schedule COSTS.—Section 1861(v)(1)(S)(ii)(II) (42 U.S.C. ITEMS.— amount for the services furnished by the cer- ‘‘(A) INDIVIDUAL’S RIGHT TO CHOOSE UP- 1395x(v)(1)(S)(ii)(II)) is amended by striking ‘‘through 1998’’ and inserting ‘‘through 2002’’. tified registered nurse anesthetist shall be GRADED ITEM.—Notwithstanding any other equal to 50 percent (or 40 percent, in the case provision of this title, effective on the date SEC. 15606. FREEZE IN PAYMENTS FOR AMBULA- of services furnished during 1996 or 1997) of TORY SURGICAL CENTER SERVICES. on which the Secretary issues regulations the fee schedule amount applicable under The Secretary of Health and Human Serv- under subparagraph (C), payment may be section 1848 for anesthesia services person- ices shall not provide for any inflation up- made under this part for an upgraded item of ally performed by the physician alone (with- date in the payment amounts under subpara- durable medical equipment in the same man- out regard to this clause).’’. graphs (A) and (B) of section 1833(i)(2) of the ner as payment may be made for a standard (b) EFFECTIVE DATE.—The amendments item of durable medical equipment. Social Security Act for any of the fiscal made by subsections (a) shall apply to serv- ‘‘(B) PAYMENTS TO SUPPLIER.—In the case years 1996 through 2002. ices furnished on or after July 1, 1996. of the purchase or rental of an upgraded item SEC. 15607. RURAL EMERGENCY ACCESS CARE SEC. 15609. STATEWIDE FEE SCHEDULE AREA under subparagraph (A)— HOSPITALS. FOR PHYSICIANS’ SERVICES. ‘‘(i) the supplier shall receive payment (a) COVERAGE UNDER PART B.—Section (a) IN GENERAL.—Notwithstanding section under this subsection with respect to such 1832(a)(2) (42 U.S.C. 1395k(a)(2)) is amended— 1848(j)(2) of the Social Security Act, in the item as if such item were a standard item; (1) by striking ‘‘and’’ at the end of subpara- case of the State of Wisconsin, the Secretary and graph (I); of Health and Human Services shall treat the ‘‘(ii) the individual purchasing or renting (2) by striking the period at the end of sub- State as a single fee schedule area for pur- the item shall pay the supplier an amount paragraph (J) and inserting ‘‘; and’’; and poses of determining the fee schedule equal to the difference between the suppli- (3) by adding at the end the following new amount (as referred to in section 1848(a) of er’s charge and the amount under clause (i). subparagraph: such Act) for physicians’ services (as defined In no event may the supplier’s charge for an ‘‘(K) rural emergency access care hospital in section 1848(j)(3) of such Act) under part B upgraded item exceed the applicable fee services (as defined in section 1861(oo)(2)).’’. of the medicare program. schedule amount (if any) for such item. (b) PAYMENT BASED ON PAYMENT FOR OUT- (b) BUDGET-NEUTRALITY.—Notwithstanding ‘‘(C) CONSUMER PROTECTION SAFEGUARDS.— PATIENT RURAL PRIMARY CARE HOSPITAL any provision of part B of title XVIII of the The Secretary shall issue regulations provid- SERVICES.— Social Security Act, the Secretary shall ing for consumer protection standards with (1) IN GENERAL.—Section 1833(a)(6) (42 carry out subsection (a) in a manner that en- respect to the furnishing of upgraded equip- U.S.C. 1395l(a)(6)) is amended by striking sures that total payments for physicians’ ment under subparagraph (A). Such regula- ‘‘services,’’ and inserting ‘‘services and rural services (as so defined) furnished by physi- tions shall provide for— emergency access care hospital services,’’. cians in Wisconsin during a year are not ‘‘(i) full disclosure by the supplier of the (2) PAYMENT METHODOLOGY DESCRIBED.— greater or less than total payments for such availability and price of standard items and Section 1834(g) (42 U.S.C. 1395m(g)) is amend- services would have been but for this section. proof of receipt of such disclosure informa- ed— (c) CONSTRUCTION.—Nothing in this section tion by the beneficiary before the furnishing (A) in the heading, by striking ‘‘SERVICES’’ shall be construed as limiting the availabil- of the upgraded item; and inserting ‘‘SERVICES AND RURAL EMER- ity (to the Secretary, the appropriate agency ‘‘(ii) conditions of participation for suppli- GENCY ACCESS CARE HOSPITAL SERVICES’’; and or organization with a contract under sec- ers of upgraded items, including conditions (B) by adding at the end the following new tion 1842 of such Act, or physicians in the relating to billing procedures; sentence: ‘‘The amount of payment for rural State of Wisconsin) of otherwise applicable October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10429 administrative procedures for modifying the nizations the data and data analysis used in ‘‘(B) the total of the monthly premiums fee schedule area or areas in the State after establishing the fee schedule, including data paid by the individual under this section (de- implementation of subsection (a). on variations in payments for ambulance termined without regard to subsection (b)) (d) EFFECTIVE DATE.—This section shall services under part B of the medicare pro- during such calendar year. apply with respect to physicians’ services gram for years prior to 1998 among geo- ‘‘(2) In the case of an individual described furnished on or after January 1, 1997. graphic areas and types of ambulance service in paragraph (1) whose modified adjusted SEC. 15609A. ESTABLISHMENT OF FEE SCHEDULE providers. gross income exceeds the threshold amount FOR AMBULANCE SERVICES. (c) EFFECTIVE DATE.—The amendment by less than $25,000, the amount of the in- (a) PAYMENT IN ACCORDANCE WITH FEE made by subsection (a) and the fee schedule crease in the monthly premium applicable SCHEDULE.—Section 1833(a)(1) (42 U.S.C. described in subsection (b) shall apply to am- under paragraph (1) shall be an amount 1395l(a)(1)) is amended— bulance services furnished on or after Janu- which bears the same ratio to the amount of (1) by striking ‘‘and (P)’’ and inserting ary 1, 1998. the increase described in paragraph (1) (de- ‘‘(P)’’; and SEC. 15609B. STANDARDS FOR PHYSICAL THER- termined without regard to this paragraph) (2) by striking the semicolon at the end APY SERVICES FURNISHED BY PHY- as such excess bears to $25,000. In the case of SICIANS. and inserting the following: ‘‘, and (Q) with a joint return filed under section 6013 of the (a) APPLICATION OF STANDARDS FOR OTHER respect to ambulance service, the amounts Internal Revenue Code of 1986 by spouses PROVIDERS OF PHYSICAL THERAPY SERVICES paid shall be 80 percent of the lesser of the both of whom are enrolled under this part, TO SERVICES FURNISHED BY PHYSICIANS.—Sec- actual charge for the services or the amount the previous sentence shall be applied by tion 1862(a) (42 U.S.C. 1395y(a)), as amended determined by a fee schedule established by substituting ‘$50,000’ for ‘$25,000’. The preced- the Secretary for the purposes of this sub- by section 15525(a)(2), is amended— ing provisions of this paragraph shall not paragraph (in accordance with section (1) by striking ‘‘or’’ at the end of paragraph apply to any individual whose threshold 15608(b) of the Medicare Preservation Act);’’. (15); amount is zero. (b) REQUIREMENTS FOR ESTABLISHMENT OF (2) by striking the period at the end of ‘‘(3) The Secretary shall make an initial FEE SCHEDULE.— paragraph (16) and inserting ‘‘; or’’; and (1) IN GENERAL.—The Secretary of Health (3) by inserting after paragraph (16) the fol- determination of the amount of an individ- and Human Services shall establish the fee lowing new paragraph: ual’s modified adjusted gross income for a schedule for ambulance services under sec- ‘‘(17) in the case of physicians’ services taxable year ending with or within a cal- tion 1833(a)(1)(Q) of the Social Security Act under section 1848(j)(3) consisting of out- endar year for purposes of this subsection as (as added by subsection (a)) through a nego- patient physical therapy services or out- follows: tiated rulemaking process described in title patient occupational therapy services, which ‘‘(A) Not later than October 1 of the year 5, United States Code, and in accordance are furnished by a physician who does not preceding the year, the Secretary shall pro- with the requirements of this subsection. meet the requirements applicable under sec- vide notice to each individual whom the Sec- (2) CONSIDERATIONS.—In establishing the tion 1861(p) to a clinic or rehabilitation agen- retary finds (on the basis of the individual’s fee schedule for ambulance services, the Sec- cy furnishing such services.’’. actual modified adjusted gross income for retary shall— (b) CONFORMING AMENDMENT.—Section the most recent taxable year for which such (A) establish mechanisms to control in- 1848(j)(3) (42 U.S.C. 1395w–4(j)(3)) is amended information is available or other informa- creases in expenditures for ambulance serv- by inserting ‘‘(subject to section 1862(a)(17))’’ tion provided to the Secretary by the Sec- ices under part B of the medicare program after ‘‘(2)(D)’’. retary of the Treasury) will be subject to an which fairly reflect the changing nature of (c) EFFECTIVE DATE.—The amendments increase under this subsection that the indi- the ambulance service industry; made by this section shall apply to services vidual will be subject to such an increase, (B) establish definitions for ambulance furnished on or after January 1, 1996. and shall include in such notice the Sec- services which promote efficiency and link PART 2—PART B PREMIUM retary’s estimate of the individual’s modi- fied adjusted gross income for the year. payments (including fees for assessment and SEC. 15611. EXTENSION OF PART B PREMIUM. treatment services) to the type of service ‘‘(B) If, during the 30-day period beginning (a) IN GENERAL.—Section 1839(e)(1) (42 on the date notice is provided to an individ- provided; U.S.C. 1395r(e)(1)) is amended— ual under subparagraph (A), the individual (C) take into account regional differences (1) in subparagraph (A)— provides the Secretary with information on which affect cost and productivity, including (A) by striking ‘‘and prior to January the individual’s anticipated modified ad- differences in the costs of resources and the 1999’’, and justed gross income for the year, the amount costs of uncompensated care; (B) by inserting ‘‘(or, if higher, the percent initially determined by the Secretary under (D) apply dynamic adjustments to payment described in subparagraph (C))’’ after ‘‘50 per- this paragraph with respect to the individual rates to account for inflation, demographic cent’’; and shall be based on the information provided changes in the population of medicare bene- (2) by adding at the end the following new by the individual. ficiaries, and changes in the number of pro- subparagraph: viders of ambulance services participating in ‘‘(C) For purposes of subparagraph (A), the ‘‘(C) If an individual does not provide the the medicare program; and percent described in this subparagraph is the Secretary with information under subpara- (E) phase in the application of the payment ratio (expressed as a percentage) of the graph (B), the amount initially determined rates under the fee schedule in an efficient monthly premium established under this sec- by the Secretary under this paragraph with and fair manner. tion for months in 1995 to the monthly actu- respect to the individual shall be the amount (3) SAVINGS.—In establishing the fee sched- arial rate for enrollees age 65 and over appli- included in the notice provided to the indi- ule for ambulance services, the Secretary cable to such months (as specified in the vidual under subparagraph (A). shall— most recent report of the Board of Trustees ‘‘(4)(A) If the Secretary determines (on the (A) ensure that the aggregate amount of of the Federal Supplementary Medical Insur- basis of final information provided by the payments made for ambulance services ance Trust Fund published prior to the date Secretary of the Treasury) that the amount under part B of the medicare program during of the enactment of the Medicare Preserva- of an individual’s actual modified adjusted 1998 does not exceed the aggregate amount of tion Act of 1995).’’. gross income for a taxable year ending with payments which would have been made for (b) EFFECTIVE DATE.—The amendments or within a calendar year is less than or such services under part B of the program made by subsection (a) apply to premiums greater than the amount initially deter- during 1998 if the amendments made by this for months beginning with January 1996. mined by the Secretary under paragraph (3), section were not in effect; and SEC. 15612. INCOME-RELATED REDUCTION IN the Secretary shall increase or decrease the (B) set the payment amounts provided MEDICARE SUBSIDY. amount of the individual’s monthly premium under the fee schedule for services furnished (a) IN GENERAL.—Section 1839 (42 U.S.C. under this section (as the case may be) for in 1999 and each subsequent year at amounts 1395r) is amended by adding at the end the months during the following calendar year equal to the payment amounts under the fee following: by an amount equal to 1⁄12 of the difference schedule for service furnished during the pre- ‘‘(h)(1) Notwithstanding the previous sub- between— vious year, increased by the percentage in- sections of this section, in the case of an in- ‘‘(i) the total amount of all monthly pre- crease in the consumer price index for all dividual whose modified adjusted gross in- miums paid by the individual under this sec- urban consumers (U.S. city average) for the come for a taxable year ending with or with- tion during the previous calendar year; and 12-month period ending with June of the pre- in a calendar year (as initially determined ‘‘(ii) the total amount of all such pre- vious year. by the Secretary in accordance with para- miums which would have been paid by the (4) CONSULTATION.—In establishing the fee graph (3)) exceeds the threshold amount de- individual during the previous calendar year schedule for ambulance services, the Sec- scribed in paragraph (5)(B), the Secretary if the amount of the individual’s modified retary shall consult regularly with the shall increase the amount of the monthly adjusted gross income initially determined American Ambulance Association, the Na- premium for months in the calendar year by under paragraph (3) were equal to the actual tional Association of State Medical Direc- an amount equal to the difference between— amount of the individual’s modified adjusted tors, and other national organizations rep- ‘‘(A) 200 percent of the monthly actuarial gross income determined under this para- resenting individuals and entities who fur- rate for enrollees age 65 and over as deter- graph. nish or regulate ambulance services, and mined under subsection (a)(1) for that cal- ‘‘(B) In the case of an individual who is not shall share with such associations and orga- endar year; and enrolled under this part for any calendar H 10430 CONGRESSIONAL RECORD — HOUSE October 19, 1995 year for which the individual’s monthly pre- ‘‘(iv) the amounts excluded from such tax- intermediaries and carriers under the medi- mium under this section for months during payer’s gross income under sections 135 and care program may not implement any new the year would be increased pursuant to sub- 911, requirement relating to the submission of a paragraph (A) if the individual were enrolled ‘‘(v) the interest received or accrued during claim for clinical diagnostic laboratory tests under this part for the year, the Secretary the taxable year which is exempt from the retroactive to January 1, 1995, and carriers may take such steps as the Secretary consid- tax imposed by chapter 1 to the extent such may not initiate any new coverage, adminis- ers appropriate to recover from the individ- information is available, and trative, or payment policy unless the policy ual the total amount by which the individ- ‘‘(vi) the amounts excluded from such tax- promotes the goal of administrative sim- ual’s monthly premium for months during payer’s gross income by sections 931 and 933 plification of requirements imposed on clini- the year would have been increased under to the extent such information is available. cal laboratories in accordance with the Sec- subparagraph (A) if the individual were en- ‘‘(B) RESTRICTION ON USE OF DISCLOSED IN- retary’s promulgation of the negotiated rule- rolled under this part for the year. FORMATION.—Return information disclosed making. ‘‘(C) In the case of a deceased individual for under subparagraph (A) may be used by offi- (5) Not later than 6 months after the date whom the amount of the monthly premium cers and employees of the Health Care Fi- of the enactment of this Act, the medical di- under this section for months in a year nancing Administration only for the pur- rectors shall submit their recommendations would have been decreased pursuant to sub- poses of, and to the extent necessary in, es- to the Secretary, and the Secretary shall paragraph (A) if the individual were not de- tablishing the appropriate monthly premium publish the recommendations and solicit ceased, the Secretary shall make a payment under section 1839 of the Social Security public comment using negotiated rule- to the individual’s surviving spouse (or, in Act.’’ making in accordance with title 5, United the case of an individual who does not have (2) CONFORMING AMENDMENT.—Paragraphs States Code. The Secretary shall publish a surviving spouse, to the individual’s es- (3)(A) and (4) of section 6103(p) of such Code final uniform policies for coverage, adminis- tate) in an amount equal to the difference are each amended by striking ‘‘or (14)’’ each tration, and payment of claims for clinical between— place it appears and inserting ‘‘(14), or (15)’’. diagnostic laboratory tests, effective after ‘‘(i) the total amount by which the individ- (d) EFFECTIVE DATE.—The amendments the expiration of the 180-day period which ual’s premium would have been decreased for made by subsections (a) and (b) shall apply begins on the date of publication. all months during the year pursuant to sub- to the monthly premium under section 1839 (6) After the publication of the final uni- paragraph (A); and of the Social Security Act for months begin- form policies, the Secretary shall implement ‘‘(ii) the amount (if any) by which the indi- ning with January 1997. identical uniform documentation and proc- vidual’s premium was decreased for months PART 3—ADMINISTRATION AND BILLING essing policies for all clinical diagnostic lab- during the year pursuant to subparagraph OF LABORATORY SERVICES oratory tests paid under the medicare pro- (A). SEC. 15621. ADMINISTRATIVE SIMPLIFICATION gram through fiscal intermediaries or car- ‘‘(5) In this subsection, the following defi- FOR LABORATORY SERVICES. riers. nitions apply: (a) IN GENERAL.—Not later than 1 year (c) OPTIONAL SELECTION OF SINGLE CAR- ‘‘(A) The term ‘modified adjusted gross in- after the date of the enactment of this Act, RIER.—Effective for claims submitted after come’ means adjusted gross income (as de- the Secretary of Health and Human Services the expiration of the 90-day period which be- fined in section 62 of the Internal Revenue (in accordance with the process described in gins on the date of the enactment of this Code of 1986)— subsection (b)) shall adopt uniform coverage, Act, an independent laboratory may select a ‘‘(i) determined without regard to sections administration, and payment policies for single carrier for the processing of all of its 135, 911, 931, and 933 of such Code, and clinical diagnostic laboratory tests under claims for payment under part B of the medi- ‘‘(ii) increased by the amount of interest part B of the medicare program. care program, without regard to the location received or accrued by the taxpayer during (b) PROCESS FOR ADOPTION OF POLICIES.— where the laboratory or the patient or pro- the taxable year which is exempt from tax The Secretary shall adopt uniform policies vider involved resides or conducts business. under such Code. under subsection (a) in accordance with the Such election of a single carrier shall be ‘‘(B) The term ‘threshold amount’ means— following process: made by the clinical laboratory and an ‘‘(i) except as otherwise provided in this (1) The Secretary shall select from carriers agreement made between the carrier and the paragraph, $75,000, with whom the Secretary has a contract laboratory shall be forwarded to the Sec- ‘‘(ii) $125,000, in the case of a joint return under part B during 1995 15 medical direc- retary of Health and Human Services. Noth- (as defined in section 7701(a)(38) of such tors, who will meet and develop rec- ing in this subsection shall be construed to Code), and ommendations for such uniform policies. The require a laboratory to select a single carrier ‘‘(iii) zero in the case of a taxpayer who— medical directors selected shall represent under this subsection. ‘‘(I) is married at the close of the taxable various geographic areas and have a varied SEC. 15622. RESTRICTIONS ON DIRECT BILLING year but does not file a joint return (as so range of experience in relevant medical FOR LABORATORY SERVICES. defined) for such year, and fields, including pathology and clinical lab- (a) REQUIREMENT FOR DIRECT BILLING.— ‘‘(II) does not live apart from his spouse at oratory practice. Section 1833(h) (42 U.S.C. 1395l(h)) is amended all times during the taxable year.’’. (2) The medical directors selected under by adding at the end the following new para- (b) CONFORMING AMENDMENT.—Section paragraph (1) shall consult with independent graph: 1839(f) (42 U.S.C. 1395r(f)) is amended by experts in each major discipline of clinical ‘‘(7)(A) Effective for services furnished on striking ‘‘if an individual’’ and inserting the laboratory medicine, including clinical lab- or October 1, 1996, an individual or entity following: ‘‘if an individual (other than an oratory personnel, bioanalysts, pathologists, that performs clinical laboratory diagnostic individual subject to an increase in the and practicing physicians. The medical di- tests shall not present or cause to be pre- monthly premium under this section pursu- rectors shall also solicit comments from sented a claim, bill, or demand for payment ant to subsection (h))’’. other individuals and groups who wish to to any person, other than the individual re- (c) REPORTING REQUIREMENTS FOR SEC- participate, including consumers and other ceiving such services or the health plan des- RETARY OF THE TREASURY.— affected parties. This process shall be con- ignated by such person, except that (i) in the (1) IN GENERAL.—Subsection (l) of section ducted as a negotiated rulemaking under case of a test performed by one laboratory at 6103 of the Internal Revenue Code of 1986 (re- title 5, United States Code. the request of another laboratory, which lating to confidentiality and disclosure of re- (3) Under the negotiated rulemaking, the meets the requirements of clause (i), (ii), or turns and return information) is amended by recommendations for uniform policies shall (iii) of paragraph (5)(A), payment may be adding at the end the following new para- be designed to simplify and reduce unneces- made to the requesting laboratory, and (ii) graph: sary administrative burdens in connection the Secretary may by regulation establish ‘‘(15) DISCLOSURE OF RETURN INFORMATION with the following: appropriate exceptions to the requirement of TO CARRY OUT INCOME-RELATED REDUCTION IN (A) Beneficiary information required to be this subparagraph. MEDICARE PART B PREMIUM.— submitted with each claim. ‘‘(B)(i) Any person that collects any ‘‘(A) IN GENERAL.—The Secretary may, (B) Physicians’ obligations regarding docu- amounts that were billed in violation of upon written request from the Secretary of mentation requirements and recordkeeping. paragraph (7)(A) above shall be liable for Health and Human Services, disclose to offi- (C) Procedures for filing claims and for such amounts to the person from whom such cers and employees of the Health Care Fi- providing remittances by electronic media. amounts were collected. nancing Administration return information (D) The performance of post-payment re- ‘‘(ii) Any person that furnishes clinical lab- with respect to a taxpayer who is required to view of test claims. oratory services for which payment is made pay a monthly premium under section 1839 of (E) The prohibition of the documentation under paragraph (1)(D)(i) or paragraph the Social Security Act. Such return infor- of medical necessity except when determined (2)(D)(i) that knowingly violates subpara- mation shall be limited to— to be appropriate after identification of aber- graph (A) is subject to a civil money penalty ‘‘(i) taxpayer identity information with re- rant utilization pattern through focused of not more than $10,000 for each such viola- spect to such taxpayer, medical review. tion. The provisions of section 1128A (other ‘‘(ii) the filing status of such taxpayer, (F) Beneficiary responsibility for payment. than subsections (a) and (b)) shall apply to a ‘‘(iii) the adjusted gross income of such (4) During the pendency of the adoption by civil money penalty under this paragraph in taxpayer, the Secretary of the uniform policies, fiscal the same manner as such provisions apply October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10431 with respect to a penalty or proceeding ‘‘(i) the amount of expenditures under this nished to an individual who at the time the under section 1128A(a). section for clinical diagnostic laboratory service is furnished is under a plan of care by ‘‘(iii)(I) Any individual or entity that the tests which will be made in the period from the home health agency under this title Secretary determines has repeatedly vio- January 1, 1997, through September 30, 2002, (without regard to whether or not the item lated subparagraph (A) may be excluded and or service was furnished by the agency or by from participation in any Federal health ‘‘(ii) the amount of expenditures which others under arrangement with them made care program. The provisions of section would have been made under this section for by the agency, or otherwise). 1128A (other than subsections (a) and (b)) clinical diagnostic laboratory tests in the ‘‘(2) TYPES OF SERVICES.—The types of shall apply to an exclusion under this para- period from January 1, 1997, through Septem- home health services described in this para- graph in the same manner as such provisions ber 30, 2002, if paragraph (7) had not been en- graph are the following: apply with respect to a penalty or proceeding acted. ‘‘(A) Part-time or intermittent nursing under section 1128A(a). ‘‘(B) If the amount estimated under sub- care provided by or under the supervision of ‘‘(II) The provisions of section 1128(e) of the paragraph (A)(i) is greater than 97 percent of a registered professional nurse. Social Security Act shall apply to any exclu- the amount estimated under subparagraph ‘‘(B) Physical therapy. sion under clause (iii)(I) in the same manner (A)(ii), the Secretary shall establish a limi- ‘‘(C) Occupational therapy. as such provisions apply to a proceeding tation amount under paragraph (4)(B)(ix) ‘‘(D) Speech-language pathology services. under section 1128. such that, when such limitation amount is ‘‘(E) Medical social services under the di- ‘‘(iv) If the Secretary finds, after a reason- considered, the amount estimated under sub- rection of a physician. able notice and opportunity for a hearing, paragraph (A)(i) is 97 percent of the amount ‘‘(F) To the extent permitted in regula- that a laboratory which holds a certificate estimated under subparagraph (A)(ii). tions, part-time or intermittent services of a pursuant to section 353 of the Public Health ‘‘(C) The Director of the Congressional home health aide who has successfully com- Service Act has on a repeated basis violated Budget Office (hereafter in this subpara- pleted a training program approved by the subparagraph (A), the Secretary may sus- graph referred to as the ‘Director’) shall— Secretary. pend, revoke, or limit such certification in ‘‘(i) independently estimate the amounts ‘‘(b) ESTABLISHMENT OF PER VISIT RATE accordance with the procedures established specified in subparagraph (A) and compute FOR EACH TYPE OF SERVICES.— in section 353(k) of Public Health Service any limitation amount required under sub- ‘‘(1) IN GENERAL.—The Secretary shall, sub- Act. paragraph (B), and ject to paragraph (3), establish a per visit ‘‘(C) For purposes of this paragraph, the ‘‘(ii) submit a report on such estimates and payment rate for a home health agency in an following definitions shall apply: computation to Congress not later than Au- area for each type of home health service de- ‘‘(i) The term ‘Federal health care pro- gust 31, 1999. scribed in subsection (a)(2). Such rate shall gram’ means— The Secretary shall provide the Director be equal to the national per visit payment ‘‘(I) any plan or program that provides with such data as the Director reasonably re- rate determined under paragraph (2) for each health benefits, whether directly, through quires to prepare such estimates and com- such type, except that the labor-related por- insurance, or otherwise, which is funded, in putation.’’. tion of such rate shall be adjusted by the whole or in part, by the United States Gov- area wage index applicable under section ernment; or PART 4—QUALITY STANDARDS FOR 1886(d)(3)(E) for the area in which the agency ‘‘(II) any State health care program, as de- DURABLE MEDICAL EQUIPMENT is located (as determined without regard to fined in section 1128(h). SEC. 15631. RECOMMENDATIONS FOR QUALITY any reclassification of the area under section ‘‘(ii) The term ‘health plan’ means any hos- STANDARDS FOR DURABLE MEDI- 1886(d)(8)(B) or a decision of the Medicare Ge- pital or medical service policy or certificate, CARE EQUIPMENT. ographic Classification Review Board or the hospital or medical service plan contract, or (a) APPOINTMENT OF TASK FORCE BY SEC- Secretary under section 1886(d)(10) for cost health maintenance organization contract RETARY.— reporting periods beginning after October 1, offered by an insurer, except that such term (1) IN GENERAL.—The Secretary of Health 1995). does not include any of the following: and Human Services shall establish a broad- ‘‘(2) NATIONAL PER VISIT PAYMENT RATE.— ‘‘(I) Coverage only for accident, dental, vi- ly based task force to develop recommenda- The national per visit payment rate for each sion, disability income, or long-term care in- tions for quality standards for durable medi- type of service described in subsection surance, or any combination thereof. cal equipment under part B of the medicare (a)(2)— ‘‘(II) Medicare supplemental health insur- program. ‘‘(A) for fiscal year 1997, is an amount ance. (2) COMPOSITION.—The task force shall in- equal to the national average amount paid ‘‘(III) Coverage issued as a supplement to clude individuals selected by the Secretary per visit under this title to home health liability insurance. from representatives of suppliers of items of agencies for such type of service during the ‘‘(IV) Liability insurance, including gen- durable medical equipment under part B, most recent 12-month cost reporting period eral liability insurance and automobile li- consumers, and other users of such equip- ending on or before June 30, 1994, increased ability insurance. ment. In appointing members, the Secretary (in a compounded manner) by the home ‘‘(V) Worker’s compensation or similar in- shall assure representation from various geo- health market basket percentage increase surance. graphic regions of the United States. for fiscal years 1995, 1996, and 1997; and ‘‘(VI) Automobile medical-payment insur- (3) NO COMPENSATION FOR SERVICE.—Mem- ‘‘(B) for each subsequent fiscal year, is an ance. bers of the task force shall not receive any amount equal to the national per visit pay- ‘‘(VII) Coverage for a specified disease or compensation for service on the task force. ment rate in effect for the preceding fiscal illness. (4) TERMINATION.—The task force shall ter- year, increased by the home health market ‘‘(VIII) A hospital or fixed indemnity pol- minate 30 days after it submits the report basket percentage increase for such subse- icy. described in subsection (b). quent fiscal year minus 2 percentage points. (b) LOOK BACK PROVISIONS TO ASSURE SAV- (b) REPORT.—Not later than 1 year after ‘‘(3) REBASING OF RATES.—The Secretary INGS.— the date of the enactment of this Act, the shall provide for an update to the national (1) IN GENERAL.—Section 1833(h)(4)(B) (42 task force established under subsection (a) per visit payment rates under this sub- U.S.C. 1395l(h)(4)(B)), as amended by section shall submit to the Secretary its rec- section for cost reporting periods beginning 15604(b), is amended— ommendations for quality standards for du- not later than the first day of the fifth fiscal (A) in clause (vii), by striking ‘‘and’’ at the rable medicare equipment under part B of year which begins after fiscal year 1997, and end; the medicare program. not later than every 5 years thereafter, to re- (B) in clause (viii)— Subtitle H—Provisions Relating to Medicare flect the most recent available data. (i) by inserting ‘‘and before January 1, Parts A and B ‘‘(4) HOME HEALTH MARKET BASKET PER- 2000,’’ after ‘‘1996,’’, and PART 1—PAYMENTS FOR HOME HEALTH CENTAGE INCREASE.—For purposes of this sub- (ii) by striking the period at the end and SERVICES section, the term ‘home health market bas- inserting ‘‘, and’’; and ket percentage increase’ means, with respect SEC. 15701. PAYMENT FOR HOME HEALTH SERV- (C) by adding at the end the following new ICES. to a fiscal year, a percentage (estimated by clause: the Secretary before the beginning of the fis- (a) IN GENERAL.—Title XVIII (42 U.S.C. 1395 ‘‘(ix) after December 31, 1999, is equal to cal year) determined and applied with re- et seq.), as amended by section 15106, is such percentage of such median as the Sec- spect to the types of home health services amended by adding at the end the following retary establishes under paragraph (8)(B), or, described in subsection (a)(2) in the same new section: if the Secretary does not act under para- manner as the market basket percentage in- graph (8)(B), is equal to 65 percent of such ‘‘PAYMENT FOR HOME HEALTH SERVICES crease under section 1886(b)(3)(B)(iii) is de- median.’’. ‘‘SEC. 1894. (a) IN GENERAL.— termined and applied to inpatient hospital (2) PROCESS FOR REDUCTIONS.—Section ‘‘(1) PER VISIT PAYMENTS.—Subject to sub- services for the fiscal year. 1833(h) (42 U.S.C. 1395l(h)), as amended by section (c), the Secretary shall make per ‘‘(c) PER EPISODE LIMIT.— subsection (a), is amended by adding at the visit payments beginning with fiscal year ‘‘(1) AGGREGATE LIMIT.— end the following new paragraph: 1997 to a home health agency in accordance ‘‘(A) IN GENERAL.—Except as provided in ‘‘(8)(A) On July 31, 1999, the Secretary shall with this section for each type of home paragraph (2), a home health agency may not estimate— health service described in paragraph (2) fur- receive aggregate per visit payments under H 10432 CONGRESSIONAL RECORD — HOUSE October 19, 1995 subsection (a) for a fiscal year in excess of an exemptions and exceptions do not result in ‘‘(A) discharging patients to another home amount equal to the sum of the following greater payments under this section than health agency or similar provider; products determined for each case-mix cat- the exemptions and exceptions provided ‘‘(B) altering corporate structure or name egory for which the agency receives pay- under section 1861(v)(1)(L)(ii) in fiscal year to avoid being subject to this section or for ments: 1994, increased by the home health market the purpose of increasing payments under ‘‘(i) The number of episodes of each case- basket percentage increase for the fiscal this title; or mix category during the fiscal year; multi- year involved (as defined in subsection ‘‘(C) undertaking other actions considered plied by (b)(4)). unnecessary for effective patient care and in- ‘‘(ii) the per episode limit determined for ‘‘(2) RECONCILIATION OF AMOUNTS.— tended to achieve maximum payments under such case-mix category for such fiscal year. ‘‘(A) OVERPAYMENTS TO HOME HEALTH AGEN- this title. ‘‘(B) ESTABLISHMENT OF PER EPISODE LIM- CIES.—Subject to subparagraph (B), if a home ‘‘(2) TRACKING OF PATIENTS THAT SWITCH ITS.— health agency has received aggregate per HOME HEALTH AGENCIES DURING EPISODE.— ‘‘(i) IN GENERAL.—The per episode limit for visit payments under subsection (a) for a fis- ‘‘(A) DEVELOPMENT OF SYSTEM.—The Sec- a fiscal year for any case-mix category for cal year in excess of the amount determined retary shall develop a system that tracks the area in which a home health agency is under paragraph (1) with respect to such home health patients that receive home located is equal to— home health agency for such fiscal year, the health services described in subsection (a)(2) ‘‘(I) the mean number of visits for each Secretary shall reduce payments under this from more than 1 home health agency during type of home health service described in sub- section to the home health agency in the fol- an episode described in subsection (c)(1)(D). section (a)(2) furnished during an episode of lowing fiscal year in such manner as the Sec- ‘‘(B) ADJUSTMENT OF PAYMENTS.—The Sec- such case-mix category in such area during retary considers appropriate (including on an retary shall adjust payments under this sec- fiscal year 1994, adjusted by the case-mix ad- installment basis) to recapture the amount tion to each home health agency that fur- justment factor determined in clause (ii) for of such excess. nishes an individual with a type of home the fiscal year involved; multiplied by ‘‘(B) EXCEPTION FOR HOME HEALTH SERVICES health service described in subsection (a)(2) ‘‘(II) the per visit payment rate established FURNISHED OVER A PERIOD GREATER THAN 165 to ensure that aggregate payments on behalf under subsection (b) for such type of home DAYS.— of such individual during such episode do not health service for the fiscal year for which ‘‘(i) IN GENERAL.—For purposes of subpara- exceed the amount that would be paid under the determination is being made. graph (A), the amount of aggregate per visit this section if the individual received such ‘‘(ii) CASE MIX ADJUSTMENT FACTOR.—For payments determined under subsection (a) services from a single home health agency. purposes of clause (i), the case-mix adjust- shall not include payments for home health ‘‘(3) LOW-COST CASES.—The Secretary shall ment factor for a year is the factor deter- visits furnished to an individual on or after develop a system designed to adjust pay- mined by the Secretary to assure that aggre- a continuous period of more than 165 days ments to a home health agency for a fiscal gate payments for home health services after an individual begins an episode de- year to eliminate any increase in growth of under this section during the year will not scribed in subsection (c)(1)(D) (if such period the percentage of low-cost episodes for which exceed the payment for such services during is not interrupted by the beginning of a new home health services are furnished by the the previous year as a result of changes in episode). agency over such percentage determined for the number and type of home health visits ‘‘(ii) REQUIREMENT OF CERTIFICATION.— the agency for the 12-month cost reporting within case-mix categories over the previous Clause (i) shall not apply if the agency has period ending on June 30, 1994. The Secretary year. not obtained a physician’s certification with shall define a low-cost episode in a manner ‘‘(iii) REBASING OF PER EPISODE AMOUNTS.— respect to the individual requiring such vis- that provides that a home health agency has Beginning with fiscal year 1999 and every 2 its that includes a statement that the indi- an incentive to be cost efficient in delivering years thereafter, the Secretary shall revise vidual requires such continued visits, the home health services and that the volume of the mean number of home health visits de- reason for the need for such visits, and a de- such services does not increase as a result of termined under clause (i)(I) for each type of scription of such services furnished during factors other than patient needs. home health service visit described in sub- such visits. section (a)(2) furnished during an episode in ‘‘(C) SHARE OF SAVINGS.— ‘‘(f) REPORT BY MEDICARE PAYMENT REVIEW a case-mix category to reflect the most re- ‘‘(i) BONUS PAYMENTS.—If a home health COMMISSION.—During the first 3 years in cently available data on the number of vis- agency has received aggregate per visit pay- which payments are made under this section, its. ments under subsection (a) for a fiscal year the Medicare Payment Review Commission ‘‘(iv) DETERMINATION OF APPLICABLE in an amount less than the amount deter- shall annually submit a report to Congress AREA.—For purposes of determining per epi- mined under paragraph (1) with respect to on the effectiveness of the payment meth- sode limits under this subparagraph, the such home health agency for such fiscal odology established under this section that area in which a home health agency is con- year, the Secretary shall pay such home shall include recommendations regarding the sidered to be located shall be such area as health agency a bonus payment equal to 50 following: the Secretary finds appropriate for purposes percent of the difference between such ‘‘(1) Case-mix and volume increases. of this subparagraph. amounts in the following fiscal year, except ‘‘(2) Quality monitoring of home health ‘‘(C) CASE-MIX CATEGORY.—For purposes of that the bonus payment may not exceed 5 agency practices. this paragraph, the term ‘case-mix category’ percent of the aggregate per visit payments ‘‘(3) Whether a capitated payment for home means each of the 18 case-mix categories es- made to the agency for the year. care patients receiving care during a contin- tablished under the Phase II Home Health ‘‘(ii) INSTALLMENT BONUS PAYMENTS.—The uous period exceeding 165 days is warranted. Agency Prospective Payment Demonstration Secretary may make installment payments ‘‘(4) Whether public providers of service are Project conducted by the Health Care Fi- during a fiscal year to a home health agency adequately reimbursed. nancing Administration. The Secretary may based on the estimated bonus payment that ‘‘(5) The adequacy of the exemptions and develop an alternate methodology for deter- the agency would be eligible to receive with exceptions to the limits provided under sub- mining case-mix categories. respect to such fiscal year. section (c)(1)(E). ‘‘(D) EPISODE.— ‘‘(d) MEDICAL REVIEW PROCESS.—The Sec- ‘‘(6) The appropriateness of the methods ‘‘(i) IN GENERAL.—For purposes of this retary shall implement a medical review provided under this section to adjust the per paragraph, the term ‘episode’ means the con- process (with a particular emphasis on fiscal episode limits and annual payment updates tinuous 120-day period that— years 1997 and 1998) for the system of pay- to reflect changes in the mix of services, ‘‘(I) begins on the date of an individual’s ments described in this section that shall number of visits, and assignment to case cat- first visit for a type of home health service provide an assessment of the pattern of care egories to reflect changing patterns of home described in subsection (a)(2) for a case-mix furnished to individuals receiving home health care. category, and health services for which payments are made ‘‘(7) The geographic areas used to deter- ‘‘(II) is immediately preceded by a 60-day under this section to ensure that such indi- mine the per episode limits. period in which the individual did not re- viduals receive appropriate home health ‘‘(g) NO EFFECT ON NON-MEDICARE SERV- ceive visits for a type of home health service services. Such review process shall focus on ICES.—Nothing in this section may be con- described in subsection (a)(2). low-cost cases described in subsection (e)(3) strued to affect the provision of or payment ‘‘(ii) TREATMENT OF EPISODES SPANNING and cases described in subsection (c)(2)(B) for home health services for which payment COST REPORTING PERIODS.—The Secretary and shall require recertification by is not made under this title.’’. shall provide for such rules as the Secretary intermediaries at 30, 60, 90, 120, and 165 days considers appropriate regarding the treat- into an episode described in subsection (b) PAYMENT FOR PROSTHETICS AND ment of episodes under this paragraph which (c)(1)(D). ORTHOTICS UNDER PART A.—Section 1814(k) begin during a cost reporting period and end ‘‘(e) ADJUSTMENT OF PAYMENTS TO AVOID (42 U.S.C. 1395f(k)) is amended— in a subsequent cost reporting period. CIRCUMVENTION OF LIMITS.— (1) by inserting ‘‘and prosthetics and ‘‘(E) EXEMPTIONS AND EXCEPTIONS.—The ‘‘(1) IN GENERAL.—The Secretary shall pro- orthotics’’ after ‘‘durable medical equip- Secretary may provide for exemptions and vide for appropriate adjustments to pay- ment’’; and exceptions to the limits established under ments to home health agencies under this (2) by inserting ‘‘and 1834(h), respectively’’ this paragraph for a fiscal year as the Sec- section to ensure that agencies do not cir- after ‘‘1834(a)(1)’’. retary deems appropriate, to the extent such cumvent the purpose of this section by— (c) CONFORMING AMENDMENTS.— October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10433

(1) PAYMENTS UNDER PART A.—Section (3) SUNSET OF REASONABLE COST LIMITA- SEC. 15704. REPORT ON RECOMMENDATIONS FOR 1814(b) (42 U.S.C. 1395f(b)), as amended by sec- TIONS.—Section 1861(v)(1)(L) (42 U.S.C. PAYMENTS AND CERTIFICATION tion 15522(b), is amended in the matter pre- 1395x(v)(1)(L)) is amended by adding at the FOR HOME HEALTH SERVICES OF CHRISTIAN SCIENCE PROVIDERS. ceding paragraph (1) by striking ‘‘1888 and end the following new clause: Not later than July 1, 1996, the Secretary 1888A’’ and inserting ‘‘1888, 1888A, and 1894’’. ‘‘(iv) This subparagraph shall apply only to of Health and Human Services shall submit (2) TREATMENT OF ITEMS AND SERVICES PAID services furnished by home health agencies recommendations to Congress regarding an UNDER PART B.— during cost reporting periods ending on or appropriate methodology for making pay- (A) PAYMENTS UNDER PART B.—Section before September 30, 1996.’’. ments under the medicare program for home 1833(a)(2) (42 U.S.C. 1395l(a)(2)) is amended— (d) LIMITATION ON PART A COVERAGE.— health services furnished by Christian (i) by amending subparagraph (A) to read (1) IN GENERAL.—Section 1812(a)(3) (42 Science providers who meet applicable re- as follows: U.S.C. 1395d(a)(3)) is amended by striking the quirements of the First Church of Christ, ‘‘(A) with respect to home health serv- semicolon and inserting ‘‘for up to 165 days Scientist, Boston, Massachusetts, and appro- ices— during any spell of illness;’’. priate criteria for the certification of such ‘‘(i) that are a type of home health service (2) CONFORMING AMENDMENT.—Section providers for purposes of the medicare pro- described in section 1894(a)(2), and which are 1812(b) (42 U.S.C. 1395d(b)) is amended— gram. furnished to an individual who (at the time (A) by striking ‘‘or’’ at the end of para- the item or service is furnished) is under a graph (2), SEC. 15705. EXTENSION OF PERIOD OF HOME (B) by striking the period at the end of HEALTH AGENCY CERTIFICATION. plan of care of a home health agency, the Section 1891(c)(2)(A) (42 U.S.C. paragraph (3) and inserting ‘‘; or’’, and amount determined under section 1894; or 1395bbb(c)(2)(A)) is amended— (C) by adding at the end the following new ‘‘(ii) that are not described in clause (i) (1) by striking ‘‘15 months’’ and inserting paragraph: (other than a covered osteoporosis drug) (as ‘‘36 months’’; and ‘‘(4) home health services furnished to the defined in section 1861(kk)), the lesser of— (2) by striking the second sentence and in- individual during such spell after such serv- ‘‘(I) the reasonable cost of such services, as serting the following: ‘‘The Secretary shall ices have been furnished to the individual for determined under section 1861(v), or establish a frequency for surveys of home 165 days during such spell.’’. ‘‘(II) the customary charges with respect health agencies within this 36-month inter- (3) EXCLUSION OF ADDITIONAL PART B COSTS to such services;’’. val commensurate with the need to assure FROM DETERMINATION OF PART B MONTHLY (ii) by striking ‘‘and’’ at the end of sub- the delivery of quality home health serv- PREMIUM.—Section 1839(a) (42 U.S.C. 1395r(a)) paragraph (E); ices.’’. (iii) by adding ‘‘and’’ at the end of subpara- is amended— graph (F); and (A) in the second sentence of paragraph (1), PART 2—MEDICARE SECONDARY PAYER (iv) by adding at the end the following new by striking ‘‘enrollees.’’ and inserting ‘‘en- IMPROVEMENTS subparagraph: rollees (except as provided in paragraph SEC. 15711. EXTENSION AND EXPANSION OF EX- ‘‘(G) with respect to items and services de- (5)).’’; and ISTING REQUIREMENTS. scribed in section 1861(s)(10)(A), the lesser (B) by adding at the end the following new (a) DATA MATCH.— of— paragraph: (1) Section 1862(b)(5)(C) (42 U.S.C. ‘‘(i) the reasonable cost of such services, as ‘‘(5) In estimating the benefits and admin- 1395y(b)(5)(C)) is amended by striking clause determined under section 1861(v), or istrative costs which will be payable from (iii). ‘‘(ii) the customary charges with respect to the Federal Supplementary Medical Insur- (2) Section 6103(l)(12) of the Internal Reve- such services, ance Trust Fund for a year (beginning with nue Code of 1986 is amended by striking sub- 1996), the Secretary shall exclude an esti- paragraph (F). or, if such services are furnished by a public mate of any benefits and costs attributable (b) APPLICATION TO DISABLED INDIVIDUALS provider of services, or by another provider to home health services for which payment IN LARGE GROUP HEALTH PLANS.— which demonstrates to the satisfaction of would have been made under part A during (1) IN GENERAL.—Section 1862(b)(1)(B) (42 the Secretary that a significant portion of the year but for paragraph (4) of section U.S.C. 1395y(b)(1)(B)) is amended— its patients are low-income (and requests 1812(b).’’. (A) in clause (i), by striking ‘‘clause (iv)’’ that payment be made under this provision), (4) EFFECTIVE DATE.—The amendments and inserting ‘‘clause (iii)’’, free of charge or at nominal charges to the made by this subsection shall apply to spells (B) by striking clause (iii), and public, the amount determined in accordance of illness beginning on or after October 1, (C) by redesignating clause (iv) as clause with section 1814(b)(2);’’. 1995. (iii). (B) REQUIRING PAYMENT FOR ALL ITEMS AND (e) EFFECTIVE DATE.—Except as provided in (2) CONFORMING AMENDMENTS.—Paragraphs SERVICES TO BE MADE TO AGENCY.— subsection (d)(4), the amendments made by (1) through (3) of section 1837(i) (42 U.S.C. (i) IN GENERAL.—The first sentence of sec- this section shall apply to cost reporting pe- 1395p(i)) and the second sentence of section tion 1842(b)(6) (42 U.S.C. 1395u(b)(6)), as riods beginning on or after October 1, 1996. 1839(b) (42 U.S.C. 1395r(b)) are each amended amended by section 15525(a)(1), is amended— by striking ‘‘1862(b)(1)(B)(iv)’’ each place it (I) by striking ‘‘and (E)’’ and inserting SEC. 15702. MAINTAINING SAVINGS RESULTING FROM TEMPORARY FREEZE ON PAY- appears and inserting ‘‘1862(b)(1)(B)(iii)’’. ‘‘(E)’’; and MENT INCREASES FOR HOME (c) EXPANSION OF PERIOD OF APPLICATION (II) by striking the period at the end and HEALTH SERVICES. TO INDIVIDUALS WITH END STAGE RENAL DIS- inserting the following: ‘‘, and (F) in the case (a) BASING UPDATES TO PER VISIT COST EASE.—Section 1862(b)(1)(C) (42 U.S.C. of types of home health services described in LIMITS ON LIMITS FOR FISCAL YEAR 1993.— 1395y(b)(1)(C)) is amended— section 1894(a)(2) furnished to an individual Section 1861(v)(1)(L)(iii) (42 U.S.C. (1) in the first sentence, by striking ‘‘12- who (at the time the item or service is fur- 1395x(v)(1)(L)(iii)) is amended by adding at month’’ each place it appears and inserting nished) is under a plan of care of a home the end the following sentence: ‘‘In estab- ‘‘24-month’’, and health agency, payment shall be made to the lishing limits under this subparagraph, the (2) by striking the second sentence. agency (without regard to whether or not the Secretary may not take into account any SEC. 15712. IMPROVEMENTS IN RECOVERY OF item or service was furnished by the agency, changes in the costs of the provision of serv- PAYMENTS. by others under arrangement with them ices furnished by home health agencies with (a) PERMITTING RECOVERY AGAINST THIRD made by the agency, or otherwise).’’. respect to cost reporting periods which PARTY ADMINISTRATORS OF PRIMARY PLANS.— (ii) CONFORMING AMENDMENT.—Section began on or after July 1, 1994, and before Section 1862(b)(2)(B)(ii) (42 U.S.C. 1832(a)(1) (42 U.S.C. 1395k(a)(1)), as amended July 1, 1996.’’. 1395y(b)(2)(B)(ii)) is amended— by section 15525(a)(3), is amended by striking (b) NO EXCEPTIONS PERMITTED BASED ON (1) by striking ‘‘under this subsection to ‘‘section 1842(b)(6)(E);’’ and inserting ‘‘sub- AMENDMENT.—The Secretary of Health and pay’’ and inserting ‘‘(directly, as a third- paragraphs (E) and (F) of section 1842(b)(6);’’. Human Services shall not consider the party administrator, or otherwise) to make (C) EXCLUSIONS FROM COVERAGE.—Section amendment made by subsection (a) in mak- payment’’, and 1862(a) (42 U.S.C. 1395y(a)), as amended by ing any exemptions and exceptions pursuant (2) by adding at the end the following: section 15525(a)(2) and section 15609B(a), is to section 1861(v)(1)(L)(ii) of the Social Secu- ‘‘The United States may not recover from a amended— rity Act. third-party administrator under this clause (i) by striking ‘‘or’’ at the end of paragraph SEC. 15703. EXTENSION OF WAIVER OF PRESUMP- in cases where the third-party administrator (16); TION OF LACK OF KNOWLEDGE OF would not be able to recover the amount at (ii) by striking the period at the end of EXCLUSION FROM COVERAGE FOR issue from the employer or group health plan paragraph (17) and inserting ‘‘; or’’; and HOME HEALTH AGENCIES. for whom it provides administrative services (iii) by adding at the end the following new Section 9305(g)(3) of OBRA–1986, as amend- due to the insolvency or bankruptcy of the paragraph: ed by section 426(d) of the Medicare Cata- employer or plan.’’. ‘‘(18) where such expenses are for home strophic Coverage Act of 1988 and section (b) EXTENSION OF CLAIMS FILING PERIOD.— health services furnished to an individual 4207(b)(3) of OBRA–1990 (as renumbered by Section 1862(b)(2)(B) (42 U.S.C. 1395y(b)(2)(B)) who is under a plan of care of the home section 160(d)(4) of the Social Security Act is amended by adding at the end the follow- health agency if the claim for payment for Amendments of 1994), is amended by striking ing new clause: such services is not submitted by the agen- ‘‘December 31, 1995’’ and inserting ‘‘Septem- ‘‘(v) CLAIMS-FILING PERIOD.—Notwithstand- cy.’’. ber 30, 1996’’. ing any other time limits that may exist for H 10434 CONGRESSIONAL RECORD — HOUSE October 19, 1995

filing a claim under an employer group ‘‘(1) IN GENERAL.—For purposes of this sec- In making the estimate under clause (ii), the health plan, the United States may seek to tion, items and services included under each Secretary shall take into account estimated recover conditional payments in accordance of the following subparagraphs shall be con- enrollment and demographic profile of indi- with this subparagraph where the request for sidered to be a separate ‘sector’ of medicare viduals electing MedicarePlus products. payment is submitted to the entity required services: ‘‘(B) MEDICARE BENEFIT BUDGET.—For pur- or responsible under this subsection to pay ‘‘(A) Inpatient hospital services. poses of this subsection, subject to subpara- with respect to the item or service (or any ‘‘(B) Home health services. graph (C), the ‘medicare benefit budget’— portion thereof) under a primary plan within ‘‘(C) Extended care services (for inpatients ‘‘(i) for fiscal year 1997 is $208.0 billion; the 3-year period beginning on the date on of skilled nursing facilities). ‘‘(ii) for fiscal year 1998 is $217.1 billion; ‘‘(D) Hospice care. which the item or service was furnished.’’. ‘‘(iii) for fiscal year 1999 is $228.4 billion; (c) EFFECTIVE DATE.—The amendments ‘‘(E) Physicians’ services (including serv- ‘‘(iv) for fiscal year 2000 is $246.4 billion; made by this section shall apply to items ices and supplies described in section ‘‘(v) for fiscal year 2001 is $265.5 billion; and services furnished on or after the date of 1861(s)(2)(A)) and services of other health ‘‘(vi) for fiscal year 2002 is $288.0 billion; the enactment of this Act. care professionals (including certified reg- and SEC. 15713. PROHIBITING RETROACTIVE APPLI- istered nurse anesthetists, nurse practition- CATION OF POLICY REGARDING ers, physician assistants, and clinical psy- ‘‘(vii) for a subsequent fiscal year is equal ESRD BENEFICIARIES ENROLLED IN chologists) for which separate payment is to the medicare benefit budget under this PRIMARY PLANS. made under this title. subparagraph for the preceding fiscal year For purposes of carrying out section ‘‘(F) Outpatient hospital services and am- increased by the product of (I) 1.05, and (II) 1862(b)(1)(C) of the Social Security Act, the bulatory facility services. 1 plus the annual percentage increase in the Secretary of Health and Human Services ‘‘(G) Durable medical equipment and sup- average number of medicare beneficiaries shall apply the policy directive issued by the plies, including prosthetic devices and from the previous fiscal year to the fiscal Administrator of the Health Care Financing orthotics. year involved. Administration on April 24, 1995, only with ‘‘(H) Diagnostic tests (including clinical ‘‘(3) MEDICARE ALLOTMENT PROPORTION DE- respect to items and services furnished on or laboratory services and x-ray services). FINED.— after such date. ‘‘(I) Other items and services. ‘‘(A) IN GENERAL.—For purposes of this sec- PART 3—FAILSAFE ‘‘(2) CLASSIFICATION OF ITEMS AND SERV- tion and with respect to a sector of medicare SEC. 15721. FAILSAFE BUDGET MECHANISM. ICES.—The Secretary shall classify each type services for a fiscal year, the term ‘medicare of items and services covered and paid for (a) IN GENERAL.—Title XVIII, as amended allotment proportion’ means the ratio of— by sections 15106(a) and 15701(a), is amended separately under this title into one of the ‘‘(i) the baseline-projected medicare ex- by adding at the end the following new sec- sectors specified in paragraph (1). After pub- penditures (as determined under subpara- tion: lication of such classification under sub- graph (B)) for the sector for the fiscal year, section (e)(1), the Secretary is not authorized ‘‘FAILSAFE BUDGET MECHANISM to to make substantive changes in such classi- ‘‘(ii) the sum of such baseline expenditures ‘‘SEC. 1895. (a) REQUIREMENT OF PAYMENT fication. for all such sectors for the fiscal year. ADJUSTMENTS TO ACHIEVE MEDICARE BUDGET ‘‘(c) ALLOTMENT.— ‘‘(B) BASELINE-PROJECTED MEDICARE EX- TARGETS.—If the Secretary determines under ‘‘(1) ALLOTMENTS FOR EACH SECTOR.—For PENDITURES.—In this paragraph, the ‘base- subsection (e)(3)(C) before a fiscal year (be- purposes of this section, subject to sub- line, projected medicare expenditures’ for a ginning with fiscal year 1998) that— section (h)(1), the allotment for a sector of ‘‘(1) the fee-for-service expenditures (as de- medicare services for a fiscal year is equal to sector of medicare services— fined in subsection (f)) for a sector of medi- the product of— ‘‘(i) for fiscal year 1996 is equal to fee-for- care services (as defined in subsection (b)) ‘‘(A) the total allotment for the fiscal year service expenditures for such sector during for the fiscal year, will exceed established under paragraph (2), and fiscal year 1995, increased by the baseline an- ‘‘(2) the allotment specified under sub- ‘‘(B) the allotment proportion (specified nual growth rate for such sector of medicare section (c)(2) for such fiscal year (taking into under paragraph (3)) for the sector and fiscal services for fiscal year 1996 (as specified in account any adjustment in the allotment year involved. table in subparagraph (C)); and under subsection (h) for that fiscal year), ‘‘(2) TOTAL ALLOTMENT.— ‘‘(ii) for a subsequent fiscal year is equal to then, notwithstanding any other provision of ‘‘(A) IN GENERAL.—For purposes of this sec- the baseline-projected medicare expenditures this title, there shall be an adjustment (con- tion, the total allotment for a fiscal year is under this subparagraph for the sector for sistent with subsection (d)) in applicable equal to— the previous fiscal year increased by the payment rates or payments for items and ‘‘(i) the medicare benefit budget for the fis- baseline annual growth rate for such sector services included in the sector in the fiscal cal year (as specified under subparagraph for the fiscal year involved (as specified in year so that such expenditures for the sector (B)), reduced by such table). for the year will be reduced by 1331⁄3 percent ‘‘(ii) the amount of payments the Sec- ‘‘(C) BASELINE ANNUAL GROWTH RATES.—The of the amount of such excess. retary estimates will be made in the fiscal following table specifies the baseline annual ‘‘(b) SECTORS OF MEDICARE SERVICES DE- year under the MedicarePlus program under growth rates for each of the sectors for dif- SCRIBED.— part C. ferent fiscal years:

Baseline annual growth rates for fiscal year— 2002 ‘‘For the following sector— and 1996 1997 1998 1999 2000 2001 there- after

(A) Inpatient hospital services ...... 5.7% 5.6% 6.0% 6.1% 5.7% 5.5% 5.2% (B) Home health services ...... 17.2% 15.1% 11.7% 9.1% 8.4% 8.1% 7.9% (C) Extended care services ...... 19.7% 12.3% 9.3% 8.7% 8.6% 8.4% 8.0% (D) Hospice care ...... 32.0% 24.0% 18.0% 15.0% 12.0% 10.0% 9.0% (E) Physicians’ services ...... 12.4% 9.7% 8.7% 9.0% 9.3% 9.6% 10.1% (F) Outpatient hospital services ...... 14.7% 13.9% 14.5% 15.0% 14.1% 13.9% 14.0% (G) Durable medical equipment and supplies ...... 16.1% 15.5% 13.7% 12.4% 13.2% 13.9% 14.5% (H) Diagnostic tests ...... 13.1% 11.3% 11.0% 11.4% 11.4% 11.5% 11.9% (I) Other items and services ...... 11.2% 10.2% 10.9% 12.0% 11.6% 11.6% 11.8%

‘‘(d) MANNER OF PAYMENT ADJUSTMENT.— approximate (and not exceed) the allotment fiscal year (payment for which may occur in ‘‘(1) IN GENERAL.—Subject to the succeed- for the sector for the fiscal year. a subsequent fiscal year), ing provisions of this subsection, the Sec- ‘‘(2) TAKING INTO ACCOUNT VOLUME AND CASH in a manner that is consistent with assuring retary shall apply a payment reduction for a FLOW.—In providing for an adjustment in that total fee-for-services expenditures for sector for a fiscal year in such a manner as payments under this subsection for a sector each sector for the fiscal year will not exceed to— for a fiscal year, the Secretary shall take the allotment under subsection (c)(1) for ‘‘(A) make a change in payment rates (to into account (in a manner consistent with such sector for such year. the maximum extent practicable) at the actuarial projections)— ‘‘(3) PROPORTIONALITY OF REDUCTIONS WITH- time payment rates are otherwise changed or ‘‘(A) the impact of such an adjustment on IN A SECTOR.—In making adjustments under subject to change for that fiscal year; and the volume or type of services provided in this subsection in payment for items and ‘‘(B) provide for the full appropriate ad- such sector (and other sectors), and services included within a sector of medicare justment so that the fee-for-service expendi- ‘‘(B) the fact that an adjustment may services for a fiscal year, the Secretary shall tures for the sector for the fiscal year will apply to items and services furnished in a provide for such an adjustment that results (to the maximum extent feasible) in the October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10435 same percentage reductions in aggregate ‘‘(iii) Payment rate reductions effected items and services in a cost reporting period, Federal payments under parts A and B for under this subparagraph for a calendar year the Secretary shall provide for the payment the different classes of items and services in- and applicable to the last 3 quarters of the adjustment under such subsection for a fiscal cluded within the sector for the fiscal year. fiscal year in which the calendar year ends year through an appropriate proportional re- ‘‘(4) APPLICATION TO PAYMENTS MADE BASED shall continue to apply during the first quar- duction in the payment for costs for such ON PROSPECTIVE PAYMENT RATES DETERMINED ter of the succeeding fiscal year. items and services incurred at any time dur- ON A FISCAL YEAR BASIS.— ‘‘(B) APPLICATION IN SPECIFIC CASES.—The ing each cost reporting period any part of ‘‘(A) IN GENERAL.—In applying subsection payment adjustment described in subpara- which occurs during the fiscal year involved, (a) with respect to items and services for graph (A) applies for a fiscal year to at least but only (for each such cost reporting period) which payment is made under part A or B on the following: in the same proportion as the fraction of the the basis of rates that are established on a ‘‘(i) UPDATE IN CONVERSION FACTOR FOR cost reporting period that occurs during the prospective basis for (and in advance of) a PHYSICIANS’ SERVICES.—To the computation fiscal year involved. of the conversion factor under subsection (d) fiscal year, the Secretary shall provide for ‘‘(B) APPLICATION IN SPECIFIC CASES.—The of section 1848 used in the fee schedule estab- the payment adjustment under such sub- payment adjustment described in subpara- lished under subsection (b) of such section, section through an appropriate reduction in graph (A) applies for a fiscal year to at least such rates established for items and services for items and services furnished during the calendar year in which the fiscal year ends. the following: furnished (or, in the case of payment for op- ‘‘(i) CAPITAL-RELATED COSTS OF HOSPITAL erating costs of inpatient hospital services of ‘‘(ii) PAYMENT RATES FOR OTHER HEALTH CARE PROFESSIONALS.—To the computation of SERVICES.—To the computation of payment subsection (d) hospitals and subsection (d) payments for professional services of cer- amounts for inpatient and outpatient hos- Puerto Rico hospitals (as defined in para- tified registered nurse anesthetists under pital services under sections 1886(g) and graphs (1)(B) and (9)(A) of section 1886(d)), section 1833(l), nurse midwives, physician as- 1861(v) for portions of cost reporting periods discharges occurring) during such year. sistants, nurse practitioners and clinical occurring during the fiscal year. ‘‘(B) DESCRIPTION OF APPLICATION TO SPE- nurse specialists under section 1833(r), clini- ‘‘(ii) OPERATING COSTS FOR PPS-EXEMPT HOS- CIFIC SERVICES.—The payment adjustment cal psychologists, clinical social workers, PITALS.—To the computation of payment described in subparagraph (A) applies for a physical or occupational therapists, and any amounts under section 1886(b) for operating fiscal year to at least the following: other health professionals for which pay- costs of inpatient hospital services of PPS- ‘‘(i) UPDATE FACTOR FOR PAYMENT FOR OP- ment rates are based (in whole or in part) on exempt hospitals for portions of cost report- ERATING COSTS OF INPATIENT HOSPITAL SERV- payments for physicians’ services, for serv- ing periods occurring during the fiscal year. ICES OF PPS HOSPITALS.—To the computation ices furnished during the calendar year in ‘‘(iii) DIRECT GRADUATE MEDICAL EDU- of the applicable percentage increase speci- which the fiscal year ends. CATION.—To the computation of payment fied in section 1886(d)(3)(B)(i) for discharges ‘‘(iii) UPDATE IN LAB FEE SCHEDULE.—To the amounts under section 1886(h) for reasonable occurring in the fiscal year. computation of the fee schedule amount costs of direct graduate medical education ‘‘(ii) HOME HEALTH SERVICES.—To the ex- under section 1833(h)(2) for clinical diag- costs for portions of cost reporting periods tent payment amounts for home health serv- nostic laboratory services furnished during ices are based on per visit payment rates occurring during the fiscal year. the calendar year in which the fiscal year ‘‘(iv) INPATIENT RURAL PRIMARY CARE HOS- under section 1894, to the computation of the ends. increase in the national per visit payment PITAL SERVICES.—To the computation of pay- ‘‘(iv) UPDATE IN REASONABLE CHARGES FOR ment amounts under section 1814(j) for inpa- rates established for the year under section VACCINES.—To the computation of the rea- 1894(b)(2)(B). tient rural primary care hospital services for sonable charge for vaccines described in sec- portions of cost reporting periods occurring ‘‘(iii) HOSPICE CARE.—To the update of pay- tion 1861(s)(10) for vaccines furnished during during the fiscal year. ment rates for hospice care under section the calendar year in which the fiscal year ‘‘(v) EXTENDED CARE SERVICES OF A SKILLED 1814(i) for services furnished during the fiscal ends. NURSING FACILITY.—To the computation of year. ‘‘(v) DURABLE MEDICAL EQUIPMENT-RELATED payment amounts under section 1861(v) for ‘‘(iv) UPDATE FACTOR FOR PAYMENT OF OP- ITEMS.—To the computation of the payment ERATING COSTS OF INPATIENT HOSPITAL SERV- basis under section 1834(a)(1)(B) for covered post-hospital extended care services of a ICES OF PPS-EXEMPT HOSPITALS.—To the com- items described in section 1834(a)(13), for skilled nursing facility (other than covered putation of the target amount under section items furnished during the calendar year in non-routine services subject to section 1886(b)(3) for discharges occurring during the which the fiscal year ends. 1888A) for portions of cost reporting periods fiscal year. ‘‘(vi) RADIOLOGIST SERVICES.—To the com- occurring during the fiscal year. ‘‘(v) COVERED NON-ROUTINE SERVICES OF putation of conversion factors for radiologist ‘‘(vi) REASONABLE COST CONTRACTS.—To the SKILLED NURSING FACILITIES.—To the com- services under section 1834(b), for services computation of payment amounts under sec- putation of the facility per stay limits for furnished during the calendar year in which tion 1833(a)(1)(A) for organizations for por- the year under section 1888A(d) for covered the fiscal year ends. tions of cost reporting periods occurring dur- non-routine services of a skilled nursing fa- ‘‘(vii) SCREENING MAMMOGRAPHY.—To the ing the fiscal year. cility (as described in such section). computation of payment rates for screening ‘‘(vii) HOME HEALTH SERVICES.—Subject to ‘‘(5) APPLICATION TO PAYMENTS MADE BASED mammography under section 1834(c)(1)(C)(ii), paragraph (4)(B)(ii), for payment amounts for ON PROSPECTIVE PAYMENT RATES DETERMINED for screening mammography performed dur- home health services, for portions of cost re- ON A CALENDAR YEAR BASIS.— ing the calendar year in which the fiscal porting periods occurring during such fiscal ‘‘(A) IN GENERAL.—In applying subsection year ends. year. (a) for a fiscal year with respect to items and ‘‘(viii) PROSTHETICS AND ORTHOTICS.—To ‘‘(7) OTHER.—In applying subsection (a) for services for which payment is made under the computation of the amount to be recog- a fiscal year with respect to items and serv- part A or B on the basis of rates that are es- nized under section 1834(h) for payment for ices for which payment is made under part A tablished on a prospective basis for (and in prosthetic devices and orthotics and pros- or B on a basis not described in a previous advance of) a calendar year, the Secretary thetics, for items furnished during the cal- paragraph of this subsection, the Secretary shall provide for the payment adjustment endar year in which the fiscal year ends. shall provide for the payment adjustment under such subsection through an appro- ‘‘(ix) SURGICAL DRESSINGS.—To the com- under such subsection through an appro- priate reduction in such rates established for putation of the payment amount referred to priate proportional reduction in the pay- items and services furnished at any time in section 1834(i)(1)(B) for surgical dressings, ments (or payment bases for items and serv- during such calendar year as follows: for items furnished during the calendar year ices furnished) during the fiscal year. ‘‘(i) For fiscal year 1997, the reduction shall in which the fiscal year ends. ‘‘(8) ADJUSTMENT OF PAYMENT LIMITS.—The be made for payment rates during calendar ‘‘(x) PARENTERAL AND ENTERAL NUTRI- Secretary shall provide for such proportional year 1997 in a manner so as to achieve the TION.—To the computation of reasonable adjustment in any limits on payment estab- necessary payment reductions for such fiscal charge screens for payment for parenteral lished under part A or B for payment for year for items and services furnished during and enteral nutrition under section 1834(h), items and services within a sector as may be the first 3 quarters of calendar year 1997. for nutrients furnished during the calendar appropriate based on (and in order to prop- ‘‘(ii) For a subsequent fiscal year, the re- year in which the fiscal year ends. erly carry out) the adjustment on the duction shall be made for payment rates dur- ‘‘(xi) AMBULANCE SERVICES.—To the com- amount of payment under this subsection in ing the calendar year in which the fiscal putation of limits on reasonable charges for the sector. year ends in a manner so as to achieve the ambulance services, for services furnished ‘‘(9) REFERENCES TO PAYMENT RATES.—Ex- necessary payment reductions for such fiscal during the calendar year in which the fiscal cept as the Secretary may provide, any ref- year for items and services furnished during year ends. erence in this title (other than this section) the first 3 quarters of the calendar year, but ‘‘(6) APPLICATION TO PAYMENTS MADE BASED to a payment rate is deemed a reference to also taking into account the payment reduc- ON COSTS DURING A COST REPORTING PERIOD.— such a rate as adjusted under this sub- tions made in the first quarter of the fiscal ‘‘(A) IN GENERAL.—In applying subsection year resulting from payment reductions (a) for a fiscal year with respect to items and section. made under this paragraph for the previous services for which payment is made under ‘‘(e) PUBLICATION OF DETERMINATIONS; JUDI- calendar year. part A or B on the basis of costs incurred for CIAL REVIEW.— H 10436 CONGRESSIONAL RECORD — HOUSE October 19, 1995

‘‘(1) ONE-TIME PUBLICATION OF SECTORS AND tive or judicial review under section 1878 or the same manner as such provisions apply to GENERAL PAYMENT ADJUSTMENT METHODOL- otherwise of— a joint resolution described in section 2908(a) OGY.—Not later than October 1, 1996, the Sec- ‘‘(A) the classification of items and serv- of such Act. retary shall publish in the Federal Register ices among the sectors of medicare services ‘‘(D) SPECIAL RULES.—For purposes of ap- the classification of medicare items and under subsection (b), plying subparagraph (C) with respect to such services into the sectors of medicare services ‘‘(B) the determination of the amounts of provisions— under subsection (b) and the general meth- allotments for the different sectors of medi- ‘‘(i) any reference to the Committee on odology to be used in applying payment ad- care services under subsection (c), Armed Services of the House of Representa- justments to the different classes of items ‘‘(C) the determination of the amount (or tives shall be deemed a reference to an ap- and services within the sectors. method of application) of any payment ad- propriate Committee of the House of Rep- ‘‘(2) INCLUSION OF INFORMATION IN PRESI- justment under subsection (d), or resentatives (specified by the Speaker of the DENT’S BUDGET.— ‘‘(D) any adjustment in an allotment ef- House of Representatives at the time of sub- ‘‘(A) IN GENERAL.—With respect to fiscal fected under subsection (h). mission of a legislative proposal under para- years beginning with fiscal year 1999, the ‘‘(f) FEE-FOR-SERVICE EXPENDITURES DE- graph (1)) and any reference to the Commit- President shall include in the budget submit- FINED.—In this section, the term ‘fee-for- tee on Armed Services of the Senate shall be ted under section 1105 of title 31, United service expenditures’, for items and services deemed a reference to the Committee on Fi- States Code, information on— within a sector of medicare services in a fis- nance of the Senate; ‘‘(i) the fee-for-service expenditures, within cal year, means amounts payable for such ‘‘(ii) any reference to a resolution of which each sector, for the second previous fiscal items and services which are furnished dur- a committee shall be discharged from fur- year, and how such expenditures compare to ing the fiscal year, and— ther consideration shall be deemed to be a the adjusted sector allotment for that sector ‘‘(1) includes types of expenses otherwise reference to the first such resolution intro- for that fiscal year; and reimbursable under parts A and B (including duced; and ‘‘(ii) actual annual growth rates for fee-for- administrative costs incurred by organiza- ‘‘(iii) any reference to the date on which service expenditures in the different sectors tions described in sections 1816 and 1842) with the President transmits a report shall be in the second previous fiscal year. respect to such items and services, and deemed a reference to the date on which the ‘‘(2) does not include amounts paid under ‘‘(B) RECOMMENDATIONS REGARDING GROWTH President submits the legislative proposal part C. FACTORS.—The President may include in under paragraph (1). ‘‘(g) EXPEDITED PROCESS FOR ADJUSTMENT such budget for a fiscal year (beginning with ‘‘(h) LOOK-BACK ADJUSTMENT IN ALLOT- OF SECTOR GROWTH RATES.— fiscal year 1998) recommendations regarding MENTS TO REFLECT ACTUAL EXPENDITURES.— ‘‘(1) OPTIONAL INCLUSION OF LEGISLATIVE percentages that should be applied (for one ‘‘(1) IN GENERAL.—If the Secretary deter- PROPOSAL.—The President may include in or more fiscal years beginning with that fis- recommendations under subsection (e)(2)(B) mines under subsection (e)(3)(B) with respect cal year) instead of the baseline annual submitted with respect to a fiscal year a spe- to a particular fiscal year (beginning with growth rates under subsection (c)(3)(C). Such cific legislative proposal that provides only fiscal year 1999) that the fee-for-service ex- recommendations shall take into account for the substitution of percentages specified penditures for a sector of medicare services medically appropriate practice patterns. in the proposal for one or more of the base- for the second preceding fiscal year— ‘‘(3) DETERMINATIONS CONCERNING PAYMENT line annual growth rates (specified in the ‘‘(A) exceeded the adjusted allotment for ADJUSTMENTS.— table in subsection (c)(3)(C) or in a previous such sector for such year (as defined in para- ‘‘(A) RECOMMENDATIONS OF COMMISSION.— legislative proposal under this subsection) graph (2)), then the allotment for the sector By not later than March 1 of each year (be- for that fiscal year or any subsequent fiscal for the particular fiscal year shall be reduced ginning with 1997), the Medicare Payment year. by 1331⁄3 percent of the amount of such ex- Review Commission shall submit to the Sec- ‘‘(2) CONGRESSIONAL CONSIDERATION.— cess, or retary and the Congress a report that ana- ‘‘(A) IN GENERAL.—The percentages con- ‘‘(B) was less than the adjusted allotment lyzes the previous operation (if any) of this tained in a legislative proposal submitted for such sector for such year, then the allot- section and that includes recommendations under paragraph (1) shall apply under this ment for the sector for the particular fiscal concerning the manner in which this section section if a joint resolution (described in year shall be increased by the amount of should be applied for the following fiscal subparagraph (B)) approving such proposal is such deficit. year. enacted, in accordance with the provisions of ‘‘(2) ADJUSTED ALLOTMENT.—The adjusted ‘‘(B) PRELIMINARY NOTICE BY SECRETARY.— subparagraph (C), before the end of the 60- allotment under this paragraph for a sector Not later than May 15 preceding the begin- day period beginning on the date on which for a fiscal year is— ning of each fiscal year (beginning with fis- such proposal was submitted. For purposes of ‘‘(A) the amount that would be computed cal year 1998), the Secretary shall publish in applying the preceding sentence and sub- as the allotment under subsection (c) for the the Federal Register a notice containing the paragraphs (B) and (C), the days on which ei- sector for the fiscal year if the actual Secretary’s preliminary determination, for ther House of Congress is not in session be- amount of payments made in the fiscal year each sector of medicare services, concerning cause of an adjournment of more than three under the MedicarePlus program under part the following: days to a day certain shall be excluded in the C in the fiscal year were substituted for the ‘‘(i) The projected allotment under sub- computation of a period. amount described in subsection (c)(2)(A)(ii) section (c) for such sector for the fiscal year. ‘‘(B) JOINT RESOLUTION OF APPROVAL.—A for that fiscal year, ‘‘(ii) Whether there will be a payment ad- joint resolution described in this subpara- ‘‘(B) adjusted to take into account the justment for items and services included in graph means only a joint resolution which is amount of any adjustment under paragraph such sector for the fiscal year under sub- introduced within the 10-day period begin- (1) for that fiscal year (based on expenditures section (a). ning on the date on which the President sub- in the second previous fiscal year). ‘‘(iii) If there will be such an adjustment, mits a proposal under paragraph (1) and— ‘‘(i) PROSPECTIVE APPLICATION OF CERTAIN the size of such adjustment and the meth- ‘‘(i) which does not have a preamble; NATIONAL COVERAGE DETERMINATIONS.—In odology to be used in making such a pay- ‘‘(ii) the matter after the resolving clause the case of a national coverage determina- ment adjustment for classes of items and of which is as follows: ‘That Congress ap- tion that the Secretary projects will result services included in such sector. proves the proposal of the President provid- in significant additional expenditures under ‘‘(iv) Beginning with fiscal year 1999, the ing for substitution of percentages for cer- this title (taking into account any substi- fee-for-service expenditures for such sector tain baseline annual growth rates under sec- tution for existing procedures or tech- for the second preceding fiscal year. tion 1895 of the Social Security Act, as sub- nologies), such determination shall not be- Such notice shall include an explanation of mitted by the President on lllllll.’, come effective before the beginning of the the basis for such determination. Determina- the blank space being filled in with the ap- fiscal year that begins after the date of such tions under this subparagraph and subpara- propriate date; and determination and shall apply to contracts graph (C) shall be based on the best data ‘‘(iii) the title of which is as follows: ‘Joint under part C entered into (or renewed) after available at the time of such determinations. resolution approving Presidential proposal the date of such determination.’’. ‘‘(C) FINAL DETERMINATION.—Not later than to substitute certain specified percentages (b) REPORT OF TRUSTEES ON GROWTH RATE September 1 preceding the beginning of each for baseline annual growth rates under sec- IN PART A EXPENDITURES.—Section 1817 (42 fiscal year (beginning with fiscal year 1998), tion 1895 of the Social Security Act, as sub- U.S.C. 1395i) is amended by adding at the end the Secretary shall publish in the Federal mitted by the President on lllllll.’, the following new subsection: Register a final determination, for each sec- the blank space being filled in with the ap- ‘‘(k) Each annual report provided in sub- tor of medicare services, concerning the propriate date. section (b)(2) shall include information re- matters described in subparagraph (B) and ‘‘(C) PROCEDURES FOR CONSIDERATION OF garding the annual rate of growth in pro- an explanation of the reasons for any dif- RESOLUTION OF APPROVAL.—Subject to sub- gram expenditures that would be required to ferences between such determination and the paragraph (D), the provisions of section 2908 maintain the financial solvency of the Trust preliminary determination for such fiscal (other than subsection (a)) of the Defense Fund and the extent to which the provisions year published under subparagraph (B). Base Closure and Realignment Act of 1990 of section 1895 restrain the rate of growth of ‘‘(4) LIMITATION ON ADMINISTRATIVE OR JUDI- shall apply to the consideration of a joint expenditures under this part in order to CIAL REVIEW.—There shall be no administra- resolution described in subparagraph (B) in achieve such solvency.’’. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10437 PART 4—ADMINISTRATIVE ment agencies and private organizations in tory requirements for written signatures SIMPLIFICATION accordance with paragraph (5). with respect to information transactions re- SEC. 15731. STANDARDS FOR MEDICARE INFOR- ‘‘(4) IMPLEMENTATION SPECIFICATIONS.—The quired by this section and written signatures MATION TRANSACTIONS AND DATA Secretary shall establish specifications for on enrollment and disenrollment forms. ELEMENTS. implementing each of the standards and the ‘‘(B) PAYMENTS FOR SERVICES AND PRE- Title XVIII, as amended by section 15031, is modifications to the standards adopted pur- MIUMS.—Nothing in this section shall be con- amended by inserting after section 1806 the suant to paragraph (1) or (3). strued to prohibit the payment of health following new section: ‘‘(5) ASSISTANCE TO THE SECRETARY.—In care services or health plan premiums by ‘‘STANDARDS FOR MEDICARE INFORMATION complying with the requirements of this sec- debit, credit, payment card or numbers, or TRANSACTIONS AND DATA ELEMENTS tion, the Secretary shall rely on rec- other electronic means. ‘‘SEC. 1807. (a) ADOPTION OF STANDARDS FOR ommendations of the Medicare Information ‘‘(5) TRANSFER OF INFORMATION BETWEEN DATA ELEMENTS.— Advisory Committee established under sub- HEALTH PLANS.—The Secretary shall develop ‘‘(1) IN GENERAL.—Pursuant to subsection section (g) and shall consult with appro- rules and procedures— (b), the Secretary shall adopt standards for priate Federal and State agencies and pri- ‘‘(A) for determining the financial liability information transactions and data elements vate organizations. The Secretary shall pub- of health plans when health care benefits are of medicare information and modifications lish in the Federal Register the rec- payable under two or more health plans; and to the standards under this section that ommendations of the Medicare Information ‘‘(B) for transferring among health plans are— Advisory Committee regarding the adoption appropriate standard data elements needed ‘‘(A) consistent with the objective of reduc- of a standard under this section. for the coordination of benefits, the sequen- ing the administrative costs of providing and ‘‘(b) STANDARDS FOR INFORMATION TRANS- tial processing of claims, and other data ele- paying for health care; and ACTIONS AND DATA ELEMENTS.— ments for individuals who have more than ‘‘(B) developed or modified by a standard ‘‘(1) IN GENERAL.—The Secretary shall one health plan. setting organization (as defined in sub- adopt standards for transactions and data ‘‘(6) COORDINATION OF BENEFITS.—If, at the section (h)(8)). elements to make medicare information uni- end of the 5-year period beginning on the formly available to be exchanged electroni- ‘‘(2) SPECIAL RULE RELATING TO DATA ELE- date of the enactment of this section, the cally, that is— MENTS.—The Secretary may adopt or modify Secretary determines that additional trans- a standard relating to data elements that is ‘‘(A) appropriate for the following financial action standards for coordinating benefits different from the standard developed by a and administrative transactions: claims (in- are necessary to reduce administrative costs standard setting organization, if— cluding coordination of benefits) or equiva- or duplicative (or inappropriate) payment of lent encounter information, enrollment and ‘‘(A) the different standard or modification claims, the Secretary shall establish further disenrollment, eligibility, premium pay- will substantially reduce administrative transaction standards for the coordination of ments, and referral certification and author- costs to health care providers and health benefits between health plans. ization; and plans compared to the alternative; and ‘‘(7) PROTECTION OF TRADE SECRETS.—Ex- ‘‘(B) related to other financial and admin- ‘‘(B) the standard or modification is pro- cept as otherwise required by law, the stand- istrative transactions determined appro- mulgated in accordance with the rulemaking ards adopted under this section shall not re- priate by the Secretary consistent with the quire disclosure of trade secrets or confiden- procedures of subchapter III of chapter 5 of goals of improving the operation of the tial commercial information by an entity op- title 5, United States Code. health care system and reducing administra- erating a medicare information network. ‘‘(3) SECURITY STANDARDS FOR HEALTH IN- tive costs. ‘‘(c) TIMETABLES FOR ADOPTION OF STAND- FORMATION NETWORK.— ‘‘(2) UNIQUE HEALTH IDENTIFIERS.— ARDS.— ‘‘(A) IN GENERAL.—Each person, who main- ‘‘(A) ADOPTION OF STANDARDS.—The Sec- ‘‘(1) INITIAL STANDARDS.—Not later than 18 tains or transmits medicare information or retary shall adopt standards providing for a months after the date of the enactment of data elements of medicare information and standard unique health identifier for each in- this section, the Secretary shall adopt stand- is subject to this section, shall maintain rea- dividual, employer, health plan, and health ards relating to the information trans- sonable and appropriate administrative, care provider for use in the medicare infor- actions, data elements of medicare informa- technical, and physical safeguards— mation system. In developing unique health tion and security described in subsections (a) ‘‘(i) to ensure the integrity and confiden- identifiers for each health plan and health and (b). tiality of the information; care provider, the Secretary shall take into ‘‘(2) ADDITIONS AND MODIFICATIONS TO ‘‘(ii) to protect against any reasonably an- account multiple uses for identifiers and STANDARDS.— ticipated— multiple locations and specialty classifica- ‘‘(A) IN GENERAL.—The Secretary shall re- ‘‘(I) threats or hazards to the security or tions for health care providers. view the standards adopted under this sec- integrity of the information; and ‘‘(B) PENALTY FOR IMPROPER DISCLOSURE.— tion and shall adopt additional or modified ‘‘(II) unauthorized uses or disclosures of A person who knowingly uses or causes to be standards, that have been developed or modi- the information; and used a unique health identifier under sub- fied by a standard setting organization, as ‘‘(iii) to otherwise ensure compliance with paragraph (A) for a purpose that is not au- determined appropriate, but not more fre- this section by the officers and employees of thorized by the Secretary shall— quently than once every 12 months. Any ad- such person. ‘‘(i) be fined not more than $50,000, impris- dition or modification to such standards ‘‘(B) SECURITY STANDARDS.—The Secretary oned not more than 1 year, or both; or shall be completed in a manner which mini- shall establish security standards and modi- ‘‘(ii) if the offense is committed under false mizes the disruption and cost of compliance. fications to such standards with respect to pretenses, be fined not more than $100,000, ‘‘(B) ADDITIONS AND MODIFICATIONS TO CODE medicare information network services, imprisoned not more than 5 years, or both. SETS.— health plans, and health care providers ‘‘(3) CODE SETS.— ‘‘(i) IN GENERAL.—The Secretary shall en- that— ‘‘(A) IN GENERAL.—The Secretary, in con- sure that procedures exist for the routine ‘‘(i) take into account— sultation with the Medicare Information Ad- maintenance, testing, enhancement, and ex- ‘‘(I) the technical capabilities of record visory Committee, experts from the private pansion of code sets. systems used to maintain medicare informa- sector, and Federal and State agencies, ‘‘(ii) ADDITIONAL RULES.—If a code set is tion; shall— modified under this paragraph, the modified ‘‘(II) the costs of security measures; ‘‘(i) select code sets for appropriate data code set shall include instructions on how ‘‘(III) the need for training persons who elements from among the code sets that have data elements of medicare information that have access to medicare information; and been developed by private and public enti- were encoded prior to the modification may ‘‘(IV) the value of audit trails in computer- ties; or be converted or translated so as to preserve ized record systems; and ‘‘(ii) establish code sets for such data ele- the informational value of the data elements ‘‘(ii) ensure that a medicare information ments if no code sets for the data elements that existed before the modification. Any network service, if it is part of a larger orga- have been developed. modification to a code set under this para- nization, has policies and security proce- ‘‘(B) DISTRIBUTION.—The Secretary shall graph shall be implemented in a manner that dures which isolate the activities of such establish efficient and low-cost procedures minimizes the disruption and cost of comply- service with respect to processing informa- for distribution (including electronic dis- ing with such modification. tion in a manner that prevents unauthorized tribution) of code sets and modifications ‘‘(d) REQUIREMENTS FOR HEALTH PLANS.— access to such information by such larger or- made to such code sets under subsection ‘‘(1) IN GENERAL.—If a person desires to ganization. (c)(2). conduct any of the information transactions The security standards established by the ‘‘(4) ELECTRONIC SIGNATURE.— described in subsection (b)(1) with a health Secretary shall be based on the standards de- ‘‘(A) IN GENERAL.—The Secretary, after plan as a standard transaction, the health veloped or modified by standard setting or- consultation with the Medicare Information plan shall conduct such standard transaction ganizations. If such standards do not exist, Advisory Committee, shall promulgate regu- in a timely manner and the information the Secretary shall rely on the recommenda- lations specifying procedures for the elec- transmitted or received in connection with tions of the Medicare Information Advisory tronic transmission and authentication of such transaction shall be in the form of Committee (established under subsection (g)) signatures, compliance with which will be standard data elements of medicare informa- and shall consult with appropriate govern- deemed to satisfy Federal and State statu- tion. H 10438 CONGRESSIONAL RECORD — HOUSE October 19, 1995

‘‘(2) SATISFACTION OF REQUIREMENTS.—A have known, that the failure to comply oc- except that the members first appointed health plan may satisfy the requirement im- curred. shall serve staggered terms such that the posed on such plan under paragraph (1) by di- ‘‘(ii) EXTENSION OF PERIOD.— terms of not more than 3 members expire at rectly transmitting standard data elements ‘‘(I) NO PENALTY.—The period referred to in one time. of medicare information or submitting non- clause (i)(II) may be extended as determined ‘‘(D) INITIAL MEETING.—Not later than 30 standard data elements to a medicare infor- appropriate by the Secretary based on the days after the date on which a majority of mation network service for processing into nature and extent of the failure to comply. the members have been appointed, the com- standard data elements and transmission. ‘‘(II) ASSISTANCE.—If the Secretary deter- mittee shall hold its first meeting. ‘‘(3) TIMETABLES FOR COMPLIANCE WITH RE- mines that a health plan failed to comply be- ‘‘(4) REPORTS.—Not later than 1 year after QUIREMENTS.—Not later than 24 months after cause such plan was unable to comply, the the date of the enactment of this section, the date on which standards are adopted Secretary may provide technical assistance and annually thereafter, the committee shall under subsections (a) and (b) with respect to to such plan during the period described in submit to Congress and the Secretary a re- any type of information transaction or data clause (i)(II). Such assistance shall be pro- port regarding— element of medicare information or with re- vided in any manner determined appropriate ‘‘(A) the extent to which entities using the spect to security, a health plan shall comply by the Secretary. medicare information network are meeting with the requirements of this section with ‘‘(C) REDUCTION.—In the case of a failure to the standards adopted under this section and respect to such transaction or data element. comply which is due to reasonable cause and working together to form an integrated net- ‘‘(4) COMPLIANCE WITH MODIFIED STAND- not to willful neglect, any penalty under work that meets the needs of its users; ARDS.—If the Secretary adopts a modified paragraph (1) that is not entirely waived ‘‘(B) the extent to which such entities are standard under subsection (a) or (b), a health under subparagraph (B) may be waived to the meeting the security standards established plan shall be required to comply with the extent that the payment of such penalty pursuant to this section and the types of modified standard at such time as the Sec- would be excessive relative to the compli- penalties assessed for noncompliance with retary determines appropriate taking into ance failure involved. such standards; account the time needed to comply due to ‘‘(f) EFFECT ON STATE LAW.— ‘‘(C) any problems that exist with respect the nature and extent of the modification. ‘‘(1) GENERAL EFFECT.— to implementation of the medicare informa- However, the time determined appropriate ‘‘(A) GENERAL RULE.—Except as provided in tion network; and under the preceding sentence shall be not subparagraph (B), a provision, requirement, ‘‘(D) the extent to which timetables under earlier than the last day of the 180-day pe- or standard under this section shall super- this section are being met. riod beginning on the date such modified sede any contrary provision of State law, in- standard is adopted. The Secretary may ex- cluding a provision of State law that re- Reports made under this subsection shall be tend the time for compliance for small quires medical or health plan records (in- made available to health care providers, health plans, if the Secretary determines cluding billing information) to be main- health plans, and other entities that use the such extension is appropriate. tained or transmitted in written rather than medicare information network to exchange ‘‘(e) GENERAL PENALTY FOR FAILURE TO electronic form. medicare information. COMPLY WITH REQUIREMENTS AND STAND- ‘‘(B) EXCEPTIONS.—A provision, require- ‘‘(h) DEFINITIONS.—For purposes of this sec- ARDS.— ment, or standard under this section shall tion: ‘‘(1) GENERAL PENALTY.— not supersede a contrary provision of State ‘‘(1) CODE SET.—The term ‘code set’ means ‘‘(A) IN GENERAL.—Except as provided in law if the Secretary determines that the pro- any set of codes used for encoding data ele- paragraph (2), the Secretary shall impose on vision of State law should be continued for ments, such as tables of terms, enrollment any person that violates a requirement or any reason, including for reasons relating to information, and encounter data. standard— prevention of fraud and abuse or regulation ‘‘(2) COORDINATION OF BENEFITS.—The term ‘‘(i) with respect to medicare information of controlled substances. ‘coordination of benefits’ means determining transactions, data elements of medicare in- ‘‘(2) PUBLIC HEALTH REPORTING.—Nothing in and coordinating the financial obligations of formation, or security imposed under sub- this section shall be construed to invalidate health plans when health care benefits are section (a) or (b); or or limit the authority, power, or procedures payable under such a plan and under this ‘‘(ii) with respect to health plans imposed established under any law providing for the title (including under a MedicarePlus prod- under subsection (d); reporting of disease or injury, child abuse, uct). a penalty of not more than $100 for each such birth, or death, public health surveillance, or ‘‘(3) MEDICARE INFORMATION.—The term violation of a specific standard or require- public health investigation or intervention. ‘medicare information’ means any informa- ment, but the total amount imposed for all ‘‘(g) MEDICARE INFORMATION ADVISORY COM- tion that relates to the enrollment of indi- such violations of a specific standard or re- MITTEE.— viduals under this title (including informa- quirement during the calendar year shall not ‘‘(1) ESTABLISHMENT.—There is established tion relating to elections of MedicarePlus exceed $25,000. a committee to be known as the Medicare In- products under section 1805) and the provi- ‘‘(B) PROCEDURES.—The provisions of sec- formation Advisory Committee (in this sub- sion of health benefits (including benefits tion 1128A (other than subsections (a) and (b) section referred to as the ‘committee’). provided under such products) under this and the second sentence of subsection (f)) ‘‘(2) DUTIES.—The committee shall— title. shall apply to the imposition of a civil ‘‘(A) advise the Secretary in the develop- ‘‘(4) MEDICARE INFORMATION NETWORK.—The money penalty under this paragraph in the ment of standards under this section; and term ‘medicare information network’ means same manner as such provisions apply to the ‘‘(B) be generally responsible for advising the medicare information system that is imposition of a penalty under such section the Secretary and the Congress on the status formed through the application of the re- 1128A. and the future of the medicare information quirements and standards established under ‘‘(C) DENIAL OF PAYMENT.—Except as pro- network. this section. vided in paragraph (2), the Secretary may ‘‘(3) MEMBERSHIP.— ‘‘(5) MEDICARE INFORMATION NETWORK SERV- deny payment under this title for an item or ‘‘(A) IN GENERAL.—The committee shall ICE.—The term ‘medicare information net- service furnished by a person if the person consist of 9 members of whom— work service’ means a public or private en- fails to comply with an applicable require- ‘‘(i) 3 shall be appointed by the President; tity that— ment or standard for medicare information ‘‘(ii) 3 shall be appointed by the Speaker of ‘‘(A) processes or facilitates the processing relating to that item or service. the House of Representatives after consulta- of nonstandard data elements of medicare in- ‘‘(2) LIMITATIONS.— tion with the minority leader of the House of formation into standard data elements; ‘‘(A) NONCOMPLIANCE NOT DISCOVERED.—A Representatives; and ‘‘(B) provides the means by which persons penalty may not be imposed under paragraph ‘‘(iii) 3 shall be appointed by the President may meet the requirements of this section; (1) if it is established to the satisfaction of pro tempore of the Senate after consultation or the Secretary that the person liable for the with the minority leader of the Senate. ‘‘(C) provides specific information process- penalty did not know, and by exercising rea- The appointments of the members shall be ing services. sonable diligence would not have known, made not later than 60 days after the date of ‘‘(6) HEALTH PLAN.—The term ‘health plan’ that such person failed to comply with the the enactment of this section. The President means a plan which provides, or pays the requirement or standard described in para- shall designate 1 member as the Chair. cost of, health benefits. Such term includes graph (1). ‘‘(B) EXPERTISE.—The membership of the the following, or any combination thereof: ‘‘(B) FAILURES DUE TO REASONABLE CAUSE.— committee shall consist of individuals who ‘‘(A) Part A or part B of this title, and in- ‘‘(i) IN GENERAL.—Except as provided in are of recognized standing and distinction in cludes a MedicarePlus product. clause (ii), a penalty may not be imposed the areas of information systems, informa- ‘‘(B) The medicaid program under title XIX under paragraph (1) if— tion networking and integration, consumer and the MediGrant program under title XXI. ‘‘(I) the failure to comply was due to rea- health, or health care financial manage- ‘‘(C) A medicare supplemental policy (as sonable cause and not to willful neglect; and ment, and who possess the demonstrated ca- defined in section 1882(g)(1)). ‘‘(II) the failure to comply is corrected dur- pacity to discharge the duties imposed on ‘‘(D) Worker’s compensation or similar in- ing the 30-day period beginning on the first the committee. surance. date the person liable for the penalty knew, ‘‘(C) TERMS.—Each member of the commit- ‘‘(E) Automobile or automobile medical- or by exercising reasonable diligence would tee shall be appointed for a term of 5 years, payment insurance. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10439 ‘‘(F) A long-term care policy, other than a (3) by inserting after paragraph (18) the fol- ties (if any) with whom the facility has made fixed indemnity policy. lowing new paragraph: such arrangements.’’. ‘‘(G) The Federal Employees Health Bene- ‘‘(19) where such expenses are for items or (b) EFFECTIVE DATE.—The amendment fit Plan under chapter 89 of title 5, United services, or to assist in the purchase, in made by subsection (a) shall apply to items States Code. whole or in part, of health benefit coverage and services furnished on or after January 1, ‘‘(H) An employee welfare benefit plan, as that includes items or services, for the pur- 1996. defined in section 3(1) of the Employee Re- pose of causing, or assisting in causing, the Subtitle I—Clinical Laboratories tirement Income Security Act of 1974 (29 death, suicide, euthanasia, or mercy killing U.S.C. 1002(1)), but only to the extent the of a person.’’. SEC. 15801. EXEMPTION OF PHYSICIAN OFFICE plan is established or maintained for the pur- (b) EFFECTIVE DATE.—The amendments LABORATORIES. pose of providing health benefits. made by subsection (a) shall apply to pay- Section 353(d) of the Public Health Service ‘‘(7) INDIVIDUALLY IDENTIFIABLE MEDICARE ment for items and services furnished on or Act (42 U.S.C. 263a(d)) is amended— INFORMATION.—The term ‘individually identi- after the date of the enactment of this Act. (1) by redesignating paragraphs (2), (3), and fiable medicare information’ means medi- SEC. 15743. COMPETITIVE BIDDING FOR CERTAIN (4) as paragraphs (3), (4), and (5) and by add- care enrollment information, including de- ITEMS AND SERVICES. ing after paragraph (1) the following: mographic information collected from an in- (a) ESTABLISHMENT OF DEMONSTRATION.— ‘‘(2) EXEMPTION OF PHYSICIAN OFFICE LAB- dividual, that— Not later than 1 year after the date of the ORATORIES.— ‘‘(A) is created or received by a health care enactment of this Act, the Secretary of ‘‘(A) IN GENERAL.—Except as provided in provider, health plan, employer, or medicare Health and Human Services shall establish subparagraph (B), a clinical laboratory in a information network service, and and operate over a 2-year period a dem- physician’s office (including an office of a ‘‘(B) identifies an individual. onstration project in 2 geographic regions se- group of physicians) which is directed by a ‘‘(8) STANDARD SETTING ORGANIZATION.—The lected by the Secretary under which (not- physician and in which examinations and term ‘standard setting organization’ means a withstanding any provision of title XVIII of procedures are either performed by a physi- standard setting organization accredited by the Social Security Act to the contrary) the cian or by individuals supervised by a physi- the American National Standards Institute. amount of payment made under the medi- cian solely as an adjunct to other services ‘‘(9) STANDARD TRANSACTION.—The term care program for a selected item or service provided by the physician’s office is exempt ‘standard transaction’ means, when referring (other than clinical diagnostic laboratory from this section. to an information transaction or to data ele- tests) furnished in the region shall be equal ‘‘(B) EXCEPTION.—A clinical laboratory de- ments of medicare information, any trans- to the price determined pursuant to a com- scribed in subparagraph (A) is not exempt action that meets the requirements and im- petitive bidding process which meets the re- from this section when it performs a pap plementation specifications adopted by the quirements of subsection (b). smear (Papanicolaou Smear) analysis. Secretary under subsections (a) and (b).’’. (b) REQUIREMENTS FOR COMPETITIVE BID- ‘‘(C) DEFINITION.—For purposes of subpara- PART 5—OTHER PROVISIONS RELATING DING PROCESS.—The competitive bidding graph (A), the term ‘physician’ has the same TO PARTS A AND B process used under the demonstration meaning as is prescribed for such term by SEC. 15741. CLARIFICATION OF MEDICARE COV- project under this section shall meet such re- section 1861(r) of the Social Security Act (42 ERAGE OF ITEMS AND SERVICES AS- quirements as the Secretary may impose to U.S.C. 1395x(r)).’’; SOCIATED WITH CERTAIN MEDICAL ensure the cost-effective delivery to medi- (2) in paragraph (3) (as so redesignated) by DEVICES APPROVED FOR INVES- care beneficiaries in the project region of striking ‘‘(3)’’ and inserting ‘‘(4)’’; and TIGATIONAL USE. items and services of high quality. (3) in paragraphs (4) and (5) (as so redesig- (a) COVERAGE.—Nothing in title XVIII of (c) DETERMINATION OF SELECTED ITEMS OR nated) by striking ‘‘(2)’’ and inserting ‘‘(3)’’. the Social Security Act may be construed to SERVICES.—The Secretary shall select items Subtitle J—Lock-Box Provisions for Medicare prohibit coverage under part A or part B of and services to be subject to the demonstra- Part B Savings from Growth Reductions the medicare program of items and services tion project under this section if the Sec- associated with the use of a medical device retary determines that the use of competi- SEC. 15901. ESTABLISHMENT OF MEDICARE in the furnishing of inpatient hospital serv- tive bidding with respect to the item or serv- GROWTH REDUCTION TRUST FUND ices (as defined for purposes of part A of the ice under the project will be appropriate and FOR PART B SAVINGS. medicare program) solely on the grounds cost-effective. In determining the items or Part B of title XVIII is amended by insert- that the device is not an approved device, services to be selected, the Secretary shall ing after section 1841 the following new sec- if— consult with an advisory taskforce which in- tion: (1) the device is an investigational device; cludes representatives of providers and sup- ‘‘MEDICARE GROWTH REDUCTION TRUST FUND and pliers of items and services (including small ‘‘SEC. 1841A. (a)(1) There is hereby created (2) the device is used instead of an ap- business providers and suppliers) in each geo- on the books of the Treasury of the United proved device. graphic region in which the project will be States a trust fund to be known as the ‘Fed- (b) CLARIFICATION OF PAYMENT AMOUNT.— effective. Notwithstanding any other provision of title eral Medicare Growth Reduction Trust Fund’ SEC. 15744. DISCLOSURE OF CRIMINAL CONVIC- (in this section referred to as the ‘Trust XVIII of the Social Security Act, the amount TIONS RELATING TO PROVISION OF of payment made under the medicare pro- Fund’). The Trust Fund shall consist of such HOME HEALTH SERVICES. gifts and bequests as may be made as pro- gram for any item or service associated with (a) IN GENERAL.—Section 1891 (42 U.S.C. vided in section 201(i)(1) and amounts appro- the use of an investigational device in the 1395bbb) is amended by adding at the end the priated under paragraph (2). furnishing of inpatient hospital services (as following new subsection: defined for purposes of part A of the medi- ‘‘(g) The Secretary, and each State or local ‘‘(2) There are hereby appropriated to the care program) may not exceed the amount of survey agency or other State agency respon- Trust Fund, out of any amounts in the the payment which would have been made sible for monitoring compliance of home Treasury not otherwise appropriated, under the program for the item or service if health agencies with requirements, shall amounts equivalent to 100 percent of the the item or service were associated with the make available, upon request of any person, Secretary’s estimate of the reductions in use of an approved device. information the Secretary or agency has on outlays under this part that are attributable (c) DEFINITIONS.—In this section— individuals who have been convicted of felo- to the Medicare Preservation Act of 1995. (1) the term ‘‘approved device’’ means a nies relating to the provision of home health The amounts appropriated by the preceding medical device which has been approved for services.’’. sentence shall be transferred from time to marketing under pre-market approval under (b) EFFECTIVE DATE.—The amendment time (not less frequently than monthly) from the Federal Food, Drug, and Cosmetic Act or made by subsection (a) shall take effect on the general fund in the Treasury to the Trust cleared for marketing under a 510(k) notice the date of the enactment of this Act. Fund. under such Act; and SEC. 15745. REQUIRING RENAL DIALYSIS FACILI- ‘‘(3)(A) Subject to subparagraph (B), with (2) the term ‘‘investigational device’’ TIES TO MAKE SERVICES AVAILABLE respect to monies transferred to the Trust means a medical device (other than a device ON A 24-HOUR BASIS. Fund, no transfers, authorizations of appro- described in paragraph (1)) which is approved (a) IN GENERAL.—Section 1881(b)(1) (42 priations, or appropriations are permitted. for investigational use under section 520(g) of U.S.C. 1395rr(b)(1)) is amended by striking ‘‘(B) Beginning with fiscal year 2003, the the Federal Food, Drug, and Cosmetic Act. the period at the end and inserting the fol- Secretary may expend funds in the Trust SEC. 15742. ADDITIONAL EXCLUSION FROM COV- lowing: ‘‘, together with a requirement (in Fund to carry out this title, but only to the ERAGE. the case of a renal dialysis facility) that the extent provided by Congress in advance (a) IN GENERAL.—Section 1862(a) (42 U.S.C. facility make institutional dialysis services through a specific amendment to this sec- 1395y(a)), as amended by section 15525(a)(2), and supplies available on a 24-hour basis (ei- tion. section 15609B(a), and section 15701(c)(2)(C), ther directly or through arrangements with ‘‘(b) The provisions of subsections (b) is amended— providers of services or other renal dialysis through (e) of section 1841 shall apply to the (1) by striking ‘‘or’’ at the end of paragraph facilities that meet the requirements of such Trust Fund in the same manner as they (17), subparagraph) and that the facility provide apply to the Federal Supplementary Medical (2) by striking the period at the end of notice informing its patients of the other Insurance Trust Fund, except that the Board paragraph (18) and inserting ‘‘; or’’, and providers of services or renal dialysis facili- of Trustees and Managing Trustee of the H 10440 CONGRESSIONAL RECORD — HOUSE October 19, 1995

Trust Fund shall be composed of the mem- Sec. 15005. Prospective payment for skilled PART 3—DIRECT SPENDING FOR ANTI-FRAUD bers of the Board of Trustees and the Manag- nursing facilities. ACTIVITIES UNDER MEDICARE ing Trustee, respectively, of the Federal Sup- Sec. 15006. Maintaining savings resulting Sec. 15321. Direct spending for anti-fraud ac- plementary Medical Insurance Trust Fund.’’. from temporary freeze on pay- tivities under medicare. The CHAIRMAN. No further amend- ment increases for skilled nurs- ing facilities. PART 4—PREEMPTION OF STATE CORPORATE ment is in order except the amendment PRACTICE LAWS UNDER MEDICARE in the nature of a substitute numbered Subtitle B—Provisions Relating to Medicare Sec. 15331. Preemption of State laws prohib- 2 printed in the designated place in the Part B Sec. 15101. Payment for physicians’ services. iting corporate practice of med- CONGRESSIONAL RECORD, which may be Sec. 15102. Freeze in updates to payment icine for purposes of medicare. offered only by the gentleman from amounts for certain items and PART 5—MEDICARE ANTI-FRAUD AND ABUSE Missouri [Mr. GEPHARDT] or his des- services. COMMISSION ignee, is considered read, is debatable Sec. 15103. Reduction in effective beneficiary Sec. 15341. Establishment of Medicare Anti- for 1 hour, equally divided and con- coinsurance rate for certain Fraud and Abuse Commission. trolled by the proponent and an oppo- hospital outpatient services. Sec. 15104. Expanding coverage of preventive Sec. 15342. Functions of Commission. nent of the amendment and is not sub- Sec. 15343. Organization and compensation. ject to amendment. benefits. Sec. 15105. Reduction in payment for cap- Sec. 15344. Staff of Commission. Does the gentleman from Missouri ital-related costs of hospital Sec. 15345. Authority of Commission. [Mr. GEPHARDT] choose to control the outpatient services. Sec. 15346. Termination. time, or is he designating a Member to Sec. 15106. Part B premium. Sec. 15347. Authorization of appropriations. do so on his behalf? Sec. 15107. Ensuring payment for physician Subtitle A—Provisions Relating to Medicare and nurse for jointly furnished Mr. GIBBONS. Mr. Chairman, I have Part A been designated, along with the gen- anesthesia services. SEC. 15001. REDUCTIONS IN INFLATION UPDATES INGELL Subtitle C—Provisions Relating to Parts A tleman from Michigan [Mr. D ]. FOR INPATIENT HOSPITAL SERV- The CHAIRMAN. Who seeks time in and B ICES. PART 1—MEDICARE SECONDARY PAYOR opposition? (a) PPS HOSPITALS.—Section 1886(b) Mr. ARCHER. Mr. Chairman, I seek Sec. 15201. Extension of existing secondary (3)(B)(i) (42 U.S.C. 1395ww(b)(3)(B)(i)) is time in opposition. payer requirements. amended by striking subclauses (XI), (XII), Mr. BLILEY. Mr. Chairman, I seek Sec. 15202. Clarification of time and filing and (XIII) and inserting the following: time in opposition as well. limitations. ‘‘(XI) for each of the fiscal years 1996 Sec. 15203. Clarification of liability of third AMENDMENT IN THE NATURE OF A SUBSTITUTE through 2002, the market basket percentage party–administrators. increase minus 0.5 percentage point for hos- OFFERED BY MR. GIBBONS Sec. 15204. Clarification of payment Mr. GIBBONS. Mr. Chairman, I offer pitals located in a rural area and the market amounts to medicare. basket percentage increase minus 1.0 per- an amendment in the nature of a sub- Sec. 15205. Conditions for double damages. centage point for all other hospitals, and stitute. PART 2—OTHER PROVISIONS RELATING TO ‘‘(XII) for fiscal year 2003 and each subse- The CHAIRMAN. The Clerk will des- PARTS A AND B quent fiscal year, the market basket per- ignate the amendment in the nature of Sec. 15221. Making additional choices of centage increase for hospitals in all areas.’’. a substitute. health plans available to bene- (b) PPS-EXEMPT HOSPITALS.—Section The text of the amendment in the na- ficiaries. 1886(b)(3)(B)(ii) (42 U.S.C. 1395ww(b)(3)(B)(ii)) ture of a substitute is as follows: Sec. 15222. Teaching hospital and graduate is amended— Amendment in the nature of a substitute medical education trust fund. (1) in subclause (V)— Sec. 15223. Revisions in determination of offered by Mr. GIBBONS: (A) by striking ‘‘thorugh 1997’’ and insert- Strike all after the enacting clause and in- amount of payment for medical ing ‘‘through 1995’’, and sert the following: education. (B) by striking ‘‘and’’ at the end; Sec. 15224. Payments for home health serv- TITLE XV—MEDICARE (2) by redesignating subclause (VI) as ices. subclause (VII); and SEC. 15000. SHORT TITLE OF TITLE; AMEND- Sec. 15225. Requiring health maintenance or- (3) by inserting after subclause (V) the fol- MENTS AND REFERENCES TO OBRA; ganizations to cover appro- lowing new subclause: TABLE OF CONTENTS OF TITLE. priate range of services. (a) SHORT TITLE.—This title may be cited ‘‘(VI) fiscal years 1996 through 2002, is the Sec. 15226. Clarification of medicare cov- market basket percentage increase minus 0.5 as the ‘‘Medicare Enhancement Act of 1995’’. erage of items and services as- (b) AMENDMENTS TO SOCIAL SECURITY percentage point for hospitals located in a sociated with certain medical rural area and the market basket percentage ACT.—Except as otherwise specifically pro- devices approved for investiga- vided, whenever in this title an amendment increase minus 1.0 percentage point for all tional use. other hospitals, and’’. is expressed in terms of an amendment to or Sec. 15227. Commission on the Future of repeal of a section or other provision, the Medicare and the Protection of SEC. 15002. CONTINUATION OF CURRENT REDUC- reference shall be considered to be made to TION IN PAYMENTS FOR CAPITAL- the Health of the Nation’s Sen- RELATED COSTS FOR INPATIENT that section or other provision of the Social ior Citizens. Security Act. HOSPITAL SERVICES. (c) REFERENCES TO OBRA.—In this title, Subtitle D—Preventing Fraud and Abuse (a) REDUCTION IN PAYMENTS FOR PPS HOS- the terms ‘‘OBRA–1986’’, ‘‘OBRA–1987’’, PART 1—AMENDMENTS TO ANTI-FRAUD AND PITALS.—Section 1886(g)(1)(A) (42 U.S.C. ‘‘OBRA–1989’’, ‘‘OBRA–1990’’, and ‘‘OBRA– ABUSE PROVISIONS APPLICABLE TO MEDI- 1395ww(g)(1)(A)) is amended in the second 1993’’ refer to the Omnibus Budget Reconcili- CARE, MEDICAID, AND STATE HEALTH CARE sentence by striking ‘‘through 1995’’ and in- ation Act of 1986 (Public Law 99–509), the PROGRAMS serting ‘‘through 2002’’. Omnibus Budget Reconciliation Act of 1987 Sec. 15301. Anti-kickback statutory provi- (b) REDUCTION IN PAYMENTS FOR PPS-EX- (Public Law 100–203), the Omnibus Budget sions. EMPT HOSPITALS.—Section 1886(g) (42 U.S.C. Reconciliation Act of 1989 (Public Law 101– Sec. 15302. Civil money penalties. 1395ww(g)) is amended by adding at the end 239), the Omnibus Budget Reconciliation Act Sec. 15303. Private right of action. the following new paragraph: of 1990 (Public Law 101–508), and the Omnibus Sec. 15304. Amendments to exclusionary pro- ‘‘(4)(A) Except as provided in subparagraph Budget Reconciliation Act of 1993 (Public visions in fraud and abuse pro- (B), in determining the amount of the pay- Law 103–66), respectively. gram. ments that may be made under this title (d) TABLE OF CONTENTS OF TITLE.—The Sec. 15305. Sanctions against practitioners with respect to all the capital-related costs table of contents of this title is as follows: and persons for failure to com- of inpatient hospital services furnished dur- Subtitle A—Provisions Relating to Medicare ply with statutory obligations ing fiscal years 1996 through 2002 of a hos- Part A relating to quality of care. pital which is not a subsection (d) hospital or Sec. 15306. Revisions to criminal penalties. Sec. 15001. Reductions in inflation updates a subsection (d) Puerto Rico hospital, the Sec. 15307. Definitions. for inpatient hospital services. Secretary shall reduce the amounts of such Sec. 15308. Effective date. Sec. 15002. Continuation of current reduc- payments otherwise determined under this tion in payments for capital-re- PART 2—INTERPRETIVE RULINGS ON title by 10 percent. lated costs for inpatient hos- KICKBACKS AND SELF-REFERRAL ‘‘(B) Subparagraph (A) shall not apply to pital services. Sec. 15311. Establishment of process for issu- payments with respect to the capital-related Sec. 15003. Elimination of certain additional ance of interpretive rulings. costs of any hospital that is a sole commu- payments for outlier cases. Sec. 15312. Effect of issuance of interpretive nity hospital (as defined in subsection Sec. 15004. Clarification of treatment of ruling. (d)(5)(D)(iii) or a rural primary care hospital transfers. Sec. 15313. Imposition of fees. (as defined in section 1861(mm)(1)).’’. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10441 SEC. 15003. ELIMINATION OF CERTAIN ADDI- service costs, ancillary costs, and capital-re- minus 1 and multiplied by 100. TIONAL PAYMENTS FOR OUTLIER lated costs) in accordance with a prospective ‘‘(B) SUBSEQUENT FISCAL YEARS.—The cu- CASES. payment system established by the Sec- mulative expenditure target for all physi- (a) INDIRECT MEDICAL EDUCATION.—Section retary. The Secretary shall adjust the pay- cians’ services and for each category of phy- 1886(d)(5)(B)(i)(I) (42 U.S.C. ment amounts under this subsection in a sicians’ services for fiscal year 1997 and each 1395ww(d)(5)(B)(i)(I)) is amended— manner to assure that the aggregate pay- subsequent fiscal year shall be equal to the (1) by striking ‘‘the sum of’’; and ments made under this subsection in a fiscal cumulative expenditure target determined (2) by striking ‘‘and the amount paid to the year result in a 5 percent reduction (as esti- under this paragraph for the previous fiscal hospital under subparagraph (A)’’. mated by the Secretary) in the amount of year, increased by the product of— (b) DISPROPORTIONATE SHARE ADJUST- payments that would otherwise have been ‘‘(i) 1 plus the Secretary’s estimate of the MENTS.—Section 1886(d)(5)(F)(ii)(I) (42 U.S.C. made for such fiscal year. percentage change in the medicare economic 1395ww(d)(5)(F)(ii)(I)) is amended— ‘‘(i) The Secretary may provide for such index for the fiscal year involved (described (1) by striking ‘‘the sum of’’; and exceptions as the Secretary determines ap- in the fourth sentence of section 1842(b)(3)) (2) by striking ‘‘and the amount paid to the propriate to the amount of payment based on (divided by 100), hospital under subparagraph (A) for that dis- application of subsections (e) though (h).’’ ‘‘(ii) 1 plus the Secretary’s estimate of the charge’’. SEC. 15006. MAINTAINING SAVINGS RESULTING percentage change (divided by 100) in the av- (c) EFFECTIVE DATE.—The amendments FROM TEMPORARY FREEZE ON PAY- erage number of individuals enrolled under made by this section shall apply to dis- MENT INCREASES FOR SKILLED this part (other than private plan enrollees) charges occurring on or after October 1, 1995. NURSING FACILITIES. from the previous fiscal year to the fiscal SEC. 15004. CLARIFICATION OF TREATMENT OF (a) BASING UPDATES TO PER DIEM COST LIM- year involved, TRANSFERS. ITS ON LIMITS FOR FISCAL YEAR 1993.— ‘‘(iii) 1 plus the Secretary’s estimate of the (a) IN GENERAL.—Section 1886(d)(5)(I) (42 (1) IN GENERAL.—The last sentence of sec- projected percentage growth in real gross do- U.S.C. 1395ww(d)(5)(I)) is amended by adding tion 1888(a) (42 U.S.C. 1395yy(a)) is amended mestic product per capita (divided by 100) at the end the following new clause: by adding at the end the following: ‘‘(except from the previous fiscal year to the fiscal ‘‘(iii) In making adjustments under clause that such updates may not take into account year involved, plus 2 percentage points, and (i) for transfer cases, the Secretary shall any changes in the routine service costs of ‘‘(iv) 1 plus the Secretary’s estimate of the treat as a transfer any transfer to a hospital skilled nursing facilities occurring during percentage change (divided by 100) in expend- (without regard to whether or not the hos- cost reporting periods which began during itures for all physicians’ services or of the pital is a subsection (d) hospital), a unit fiscal year 1994 or fiscal year 1995).’’. category of physicians’ services in the fiscal thereof, or a skilled nursing facility.’’. (2) NO EXCEPTIONS PERMITTED BASED ON year (compared with the previous fiscal (b) EFFECTIVE DATE.—The amendment AMENDMENT.—The Secretary of Health and year) which will result from changes in law, made by subsection (a) shall apply to dis- Human Services shall not consider the determined without taking into account es- charges occurring on or after October 1, 1995. amendment made by paragraph (1) in mak- timated changes in expenditures due to SEC. 15005. PROSPECTIVE PAYMENT FOR ing any adjustments pursuant to section changes in the volume and intensity of phy- SKILLED NURSING FACILITIES. 1888(c) of the Social Security Act. sicians’ services or changes in expenditures Section 1888 (42 U.S.C. 1395yy) is amended (b) PAYMENTS DETERMINED ON PROSPECTIVE resulting from changes in the update to the by adding at the end the following: BASIS.—Any change made by the Secretary conversion factor under subsection (d)(3), ‘‘(e) Notwithstanding any other provision of Health and Human Services in the amount minus 1 and multiplied by 100.’’. of this title, the Secretary shall, for cost re- of any prospective payment paid to a skilled ‘‘(2) EXCLUSION OF SERVICES FURNISHED TO porting periods beginning on or after October nursing facility under section 1888(d) of the PRIVATE PLAN ENROLLEES.—In this sub- 1, 1996, provide for payment for routine costs Social Security Act for cost reporting peri- section, the term ‘physicians’ services’ with of extended care services in accordance with ods beginning on or after October 1, 1995, respect to a fiscal year does not include serv- a prospective payment system established by may not take into account any changes in ices furnished to an individual enrolled the Secretary, subject to the limitations in the costs of services occurring during cost under this part who has elected to receive subsections (f) through (h). reporting periods which began during fiscal benefits under this title for the fiscal year ‘‘(f)(1) The amount of payment under sub- year 1994 or fiscal year 1995. through enrollment with an eligible organi- section (e) shall be determined on a per diem zation with a risk-sharing contract under basis. Subtitle B—Provisions Relating to Medicare Part B section 1876.’’. ‘‘(2) The Secretary shall compute the rou- (b) ESTABLISHING UPDATE TO CONVERSION tine costs per diem in a base year (deter- SEC. 15101. PAYMENT FOR PHYSICIANS’ SERV- FACTOR TO MATCH SPENDING UNDER CUMU- mined by the Secretary) for each skilled ICES. LATIVE EXPENDITURE TARGET.— nursing facility, and shall update the per (a) REPLACEMENT OF VOLUME PERFORMANCE (1) IN GENERAL.—Section 1848(d) (42 U.S.C. diem rate on the basis of a market basket STANDARD WITH CUMULATIVE EXPENDITURE 1395w–4(d)(3)) is amended— and other factors as the Secretary deter- TARGET.—Section 1848(f)(2) (42 U.S.C. 1395w– (A) by striking paragraph (2); mines appropriate. 4(f)(2)) is amended to read as follows: (B) by amending paragraph (3) to read as ‘‘(3) The per diem rate applicable to a ‘‘(f) CUMULATIVE EXPENDITURE TARGET.— follows: skilled nursing facility may not exceed the ‘‘(1) SPECIFICATION OF TARGET.— ‘‘(3) UPDATE.— following limits— ‘‘(A) FISCAL YEAR 1996.—The cumulative ‘‘(A) IN GENERAL.—Subject to subparagraph ‘‘(A) With respect to skilled nursing facili- expenditure target for all physicians’ serv- (E), for purposes of this section the update ties located in rural areas, the limit shall be ices and for each category of such services for a year (beginning with 1997) is equal to equal to 112 percent of the mean per diem for fiscal year 1996 shall be equal to the prod- the product of— routine costs in a base year (determined by uct of— ‘‘(i) 1 plus the Secretary’s estimate of the the Secretary) for freestanding skilled nurs- ‘‘(i) 1 plus the Secretary’s estimate of the percentage increase in the medicare eco- ing facilities located in rural areas within percentage change in the medicare economic nomic index (described in the fourth sen- the same region, as updated by the same per- index for 1996 (described in the fourth sen- tence of section 1842(b)(3)) for the year (di- centage determined under paragraph (2). tence of section 1842(b)(3)) (divided by 100), vided by 100), and ‘‘(B) With respect to skilled nursing facili- ‘‘(ii) 1 plus the Secretary’s estimate of the ‘‘(ii) 1 plus the Secretary’s estimate of the ties located in urban areas, the limit shall be percentage change (divided by 100) in the av- update adjustment factor for the year (di- equal to 112 percent of the mean per diem erage number of individuals enrolled under vided by 100), routine costs in a base year (determined by this part (other than private plan enrollees) minus 1 and multiplied by 100. the Secretary) for freestanding skilled nurs- from fiscal year 1995 to fiscal year 1996, ‘‘(B) UPDATE ADJUSTMENT FACTOR.—The ing facilities located in urban areas within ‘‘(iii) 1 plus the Secretary’s estimate of the ‘update adjustment factor’ for a year for a the same region, updated by the same per- projected percentage growth in real gross do- category of physicians’ services is equal to centage determined under paragraph (2). mestic product per capita (divided by 100) the quotient of— ‘‘(g) In the case of a hospital-based skilled from fiscal year 1995 to fiscal year 1996, plus ‘‘(i) the difference between (I) the sum of nursing facility or a skilled nursing facility 2 percentage points, and the allowed expenditures for physicians’ receiving payment under subsection (d) as of ‘‘(iv) 1 plus the Secretary’s estimate of the services in such category furnished during the date of enactment of this provision, the percentage change (divided by 100) in expend- each of the years 1995 through the year in- amount of payment to the facility based on itures for all physicians’ services or of the volved and (II) the sum of the amount of ac- application of subsections (e) and (f) may not category of physicians’ services in fiscal tual expenditures for physicians’ services be less than the per diem rate applicable to year 1996 (compared with fiscal year 1995) furnished in such category during each of the the facility for routine costs on the date of which will result from changes in law, deter- years 1995 through the previous year; divided enactment of this provision. mined without taking into account esti- by ‘‘(h) Notwithstanding any other provision mated changes in expenditures due to ‘‘(ii) the Secretary’s estimate of allowed of this title, the Secretary shall, for cost re- changes in the volume and intensity of phy- expenditures for physicians’ services in such porting periods beginning on or after October sicians’ services or changes in expenditures category furnished during the year. 1, 1998, provide for payment for all costs of resulting from changes in the update to the ‘‘(C) DETERMINATION OF ALLOWED EXPENDI- extended care services (including routine conversion factor under subsection (d), TURES.—For purposes of subparagraph (B), H 10442 CONGRESSIONAL RECORD — HOUSE October 19, 1995 allowed expenditures for physicians’ services (ii) by striking the period at the end and tion 1861(nn) (42 U.S.C. 1395x(nn)) is amend- in a category of physicians’ services shall be inserting ‘‘; and’’; and ed— determined as follows (as estimated by the (C) by adding at the end the following: (A) in the heading, by striking ‘‘Smear’’ Secretary): ‘‘(C) for 1996 and 1997, 0 percentage points; and inserting ‘‘Smear; Screening Pelvic ‘‘(i) In the case of allowed expenditures for and Exam’’; 1995, such expenditures shall be equal to ac- ‘‘(D) for a subsequent year, the percentage (B) by striking ‘‘(nn)’’ and inserting tual expenditures for services furnished dur- increase in the consumer price index for all ‘‘(nn)(1)’’; ing the 12-month period ending with June of urban consumers (U.S. urban average) for (C) by striking ‘‘3 years’’ and all that fol- 1995. the 12-month period ending with June of the lows and inserting ‘‘3 years, or during the ‘‘(ii) In the case of allowed expenditures for previous year.’’. preceding year in the case of a woman de- 1996 and each subsequent year, such expendi- (2) ORTHOTICS AND PROSTHETICS.—Section scribed in paragraph (3).’’; and tures shall be equal to allowed expenditures 1834(h)(4)(A)(iii) (42 U.S.C. 1395m(h)(4)(A)(iii)) (D) by adding at the end the following new for the previous year, increased by the cumu- is amended by striking ‘‘1994 and 1995’’ and paragraphs: lative expenditure target under subsection inserting ‘‘1994, 1995, 1996, and 1997’’. ‘‘(2) The term ‘screening pelvic exam’ (f) for the fiscal year which begins during the (c) AMBULATORY SURGICAL CENTER SERV- means an pelvic examination provided to a year. ICES.—The Secretary of Health and Human woman if the woman involved has not had ‘‘(D) DETERMINATION OF ACTUAL EXPENDI- Services shall not provide for any inflation such an examination during the preceding 3 TURES.—For purposes of subparagraph (B), update in the payment amounts under sub- years, or during the preceding year in the the amount of actual expenditures for physi- paragraphs (A) and (B) of section 1833(i)(2) of case of a woman described in paragraph (3), cians’ services in a category of physicians’ the Social Security Act for fiscal years 1996 and includes a clinical breast examination. services furnished during a year shall be and 1997. ‘‘(3) A woman described in this paragraph equal to the amount of expenditures for such SEC. 15103. REDUCTION IN EFFECTIVE BENE- is a woman who— services during the 12-month period ending FICIARY COINSURANCE RATE FOR ‘‘(A) is of childbearing age and has not had with June of the previous year. CERTAIN HOSPITAL OUTPATIENT a test described in this subsection during SERVICES. ‘‘(E) RESTRICTION ON VARIATION FROM MEDI- each of the preceding 3 years that did not in- (a) IN GENERAL.— CARE ECONOMIC INDEX.—Notwithstanding the dicate the presence of cervical cancer; or (1) AMBULATORY SURGICAL CENTER PROCE- amount of the update adjustment factor de- ‘‘(B) is at high risk of developing cervical DURES.—Section 1833(i)(3)(B)(i)(II) (42 U.S.C. termined under subparagraph (B) for a year, cancer (as determined pursuant to factors 1395l(i)(3)(B)(i)(II)) is amended— the update in the conversion factor under identified by the Secretary).’’. (A) by striking ‘‘of 80 percent’’; and this paragraph for the year may not be— (2) WAIVER OF DEDUCTIBLE.—The first sen- (B) by striking the period at the end and ‘‘(i) greater than 103 percent of the Sec- tence of section 1833(b) (42 U.S.C. 1395l(b)), as inserting the following: ‘‘, less the amount a retary’s estimate of the percentage increase amended by subsection (a)(2), is amended— provider may charge as described in clause in the medicare economic index (described in (A) by striking ‘‘and (5)’’ and inserting (ii) of section 1866(a)(2)(A).’’. the fourth sentence of section 1842(b)(3)) for ‘‘(5)’’; and (2) RADIOLOGY SERVICES AND DIAGNOSTIC the year; or (B) by striking the period at the end and PROCEDURES.—Section 1833(n)(1)(B)(i)(II) (42 ‘‘(ii) less than 92.5 percent of the Sec- inserting the following: ‘‘, and (6) such de- U.S.C. 1395l(n)(1)(B)(i)(II)) is amended— retary’s estimate of the percentage increase ductible shall not apply with respect to (A) by striking ‘‘of 80 percent’’; and in the medicare economic index (described in screening pap smear and screening pelvic (B) by striking the period at the end and the fourth sentence of section 1842(b)(3)) for exam (as described in section 1861(nn)).’’. inserting the following: ‘‘, less the amount a the year.’’; and (3) CONFORMING AMENDMENTS.—(A) Section provider may charge as described in clause (C) by adding at the end the following new 1861(s)(14) (42 U.S.C. 1395x(s)(14)) is amended (ii) of section 1866(a)(2)(A).’’. paragraph: by inserting ‘‘and screening pelvic exam’’ (b) REDUCTION IN BENEFICIARY COINSURANCE ‘‘(4) REPORTING REQUIREMENTS.— after ‘‘screening pap smear’’. RATE.—Section 1866(a)(2) (42 U.S.C. ‘‘(A) IN GENERAL.—Not later than Novem- (B) Section 1862(a)(1)(F) (42 U.S.C. 1395cc(a)(2)) is amended by adding at the end ber 1 of each year (beginning with 1996), the 1395y(a)(1)(F)) is amended by inserting ‘‘and Secretary shall transmit to the Congress a the following new subparagraph: ‘‘(E)(i) In the case of services furnished screening pelvic exam’’ after ‘‘screening pap report that describes the update in the con- during a year for which the amount of pay- smear’’. version factor for physicians’ services (as de- ment under part B is determined under sec- (c) COVERAGE OF COLORECTAL SCREENING.— fined in subsection (f)(3)(A)) in the following tion 1833(i) or section 1833(n), clause (ii) of (1) IN GENERAL.—Section 1834 (42 U.S.C. year. subparagraph (A) shall be applied by reduc- 1395m) is amended by inserting after sub- ‘‘(B) COMMISSION REVIEW.—The Medicare ing ‘20 percent’ by the percentage established section (c) the following new subsection: Payment Review Commission shall review for the year under clause (ii). ‘‘(d) FREQUENCY AND PAYMENT LIMITS FOR the report submitted under subparagraph (A) ‘‘(ii) The percentage established for a year SCREENING FECAL-OCCULT BLOOD TESTS, for a year and shall submit to the Congress, under this clause shall be the percentage SCREENING FLEXIBLE SIGMOIDOSCOPIES, AND by not later than December 1 of the year, a which, if applied for the year, will result in SCREENING COLONOSCOPY.— report containing its analysis of the conver- a reduction in projected total coinsurance ‘‘(1) FREQUENCY LIMITS FOR SCREENING sion factor for the following year.’’. payments under part B during the year in an FECAL-OCCULT BLOOD TESTS.—Subject to revi- (2) EFFECTIVE DATE.—The amendments amount equal to the Secretary’s estimate of sion by the Secretary under paragraph (4), no made by this subsection shall apply to physi- the reduction in expenditures under part B payment may be made under this part for a cians’ services furnished on or after January which would have occurred as a result of the screening fecal-occult blood test provided to 1, 1997. enactment of section 15103(a) of the Medicare an individual for the purpose of early detec- (c) ESTABLISHMENT OF SINGLE CONVERSION Enhancement Act of 1995 if this subpara- tion of colon cancer if the test is performed— FACTOR FOR 1996.—Section 1848(d)(1) (42 graph were not in effect for the year. ‘‘(A) in the case of an individual under 65 U.S.C. 1395w–4(d)(1)) is amended— ‘‘(iii) The Secretary shall establish and years of age, more frequently than is pro- (1) by redesignating subparagraph (C) as publish the percentage established for a year vided in a periodicity schedule established subparagraph (D); and under this clause not later than October 1 by the Secretary for purposes of this sub- (2) by inserting after subparagraph (B) the preceding the year involved (or not later paragraph; or following new subparagraph: than December 1, 1995, in the case of the per- ‘‘(B) in the case of any other individual, ‘‘(C) SPECIAL RULE FOR 1996.—For 1996, the centage established for 1996).’’. within the 11 months following the month in conversion factor under this subsection shall (c) EFFECTIVE DATE.—The amendments which a previous screening fecal-occult blood be $34.60 for all physicians’ services.’’. made by subsections (a) and (b) shall apply test was performed. SEC. 15102. FREEZE IN UPDATES TO PAYMENT to services furnished during portions of cost ‘‘(2) SCREENING FLEXIBLE AMOUNTS FOR CERTAIN ITEMS AND reporting periods occurring on or after Janu- SIGMOIDOSCOPIES.— SERVICES. ary 1, 1996. ‘‘(A) PAYMENT AMOUNT.—The Secretary (a) CLINICAL DIAGNOSTIC LABORATORY SEC. 15104. EXPANDING COVERAGE OF PREVEN- shall establish a payment amount under sec- TESTS.—Section 1833(h)(2)(A)(ii)(IV) (42 TIVE BENEFITS. tion 1848 with respect to screening flexible U.S.C. 1395l(h)(2)(A)(ii)(IV)) is amended strik- (a) PROVIDING ANNUAL SCREENING MAMMOG- sigmoidoscopies provided for the purpose of ing ‘‘1994 and 1995’’ and inserting ‘‘1994, 1995, RAPHY FOR WOMEN OVER AGE 49.—Section early detection of colon cancer that is con- 1996, and 1997’’. 1834(c)(2)(A) (42 U.S.C. 1395m(c)(2)(A)) is sistent with payment amounts under such (b) DURABLE MEDICAL EQUIPMENT.— amended— section for similar or related services, except (1) COVERED ITEMS.—Section 1834(a)(14) (42 (1) in clause (iv), by striking ‘‘but under 65 that such payment amount shall be estab- U.S.C. 1395m(a)(14)) is amended— years of age,’’; and lished without regard to subsection (a)(2)(A) (A) by striking ‘‘and’’ at the end of sub- (2) by striking clause (v). of such section. paragraph (A); (b) COVERAGE OF SCREENING PAP SMEAR ‘‘(B) FREQUENCY LIMITS.—Subject to revi- (B) in subparagraph (B)— AND PELVIC EXAMS.— sion by the Secretary under paragraph (4), no (i) by striking ‘‘a subsequent year’’ and in- (1) COVERAGE OF PELVIC EXAM; INCREASING payment may be made under this part for a serting ‘‘1993, 1994, and 1995’’, and FREQUENCY OF COVERAGE OF PAP SMEAR.—Sec- screening flexible sigmoidoscopy provided to October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10443 an individual for the purpose of early detec- ‘‘(G) in the case of screening fecal-occult the quality standards described in paragraph tion of colon cancer if the procedure is per- blood tests, screening flexible (2)(B), but only if the physician who is man- formed— sigmoidoscopies, and screening colonoscopy aging the individual’s diabetic condition cer- ‘‘(i) in the case of an individual under 65 provided for the purpose of early detection of tifies that such services are needed under a years of age, more frequently than is pro- colon cancer, which are performed more fre- comprehensive plan of care related to the in- vided in a periodicity schedule established quently than is covered under section dividual’s diabetic condition to provide the by the Secretary for purposes of this sub- 1834(d);’’; and individual with necessary skills and knowl- paragraph; or (ii) in paragraph (7), by striking ‘‘para- edge (including skills related to the self-ad- ‘‘(ii) in the case of any other individual, graph (1)(B) or under paragraph (1)(F)’’ and ministration of injectable drugs) to partici- within the 59 months following the month in inserting ‘‘subparagraphs (B), (F), or (G) of pate in the management of the individual’s which a previous screening flexible paragraph (1)’’. condition. sigmoidoscopy was performed. (d) PROSTATE CANCER SCREENING TESTS.— ‘‘(2) In paragraph (1)— (1) IN GENERAL.—Section 1861(s)(2) (42 ‘‘(3) SCREENING COLONOSCOPY FOR INDIVID- ‘‘(A) a ‘certified provider’ is an individual U.S.C. 1395x(s)(2)) is amended— UALS AT HIGH RISK FOR COLORECTAL CANCER.— or entity that, in addition to providing dia- (A) by striking ‘‘and’’ at the end of sub- ‘‘(A) PAYMENT AMOUNT.—The Secretary betes outpatient self-management training shall establish a payment amount under sec- paragraph (N) and subparagraph (O); and services, provides other items or services for (B) by inserting after subparagraph (O) the tion 1848 with respect to screening which payment may be made under this following new subparagraph: colonoscopy for individuals at high risk for title; and ‘‘(P) prostate cancer screening tests (as de- colorectal cancer (as determined in accord- ‘‘(B) an individual or entity meets the fined in subsection (oo)); and’’. ance with criteria established by the Sec- quality standards described in this para- (2) TESTS DESCRIBED.—Section 1861 (42 retary) provided for the purpose of early de- graph if the individual or entity meets qual- U.S.C. 1395x) is amended by adding at the end tection of colon cancer that is consistent ity standards established by the Secretary, the following new subsection: with payment amounts under such section except that the individual or entity shall be for similar or related services, except that ‘‘Prostate Cancer Screening Tests deemed to have met such standards if the in- such payment amount shall be established ‘‘(oo) The term ‘prostate cancer screening dividual or entity meets applicable stand- without regard to subsection (a)(2)(A) of such test’ means a test that consists of a digital ards originally established by the National section. rectal examination or a prostate-specific Diabetes Advisory Board and subsequently ‘‘(B) FREQUENCY LIMIT.—Subject to revision antigen blood test (or both) provided for the revised by organizations who participated in by the Secretary under paragraph (4), no purpose of early detection of prostate cancer the establishment of standards by such payment may be made under this part for a to a man over 40 years of age who has not Board, or is recognized by the American Dia- screening colonoscopy for individuals at high had such a test during the preceding year.’’. betes Association as meeting standards for risk for colorectal cancer provided to an in- (3) PAYMENT FOR PROSTATE-SPECIFIC ANTI- furnishing the services.’’. dividual for the purpose of early detection of GEN BLOOD TEST UNDER CLINICAL DIAGNOSTIC (C) CONSULTATION WITH ORGANIZATIONS IN colon cancer if the procedure is performed LABORATORY TEST FEE SCHEDULES.—Section ESTABLISHING PAYMENT AMOUNTS FOR SERV- within the 47 months following the month in 1833(h)(1)(A) (42 U.S.C. 1395l(h)(1)(A)) is ICES PROVIDED BY PHYSICIANS.—In establish- which a previous screening colonoscopy was amended by inserting after ‘‘laboratory ing payment amounts under section 1848(a) performed. tests’’ the following: ‘‘(including prostate of the Social Security Act for physicians’ ‘‘(C) FACTORS CONSIDERED IN ESTABLISHING cancer screening tests under section 1861(oo) services consisting of diabetes outpatient CRITERIA FOR DETERMINING INDIVIDUALS AT consisting of prostate-specific antigen blood self-management training services, the Sec- HIGH RISK.—In establishing criteria for deter- tests)’’. retary of Health and Human Services shall mining whether an individual is at high risk (4) CONFORMING AMENDMENT.—Section consult with appropriate organizations, in- for colorectal cancer for purposes of this 1862(a) (42 U.S.C. 1395y(a)), as amended by cluding the American Diabetes Association, paragraph, the Secretary shall take into con- subsection (c)(3)(C), is amended— in determining the relative value for such sideration family history, prior experience of (A) in paragraph (1)— services under section 1848(c)(2) of such Act. cancer, a history of chronic digestive disease (i) in subparagraph (F), by striking ‘‘and’’ (2) BLOOD-TESTING STRIPS FOR INDIVIDUALS condition, and the presence of any appro- at the end, WITH DIABETES.— priate recognized gene markers for (ii) in subparagraph (G), by striking the (A) INCLUDING STRIPS AS DURABLE MEDICAL colorectal cancer. semicolon at the end and inserting ‘‘, and’’, EQUIPMENT.—Section 1861(n) (42 U.S.C. ‘‘(4) REVISION OF FREQUENCY.— and 1395x(n)) is amended by striking the semi- ‘‘(A) REVIEW.—The Secretary shall review (iii) by adding at the end the following new colon in the first sentence and inserting the periodically the appropriate frequency for subparagraph: following: ‘‘, and includes blood-testing performing screening fecal-occult blood ‘‘(H) in the case of prostate cancer screen- strips for individuals with diabetes without tests, screening flexible sigmoidoscopies, and ing test (as defined in section 1861(oo)) pro- regard to whether the individual has Type I screening colonoscopy based on age and such vided for the purpose of early detection of or Type II diabetes (as determined under other factors as the Secretary believes to be prostate cancer, which are performed more standards established by the Secretary in pertinent. frequently than is covered under such sec- consultation with the American Diabetes As- ‘‘(B) REVISION OF FREQUENCY.—The Sec- tion;’’; and sociation);’’. retary, taking into consideration the review (B) in paragraph (7), by striking ‘‘or (G)’’ (2) PAYMENT FOR STRIPS BASED ON METH- made under clause (i), may revise from time and inserting ‘‘(G), or (H)’’. ODOLOGY FOR INEXPENSIVE AND ROUTINELY to time the frequency with which such tests (e) DIABETES SCREENING BENEFITS.— PURCHASED EQUIPMENT.—Section 1834(a)(2)(A) and procedures may be paid for under this (1) DIABETES OUTPATIENT SELF-MANAGEMENT (42 U.S.C. 1395m(a)(2)(A)) is amended— subsection.’’. TRAINING SERVICES.— (A) by striking ‘‘or’’ at the end of clause (2) CONFORMING AMENDMENTS.—(A) Para- (A) IN GENERAL.—Section 1861(s)(2) (42 (ii); graphs (1)(D) and (2)(D) of section 1833(a) (42 U.S.C. 1395x(s)(2)), as amended by subsection (B) by adding ‘‘or’’ at the end of clause U.S.C. 1395l(a)) are each amended by striking (d)(1), is amended— (iii); and ‘‘subsection (h)(1),’’ and inserting ‘‘sub- (i) by striking ‘‘and’’ at the end of subpara- (C) by inserting after clause (iii) the fol- section (h)(1) or section 1834(d)(1),’’. graph (N); lowing new clause: (B) Clauses (i) and (ii) of section (ii) by striking ‘‘and’’ at the end of sub- ‘‘(iv) which is a blood-testing strip for an 1848(a)(2)(A) (42 U.S.C. 1395w–4(a)(2)(A)) are paragraph (O); and individual with diabetes,’’. (iii) by inserting after subparagraph (O) each amended by striking ‘‘a service’’ and in- (e) EFFECTIVE DATE.—The amendments serting ‘‘a service (other than a screening the following new subparagraph: made by this section shall apply to items flexible sigmoidoscopy provided to an indi- ‘‘(P) diabetes outpatient self-management and services furnished on or after January 1, vidual for the purpose of early detection of training services (as defined in subsection 1996. colon cancer or a screening colonoscopy pro- (pp)); and’’. SEC. 15105. REDUCTION IN PAYMENT FOR CAP- vided to an individual at high risk for (B) DEFINITION.—Section 1861 (42 U.S.C. 1395x), as amended by subsection (d)(2), is ITAL-RELATED COSTS OF HOSPITAL colorectal cancer for the purpose of early de- OUTPATIENT SERVICES. tection of colon cancer)’’. amended by adding at the end the following new subsection: Section 1861(v)(1)(S)(ii)(I) (42 U.S.C. (C) Section 1862(a) (42 U.S.C. 1395y(a)) is 1395x(v)(1)(S)(ii)(I)) is amended by striking ‘‘DIABETES OUTPATIENT SELF-MANAGEMENT amended— ‘‘through 1998’’ and inserting ‘‘through 2002’’. (i) in paragraph (1)— TRAINING SERVICES (I) in subparagraph (E), by striking ‘‘and’’ ‘‘(pp)(1) The term ‘diabetes outpatient self- SEC. 15106. PART B PREMIUM. at the end; management training services’ means edu- Section 1839(e)(1) (42 U.S.C. 1395r(e)(1)) is (II) in subparagraph (F), by striking the cational and training services furnished to amended— semicolon at the end and inserting ‘‘, and’’; an individual with diabetes by or under ar- (1) in subparagraph (A), by striking ‘‘1995’’ and rangements with a certified provider (as de- and inserting ‘‘1996’’, and (III) by adding at the end the following new scribed in paragraph (2)(A)) in an outpatient (2) in subparagraph (B)(v), by inserting subparagraph: setting by an individual or entity who meets ‘‘and 1996’’ after ‘‘1995’’. H 10444 CONGRESSIONAL RECORD — HOUSE October 19, 1995 SEC. 15107. ENSURING PAYMENT FOR PHYSICIAN SEC. 15202. CLARIFICATION OF TIME AND FILING (1) by striking ‘‘, in accordance with para- AND NURSE FOR JOINTLY FUR- LIMITATIONS. graph (3)(A)’’, and NISHED ANESTHESIA SERVICES. (a) IN GENERAL.—Section 1862(b)(2)(B) (42 (2) by inserting ‘‘, unless the entity dem- (a) PAYMENT FOR JOINTLY FURNISHED SIN- U.S.C. 1395y(b)(2)(B)) is amended by adding onstrates that it did not know, and could not GLE CASE.— at the end the following new clause: have known, of its obligation to pay’’ after (1) PAYMENT TO PHYSICIAN.—Section ‘‘(v) TIME, FILING, AND RELATED PROVISIONS ‘‘against that entity’’. 1848(a)(4) (42 U.S.C. 1395w–4(a)(4)) is amended UNDER PRIMARY PLAN.—Requirements under a (b) CONFORMING AMENDMENT.—Section by adding at the end the following new sub- primary plan as to the filing of a claim, time 1862(b)(3)(A) (42 U.S.C. 1395y(b)(3)(A)) is paragraph: limitations for the filing of a claim, informa- amended by striking ‘‘(or appropriate reim- ‘‘(C) PAYMENT FOR SINGLE CASE.—Notwith- tion not maintained by the Secretary, or no- bursement)’’. standing section 1862(a)(1)(A), with respect to tification or pre-admission review, shall not physicians’ services consisting of the fur- apply to a claim by the United States under (c) EFFECTIVE DATE.—The amendments nishing of anesthesia services for a single clause (ii) or (iii).’’. made by this section shall apply to items case that are furnished jointly with a cer- (b) EFFECTIVE DATE.—The amendment and services furnished after 1993. tified registered nurse anesthetist, if the car- made by subsection (a) applies to items and PART 2—OTHER PROVISIONS RELATING rier determines that the use of both the phy- services furnished after 1993. TO PARTS A AND B sician and the nurse anesthetist to furnish SEC. 15203. CLARIFICATION OF LIABILITY OF the anesthesia service was not medically THIRD PARTY–ADMINISTRATORS. SEC. 15221. MAKING ADDITIONAL CHOICES OF necessary, the fee schedule amount for the HEALTH PLANS AVAILABLE TO (a) IN GENERAL.—Section 1862(b)(2)(B)(ii) BENEFICIARIES. physicians’ services shall be equal to 50 per- (42 U.S.C. 1395y(b)(2)(B)(ii)) is amended by in- cent (or 55 percent, in the case of services serting ‘‘, or which determines claims under (a) DEFINITION OF PPO.—Section 1876 (42 furnished during 1996 or 1997) of the fee the primary plan’’ after ‘‘primary plan’’. U.S.C. 1395mm) is amended by adding at the schedule amount applicable under this sec- (b) CLAIMS BETWEEN PARTIES OTHER THAN end the following new subsection: tion for anesthesia services personally per- THE UNITED STATES.— Section 1862(b)(2)(B) ‘‘(k)(1) A preferred provider organization formed by the physician alone (without re- (42 U.S.C. 1395y(b)(2)(B)), (as amended by sec- (as defined in paragraph (2)) shall be consid- gard to this subparagraph). Nothing in this tion 15201(a)) is further amended by adding ered to be an eligible organization under this subparagraph may be construed to affect the at the end the following new clause: section. application of any provision of law regarding ‘‘(vi) CLAIMS BETWEEN PARTIES OTHER THAN ‘‘(2) In this section, the term ‘preferred balance billing.’’. THE UNITED STATES.—A claim by the United provider organization’ means an organiza- (2) PAYMENT TO CRNA.—Section 1833(l)(4)(B) States under clause (ii) or (iii) shall not pre- tion that— (42 U.S.C. 1395l(l)(4)(B)) is amended by adding clude claims between other parties.’’. ‘‘(A) would be an eligible organization (as at the end the following new clause: (c) EFFECTIVE DATE.—The amendments defined in subsection (b)) if— ‘‘(iv) Notwithstanding section 1862(a)(1)(A), made by the previous subsections apply to ‘‘(i) clauses (ii) through (iv) of subsection in the case of services of a certified reg- items and services furnished after 1993. (b)(2)(A) did not apply, istered nurse anesthetist consisting of the SEC. 15204. CLARIFICATION OF PAYMENT ‘‘(ii) subsection (b)(2)(C) did not apply, and furnishing of anesthesia services for a single AMOUNTS TO MEDICARE. ‘‘(iii) subsection (b)(2)(D) only applied (in case that are furnished jointly with a physi- (a) IN GENERAL.—Section 1862(b)(2)(B)(i) (42 the case of services not provided under this cian, if the carrier determines that the use of U.S.C. 1395y(b)(2)(B)(i)) is amended to read as title) to the physicians’ services the organi- both the physician and the nurse anesthetist follows: zation provides; and to furnish the anesthesia service was not ‘‘(i) REPAYMENT REQUIRED.— ‘‘(B) permits enrollees to obtain benefits medically necessary, the fee schedule ‘‘(I) Any payment under this title, with re- through any lawful provider. amount for the services furnished by the cer- spect to any item or service for which pay- tified registered nurse anesthetist shall be ment by a primary plan is required under the Nothing in subparagraph (B) shall be con- equal to 50 percent (or 40 percent, in the case preceding provisions of this subsection, shall strued as requiring that the benefits for serv- of services furnished during 1996 or 1997) of be conditioned on reimbursement to the ap- ices provided through providers that do not the fee schedule amount applicable under propriate Trust Fund established by this have a contract with the organization be the section 1848 for anesthesia services person- title when notice or other information is re- same as those for services provided through ally performed by the physician alone (with- ceived that payment for that item or service providers that have such contracts so long as out regard to this clause).’’. has been or should have been made under an enrollee’s liabilities do not exceed the li- (b) EFFECTIVE DATE.—The amendments those provisions. If reimbursement is not abilities that the enrollee would have under made by subsections (a) shall apply to serv- made to the appropriate Trust Fund before parts A and B if the individual were not en- ices furnished on or after July 1, 1996. the expiration of the 60-day period that be- rolled under this section.’’. Subtitle C—Provisions Relating to Parts A gins on the date such notice or other infor- (b) PARTIAL RISK PAYMENT METHODS.—Sec- and B mation is received, the Secretary may tion 1876 (42 U.S.C. 1395mm) is further PART 1—MEDICARE SECONDARY PAYER charge interest (beginning with the date on amended by adding at the end the following new subsection: SEC. 15201. EXTENSION OF EXISTING SECONDARY which the notice or other information is re- PAYER REQUIREMENTS. ceived) on the amount of the reimbursement ‘‘(l) Notwithstanding the previous provi- (a) DATA MATCH.— until reimbursement is made (at a rate de- sions of this section, at the election of an eli- (1) Section 1862(b)(5)(C) (42 U.S.C. termined by the Secretary in accordance gible organization the Secretary may estab- 1395y(b)(5)(C)) is amended by striking clause with regulations of the Secretary of the lish an alternative partial-risk-sharing (iii). Treasury applicable to charges for late pay- mechanism for making payment to the orga- (2) Section 6103(l)(12) of the Internal Reve- ments). nization under this section. Under such nue Code of 1986 is amended by striking sub- ‘‘(II) The amount owed by a primary plan mechanism fee-for-service payments would paragraph (F). under the first sentence of subclause (I) is be made to the organization for some serv- (b) APPLICATION TO DISABLED INDIVIDUALS the lesser of the full primary payment re- ices provided under the contract, under such IN LARGE GROUP HEALTH PLANS.— quired (if that amount is readily determina- conditions and subject to such restrictions (1) IN GENERAL.—Section 1862(b)(1)(B) (42 ble) and the amount paid under this title for as the Secretary may determine.’’. U.S.C. 1395y(b)(1)(B)) is amended— that item or service.’’. (c) CONFORMING AMENDMENT.—Section 1876 (A) in clause (i), by striking ‘‘clause (iv)’’ (b) CONFORMING AND TECHNICAL AMEND- (42 U.S.C. 1395mm) is further amended— MENTS and inserting ‘‘clause (iii)’’, .— (1) in the heading by striking ‘‘ORGANIZA- (B) by striking clause (iii), and (1) Subparagraphs (A)(i)(I) and (B)(i) of sec- TIONS AND COMPETITIVE MEDICAL PLANS’’ and (C) by redesignating clause (iv) as clause tion 1862(b)(1) (42 U.S.C. 1395y(b)(1)) are each inserting ‘‘ORGANIZATIONS, COMPETITIVE (iii). amended by inserting ‘‘(or eligible to be cov- MEDICAL PLANS, AND PREFERRED PROVIDER (2) CONFORMING AMENDMENTS.—Paragraphs ered)’’ after ‘‘covered’’. ORGANIZATIONS’’, and (1) through (3) of section 1837(i) (42 U.S.C. (2) Section 1862(b)(1)(C)(ii) (42 U.S.C. (2) in subsection (c)(3)(E)(ii), by inserting 1395p(i)) and the second sentence of section 1395y(b)(1)(C)(ii)) is amended by striking ‘‘(if any)’’ after ‘‘the restrictions’’. ‘‘covered by such plan’’. 1839(b) (42 U.S.C. 1395r(b)) are each amended (d) EFFECTIVE DATE.—The amendments by striking ‘‘1862(b)(1)(B)(iv)’’ each place it (3) The matter in section 1861(b)(2)(A) (42 U.S.C. 1395x(b)(2)(A)) preceding clause (i) is made by this section shall apply to contract appears and inserting ‘‘1862(b)(1)(B)(iii)’’. years beginning on or after January 1, 1996. (c) PERIOD OF APPLICATION TO INDIVIDUALS amended by striking ‘‘, except as provided in WITH END STAGE RENAL DISEASE.—Section subparagraph (B),’’. SEC. 15222. TEACHING HOSPITAL AND GRADUATE 1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is (c) EFFECTIVE DATE.—The amendments MEDICAL EDUCATION TRUST FUND. amended— made by the previous subsections apply to (a) TEACHING HOSPITAL AND GRADUATE (1) in the first sentence, by striking ‘‘12- items and services furnished after 1993. MEDICAL EDUCATION TRUST FUND.—The So- month’’ each place it appears and inserting SEC. 15205. CONDITIONS FOR DOUBLE DAMAGES. cial Security Act (42 U.S.C. 300 et seq.) is ‘‘18-month’’, and (a) IN GENERAL.—Section 1862(b)(2)(B)(ii) amended by adding at the end the following (2) by striking the second sentence. (42 U.S.C. 1395y(b)(2)(B)(ii)) is amended— title: October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10445

‘‘TITLE XXI—TEACHING HOSPITAL AND ‘‘PART B—PAYMENTS TO TEACHING HOSPITALS bers of the Council from among Federal offi- GRADUATE MEDICAL EDUCATION ‘‘SEC. 2111. FORMULA PAYMENTS TO TEACHING cers or employees who are appointed by the TRUST FUND HOSPITALS. President, or by the Secretary (or by other Federal officers who are appointed by the ‘‘PART A—ESTABLISHMENT OF FUND ‘‘(a) IN GENERAL.—In the case of each teaching hospital that in accordance with President with the advice and consent of the ‘‘SEC. 2101. ESTABLISHMENT OF FUND. subsection (b) submits to the Secretary a Senate). Individuals designated under the ‘‘(a) IN GENERAL.—There is established in payment document for fiscal year 1996 or any preceding sentence shall include each of the the Treasury of the United States a fund to subsequent fiscal year, the Secretary shall following officials (or a designee of the offi- be known as the Teaching Hospital and make payments for the year to the teaching cial): Graduate Medical Education Trust Fund (in hospital for the direct and indirect costs of (i) The Secretary of Health and Human this title referred to as the ‘Fund’), consist- operating approved medical residency train- Services. ing of amounts transferred to the Fund ing programs. Such payments shall be made (ii) The Secretary of Veterans Affairs. under subsection (c), amounts appropriated from the Fund, and shall be made in accord- (iii) The Secretary of Defense. to the Fund pursuant to subsections (d) and ance with a formula established by the Sec- (4) CHAIR.—The Secretary shall, from (e)(3), and such gifts and bequests as may be retary. among members of the council appointed under paragraph (3)(A), designate an individ- deposited in the Fund pursuant to subsection ‘‘(b) PAYMENT DOCUMENT.—For purposes of (f). Amounts in the Fund are available until subsection (a), a payment document is a doc- ual to serve as the chair of the council. expended. ument containing such information as may (5) TERMINATION.—The Council terminates be necessary for the Secretary to make pay- December 31, 1999. ‘‘(b) EXPENDITURES FROM FUND.—Amounts (c) REMOVE MEDICAL EDUCATION AND DIS- ments under such subsection to a teaching in the Fund are available to the Secretary PROPORTIONATE SHARE HOSPITAL PAYMENTS hospital for a fiscal year. The document is for making payments under section 2111. FROM CALCULATION OF ADJUSTED AVERAGE submitted in accordance with this subsection ‘‘(c) TRANSFERS TO FUND.— PER CAPITA COST.— if the document is submitted not later than ‘‘(1) IN GENERAL.—From the Federal Hos- (1) IN GENERAL.—Section 1876(a)(4) (42 the date specified by the Secretary, and the pital Insurance Trust Fund and the Federal U.S.C. 1395mm(a)(4)) is amended— document is in such form and is made in Supplementary Medical Insurance Trust (A) by striking ‘‘(4)’’ and inserting such manner as the Secretary may require. Fund, the Secretary shall, for fiscal year 1996 ‘‘(4)(A)’’; and The Secretary may require that information and each subsequent fiscal year, transfer to (B) by adding at the end the following new under this subsection be submitted to the the Fund an amount determined by the Sec- subparagraph: retary for the fiscal year involved in accord- Secretary in periodic reports.’’. ‘‘(B) In determining the adjusted average ance with paragraph (2). (b) NATIONAL ADVISORY COUNCIL ON POST- per capita cost for a contract year under sub- GRADUATE MEDICAL EDUCATION.— ‘‘(2) DETERMINATION OF AMOUNTS.—For pur- paragraph (A), the Secretary shall exclude poses of paragraph (1), the amount deter- (1) IN GENERAL.—There is established with- any amounts which the Secretary estimates mined under this paragraph for a fiscal year in the Department of Health and Human would be payable under this title during the is an estimate by the Secretary of an Services an advisory council to be known as year for— amount equal to 75 percent of the difference the National Advisory Council on Post- ‘‘(i) payment adjustments under section between— graduate Medical Education (in this title re- 1886(d)(5)(F) for hospitals serving a dis- ‘‘(A) the nationwide total of the amounts ferred to as the ‘‘Council’’). proportionate share of low-income patients; that would have been paid under section (2) DUTIES.—The council shall provide ad- and 1876(a)(4) during the year but for the exclu- vice to the Secretary on appropriate policies ‘‘(ii) the indirect costs of medical edu- sion of medical education payments from the for making payments for the support of post- cation under section 1886(d)(5)(B) or for di- adjusted average per capita cost pursuant to graduate medical education in order to as- rect graduate medical education costs under section 1876(a)(4)(B)(ii); and sure an adequate supply of physicians section 1886(h).’’. trained in various specialities, consistent ‘‘(B) the nationwide total of the amounts (2) PAYMENTS TO HOSPITALS OF AMOUNTS AT- with the health care needs of the United paid under section 1876(a)(4) during the year. TRIBUTABLE TO DSH.—Section 1886 (42 U.S.C. States. ‘‘(3) ALLOCATION BETWEEN MEDICARE TRUST 1395ww) is amended by adding at the end the (3) COMPOSITION.— FUNDS.—In providing for a transfer under following new subsection: paragraph (1) for a fiscal year, the Secretary (A) IN GENERAL.—The Secretary shall ap- ‘‘(j)(1) In addition to amounts paid under shall provide for an allocation of the point to the Council 15 individuals who are subsection (d)(5)(F), the Secretary is author- amounts involved between part A and part B not officers or employees of the United ized to pay hospitals which are eligible for of title XVIII (and the trust funds estab- States. Such individuals shall include not such payments for a fiscal year supplemental lished under the respective parts) as reason- less than 1 individual from each of the fol- amounts that do not exceed the limit pro- ably reflects the proportion of payments for lowing categories of individuals or entities: vided for in paragraph (2). the indirect costs of medical education and (i) Organizations representing consumers ‘‘(2) The sum of the aggregate amounts direct graduate medical education costs of of health care services. paid pursuant to paragraph (1) for a fiscal hospitals associated with the provision of (ii) Physicians who are faculty members of year shall not exceed the Secretary’s esti- services under each respective part. medical schools, or who supervise approved mate of 75 percent of the amount excluded physician training programs. from the adjusted average per capita cost for ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— (iii) Physicians in private practice who are There are authorized to be appropriated to the fiscal year pursuant to section not physicians described in clause (ii). 1876(a)(4)(B)(i).’’. the Fund such sums as may be necessary for (iv) Practitioners in public health. each of the fiscal years 1996 through 2002. SEC. 15223. REVISIONS IN DETERMINATION OF (v) Advanced-practice nurses. AMOUNT OF PAYMENT FOR MEDI- ‘‘(e) INVESTMENT.— (vi) Other health professionals who are not CAL EDUCATION. ‘‘(1) IN GENERAL.—The Secretary of the physicians. (a) INDIRECT MEDICAL EDUCATION.— Treasury shall invest such amounts of the (vii) Medical schools. (1) IN GENERAL.—Section 1886(d)(5)(B) (42 Fund as such Secretary determines are not (viii) Teaching hospitals. U.S.C. 1395ww(d)(5)(B)) is amended by adding required to meet current withdrawals from (ix) The Accreditation Council on Graduate at the end the following new clauses: the Fund. Such investments may be made Medical Education. ‘‘(v) In determining such adjustment with only in interest-bearing obligations of the (x) The American Board of Medical Speci- respect to a hospital for discharges occurring United States. For such purpose, such obli- alities. on or after October 1, 1995, and on or before gations may be acquired on original issue at (xi) The Council on Postdoctoral Training September 30, 2002— the issue price, or by purchase of outstand- of the American Osteopathic Association. ‘‘(I) the total number of interns and resi- ing obligations at the market price. (xii) The Council on Podiatric Medical dents counted by the Secretary may not ex- ‘‘(2) SALE OF OBLIGATIONS.—Any obligation Education of the American Podiatric Medi- ceed the number of interns and residents acquired by the Fund may be sold by the cal Association. counted with respect to the hospital as of Secretary of the Treasury at the market (B) REQUIREMENTS REGARDING REPRESENTA- August 1, 1995, and price. TIVE MEMBERSHIP.—To the greatest extent ‘‘(II) the number of interns and residents ‘‘(3) AVAILABILITY OF INCOME.—Any interest feasible, the membership of the Council shall counted by the Secretary who are not pri- derived from obligations acquired by the represent the various geographic regions of mary care residents (as defined in subsection Fund, and proceeds from any sale or redemp- the United States, shall reflect the racial, (h)(5)(H)) may not exceed the number of such tion of such obligations, are hereby appro- ethnic, and gender composition of the popu- residents counted with respect to the hos- priated to the Fund. lation of the United States, and shall be pital as of such date. ‘‘(f) ACCEPTANCE OF GIFTS AND BEQUESTS.— broadly representative of medical schools ‘‘(vi) In calculating the number of full- The Fund may accept on behalf of the United and teaching hospitals in the United States. time-equivalent interns and residents of a States money gifts and bequests made un- (C) EX OFFICIO MEMBERS; OTHER FEDERAL hospital in determining such adjustment conditionally to the Fund for the benefit of OFFICERS OR EMPLOYEES.—The membership of with respect to the hospital, the Secretary the Fund or any activity financed through the Council shall include individuals des- shall provide for a weighting factor of .50 the Fund. ignated by the Secretary to serve as mem- with respect to each intern and resident who H 10446 CONGRESSIONAL RECORD — HOUSE October 19, 1995 is not in an initial residency period (as de- amended by adding at the end the following The Secretary shall develop such a system fined in subsection (h)(5)(F)).’’. new clauses: for implementation in fiscal year 2000. (2) PAYMENT FOR INTERNS AND RESIDENTS ‘‘(iv) For services furnished by home (f) PAYMENTS DETERMINED ON PROSPECTIVE PROVIDING OFF-SITE SERVICES.—Section health agencies for cost reporting periods be- BASIS.—Title XVIII is amended by adding at 1886(d)(5)(B)(iv) (42 U.S.C. 1395ww(d)(5)(B)(iv)) ginning on or after October 1, 1996, the Sec- the end the following new section: is amended by striking ‘‘any entity’’ and all retary shall provide for an interim system of ‘‘PROSPECTIVE PAYMENT FOR HOME HEALTH that follows through ‘‘and residents)’’ and limits. Payment shall be the lower of— SERVICES inserting ‘‘any other entity under an agree- ‘‘(I) costs determined under the preceding ‘‘SEC. 1893. (a) Notwithstanding section ment with the hospital’’. provisions of this subparagraph, or 1861(v), the Secretary shall, for cost report- (b) DIRECT MEDICAL EDUCATION.— ‘‘(II) an agency-specific per beneficiary an- ing periods beginning on or after fiscal year (1) LIMITATION ON NUMBER OF RESIDENTS.— nual limit calculated from the agency’s 12- 2000, provide for payments for home health Section 1886(h)(4) (42 U.S.C. 1395ww(h)(4)) is month cost reporting period ending on or services in accordance with a prospective amended by adding at the end the following after January 1, 1994 and on or before Decem- payment system, which pays home health new subparagraph: ber 31, 1994 based on reasonable costs (includ- agencies on a per episode basis, established ‘‘(F) LIMITATION ON NUMBER OF RESIDENTS ing non-routine medical supplies), updated by the Secretary. FOR CERTAIN FISCAL YEARS.—Such rules shall by the home health market basket index. ‘‘(b) Such a system shall include the fol- provide that for purposes of a cost reporting The per beneficiary limitation shall be mul- lowing: period beginning on or after October 1, 1995, tiplied by the agency’s unduplicated census ‘‘(1) Per episode rates under the system and on or before September 30, 2002— count of Medicare patients for the year sub- shall be 15 percent less than those that would ‘‘(i) the total number of full-time-equiva- ject to the limitation. The limitation shall otherwise occur under fiscal year 2000 Medi- lent residents determined under this para- represent total Medicare reasonable costs di- care expenditures for home health services. graph with respect to an approved medical vided by the unduplicated census count of ‘‘(2) All services covered and paid on a rea- residency training program may not exceed Medicare patients. sonable cost basis under the Medicare home the number of full-time-equivalent residents ‘‘(v) For services furnished by home health health benefit as of the date of the enact- with respect to the program as of August 1, agencies for cost reporting periods beginning ment of the Medicare Enhancement Act of 1995, and on or after October 1, 1996, the following 1995, including medical supplies, shall be sub- ‘‘(ii) the number of full-time-equivalent rules shall apply: ject to the per episode amount. In defining residents determined under this paragraph ‘‘(I) For new providers and those providers an episode of care, the Secretary shall con- with respect to the program who are not pri- without a 12-month cost reporting period sider an appropriate length of time for an mary care residents (as defined in paragraph ending in calendar year 1994, the per bene- episode the use of services and the number of (5)(H)) may not exceed the number of such ficiary limit shall be equal to the mean of visits provided within an episode, potential residents counted with respect to the pro- these limits (or the Secretary’s best esti- changes in the mix of services provided with- gram as of such date.’’. mates thereof) applied to home health agen- in an episode and their cost, and a general (2) CONTINUATION OF FREEZE ON UPDATES TO cies as determined by the Secretary. Home system design that will provide for contin- FTE RESIDENT AMOUNTS.—Section health agencies that have altered their cor- ued access to quality services. The per epi- 1886(h)(2)(D)(ii) (42 U.S.C. 1395ww(h)(2)(D)(ii)) porate structure or name may not be consid- sode amount shall be based on the most cur- is amended by striking ‘‘fiscal year 1994 or ered new providers for payment purposes. rent audited cost report data available to the fiscal year 1995’’ and inserting ‘‘fiscal years ‘‘(II) For beneficiaries who use services fur- Secretary. 1994, 1995, 1996, or 1997’’. nished by more than one home health agen- ‘‘(c) The Secretary shall employ an appro- (3) PERMITTING PAYMENT TO NON-HOSPITAL cy, the per beneficiary limitation shall be priate case mix adjuster that explains a sig- PROVIDERS.—Section 1886 (42 U.S.C. 1395ww) pro-rated among agencies. nificant amount of the variation in cost. is amended by adding at the end the follow- ‘‘(vi) Home health agencies whose cost or ‘‘(d) The episode payment amount shall be ing new subsection: utilization experience is below 125 percent of adjusted annually by the home health mar- ‘‘(j) Beginning with cost reporting periods the mean national or census region aggre- ket basket index. The labor portion of the beginning on or after July 1, 1996, notwith- gate per beneficiary cost or utilization expe- episode amount shall be adjusted for geo- standing any other provision of this title, rience for 1994, or best estimates thereof, and graphic differences in labor-related costs the Secretary may make payments (in such whose year-end reasonable costs are below based on the most current hospital wage amounts and in such form as the Secretary the agency-specific per beneficiary limit, index. considers appropriate) to entities other than shall receive payment equal to 50 percent of ‘‘(e) The Secretary may designate a pay- hospitals for the direct costs of medical edu- the difference between the agency’s reason- ment provision for outliers, recognizing the cation, if such costs are incurred in the oper- able costs and its limit for fiscal years 1996, need to adjust payments due to unusual vari- ation of an approved medical residency 1997, 1998, and 1999. Such payments may not ations in the type or amount of medically training program described in subsection exceed 5 percent of an agency’s aggregate necessary care. (h).’’. Medicare reasonable cost in a year. ‘‘(f) A home health agency shall be respon- (c) EXPANDING DEFINITION OF PRIMARY ‘‘(vii) Effective January 1, 1997, or as soon sible for coordinating all care for a bene- CARE RESIDENTS.—Section 1886(h)(5)(H) (42 as feasible, the Secretary shall modify the ficiary. If a beneficiary elects to transfer to, U.S.C. 1395ww(h)(5)(H)) is amended by insert- agency specific per beneficiary annual limit or receive services from, another home ing ‘‘obstetrics and gynecology,’’ after ‘‘geri- described in clause (iv) to provide for re- health agency within an episode period, the atric medicine,’’. gional or national variations in utilization. episode payment shall be pro-rated between (d) EFFECTIVE DATE.—Except as provided For purposes of determining payment under home health agencies.’’. otherwise in this section (or in the amend- clause (iv), the limit shall be calculated (g) LIMITATION ON PART A COVERAGE.— ments made by this section), the amend- through a blend of 75 percent of the agency- (1) IN GENERAL.—Section 1812(a)(3) (42 ments made by this section apply to hospital specific cost or utilization experience in 1994 U.S.C. 1395d(a)(3)) is amended by striking the cost reporting periods beginning on or after with 25 percent of the national or census re- semicolon and inserting ‘‘for up to 160 visits October 1, 1995. gion cost or utilization experience in 1994, or during any spell of illness;’’. SEC. 15224. PAYMENTS FOR HOME HEALTH SERV- the Secretary’s best estimates thereof.’’. (2) CONFORMING AMENDMENT.—Section ICES. (d) USE OF INTERIM FINAL REGULATIONS.— 1812(b) (42 U.S.C. 1395d(b)) is amended— (a) REDUCTIONS IN COST LIMITS.—Section The Secretary shall implement the payment (A) by striking ‘‘or’’ at the end of para- 1861(v)(1)(L)(i) (42 U.S.C. 1395x(v)(1)(L)(i)) is limits described in section 1861(v)(1)(L)(iv) of graph (2), amended— the Social Security Act by publishing in the (B) by striking the period at the end of (1) by inserting ‘‘and before October 1, Federal Register a notice of interim final paragraph (3) and inserting ‘‘; or’’, and 1996,’’ after ‘‘July 1, 1987’’ in subclause (III), payment limits by August 1, 1996 and allow- (C) by adding at the end the following new (2) by striking the period at the end of the ing for a period of public comments thereon. paragraph: matter following subclause (III), and insert- Payments subject to these limits will be ef- ‘‘(4) home health services furnished to the ing ‘‘, and’’, fective for cost reporting periods beginning individual during such spell after such serv- (3) by adding at the end the following new on or after October 1, 1996, without the ne- ices have been furnished to the individual for subclause: cessity for consideration of comments re- 160 visits during such spell.’’. ‘‘(IV) October 1, 1996, 105 percent of the me- ceived, but the Secretary shall, by Federal (3) EXCLUSION OF ADDITIONAL PART B COSTS dian of the labor-related and nonlabor per Register notice, affirm or modify the limits FROM DETERMINATION OF PART B MONTHLY visit costs for free standing home health after considering those comments. PREMIUM.—Section 1839(a) (42 U.S.C. 1395r(a)) agencies.’’. (e) STUDIES.—The Secretary shall expand is amended— (b) DELAY IN UPDATES.—Section research on a prospective payment system (A) in the second sentence of paragraph (1), 1861(v)(1)(L)(iii) (42 U.S.C. 1395x(v)(1)(L)(iii)) for home health agencies that shall tie pro- by striking ‘‘enrollees.’’ and inserting ‘‘en- is amended by striking ‘‘July 1, 1996’’ and in- spective payments to an episode of care, in- rollees (except as provided in paragraph serting ‘‘October 1, 1996’’. cluding an intensive effort to develop a reli- (5)).’’; and (c) ADDITIONS TO COST LIMITS.—Section able case mix adjuster that explains a sig- (B) by adding at the end the following new 1861(v)(1)(L) (42 U.S.C. 1395x(v)(1)(L)) is nificant amount of the variances in costs. paragraph: October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10447 ‘‘(5) In estimating the benefits and admin- gram for any item or service associated with (C) The Minority Leader of the Senate istrative costs which will be payable from the use of an investigational device in the shall appoint 3 members. the Federal Supplementary Medical Insur- furnishing of inpatient or outpatient hos- (D) The Speaker of the House of Represent- ance Trust Fund for a year (beginning with pital services (including outpatient diag- atives shall appoint 3 members. 1996), the Secretary shall exclude an esti- nostic imaging services) for which payment (E) The Minority Leader of the House of mate of any benefits and costs attributable may be made under the program may not ex- Representatives shall appoint 3 members. to home health services for which payment ceed the amount of the payment which (2) CHAIRMAN AND VICE CHAIRMAN.—The would have been made under part A during would have been made under the program for Commission shall elect a Chairman and Vice the year but for paragraph (4) of section the item or service if the item or service Chairman from among its members. 1812(b).’’. were associated with the use of an approved (3) VACANCIES.—Any vacancy in the mem- (4) EFFECTIVE DATE.—The amendments device or a covered procedure. bership of the Commission shall be filled in made by this subsection shall apply to spells (c) DEFINITIONS.—In this section— the manner in which the original appoint- of illness beginning on or after October 1, (1) the term ‘‘approved device’’ means a ment was made and shall not affect the 1995. medical device (or devices) which has been power of the remaining members to execute (h) REQUIRING BILLING AND PAYMENT TO BE approved for marketing under pre-market the duties of the Commission. BASED ON SITE WHERE SERVICE FURNISHED.— approval under the Federal Food, Drug, and (4) QUORUM.—A quorum shall consist of 8 Section 1891 (42 U.S.C. 1395bbb) is amended Cosmetic Act or cleared for marketing under members of the Commission, except that 4 by adding at the end the following new sub- a 510(k) notice under such Act; and members may conduct a hearing under sub- section: (2) the term ‘‘investigational device’’ section (e). ‘‘(g) A home health agency shall submit means— (5) MEETINGS.—The Commission shall meet claims for payment for home health services (A) a medical device or devices (other than at the call of its Chairman or a majority of under this title only on the basis of the geo- a device described in paragraph (1)) approved its members. graphic location at which the service is fur- for investigational use under section 520(g) of (6) COMPENSATION AND REIMBURSEMENT OF nished.’’. the Federal Food, Drug, and Cosmetic Act, EXPENSES.—Members of the Commission are (i) MAINTAINING SAVINGS RESULTING FROM or not entitled to receive compensation for TEMPORARY FREEZE ON PAYMENT IN- (B) an investigational combination product service on the Commission. Members may be CREASES.— under section 503(g) of the Federal Food, reimbursed for travel, subsistence, and other (1) BASING UPDATES TO PER VISIT COST LIM- Drug, and Cosmetic Act which includes a de- necessary expenses incurred in carrying out ITS ON LIMITS FOR FISCAL YEAR 1993.—Section vice (or devices) authorized for use under the duties of the Commission. 1861(v)(1)(L)(iii) (42 U.S.C. 1395x(v)(1)(L)(iii)) section 505(i) of such Act. (d) STAFF AND CONSULTANTS.— is amended by adding at the end the follow- SEC. 15227. COMMISSION ON THE FUTURE OF (1) STAFF.—The Commission may appoint ing sentence: ‘‘In establishing limits under MEDICARE AND THE PROTECTION and determine the compensation of such this subparagraph, the Secretary may not OF THE HEALTH OF THE NATION’S staff as may be necessary to carry out the take into account any changes in the costs SENIOR CITIZENS. duties of the Commission. Such appoint- of the provision of services furnished by (a) ESTABLISHMENT.—There is established a ments and compensation may be made with- home health agencies with respect to cost re- commission to be known as the Commission out regard to the provisions of title 5, United porting periods which began on or after July on the Future of Medicare and the Protec- States Code, that govern appointments in 1, 1994, and before July 1, 1996.’’. tion of the Health of the Nation’s Senior the competitive services, and the provisions Citizens (in this section referred to as the of chapter 51 and subchapter III of chapter 53 (2) NO EXCEPTIONS PERMITTED BASED ON ‘‘Commission’’). of such title that relate to classifications AMENDMENT.—The Secretary of Health and (b) DUTIES.— Human Services shall not consider the and the General Schedule pay rates. (1) IN GENERAL.—The Commission shall— (2) CONSULTANTS.—The Commission may amendment made by paragraph (1) in mak- (A) analyze indicators of the health status procure such temporary and intermittent ing any exemptions and exceptions pursuant of individuals in the United States who are services of consultants under section 3109(b) to section 1861(v)(1)(L)(ii) of the Social Secu- eligible for benefits under the medicare pro- of title 5, United States Code, as the Com- rity Act. gram; mission determines to be necessary to carry SEC. 15225. REQUIRING HEALTH MAINTENANCE (B) make specific recommendations on ac- out the duties of the Commission. ORGANIZATIONS TO COVER APPRO- (e) POWERS.— PRIATE RANGE OF SERVICES. tions which may be taken to improve the medicare program which would promote the (1) HEARINGS AND OTHER ACTIVITIES.—For (a) IN GENERAL.—Section 1876(c) (42 U.S.C. the purpose of carrying out its duties, the 1395mm(c)) is amended by adding at the end health of medicare beneficiaries; Commission may hold such hearings and un- the following new paragraph: (C) analyze the effect of changes in the dertake such other activities as the Commis- ‘‘(9) The organization shall not deny any medicare program (including changes in sion determines to be necessary to carry out health care professionals, based solely on the medicare payments) on the access to and de- its duties. license or certification as applicable under livery of health care services to individuals (2) STUDIES BY GAO.—Upon the request of State law, the ability to participate in pro- who are not medicare beneficiaries; the Commission, the Comptroller General viding services covered under the contract (D) examine the financial impact on the shall conduct such studies or investigations under this section, or be reimbursed or in- medicare program of the significant increase as the Commission determines to be nec- demnified or by a network plan for providing in the number of medicare eligible individ- essary to carry out its duties. such services under the contract.’’. uals which will occur beginning approxi- (3) COST ESTIMATES BY CONGRESSIONAL (b) EFFECTIVE DATE.—The amendment mately during 2010 and lasting for approxi- made by subsection (a) shall apply to risk- mately 25 years, and BUDGET OFFICE.— sharing contracts under section 1876 of the (E) make specific recommendations to the (A) Upon the request of the Commission, Social Security Act which entered into or re- Congress respecting a comprehensive ap- the Director of the Congressional Budget Of- newed on or after January 1, 1996. proach to preserve the medicare program for fice shall provide to the Commission such the period during which such individuals are cost estimates as the Commission deter- SEC. 15226. CLARIFICATION OF MEDICARE COV- ERAGE OF ITEMS AND SERVICES AS- eligible for medicare. mines to be necessary to carry out its duties. SOCIATED WITH CERTAIN MEDICAL (2) CONSIDERATIONS IN MAKING REC- (B) The Commission shall reimburse the DEVICES APPROVED FOR INVES- OMMENDATIONS.—In making its recommenda- Director of the Congressional Budget Office TIGATIONAL USE. tions, the Commission shall consider the fol- for expenses relating to the employment in (a) COVERAGE.—Nothing in title XVIII of lowing: the office of the Director of such additional the Social Security Act may be construed to (A) The amount and sources of Federal staff as may be necessary for the Director to prohibit coverage under part A or part B of funds to finance the medicare program. comply with requests by the Commission the medicare program of items and services (B) The most efficient and effective man- under subparagraph (A). associated with the use of a medical device ner of administering the program. (4) DETAIL OF FEDERAL EMPLOYEES.—Upon in the furnishing of inpatient or outpatient (C) Methods used by other nations to fi- the request of the Commission, the head of hospital services (including outpatient diag- nance the delivery of health care services to any Federal agency is authorized to detail, nostic imaging services) for which payment their citizens. without reimbursement, any of the personnel may be made under the program solely on (D) The financial impact on the medicare of such agency to the Commission to assist the grounds that the device is not an ap- program of increases in the number of indi- the Commission in carrying out its duties. proved device, if— viduals in the United States without health Any such detail shall not interrupt or other- (1) the device is an investigational device; insurance coverage. wise affect the civil service status or privi- and (c) MEMBERSHIP.— leges of the Federal employee. (2) the device is used instead of either an (1) APPOINTMENT.—The Commission shall (5) TECHNICAL ASSISTANCE.—Upon the re- approved device or a covered procedure. be composed of 15 members appointed as fol- quest of the Commission, the head of a Fed- (b) CLARIFICATION OF PAYMENT AMOUNT.— lows: eral agency shall provide such technical as- Notwithstanding any other provision of title (A) The President shall appoint 3 members. sistance to the Commission as the Commis- XVIII of the Social Security Act, the amount (B) The Majority Leader of the Senate sion determines to be necessary to carry out of payment made under the medicare pro- shall appoint 3 members. its duties. H 10448 CONGRESSIONAL RECORD — HOUSE October 19, 1995

(6) USE OF MAILS.—The Commission may (B) by striking the period at the end and the individual is enrolled with and such item use the United States mails in the same inserting the following: ‘‘, and shall be sub- or service is covered under a health plan manner and under the same conditions as ject to damages of not more than three times under which the provider furnishing the item Federal agencies and shall, for purposes of the total remuneration offered, paid, solic- or service is paid by the health plan for fur- the frank, be considered a commission of ited, or received.’’. nishing the item or service only on a Congress as described in section 3215 of title (b) REVISIONS TO EXCEPTIONS.— capitated basis pursuant to a written ar- 39, United States Code. (1) EXCEPTION FOR DISCOUNTS.—Section rangement between the plan and the pro- (7) OBTAINING INFORMATION.—The Commis- 1128B(b)(3)(A) (42 U.S.C. 1320a–7b(b)(3)(A)) is vider in which the provider assumes finan- sion may secure directly from any Federal amended by striking ‘‘program;’’ and insert- cial risk for furnishing the item or service.’’. agency information necessary to enable it to ing ‘‘program and is not in the form of a cash (c) AUTHORIZATION FOR THE SECRETARY TO carry out its duties, if the information may payment;’’. ISSUE REGULATIONS.—Section 1128B(b) (42 be disclosed under section 552 of title 5, Unit- (2) EXCEPTION FOR PAYMENTS TO EMPLOY- U.S.C. 1320a–7b(b)) is amended by adding at ed States Code. Upon request of the Chair- EES.—Section 1128B(b)(3)(B) (42 U.S.C. 1320a– the end the following new paragraph: man of the Commission, the head of such 7b(b)(3)(B)) is amended by inserting at the agency shall furnish such information to the end ‘‘if the amount of remuneration under ‘‘(4) The Secretary is authorized to impose Commission. the arrangement is consistent with the fair by regulation such other requirements as (8) ADMINISTRATIVE SUPPORT SERVICES.— market value of the services and is not de- needed to protect against program or patient Upon the request of the Commission, the Ad- termined in a manner that takes into ac- abuse with respect to any of the exceptions ministrator of General Services shall provide count (directly or indirectly) the volume or described in paragraph (3).’’. to the Commission on a reimbursable basis value of any referrals, except that such em- (d) CLARIFICATION OF OTHER ELEMENTS OF such administrative support services as the ployee can be paid remuneration in the form OFFENSE.—Section 1128B(b) (42 U.S.C. 1320a– Commission may request. of a productivity bonus based on services 7b(b)) is amended— (9) ACCEPTANCE OF DONATIONS.—The Com- personally performed by the employee.’’. (1) in paragraph (1)(A), by striking ‘‘in re- mission may accept, use, and dispose of gifts (3) EXCEPTION FOR WAIVER OF COINSURANCE turn for referring’’ and inserting ‘‘to refer’’; or donations of services or property. BY CERTAIN PROVIDERS.—Section (2) in paragraph (1)(B), by striking ‘‘in re- (10) PRINTING.—For purposes of costs relat- 1128B(b)(3)(D) (42 U.S.C. 1320a–7b(b)(3)(D)) is turn for purchasing, leasing, ordering, or ar- ing to printing and binding, including the amended to read as follows: ranging for or recommending’’ and inserting cost of personnel detailed from the Govern- ‘‘(D) a waiver or reduction of any coinsur- ‘‘to purchase, lease, order, or arrange for or ment Printing Office, the Commission shall ance or other copayment if— be deemed to be a committee of the Con- ‘‘(i) the waiver or reduction is made pursu- recommend’’; and gress. ant to a public schedule of discounts which (3) by adding at the end of paragraphs (1) (f) REPORT.—Not later than May 1, 1997, the the person is obligated as a matter of law to and (2) the following sentence: ‘‘A violation Commission shall submit to Congress a re- apply to certain individuals, exists under this paragraph if one or more port containing its findings and rec- ‘‘(ii) the waiver or reduction is made pur- purposes of the remuneration is unlawful ommendations regarding how to protect and suant to an established program and applies under this paragraph.’’. preserve the medicare program in a finan- to a defined group of individuals whose in- SEC. 15302. CIVIL MONEY PENALTIES. cially solvent manner until 2030 (or, if later, comes do not exceed 150 percent (or such throughout the period of projected solvency higher percentage as the Secretary may per- (a) PROHIBITION AGAINST OFFERING INDUCE- of the Federal Old-Age and Survivors Insur- mit) of the official poverty line (as defined MENTS TO INDIVIDUALS ENROLLED UNDER ance Trust Fund). The report shall include by the Office of Management and Budget, PLANS.— detailed recommendations for appropriate and revised annually in accordance with sec- (1) OFFER OF REMUNERATION.—Section legislative initiatives respecting how to ac- tion 673(2) of the Omnibus Budget Reconcili- 1128A(a) (42 U.S.C. 1320a–7a(a)), as amended complish this objective. ation Act of 1981) applicable to a family of by section 15301(a)(1), is amended— (g) TERMINATION.—The Commission shall the size involved, (A) by striking ‘‘; or’’ at the end of para- terminate 60 days after the date of submis- ‘‘(iii) the waiver or reduction of coinsur- graph (3) and inserting a semicolon; sion of the report required in subsection (f). ance is not offered as part of any advertise- (B) by striking the semicolon at the end of (h) AUTHORIZATION OF APPROPRIATIONS.— ment or solicitation and the person offering paragraph (4) and inserting ‘‘; or’’; and There are authorized to be appropriated the waiver or reduction determines in good (C) by inserting after paragraph (4) the fol- $1,500,000 to carry out this section. Amounts faith that the individual is in financial need, lowing new paragraph: appropriated to carry out this section shall ‘‘(iv) the person offering the waiver or re- ‘‘(5) offers, pays, or transfers remuneration remain available until expended. duction fails to collect the coinsurance or to any individual eligible for benefits under Subtitle D—Preventing Fraud and Abuse other payment after making reasonable col- title XVIII of this Act, or under a State PART 1—AMENDMENTS TO ANTI-FRAUD lection efforts, or health care program (as defined in section AND ABUSE PROVISIONS APPLICABLE ‘‘(v) the waiver or reduction of coinsurance 1128(h)) that such person knows or should TO MEDICARE, MEDICAID, AND STATE is in accordance with a cost sharing schedule know is likely to influence such individual HEALTH CARE PROGRAMS or a supplemental benefit package which to order or receive from a particular pro- SEC. 15301. ANTI-KICKBACK STATUTORY PROVI- may be offered by a managed care plan (as vider, practitioner, or supplier any item or SIONS. defined in section 1128(j)); and’’. service for which payment may be made, in (a) REVISION TO PENALTIES.— (4) NEW EXCEPTION FOR CAPITATED PAY- whole or in part, under title XVIII, or a (1) PERMITTING SECRETARY TO IMPOSE CIVIL MENTS.—Section 1128B(b)(3) (42 U.S.C. 1320a– State health care program, other than to in- MONETARY PENALTY.—Section 1128A(a) (42 7b(b)(3)) is amended— fluence an individual enrolled in a managed U.S.C. 1320a–7a(a)) is amended— (A) by striking ‘‘and’’ at the end of sub- care plan or a point-of-service plan (as de- (A) by striking ‘‘or’’ at the end of para- paragraph (D); fined in section 1128(j)) to receive benefits graphs (1) and (2); (B) by striking the period at the end of under the plan in accordance with estab- (B) by striking the semicolon at the end of subparagraph (E) and inserting ‘‘; and’’; and lished practice patterns for the delivery of paragraph (3) and inserting ‘‘; or’’; and (C) by adding at the end the following new medically necessary services;’’. (C) by inserting after paragraph (3) the fol- subparagraphs: (2) REMUNERATION DEFINED.—Section lowing new paragraph: ‘‘(F) any reduction in cost sharing or in- 1128A(i) (42 U.S.C. 1320a–7a(i)) is amended by ‘‘(4) carries out any activity in violation of creased benefits given to an individual, any adding at the end the following new para- paragraph (1) or (2) of section 1128B(b);’’. amounts paid to a provider for an item or graph: (2) DESCRIPTION OF CIVIL MONETARY PEN- service furnished to an individual, or any ‘‘(6) The term ‘remuneration’ includes the ALTY APPLICABLE.—Section 1128A(a) (42 discount or reduction in price given by the waiver or reduction of coinsurance amounts, U.S.C. 1320a–7a(a)) is amended— provider for such an item or service, if the and transfers of items or services for free or (A) by striking ‘‘given).’’ at the end of the individual is enrolled with and such item or for other than fair market value, except that first sentence and inserting the following: service is covered under any of the following: such term does not include the waiver or re- ‘‘given or, in cases under paragraph (4), ‘‘(i) A health plan which is furnishing duction of coinsurance amounts by a person $50,000 for each such violation).’’; and items or services under a risk-sharing con- or entity, if— (B) by striking ‘‘claim.’’ at the end of the tract under section 1876 or section 1903(m). ‘‘(A) the waiver or reduction is made pur- second sentence and inserting the following: ‘‘(ii) A health plan receiving payments on suant to a public schedule of discounts which ‘‘claim (or, in cases under paragraph (4), a prepaid basis, under a demonstration the person is obligated as a matter of law to damages of not more than three times the project under section 402(a) of the Social Se- apply to certain individuals, total amount of remuneration offered, paid, curity Amendments of 1967 or under section ‘‘(B) the waiver or reduction is made pur- solicited, or received.’’. 222(a) of the Social Security Amendments of suant to an established program and applies (3) INCREASE IN CRIMINAL PENALTY.—Para- 1972; and to a defined group of individuals whose in- graphs (1) and (2) of section 1128B(b) (42 ‘‘(G) any amounts paid to a provider for an comes do not exceed 150 percent (or such U.S.C. 1320a–7b(b)) are each amended— item or service furnished to an individual or higher percentage as the Secretary may per- (A) by striking ‘‘$25,000’’ and inserting any discount or reduction in price given by mit) of the official poverty line (as defined ‘‘$50,000’’; and the provider for such an item or service, if by the Office of Management and Budget, October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10449 and revised annually in accordance with sec- addition, the Secretary is authorized to re- pose a civil monetary penalty under this sec- tion 673(2) of the Omnibus Budget Reconcili- cover the costs of collection in any case tion against the defendants, the Secretary ation Act of 1981) applicable to a family of where the penalties and assessments are not has not made a good faith effort to initiate the size involved, paid within 30 days after the determination such a proceeding against the defendants. ‘‘(C) the waiver or reduction of coinsurance becomes final, or in the case of a com- ‘‘(4) No action may be brought under this is not offered as part of any advertisement or promised amount, where payments are more subsection more than 6 years after the date solicitation and the person offering the waiv- than 90 days past due. In lieu of actual costs, of the activity with respect to which the ac- er or reduction determines in good faith that the Secretary is authorized to impose a tion is brought.’’. the individual is in financial need, charge of up to 10 percent of the amount of SEC. 15304. AMENDMENTS TO EXCLUSIONARY ‘‘(D) the person offering the waiver or re- penalties and assessments owed to cover the PROVISIONS IN FRAUD AND ABUSE duction fails to collect the coinsurance or costs of collection.’’. PROGRAM. other payment after making reasonable col- (e) AUTHORIZATION TO ACT.— (a) MANDATORY EXCLUSION OF INDIVIDUAL lection efforts, or (1) IN GENERAL.—The first sentence of sec- CONVICTED OF CRIMINAL OFFENSE RELATED TO ‘‘(E) the waiver or reduction of coinsurance tion 1128A(c)(1) (42 U.S.C. 1320a–7a(c)(1)) is HEALTH CARE FRAUD.— is in accordance with a cost sharing schedule amended by striking all that follows ‘‘(b)’’ (1) IN GENERAL.—Section 1128(a) (42 U.S.C. or a supplemental benefit package which and inserting the following: ‘‘unless, within 1320a–7(a)) is amended by adding at the end may be offered by a managed care plan under one year after the date the Secretary pre- the following new paragraph: section 1128(j).’’. sents a case to the Attorney General for con- ‘‘(3) FELONY CONVICTION RELATING TO (b) ADDITIONAL OFFENSES.—Section sideration, the Attorney General brings an FRAUD.—Any individual or entity that has 1128A(a) of such Act, as amended by section action in a district court of the United been convicted under Federal or State law, 15301(a)(1) and subsection (a)(1), is further States.’’. in connection with the delivery of a health amended— (2) EFFECTIVE DATE.—The amendment care item or service on or after January 1, (1) by striking ‘‘or’’ at the end of paragraph made by this paragraph (1) shall apply to 1997, or with respect to any act or omission (4); cases presented by the Secretary of Health on or after such date in a program operated (2) by striking the semicolon at the end of and Human Services for consideration on or by or financed in whole or in part by any paragraph (5) and inserting ‘‘; or’’; and after the date of the enactment of this Act. Federal, State, or local government agency, (3) by inserting after paragraph (5) the fol- (f) CLARIFICATION OF PENALTY IMPOSED ON of a criminal offense consisting of a felony lowing new paragraphs: EXCLUDED PROVIDER FURNISHING SERVICES.— relating to fraud, theft, embezzlement, ‘‘(6) engages in a practice which has the ef- Section 1128A(a)(1)(D) (42 U.S.C. 1320a– breach of fiduciary responsibility, or other fect of limiting or discouraging (as compared 7a(a)(1)(D)) is amended by inserting ‘‘who financial misconduct.’’. to other plan enrollees) the utilization of furnished the service’’ after ‘‘in which the (2) CONFORMING AMENDMENT.—Section medically necessary health care services person’’. 1128(b)(1) (42 U.S.C. 1320a–7(b)(1)) is amend- covered by law or under the service contract ed— by title XIX or other publicly subsidized pa- SEC. 15303. PRIVATE RIGHT OF ACTION. Section 1128A (42 U.S.C. 1320a–7a) is amend- (A) in the heading, by striking ‘‘CONVIC- tients, including but not limited to differen- TION’’ and inserting ‘‘MISDEMEANOR CONVIC- ed by adding at the end the following new tial standards for the location and hours of TION’’; and subsection: service offered by providers participating in (B) by striking ‘‘criminal offense’’ and in- ‘‘(m)(1) Subject to paragraphs (2) and (3), a the plan; serting ‘‘criminal offense consisting of a mis- carrier offering an insured health plan and ‘‘(7) substantially fails to cooperate with a demeanor’’. the sponsor of a self-insured health plan that quality assurance program or a utilization (b) ESTABLISHMENT OF MINIMUM PERIOD OF suffers financial harm as a direct result of review activity; or EXCLUSION FOR CERTAIN INDIVIDUALS AND EN- the submission of claims by an individual or ‘‘(8) engaging in a pattern of failing sub- TITIES SUBJECT TO PERMISSIVE EXCLUSION entity for payment for items and services stantially to provide or authorize medically FROM MEDICARE AND STATE HEALTH CARE furnished under the plan which makes the necessary items and services that are re- PROGRAMS.— individual or entity subject to a civil mone- quired to be provided to an individual cov- (1) IN GENERAL.—Section 1128(c)(3) (42 tary penalty under this section may, in a ered under a health plan (as defined in sec- U.S.C. 1320a–7(c)(3)) is amended by adding at civil action against the individual or entity tion 1128(j)) or public program for the deliv- the end the following new subparagraphs: in the United States District Court, obtain ery of or payment for health care items or ‘‘(D) In the case of an exclusion of an indi- damages against the individual or entity and services, if the failure has adversely affected vidual or entity under paragraphs (1), (2), or such equitable relief as is appropriate. (or had a substantial likelihood of adversely (3) of subsection (b), the period of exclusion ‘‘(2) A carrier or sponsor may bring a civil affecting) the individual;’’. shall be a minimum of 3 years, unless the action under this subsection only if the car- ‘‘(9) submits false or fraudulent state- Secretary determines that an alternative pe- rier or sponsor provides the Secretary and ments, data or information on claims to the riod is appropriate because of aggravating or the Attorney General with written notice of Secretary, a State health care agency, or mitigating circumstances. any other Federal, State or local agency the intent to bring an action under this sub- ‘‘(E) In the case of an exclusion of an indi- charged with implementation or oversight of section, the identities of the individuals or vidual or entity under paragraph (4) or (5) of a health plan or a public program that the entities the carrier or sponsor intends to subsection (b), the period of the exclusion person knows or should know is fraudu- name as defendants to the action, and all in- shall not be less than the period during lent;’’. formation the carrier or sponsor possesses which the individual’s or entity’s license to (c) MODIFICATIONS OF AMOUNTS OF PEN- regarding the activity that is the subject of provide health care is revoked, suspended, or ALTIES AND ASSESSMENTS.—Section 1128A(a) the action that may materially affect the surrendered, or the individual or the entity (42 U.S.C. 1320a–7a(a)), as amended by section Secretary’s decision to initiate a proceeding is excluded or suspended from a Federal or 15301(a), subsection (a)(1), and subsection (b), to impose a civil monetary penalty under State health care program. is amended in the matter following para- this section against the defendants. ‘‘(F) In the case of an exclusion of an indi- graph (9)— ‘‘(3) A carrier or sponsor may bring a civil vidual or entity under subsection (b)(6)(B), (1) by striking ‘‘$2,000’’ and inserting action under this subsection only if any of the period of the exclusion shall be not less ‘‘$10,000’’; the following conditions are met: than 1 year.’’. (2) by inserting after ‘‘under paragraph (4), ‘‘(A) During the 60-day period that begins (2) CONFORMING AMENDMENT.—Section $50,000 for each such violation’’ the follow- on the date the Secretary receives the writ- 1128(c)(3)(A) (42 U.S.C. 1320a–7(c)(3)(A)) is ing: ‘‘; in cases under paragraph (5), $10,000 ten notice described in paragraph (2), the amended by striking ‘‘subsection (b)(12)’’ and for each such offer, payment, or transfer; in Secretary does not notify the carrier or inserting ‘‘paragraph (1), (2), (3), (4), (6)(B), or cases under paragraphs (6) through (9), an sponsor that the Secretary intends to initi- (12) of subsection (b)’’. ate a proceeding to impose a civil monetary amount not to exceed $10,000 for each such SEC. 15305. SANCTIONS AGAINST PRACTITIONERS determination by the Secretary’’; and penalty under this section against the de- AND PERSONS FOR FAILURE TO (3) by striking ‘‘twice the amount’’ and in- fendants. COMPLY WITH STATUTORY OBLIGA- serting ‘‘three times the amount’’. ‘‘(B) If the Secretary notifies the carrier or TIONS RELATING TO QUALITY OF (d) INTEREST ON PENALTIES.—Section sponsor during the 60-day period described in CARE. 1128A(f) (42 U.S.C. 1320a–7a(f)) is amended by subparagraph (A) that the Secretary intends (a) MINIMUM PERIOD OF EXCLUSION FOR adding after the first sentence the following: to initiate a proceeding to impose a civil PRACTITIONERS AND PERSONS FAILING TO ‘‘Interest shall accrue on the penalties and monetary penalty under this section against MEET STATUTORY OBLIGATIONS.— assessments imposed by a final determina- the defendants, the Secretary subsequently (1) IN GENERAL.—The second sentence of tion of the Secretary in accordance with an notifies the carrier or sponsor that the Sec- section 1156(b)(1) (42 U.S.C. 1320c-5(b)(1)) is annual rate established by the Secretary retary no longer intends to initiate such a amended by striking ‘‘may prescribe)’’ and under the Federal Claims Collection Act. proceeding against the defendants. inserting ‘‘may prescribe, except that such The rate of interest charged shall be the rate ‘‘(C) After the expiration of the 2-year pe- period may not be less than one year)’’. in effect on the date the determination be- riod that begins on the date the Secretary (2) CONFORMING AMENDMENT.—Section comes final and shall remain fixed at that notifies the carrier or sponsor that the Sec- 1156(b)(2) (42 U.S.C. 1320c-5(b)(2)) is amended rate until the entire amount due is paid. In retary intends to initiate a proceeding to im- by striking ‘‘shall remain’’ and inserting H 10450 CONGRESSIONAL RECORD — HOUSE October 19, 1995 ‘‘shall (subject to the minimum period speci- PART 2—INTERPRETIVE RULINGS ON ‘‘(A) For fiscal year 1996, such amount fied in the second sentence of paragraph (1)) KICKBACKS AND SELF-REFERRAL shall be not less than $430,000,000 and not remain’’. SEC. 15311. ESTABLISHMENT OF PROCESS FOR IS- more than $440,000,000. ‘‘(B) For fiscal year 1997, such amount (b) AMOUNT OF CIVIL MONEY PENALTY.— SUANCE OF INTERPRETIVE RUL- Section 1156(b)(3) (42 U.S.C. 1320c-5(b)(3)) is INGS. shall be not less than $490,000,000 and not (a) ESTABLISHMENT.—Not later than 1 year amended by striking ‘‘the actual or esti- more than $500,000,000. after the date of the enactment of this Act, mated cost’’ and inserting the following: ‘‘(C) For fiscal year 1998, such amount shall the Secretary of Health and Human Services ‘‘$10,000 for each instance’’. be not less than $550,000,000 and not more (acting through the Inspector General of the than $560,000,000. (c) REPEAL OF ‘‘UNWILLING OR UNABLE’’ Department of Health and Human Services) ‘‘(D) For fiscal year 1999, such amount CONDITION FOR IMPOSITION OF SANCTION.— shall establish a process under which individ- shall be not less than $620,000,000 and not Section 1156(b)(1) (42 U.S.C. 1320c-5(b)(1)) is uals and entities may submit a request to more than $630,000,000. amended— the Secretary for an interpretive ruling re- ‘‘(E) For fiscal year 2000, such amount (1) in the second sentence, by striking ‘‘and garding the provisions of section 1128B(b) of shall be not less than $670,000,000 and not determines’’ and all that follows through the Social Security Act or part 3 which re- more than $680,000,000. ‘‘such obligations,’’ and late to kickbacks, bribes, and rebates, or the ‘‘(F) For fiscal year 2001, such amount (2) by striking the third sentence. provisions of section 1877 of the Social Secu- shall be not less than $690,000,000 and not SEC. 15306. REVISIONS TO CRIMINAL PENALTIES. rity Act. more than $700,000,000. (b) DEADLINE FOR REJECTION OF REQUEST.— ‘‘(G) For fiscal year 2002, such amount (a) TREBLE DAMAGES FOR CRIMINAL SANC- If the Secretary of Health and Human Serv- shall be not less than $710,000,000 and not TIONS.—Section 1128B (42 U.S.C. 1320a–7b) is ices rejects a request for an interpretive rul- more than $720,000,000. amended by adding at the end the following ing submitted under this section, the Sec- ‘‘(b) DIRECT SPENDING FOR MEDICARE-RE- new subsection: retary shall notify the individual submitting LATED ACTIVITIES OF INSPECTOR GENERAL.— the request of the rejection not later than 60 ‘‘(f) In addition to the fines that may be ‘‘(1) IN GENERAL.—There are appropriated imposed under subsection (a) or (c) any indi- days after receiving the request. from the Federal Hospital Insurance Trust vidual found to have violated the provisions SEC. 15312. EFFECT OF ISSUANCE OF INTERPRE- Fund and the Federal Supplementary Medi- of any of such subsections may be subject to TIVE RULING. cal Insurance Trust Fund to the Inspector (a) NO LEGAL EFFECT.—If the Secretary of treble damages.’’. General of the Department of Health and Health and Human Services issues an inter- Human Services for each fiscal year such (b) IDENTIFICATION OF COMMUNITY SERVICE pretive ruling under section 15311, the ruling amounts as are necessary to enable the In- OPPORTUNITIES.—Section 1128B (42 U.S.C. shall not be binding upon the Secretary, the spector General to carry out activities relat- 1320a–7b), as amended by subsection (a), is party requesting the ruling, or any other ing to the medicare program (as described in further amended by adding at the end the party. paragraph (2)), subject to paragraph (3). following new subsection: (b) PUBLICATION OF RULINGS.—The Sec- ‘‘(2) ACTIVITIES DESCRIBED.—The activities retary of Health and Human Services shall ‘‘(g) The Secretary shall— described in this paragraph are as follows: publish each interpretive ruling issued under ‘‘(1) in consultation with State and local ‘‘(A) Prosecuting medicare-related matters section 15311 in the Federal Register. health care officials, identify opportunities through criminal, civil, and administrative for the satisfaction of community service ob- SEC. 15313. IMPOSITION OF FEES. proceedings. (a) IN GENERAL.—The Secretary of Health ligations that a court may impose upon the ‘‘(B) Conducting investigations relating to and Human Services shall require an individ- conviction of an offense under this section, the medicare program. ual or entity requesting an interpretive rul- and ‘‘(C) Performing financial and performance ing under section 15311 to submit a fee. ‘‘(2) make information concerning such op- audits of programs and operations relating (b) AMOUNT.—The amount of the fee re- portunities available to Federal and State to the medicare program. quired under subsection (a) shall be equal to law enforcement officers and State and local ‘‘(D) Performing inspections and other the costs incurred by the Secretary in re- health care officials.’’. evaluations relating to the medicare pro- sponding to the request. SEC. 15307. DEFINITIONS. gram. PART 3—DIRECT SPENDING FOR ANTI- ‘‘(E) Conducting provider and consumer Section 1128 (42 U.S.C. 1320a–7) is amended FRAUD ACTIVITIES UNDER MEDICARE education activities regarding the require- by adding at the end the following new sub- SEC. 15321. DIRECT SPENDING FOR ANTI-FRAUD ments of this title. section: ACTIVITIES UNDER MEDICARE. ‘‘(3) AMOUNTS SPECIFIED.—The amount ap- ‘‘(j) OTHER DEFINITIONS RELATING TO Title XVIII (42 U.S.C. 1395 et seq.), as propriated under paragraph (1) for a fiscal HEALTH PLANS.— amended by section 15224(f), is amended by year is as follows: ‘‘(1) HEALTH PLAN.—The term ‘health plan’ adding at the end the following new section: ‘‘(A) For fiscal year 1996, such amount means— ‘‘APPROPRIATIONS FOR COMBATING FRAUD AND shall be $130,000,000. ‘‘(A) any contract of health insurance, in- ABUSE ‘‘(B) For fiscal year 1997, such amount cluding any hospital or medical service pol- ‘‘SEC. 1894. (a) DIRECT SPENDING FOR PAY- shall be $181,000,000. icy or certificate, hospital or medical service MENT SAFEGUARD ACTIVITIES.— ‘‘(C) For fiscal year 1998, such amount shall plan contract, or health maintenance organi- ‘‘(1) IN GENERAL.—There are appropriated be $204,000,000. zation group contract, that is provided by a from the Federal Hospital Insurance Trust ‘‘(D) For each subsequent fiscal year, the carrier in a State; or Fund and the Federal Supplementary Medi- amount appropriated for the previous fiscal ‘‘(B) an employee welfare benefit plan or cal Insurance Trust Fund for each fiscal year year, increased by the percentage increase in other arrangement insofar as the plan or ar- such amounts as are necessary to carry out aggregate expenditures under this title for rangement provides health benefits in a the payment safeguard activities described the fiscal year involved over the previous fis- State and is funded in a manner other than in paragraph (2), subject to paragraph (3). cal year. through the purchase of one or more policies ‘‘(2) ACTIVITIES DESCRIBED.—The payment ‘‘(c) ALLOCATION OF PAYMENTS AMONG or contracts described in subparagraph (A). safeguard activities described in this para- TRUST FUNDS.—The appropriations made ‘‘(2) MANAGED CARE PLAN.—The term ‘man- graph are as follows: under subsection (a) and subsection (b) shall aged care plan’ means a health plan that pro- ‘‘(A) Review of activities of providers of be in an allocation as reasonably reflects the vides for items and services covered under services or other individuals and entities fur- proportion of such expenditures associated the plan primarily through providers in the nishing items and services for which pay- with part A and part B.’’. provider network of the plan. ment may be made under this title (includ- ‘‘(3) POINT-OF-SERVICE PLAN.—The term ing skilled nursing facilities and home PART 4—PREEMPTION OF STATE COR- ‘point-of-service plan’ means a health plan health agencies), including medical and uti- PORATE PRACTICE LAWS UNDER MEDI- other than a managed care plan that permits lization review and fraud review. CARE an enrollee to receive benefits through a pro- ‘‘(B) Audit of cost reports. SEC. 15331. PREEMPTION OF STATE LAWS PRO- vider network. ‘‘(C) Determinations as to whether pay- HIBITING CORPORATE PRACTICE OF ‘‘(4) PROVIDER NETWORK.—The term ‘pro- ment should not be, or should not have been, MEDICINE FOR PURPOSES OF MEDI- vider network’ means, with respect to a made under this title by reason of section CARE. health plan, providers who have entered into 1862(b), and recovery of payments that Title XVIII (42 U.S.C. 1395 et seq.) is an agreement with the plan under which should not have been made. amended by adding at the end the following such providers are obligated to provide items ‘‘(D) Education of providers of services, new section: and services covered under the plan to indi- beneficiaries, and other persons with respect ‘‘PERMITTING CORPORATIONS TO SERVE AS viduals enrolled in the plan.’’. to payment integrity and benefit quality as- surance issues. PROVIDERS SEC. 15308. EFFECTIVE DATE. ‘‘(3) AMOUNTS SPECIFIED.—The amount ap- ‘‘SEC. 1893. The Secretary may not refuse The amendments made by this part shall propriated under paragraph (1) for a fiscal to treat any individual or entity as a pro- take effect January 1, 1997. year is as follows: vider of services under this title or refuse to October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10451

make payment under this title to the indi- that a majority of the public members of the (e) ADMINISTRATIVE SUPPORT SERVICES.— vidual or entity on the grounds that the indi- Commission have been appointed. The report Upon the request of the Commission, the Ad- vidual or entity is prohibited from practic- shall contain a detailed statement of the ministrator of General Services shall provide ing medicine under a provision of State or Commission’s findings, together with such to the Commission, on a reimbursable basis, local law which prohibits a corporation from recommendations as the Commission consid- the administrative support services nec- practicing medicine.’’. ers appropriate. essary for the Commission to carry out its PART 5—MEDICARE ANTI-FRAUD AND SEC. 15343. ORGANIZATION AND COMPENSATION. responsibilities under this title. ABUSE COMMISSION (a) ORGANIZATION.— (f) SUBPOENA POWER.— UORUM SEC. 15341. ESTABLISHMENT OF MEDICARE ANTI- (1) Q .—A majority of the members of (1) IN GENERAL.—The Commission may FRAUD AND ABUSE COMMISSION the Commission shall constitute a quorum issue subpoenas requiring the attendance (a) IN GENERAL.—There is established a but a lesser number may hold hearings. and testimony of witnesses and the produc- commission to be known as the ‘‘Medicare (2) CHAIRMAN.—The Commission shall elect tion of any evidence relating to any matter Anti-Fraud and Abuse Commission’’ (in this one of its members to serve as chairman of which the Commission is authorized to in- title referred to as the ‘‘Commission’’). the Commission. vestigate under this title. The attendance of (b) COMPOSITION.—The Commission shall be (3) MEETINGS.—The Commission shall meet witnesses and the production of evidence composed of 8 members as follows: at the call of the chairman or a majority of may be required from any place within the (1) OFFICIALS.— its members. Meetings of the Commission United States at any designated place of (A) The Secretary of Health and Human are open to the public under section 10(a)(10) hearing within the United States. Services (or the Secretary’s designee). of the Federal Advisory Committee Act, ex- (2) FAILURE TO OBEY A SUBPOENA.—If a per- (B) The Inspector General of the Depart- cept that the Commission may conduct son refuses to obey a subpoena issued under ment of Health and Human Services (or the meetings in executive session but only if a paragraph (1), the Commission may apply to Inspector General’s designee). majority of the members of the Commission a United States district court for an order (C) The Administrator of the Health Care (a quorum being present) approve going into requiring that person to appear before the Financing Administration (or the Adminis- executive session. Commission to give testimony, produce evi- (b) COMPENSATION OF MEMBERS.—Members trator’s designee). dence, or both, relating to the matter under of the Commission shall serve without com- (2) PUBLIC MEMBERS.—Five members, ap- investigation. The application may be made pensation, but shall be reimbursed for travel, pointed by the President, of which— within the judicial district where the hear- subsistence, and other necessary expenses in- (A) one shall be a representative of physi- ing is conducted or where that person is curred in the performance of their duties as cians; found, resides, or transacts business. Any members of the Commission. (B) one shall be a representative of hos- failure to obey the order of the court may be pital administrators; SEC. 15344. STAFF OF COMMISSION. punished by the court as civil contempt. (a) IN GENERAL.—The Commission may ap- (C) one shall be a representative of medi- (3) SERVICE OF SUBPOENAS.—The subpoenas point and fix the compensation of a staff di- care carriers; of the Commission shall be served in the rector and such other additional personnel as (D) one shall be a representative of medi- manner provided for subpoenas issued by a may be necessary to enable the Commission care peer review organizations; and United States district court under the Fed- to carry out its functions, without regard to (E) one shall be a representative of medi- eral Rules of Civil Procedure for the United the laws, rules, and regulations governing care beneficiaries. States district courts. appointment and compensation and other (4) SERVICE OF PROCESS.—All process of any In making appointments under this para- conditions of service in the competitive serv- graph of an individual who is a representa- court to which application is to be made ice. under paragraph (2) may be served in the ju- tive of persons or organizations, the Presi- (b) DETAIL OF FEDERAL EMPLOYEES.—Upon dicial district in which the person required dent shall consider the recommendations of request of the chairman, any Federal em- to be served resides or may be found. national organizations that represent such ployee who is subject to such laws, rules, and persons or organizations. The President shall regulations, may be detailed to the Commis- SEC. 15346. TERMINATION. report to Congress, within 90 days after the sion to assist it in carrying out its functions The Commission shall terminate 90 days date of the enactment of this Act, the names under this title, and such detail shall be after the date the report is submitted under of the members appointed under this para- without interruption or loss of civil service section 15342(c). graph. status or privilege. SEC. 15347. AUTHORIZATION OF APPROPRIA- (c) TERMS.—Each member shall be ap- (c) EXPERTS AND CONSULTANTS.—The Com- TIONS. pointed for the life of the Commission. A va- mission may procure temporary and inter- There are authorized to be appropriated to cancy in the Commission shall be filled in mittent services under section 3109(b) of title the Commission such sums as are necessary the manner in which the original appoint- 5, United States Code, but at rates for indi- to carry out its functions, to remain avail- ment was made. viduals not to exceed the daily equivalent of able until expended. SEC. 15342. FUNCTIONS OF COMMISSION. 120 percent of the maximum annual rate of (a) IN GENERAL.—The Commission shall— basic pay payable for GS–15 of the General The CHAIRMAN. The Chair would (1) investigate the nature, magnitude, and Schedule. point out that one opponent is all that cost of health care fraud and abuse in the SEC. 15345. AUTHORITY OF COMMISSION. the rule allows. The gentleman from medicare program, and (a) HEARINGS AND SESSIONS.—The Commis- Texas [Mr. ARCHER] will be recognized (2) identify and develop the most effective sion may, for the purpose of carrying out in opposition. methods of preventing, detecting, and pros- this title, hold hearings, sit and act at times Mr. ARCHER. Mr. Chairman, I ask ecuting or litigating such fraud and abuse, and places, take testimony, and receive evi- unanimous consent to yield half of my with particular emphasis on coordinating dence as the Commission considers appro- time to the gentleman from Virginia public and private prevention, detection, and priate. The Commission may administer enforcement efforts. oaths or affirmations to witnesses appearing [Mr. BLILEY] so that he may control (b) PARTICULARS.—Among other items, the before it. that time. Commission shall examine at least the fol- (b) OBTAINING OFFICIAL DATA.— The CHAIRMAN. Is there objection lowing: (1) IN GENERAL.—The Commission may se- to the request of the gentleman from (1) Mechanisms to provide greater stand- cure directly from any department or agency Texas? ardization of claims administration in order of the United States information necessary There was no objection. to accommodate fraud prevention and detec- to enable it to carry out this title. Upon re- tion. quest of the chairman of the Commission, Mr. GIBBONS. Mr. Chairman, I would (2) Mechanisms to allow more freedom of the head of that department or agency shall ask unanimous consent that I may al- the medicare program to exchange informa- furnish that information to the Commission. locate half of my time to the gen- tion for coordinating case development and (2) ACCESS TO INFORMATION.—Information tleman from Michigan [Mr. DINGELL] so prosecution or litigation efforts, without un- obtained by the Commission is available to that he may control that time. dermining patient and provider privacy pro- the public in the same manner in which in- The CHAIRMAN. Is there objection tections or violating anti-trust laws. formation may be made available under sec- to the request of the gentleman from (3) Criteria for physician referrals to facili- tions 552 and 552a of title 5, United States ties in which they (or family members) have Code. Florida? a financial interest. (c) GIFTS, BEQUESTS, AND DEVISES.—The There was no objection. (4) The availability of resources to the Commission may accept, use, and dispose of The CHAIRMAN. The gentleman medicare program to combat fraud and gifts, bequests, or devises of services or prop- from Florida [Mr. GIBBONS] is recog- abuse. erty for the purpose of aiding or facilitating nized for 15 minutes. (c) REPORT.—After approval by a majority the work of the Commission. Mr. GIBBONS. Mr. Chairman, I yield vote, a quorum being present, the Commis- (d) MAILS.—The Commission may use the sion shall transmit to Congress a report on United States mails in the same manner and myself such time as I may consume. its activities. The report shall be transmit- under the same conditions as other depart- Mr. Chairman, we have completed an ted not later than 18 months after the date ments and agencies of the United States. historic debate, 3 hours on probably H 10452 CONGRESSIONAL RECORD — HOUSE October 19, 1995 the biggest bill that has been consid- For seniors who have limited income, Mr. Chairman, there are clear and ered by this body in my 33 years. Yes- who already have the highest out-of- distinct differences between the Repub- terday, we spent not 3 hours, but 4 pocket costs of any group of Ameri- lican plan that guarantees Medicare’s hours on shrimp. So much for prior- cans, that is a large increase. Our sub- survival and the Democratic sub- ities. So much for Speaker GINGRICH’s stitute does not do that. stitute. While the Republican plan belief about what is important in Mr. Chairman, let me talk for a mo- saves Medicare for the next genera- America. ment to my friends who are part of the tion—the Democrat bill only saves Mr. Chairman, we have a substitute. coalition budget. This substitute is Medicare through the next election. Now I am going to let everybody in on better on deficit reduction, because we While the Republican bill fixes Medi- a secret. It is not going to be adopted. do not believe in the tax cut. If you add care for the long-term without increas- The Republicans knew that when they the revenue lost to the Treasury by the ing co-payments or deductibles, the made it in order. They have all re- tax cut of $245 billion to the $90 billion Democrat substitute is nothing more ceived their marching orders. If they of savings that we have in this bill, we than a band-aid, producing, at best, a vote for this, they get fired. But de- get $335 billion in deficit reduction short-term solution to this gaping spite all of that, this substitute does compared to $270 on the Republican problem. In fact, by the time the baby the work. side. boomers retire, the Democrat alter- Mr. Chairman, I yield 5 minutes to We are $65 billion better off, better native will have left Medicare with a the gentleman from Maryland [Mr. off on deficit reduction, as a result of projected deficit of over $300 billion. CARDIN]. the substitute that is before you. I Conversely, the Republican plan is (Mr. CARDIN asked and was given would encourage my coalition Mem- specific and realistic and gives seniors permission to revise and extend his re- bers to take a look at that particular the right to choose the Medicare plan marks.) point. that best suits their individual health Mr. CARDIN. Mr. Chairman, first and We also provide for reform in our care needs. Seniors will have the right foremost the substitute that is before substitute. We move forward rather to choose a HMO or a medisave account us will deal with the solvency of the than backward on fraud and abuse. We or they have the right to stay where Medicare trust fund. It provides for $90 strengthen, not weaken, fraud and they currently are, with their current billion of savings to go into the Medi- abuse. We do not weaken the standards doctor or hospital. care trust fund providing for solvency for civil penalties that is in the Repub- The Democrat plan, on the other to the year 2006. We have followed the lican bill. We provide additional pro- hand, doesn’t give seniors the right to suggestions of the trustees. It is equivalent to the Republican bill tection, so that we can go after fraud choose—trapping them in the same one in solvency. The Republican bill origi- and abuse. size fits all program. Mr. Chairman, our choice is clear, we nally was advertised that it was going Do not take the Democrats’ word on can either stay with our present bro- to go to the year 2014. They have later it. Do not take the Republicans’ word ken-down 1965 model Medicare system changed it to 2010. If we take away the on it. The inspector general has said, magic wand of taking general funds an independent person, that the Repub- or we can move ahead to a much im- into the trust fund, it is 2006. lican bill threatens the ability to go proved 1995 model. I urge my colleagues Mr. Chairman, our bill is equivalent after fraud and abuse. We move for- to oppose this substitute and support to the Republican bill on solvency for ward, not backward, in providing addi- the Republican Medicare preservation 10 years. Why do we have in the Repub- tional benefits to our seniors. act. lican bill three times more cuts in We provide for colorectal screening Mr. DINGELL. Mr. Chairman, I yield Medicare? It is not needed for the sol- and annual mammography testing. myself 3 minutes. vency. They do not use it for the sol- Why? Because medical technology tells Mr. Chairman, my Republican col- vency. It is used for a tax cut, paid for us that these tests are needed today. If leagues have made it plain they have a by the Medicare beneficiaries. we do not provide these tests, we are low regard for the intellect of the Mr. Chairman, they can use all the moving backward in providing seniors American senior citizens. They accuse language they want about lock-boxes the care that they need. Our bill moves us of frightening the senior citizens and that we have in the tax bill sepa- forward, not backward. Seniors already and also the hospitals. The hard fact is rate ways to pay for the tax bill, but I have too high out-of-pocket costs. that the hospitals and the senior citi- ask my colleagues to answer a simple They need these types of screenings. zens have had the daylights scared out question: If we do not pass this Medi- Mr. Chairman, I say to Members that of them by this Republican plan. care bill, the tax bill cannot go into ef- we have a choice before us. We do not Because the people, contrary to what fect, can it? Because we must have the have to vote for the extreme, mean- might be thought, understand what is savings from this bill in order to fi- spirited Republican approach that going on. My Republican colleagues ex- nance the tax cut. would slash Medicare in order to pay pect seniors to accept an absurd dec- Pure and simple, our seniors are for tax cuts. We have a substitute be- laration that, unless we destroy the being asked to pay for the tax cut. The fore us that provides for the solvency Medicare plan now, it will destroy it- substitute envisions no such thing. As of the Medicare trust fund, provides for self. What is really very simple here is a consequence of these draconian cuts, reform in the Medicare system, pro- this: If you drop the tax cut for the seniors are forced into plans that take tects our seniors, protects the system, rich, none of these Medicare cuts are away their choice. They have to pay and deals with solvency. necessary. more, $1,000 a year, just to maintain Mr. Chairman, I urge Members to Do Democrats want to protect Medi- the same benefits. We have gone support the Democrat substitute. care? Of course. Remember, we created it over united Republican opposition. through that. If seniors have to pay b more for the same benefits, it is a cut. 1530 When I was sitting in the chair 30 years The Democratic substitute does not Mr. ARCHER. Mr. Chairman, I yield 2 ago and we passed that legislation, 93 do that. The Democratic substitute minutes to the gentleman from Califor- percent of my Republican colleagues provides for $90 billion of savings to go nia [Mr. HERGER], a respected member voted against Medicare. into the Medicare trust fund without of the committee. Do we wish to protect trust fund jeopardizing our seniors’ ability to Mr. HERGER. Mr. Chairman, in soundness? Of course. Now, there is a have affordable health care. April, the Medicare trustees stated difference. My Republican colleagues There is no increase, no increase in that if nothing was done, Medicare accomplish that goal by raising senior the premium costs to our beneficiaries. would begin going broke next year, and citizens’ taxes through higher pre- Unlike the Republican bill that become functionally bankrupt by the miums, reducing Social Security changes current law and allows the year 2002. Mr. Chairman, the Repub- checks from which premiums are de- Medicare Part B premium to go up to lican reforms proposed in the Medicare ducted, kicking the seniors out of their $87 a month, the substitute that we are preservation act will preserve, will pro- own doctor’s office, denying them submitting, the premiums would be $30 tect and will strengthen Medicare for choice, shoving them into HMos which a month less, $360 a year less. future generations. senior citizens do not want, closing October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10453 local hospital emergency rooms, re- Specifically, this proposal includes: Only Our bill, theft, embezzlement makes pealing nursing home standards that modest reductions in hospital paymentsÐ it a felony, 10-year prison term, $500,000 protect patients in nursing homes, al- about half of what the Republican bill cutsÐ fine. Their bill, no mention. lowing doctors to perform office tests but protection for rural and urban hospitals Our bill, bribery, graft, 15-year prison in the office sink, and taking away the that serve the uninsured; tough provisions to term, $500,000 fine. Their bill, no men- right of citizens to recover from mal- enhance prevention, detection, and prosecu- tion. practice. tion of fraud and abuse; the nursing home Obstruction of criminal investigation They do this also by eliminating quality standards in current law, which the Re- of health care crime, 5-year prison statutory protections against fraud publicans would repeal. term, $500,000 fine. Their bill, no men- and abuse. The Secretary of HHS, the Also, fair reductions in physician payments tion. Department of Justice and the Inspec- so that the AMA's members share the burden, Democrats talk about our bill going tor General all warned that this is a di- rather than make out like bandits in a back- light on fraud, and it is just plain rect consequence of the language in room holdup; reduced copayments for seniors; wrong. Our bill is tough, much tougher this bill.It is not necessary, as the Re- less than half the Republican cuts in home than theirs. Once again, the Repub- publicans do, to cut the budget of the health care; and new preventive services, in- licans deal with facts. The Democrats’ Inspector General of HHS, who deals cluding more frequent mammography, talk does not withstand scrutiny. with waste, fraud and abuse. We Demo- colorectal screening, pap smears, and diabe- Mr. GIBBONS. Mr. Chairman, I yield crats think there is a better way. The tes services. 1 minute to the gentlewoman from gentleman from Florida, [Mr. GIBBONS], How, you may ask, do we pay for this? The Texas [Ms. JACKSON-LEE]. the gentleman from Washington [Mr. answer is simple: We aren't the ones propos- (Ms. JACKSON-LEE asked and was MCDERMOTT], and I offer this sub- ing a $245 billion tax cut targeted to the rich. given permission to revise and extend stitute to show the way. If you take the tax cut off the table, I say to her remarks.) It ensures the solvency of the Medi- Ms. JACKSON-LEE. Mr. Chairman, I my Republican colleagues, it's really not that care part A trust fund for exactly the thank the gentleman from Florida for difficult. same length of time that the Repub- yielding time to me, and I thank the Mr. Chairman, this substitute is a good one. lican claim for their bill, the year 2006. gentleman from Michigan [Mr. DIN- It is the right approach to the Medicare trust It saves the amount that the trustees GELL]. fund solvency issue. I am pleased to offer it tell us needs to be saved, $90 billion. It I am gratified that we have come with Mr. GIBBONS and Mr. MCDERMOTT. I urge should not and it will not cost the sen- today to be realistic about Medicare. If support for the amendment. iors more. I can briefly talk about the facts, this How do we do it? Simple. We are not Mr. Chairman, before I conclude, I want to captures the Republican plan on Medi- proposing a tax cut for the rich. If we express my thanks, and the thanks of all the care, the locking up of innocent seniors take the tax cut off the table, it is not Democratic members of the Commerce Com- who simply came to protest and oppose that difficult. The substitute is good. I mittee, to the Democratic staff of the commit- $270 billion in cuts. They opposed the urge that we follow this course, that teeÐBridget Taylor, Kay Holcombe, Reid $24 million that Houston-Harris County we accept the leadership of the Demo- Stuntz, Chris Knauer, David Tittsworth, Nick hospitals will lose over a 7-year period. cratic proposal on the solvency issue. I Karamanos, Carla Hultberg, Elaine Sheets, They oppose the increase in premiums. am happy to offer it with my col- Candy Butler, and Sharon Davis. I add our Maybe I need to tell Members a little leagues, the gentleman from Washing- thanks to Karen Nelson from the Staff of Sub- story about Ms. McDougall and a third ton [Mr. MCDERMOTT and the gen- committee ranking member HENRY WAXMAN, grade class. In the class was a group tleman from Florida [Mr. GIBBONS] and and to the staffs of all the Democratic mem- with sweat shirts with R, and in the I urge support of the amendment. bers of the committee. class was a group with sweat shirts Mr. Chairman, the Republicans have made I also want to commend the excellent staff with D. A little round-faced boy looked clear in this debate that they have a very low of the Ways and Means Committee Demo- at the board, and Mrs. McDougall had regard for the intellect of America's senior citi- crats, with whom we worked closely and coop- $270 billion in cuts, increased pre- zens. They expect seniors to accept without eratively on this bill and this substitute. And of miums, losing physicians and some of question their absurd declaration that unless course, I want to thank the legislative coun- our most needed hospitals. She asked we destroy the Medicare program now, it will sels, Ed Grossman and Noah Wofsy, for their the little boy, what does that mean to destroy itself. invaluable help. I say to my Republican colleagues, it's this you? He applauded and said, tax cuts Mr. BLILEY. Mr. Chairman, I yield for the wealthy. Then she turned and simple: Drop your tax cut for the rich, and myself 3 minutes. none of these Medicare cuts will be nec- asked the little round-faced girl with Before we go too much further, I do bright eyes. And she said, it is a loss essary. want to recognize the long days and Do we want to protect Medicare? Of course for all America, but, she said, you nights put in by the staff of both the we do. know what, Mrs. McDougall, we are Do we want to ensure that the trust fund is Committee on Commerce and the Com- going to fix it. sound, today, tomorrow, and for years to mittee on Ways and Means. I would That is what the Democrats are come. Of course we do. like to make note of my troops, Mary going to do. We are going to fix it. Vote The Republicans think that to accomplish McGrane, Howard Cohen, Melody for the substitute and vote down a dis- that goal, they should raise seniors' taxes, re- Harned, Bud Albright, Jon Cohrssen, astrous plan for seniors. duce their Social Security checks, kick them David Lusk, Mike Collins, Eric Bergren Mr. ARCHER. Mr. Chairman, I yield 2 out of their own doctors' offices, shove them and Margaret Daze. We could not have minutes to the gentleman from Penn- into HMO's they don't want, close their local made it this far without them. sylvania [Mr. ENGLISH], a valued mem- hospitals, repeal the nursing home standards Mr. Chairman, my colleagues, includ- ber of the Committee on Ways and that protect them, allow doctors to perform of- ing the ranking Member from Michi- Means. fice tests in the kitchen sink, and then take gan, talk about being tough on fraud, Mr. ENGLISH of Pennsylvania. Mr. away their right to recover when their doctor waste and abuse. Well, I would say to Chairman, Mark Twain once said ‘‘One commits malpractice. the Inspector General or to the Justice of the most striking differences be- We think there is a better way. Department, to HHS, read our bill. Let tween a cat and a lie is that a cat only Mr. GIBBONS, Mr. MCDERMOTT, and I are of- us compare. Our bill allows $250,000 in has nine lives.’’ You have heard and fering this substitute today to show the Amer- criminal fines for individuals and will continue to hear that Republicans ican people that there is a better way. it en- $500,000 for corporations. It outlaws are cutting Medicare to pay for tax sures the solvency of the Medicare part A fraud and provides for fines and prison cuts. Members of this body who oppose trust fund. It does so for exactly the same terms up to life. Their bill sets crimi- saving Medicare have fabricated the length of time the Republicans claim for their nal fines at $50,000 maximum. Our bill, Medicare tax-cut connection because it bill, the year 2006. And it does so by saving false statements makes it a felony, 5- is useful politically. the amount of money that the Medicare Trust- year prison term, up to $500,000 fine. Here are the facts: The tax bill ap- ees tell us needs to be saved: $90 billion. And Their bill, false statements, sets fines proved by the House in April was fi- it won't cost seniors more. at $50,000. nanced on a pay-as-you-go basis. The H 10454 CONGRESSIONAL RECORD — HOUSE October 19, 1995 tax provisions were paid for before the election cycle, we have an alternative The way my colleagues can save this debate on Medicare reform even began. now we can vote for. If we want to fix program is by cracking down on the The savings came from welfare reform, it permanently, structurally, not for fraud, waste, and abuse, but their an- lowering discretionary spending, and just the election but for the generation swer is raise the standards for inves- interest savings. We cut spending as we to follow, if we want to make sure that tigation, make it more difficult, make cut taxes and everyone here knows it. working Americans are not, after this it harder on the seniors by putting all Even so, you will hear that Repub- election, taxed by payroll deduction in- that money into fraud, waste, and licans are cutting Medicare to pay for creases that could double the payroll abuse, and we have nothing to show for tax cuts. tax deduction, if we want to avoid that, it. Even after the Ways and Means Com- then we have offered a plan that pro- Mr. BLILEY. Mr. Chairman, I yield mittee adopted my amendment to es- duces savings for the program and sol- 11⁄2 minutes to the gentleman from tablish a Medicare lock-box—a Medi- vency for the next generation. That is Kentucky [Mr. WHITFIELD]. care Preservation trust fund—to lock the choice. Mr. WHITFIELD. Mr. Chairman, as in savings from the bill into the Medi- Even the blue dog Democrats have of- my colleagues know, the October 16 care Program. The bill now contains fered a third alternative which unfor- issue of the Wall Street Journal re- my language making it illegal to use tunately is not on the floor. They rec- ported that New Yorker Henry Medicare savings for tax cuts. Under ommended $170 billion in savings. Sheinkoph would be a key strategist the English-Whitefield local-box, the President Clinton recommended $192 for President Clinton and the Demo- savings in Medicare will be used only billion in savings. At least we are get- crats in the 1996 election. In this arti- to save Medicare. Most of the Members ting down to it here. cle Mr. Sheinkoph boasts, ‘‘I subscribe on the other side voted for the similar What is the right number in order to to terror. Terror works because it lock-box Mr. CRAPO offered this spring. fix the program temporarily or perma- makes people hate.’’ Scare tactics are They liked it back then. Even so, you nently? also being used by the national Demo- will hear them claim that Republicans We propose a permanent fix. We pro- cratic Party to obstruct our efforts to are cutting Medicare to pay for tax pose fixing the program so it does not save and strengthen the Medicare sys- cuts. go bankrupt, not just for the election tem. Writing in the Washington Post on but for the next generation. The Democratic Party will not tell October 11, Robert Samuelson noted, Mr. DINGELL. Mr. Chairman, I yield us that their part A tax has increased 2 minutes to the distinguished gen- ‘‘To listen to the Democrats, you’d 23 times since the inception of this pro- tleman from Michigan [Mr. STUPAK]. think that every spending cut is needed gram. The part B premium has doubled to provide ‘a tax break for the rich.’ Mr. STUPAK. Mr. Chairman, just a speaker or two ago said that he had a in the last 8 years. Medicare is being cut to help the Four months ago this Congress plan that will cut down on fraud, wealthy; so is Medicaid, the school passed a long-awaited and needed tax waste, and abuse and then read a list of lunch program and welfare. The litany reduction for the American people. fines and costs and fines and costs and is endless. Maybe this makes good While it was not a tax reduction for the rhetoric, but it flunks first-grade arith- fines and costs that he prevails upon people. wealthy, it did provide a tax reduction metic.’’ for working men and women with chil- Mr. Chairman, only one plan saves The problem is, he never gets to the dren. While we do not apologize for Medicare, and keeps the savings from fines and costs because he has raised that tax reduction, we will not allow reform in Medicare. Reject this empty, the legal standard that must be met in savings in the Medicare plan over the placebo Band-Aid substitute, which order to bring any kind of a case next 7 years to be used to pay for our doesn’t even contain our lock-box pro- against someone who is ripping off the tections. system. Having been a police officer for tax reductions. Mr. BLILEY. Mr. Chairman, I yield 2 13 years, you try to conduct an inves- This bill, the Republican bill, in- minutes to the gentleman from Louisi- tigation, you keep putting a hurdle up cludes a lockbox provision which will establish a trust fund. All moneys ana [Mr. TAUZIN]. higher and higher for law enforcement (Mr. TAUZIN asked and was given here to do their job. saved under the plan will be appro- permission to revise and extend his re- priated to the trust fund. Money in the b 1545 marks.) fund can only be used to provide care Mr. TAUZIN. Mr. Chairman, I first But my colleagues’ answer to fraud for the elderly, and cannot be used for want to give you some good news. I and abuse is, ‘‘After you catch them any other purpose. just talked to mom again in her hos- we’ll put more fines and costs.’’ The Republican Medicare plan pro- pital room. She is up on her feet and In the Democratic plans that have vides comprehensive change for a long- doing much better. She apparently ex- been presented, Mr. Chairman, we have term solution. The Democratic plan is erted herself too much to the senior asked our colleagues to look at things a Band-Aid approach that cannot and Olympics last week where she won that do not raise the standard, but will will not provide a long term solution. three medals in the Baton Rouge State make it easier to give law enforcement Mr. ARCHER. Mr. Chairman, I yield 3 competition. The third medal was the tools they need to crack down on minutes to the gentleman from Con- bronze for javelin throwing. So do not fraud, waste, and abuse; things such as necticut [Mr. SHAYS], a member of the mess with mom. She is doing fine. putting civil penalties in the Committee on the Budget who has Let me first of all make it clear that antikickback statute, giving subpoena made a giant contribution over the what we are debating now finally is power, something very simple. We do years toward Medicare reform. their comparison of two alternative not have it under Medicare. Give us Mr. SHAYS. Mr. Chairman, I was plans, which I would hope we would grand jury investigations; that was de- asking some of my colleagues how are have debated all day instead of motives nied. Give us competitive bidding for we doing. They said we are doing well, and intentions and everything else. We durable medical equipment so we are but it is tough when people are just are finally looking at the two alter- not paying $28 for foam rubber mat- throwing charges that are not true, and native plans. And the plan we are ex- tresses that we can buy downtown for it is tough when the charges are not amining now is a plan that simply $19.95 or for the oxygen that will cost true, and they are not true. But it is says, we are going to try to save about $280 under Medicare that only costs easy when we have a bill like this to $90 billion of waste, fraud, abuse, ineffi- $123 for the VA. Let us competitively defend. Republicans, be proud of what ciencies in the Medicare program in bid to cut down on the waste, and our has been done. Be proud of the fact order that it not be bankrupt as op- colleagues said no. There is no provi- that there are no increases in posed to the plan offered that saves as sion against bundling. For every time copayments. Be proud of the fact that much as $270 billion out of waste, there is a medical piece, they add an- there are no increases in deductibles. fraud, abuse, and inefficiencies in the other price to it and put it all together Be proud of the fact that you have not program. Why one not the other? bundled up in one big package so they increased premiums. They will stay at Well, if we only want to Band-Aid the can charge more. That was what we 311⁄2 percent. In fact, be proud of the Medicare Program through the next saw happening in Medicare. fact that in one case we did increase October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10455 premiums for the most wealthy. The woman that wearing of badges is citizens. Medicare needs to be re- most wealthy are going to have to pay against the House rules. formed. Why? Because the trustees said more for Medicare part B. If someone is Mrs. CLAYTON. Mr. Chairman, I will it needed to be reformed to make sure single and making $100,000, they will observe that. there was financial stability. have to pay more for Medicare part B. PARLIAMENTARY INQUIRIES But also, since my colleague raised If someone is married and makes over Mr. THOMAS. Mr. Chairman, I have the concern of the badge I was wearing, $150,000, they will have to pay more for a parliamentary inquiry. let me tell him why I had worn that Medicare part B. We are telling the The CHAIRMAN. The gentleman will badge inadvertently into the House and most affluent that they have a rule to state his parliamentary inquiry. really in error. It was not meant to af- play in this. Mr. THOMAS. Mr. Chairman, are the front the House. But I do want to say Mr. Chairman, their bill lets the wearing of buttons, or sloganeering, or it so my colleague understands: wealthy get all the benefits the poor communicative badges against the ‘‘Shame on you. No to the Republican get. Give me a break. rules of the House? plan.’’ When I look at this bill, I know we The CHAIRMAN. The Chair has stat- Mr. Chairman, I may not be able to have three major goals. We are going ed that on several occasions today. wear that, but I can say it over and to get our financial house in order. We Mr. THOMAS. Mr. Chairman, if over again: are going to do that and balance our someone is wearing that when address- Shame on you, balancing the budget on the budget. We are going to save our trust ing the House, they are violating the most vulnerable people in society. No to any funds. We are going to protect them, rules of the House? plan that is so atrocious it does not indicate and we are going to preserve them, and The CHAIRMAN. The are indeed. what it would do to poor people, senior citi- Mr. THOMAS. Mr. Chairman, if they zens, rural communities, and inner cities, we are going to strengthen them, and and no rule removes that moral obligation we are also going to change this social, have been informed of that, they are, for the shame on your conscience. therefore, willfully violating the rules and corporate, and farming welfare The CHAIRMAN. The Committee will state into an opportunity society. but of the House? The CHAIRMAN. The Chair just re- rise informally in order that the House we are going to save our Medicare trust may receive a message. fund, and how are we going to save it? minds all Members that the rules are In part because of a strong criminal here to maintain a level of comity in f fraud that we have in our bill. the House and it would be proper for all MESSAGE FROM THE PRESIDENT Members to observe the rules. When my colleagues voted against The SPEAKER pro tempore (Mr. the rule, they voted against making Mrs. CLAYTON. Mr. Chairman, let STEARNS) assumed the Chair. crime in health care a Federal offense me make a statement. Did I not say I would be glad to ob- The SPEAKER pro tempore. The because in our rule we make health Chair will receive a message. care fraud a Federal offense. We make serve that? Did the Chair not hear me? it a Federal offense not just in Govern- Did anyone else hear me? I said I will f be glad to observe that rule, so it is not ment programs, but in private pro- MESSAGE FROM THE PRESIDENT grams as well. Theft and embezzle- willful. A message in writing from the Presi- ment, a federal offense. False state- Mr. WILLIAMS. Mr. Chairman, I dent of the United States was commu- ments, a federal offense. Bribe and have a parliamentary inquiry. nicated to the House by Mr. Edwin graft, a Federal offense. Illegal enu- The CHAIRMAN. The gentleman will Thomas, one of his secretaries. merations, Federal offense. Obstruc- state his parliamentary inquiry. Mr. WILLIAMS. Mr. Chairman, The SPEAKER pro tempore The com- tion of justice, a Federal offense. My mittee will resume its sitting. colleagues voted against it when they would wearing a paper bag over one’s voted against the rule. In our bill, con- head violate the same rule of the f trary to what the previous speaker House? The CHAIRMAN. The gentleman MEDICARE PRESERVATION ACT OF said, we have injunctive relief, we have knows the answer to that. Let us move 1995 subpoena power, we have grand jury on. The Committee resumed its sitting. disclosure. It is in our bill. Read it. My Mr. WILLIAMS. No, the gentleman Mr. BLILEY. Mr. Chairman, I yield colleagues and continually distorting would not ask the question if he knew 11⁄2 minutes to the gentleman from the facts, and, when the American peo- the answer. Florida [Mr. STEARNS], a member of ple know what we have done, they are The CHAIRMAN. The Chair’s guess is the committee. going to like it, and when I speak to that the gentleman does know. Mr. STEARNS. Mr. Chairman, to the the American people and my constitu- Mr. WILLIAMS. Mr. Chairman, I am gentleman from Florida [Mr. GIBBONS], ents, they say why would I object to a not asking for a guess. I am asking for my good friend, to the gentleman from plan that does not increase a parliamentary ruling. Would wearing Michigan [Mr. DINGELL], to the minor- copayments, does not increase deduct- a paper bag over one’s head, as has ity leader, the gentleman from Mis- ible, does not increase my premium, al- been done by some of our Republican souri [Mr. GEPHARDT], let me first of lows me to have private care? My col- colleagues in previous Congresses, vio- all say, Your argument about tax cuts leagues are into the old system. They late the same rule of the House? for the rich is clearly false, but let’s are not giving their constituents The CHAIRMAN. The Chair would re- really look at this argument in two choice. We are going what the gen- spond by saying that the Chair was not ways. tleman from Missouri [Mr. GEPHARDT] here at the time, but the Chair’s under- First of all, Mr. Chairman, all the tax did in 1980. He said we should allow standing was that that was ruled a cuts were paid for before we even start- people in Medicare to get into a pri- breach of decorum at the time, and the ed talking about Medicare. Confirmed vate-sector plan. The problem is he is Chair promises the gentleman that, if by CBO, these tax cuts were paid for as 20 years later not in step. he sees anyone with a bag over their follows: welfare reform is $90 billion in Mr. DINGELL. Mr. Chairman, I yield head today, he will ask them to remove savings; FCC spectrum auction is $15 myself 15 seconds to point out that my it. billion; Uranium Enrichment Corpora- good friend’s district would be cut $251 The Chair recognizes the gentle- tion is $2 million; and appropriation re- million between now and the year 2002 woman from North Carolina [Mrs. ductions are $38 billion in savings. My to give to the wealthy a large and CLAYTON]. friends in the House and to all Ameri- unrequested tax cut. Mrs. CLAYTON. Mr. Chairman, I cans, you should realize that they were Mr. Chairman, I yield 1 minute to the have really risen to speak in behalf of paid for—$245 billion—was saved even gentlewoman from North Carolina the amendment, and I do want to say before we even started talking about [Mrs. CLAYTON]. that the Democrats have provided, I saving Medicare. ANNOUNCEMENT BY THE CHAIRMAN think, a reasonable alternative, a rea- So the point is that there is nothing The CHAIRMAN. The Chair will take sonable plan, that addresses saving about this tax cut that is coming from this opportunity to remind the gentle- health care. It also reads for senior Medicare savings or going for the rich. H 10456 CONGRESSIONAL RECORD — HOUSE October 19, 1995 When we are going broke in a program are determined that they will gut, increase. They are increasing it, we are like Medicare and spending less, we today, Medicare, tomorrow Social Se- keeping current law. cannot put the savings into anything. curity, programs which they have al- Mr. BLILEY. Mr. Chairman, I yield 2 That is math 101. There is not more ways opposed and which they oppose minutes to the gentleman from Penn- cash by slowing of the growth in Medi- here today with their new majority. sylvania [Mr. GREENWOOD]. care. There is less debt. Now the trust Mr. ARCHER. Mr. Chairman, I yield 2 Mr. GREENWOOD. Mr. Chairman, I fund will be able to build up a reserve minutes to the gentlewoman from Con- thank the gentleman for yielding time for those future generations. It is like necticut [Mrs. JOHNSON], chairman of to me. reducing the principal on one’s home the Subcommittee on Oversight of the Mr. Chairman, just a little while ago mortgage. It does not mean that you Committee on Ways and Means. I had a young man, a sophomore in have more cash. It means that you pay Mrs. JOHNSON of Connecticut. Mr. high school, down here for a leadership less obligation to the bank. By slowing Chairman, it will not work. You cannot council meeting. He was sitting in my the spending growth, we insure that increase benefits, you cannot tell the office and we were having a little chat. the Medicare trust fund stays solvent. American people you will increase ben- He looked up at the screen and he Solving this growth means the pro- efits, cut premiums, and save Medi- heard one of the Members of the other gram will survive, and, Mr. Chairman, care. Medicare is insolvent next year. party speaking. He said, ‘‘Is that as mentioned before, the lockbox in- It is bankrupt 5 years thereafter. To true?’’ I said, ‘‘No, that is not true. sures any savings from waste, fraud, get up here with a program that says That is a lie.’’ He said, ‘‘Are they al- and abuse goes to the trust fund. ‘‘We are going to do this for you, that lowed to do that?’’ I said, ‘‘They are Mr. GIBBONS. Mr. Chairman, I yield for you, and add benefits, but we are not supposed to, but they do.’’ Half of 1 minute to the gentleman from Michi- going to cut premiums, folks, and we our job today is to try to correct these gan [Mr. LEVIN]. are going to save Medicare,’’ the Amer- misstatements. There have been an (Mr. LEVIN asked and was given per- ican people do not want those kinds of awful lot of statements about this bill, mission to revise and extend his re- answers anymore. weakening the ability to crack down marks.) Let us look at this premium issue. on waste, fraud, and abuse. What do the Republicans do? We say Here are the facts: Our bill creates a b 1600 listen, you seniors out there, you have new criminal statute, outlaws fraud, Mr. LEVIN. Mr. Chairman, the ma- to keep with the level of burden you provides for fines of up to $500,000. jority likes to quote the Trustees. are carrying now. You are carrying 31 Their bill limits the penalty for that They never say this. Here is what they percent, just the part B costs. You offense at $50,000. Our bill says if you say. The majority is asking for $270 bil- keep carrying it. Seniors with $75,000 make a false statement there is a 5- lion in Medicare cuts, almost three retirement incomes are going to carry year prison term, up to a $500,000 fine. times what is necessary to guarantee more. What is this rich-poor business? The substitute limits that fine to the life of the hospital insurance trust Not one word of support for raising pre- $50,000. We make a new crime of theft fund. As this chart shows, our sub- miums on seniors who have a retire- and embezzlement. We make it a felony stitute extends it for the same period ment income of $75,000 or more. that carries a 10-year prison term and as they do. All we say to seniors is to save this a half million dollar fine. The minori- Second, there is a critical fact: With- program, keep doing what you are ty’s substitute makes no mention of out the Medicare cuts there is not the doing, and if you can afford it, do a lit- this crime. money for the tax break, period. tle more if you have over $75,000 in in- The same thing on bribery and graft. Third, they talk about Medicare come. What the Democrats say, we are Our bill, there is a half million dollar fraud and abuse. They should not brag going to cut it to 25 percent. We are fine, 15-year prison term. Nothing over about increasing penalties when their going to give you a break. We are going there. Our bill, obstruction of criminal bill makes it more difficult to convict to give you more benefits and lower investigation of a health care crime, a anybody. We can have life imprison- premiums. Do you know what that prison term, a half million fine, and ment. In their bill, we cannot convict does? That makes people working hard nothing from the other side. Our bill is anybody. day in, day out, earning $30,000, $35,000, the toughest bill in the history of the Fourth, you talk about market-driv- and $40,000 pay more taxes. Medicare Program on waste, fraud, and en forces. Seventy percent of your sav- Six of the last ten years they have abuse. We ought to support it for that ings comes from old-fashioned price increased Medicare taxes. This is a reason, if for no other. controls, 17 percent comes from hitting back-ended, under-the-ground, surrep- Mr. THOMAS. Mr. Chairman, will the seniors. In fact, the gentleman from titious tax increase, because they are gentleman yield? California [Mr. THOMAS] likes to brag going to make the taxpayers pay more Mr. GREENWOOD. I yield to the gen- that he is a radical. I would say to the of the part B costs than they are cur- tleman from California. gentleman, he can have that label. We rently paying, as costs are rising. Mr. THOMAS. Mr. Chairman, the Democrats want reform, not radical The second deceptive aspect of the gentleman should have known the change. plan the Democrats are offering, and it statements that were just made about Mr. DINGELL. Mr. Chairman, I yield is more of the same, they only fix part how sound the Republican program is 1 minute to the distinguished gen- A. Part B is in just as much trouble. were false. They would have been pun- tleman from Montana [Mr. WILLIAMS]. Mr. Chairman, we have to save Medi- ishable under current law under the Mr. WILLIAMS. Mr. Chairman, it is care, not part A of Medicare. should have known rule. We are sound this amendment that has the arith- Mr. GIBBONS. Mr. Chairman, I yield until 2010. They are sound until 2006, I metic that the trustees say will keep 30 seconds to the gentleman from will give them the credit, but the dif- Medicare fiscally solvent. The Repub- Maryland [Mr. CARDIN]. ference is a $300 billion loss in 2010. lican proposal is nothing new for them. Mr. CARDIN. Let me just correct When we are still solvent. For half a century, congressional Re- this, Mr. Chairman. The gentlewoman Mr. GIBBONS. Mr. Chairman, I yield publicans have harbored a subtle but from Connecticut is not accurate when 1 minute to the gentleman from South sinister opposition to Social Security, she says we are cutting premiums. We Carolina [Mr. SPRATT]. and later, to Medicare. are not. We are sticking with current (Mr. SPRATT asked and was given When Social Security was first cre- law. They are changing current law. By permission to revise and extend his re- ated in 1935, 99 percent of the Repub- changing current law, they are increas- marks.) lican Members of Congress voted ing the burdens on our seniors by in- Mr. SPRATT. Mr. Chairman, the Re- against it, and a third of a decade creasing the part B premium. publicans would have us believe that later, in 1965, when Medicare was cre- The Democratic substitute or the Medicare is standing on the brink of ated, 93 percent of Republicans in Con- substitute that we are offering stays bankruptcy. Having told 37 million gress voted against it. with existing law. The dollar amount is beneficiaries whose lives depend on What is different now? Because at currently in law and it goes back to 25 Medicare, having told them that their last they have the majority, and they percent and then goes back to a COLA security is becoming worthless, they October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10457 have the audacity to say the Demo- people simply need to do nothing.’’ The what is this reporter going to do? I just crats are scaring people. Democrats are doing nothing to save heard him use the word ‘‘preserve.’’ I In truth, the Medicare hospital insur- Medicare, and their inaction is a fool’s guess there are only certain words peo- ance trust fund is not standing on the choice. I urge my colleagues to vote for ple can use because there are only obvi- brink of bankruptcy, it is sitting on a a brighter future for this country. Vote ously clues and keys. My belief is, you surplus of $136 billion. That is not my to save Medicare and reject this half- think your program preserves Medi- definition of insolvency. It is true that hearted Democrat substitute. care. We believe our program preserves this year Medicare will be drawing Mr. DINGELL. Mr. Chairman, I yield Medicare. down that surplus, but even in 1999, the such time as he may consume to the b insurance trust fund will have assets of gentleman from Pennsylvania [Mr. 1615 almost $100 billion. That is not my idea FATTAH]. That word is going to be used on this of a crisis. (Mr. FATTAH asked and was given floor back and forth. The difference is, Do we need to reduce the cost of Med- permission to revise and extend his re- how long and under what cir- icare? Sure we do, but the Democratic marks.) cumstances is Medicare preserved, and substitute lowers the cost by $90 billion Mr. FATTAH. Mr. Chairman, I rise in how do you preserve it? Yes, you pre- over 7 years, and that end result—$90 support of the Democratic alternative served it nine times in the last 10 billion of relief to the hospital insur- and oppose the Republican plan. years. Six of those were increases in ance trust fund—is all the Republicans Mr. DINGELL. Mr. Chairman, I yield the payroll tax or lifting the lid on accomplish by $270 billion of savage 2 minutes to the distinguished gen- wages subject to the payroll tax. cuts, because not only do they reduce tleman from California [Mr. WAXMAN]. What you have here is an honest rep- the cost of Part A, but they also reduce Mr. WAXMAN. Mr. Chairman, I want resentation of the difference in the the payroll taxes paid into it by $36 bil- the public that may be watching this plans. I know you do not like it, but it lion. I urge my colleagues to support debate to understand the depth of cyni- is the truth. If you will read the bill, I the Democratic substitute. cism that the Republicans have in pre- said read the bill, the Republican pro- Mr. BLILEY. Mr. Chairman, I yield 3 senting their Medicare proposal. I am gram stays sound through 2010. After minutes to the gentleman from Texas going to put into the RECORD a series of 2010, yes, we have to find some money, [Mr. DELAY], the distinguished whip. key words and phrases given to the Re- but 2010 is when the baby boomers be- Mr. DELAY. Mr. Chairman, for days, publicans to use in this debate. Mem- come eligible for Medicare. Our plan is weeks, even months we have heard the bers may well recognize some words solid. We do not have to look for new rhetoric regarding the future of Medi- like ‘‘save, preserve, protect, proud to money until we fix it for the baby care. We have heard all the scare tac- support.’’ Then when they talk about boomers. tics, we have seen the attack ads, we the Democratic proposal they are sup- The Democrats have said, they are have read the newspapers, but beyond posed to say ‘‘politics as usual, the pol- sound at 2006. I agree, you are sound at the hype, beyond the clouds of misin- itics of the past.’’ Maybe an energetic 2006. What is the difference between formation, some basic facts emerge. reporter will look through these com- 2006 and 2010? $300 billion. That is that First, Medicare is going broke, and it ments today to see how many of these red line. I know that is hard for you to will be broke in 7 years. Second, the Republicans are not cut- phrases were dutifully used by the Re- envision. Red lines, $300 billion in the ting Medicare. publicans for their proposal and hole. At the time you are trying to Third, Democrats do not have a seri- against ours. work with the baby boomer commis- ous alternative that will save Medicare The second level of cynicism, to talk sion, which you have in your bill as for the next generation. about the insolvency of the Medicare well, you are also going to have to find The American people can begin to trust fund, to use that as an excuse for money to fill a $300 billion hole. understand the basic differences in the their package, the Medicare trust fund Mr. Chairman, we do not. Our pro- approaches to saving Medicare between was nine times out of sync, and each gram better preserves and protects the Republicans and the Democrats. time it was, without fanfare and par- Medicare. It strengthens it. We do not Republicans want to reform the whole tisan propaganda, restored. Mr. Chair- go to the well like you do in terms of system. We want to make common- man, this amendment is notable for increasing taxes. We do it through sense changes which will promote what it does not do. What it does not slowing the growth and allowing inno- greater choices, give greater flexibility do, unlike the Gingrich bill, is make vative programs using market-based to seniors, crack down on fraud and the elderly pay larger premiums just to techniques to save the system. That is abuse, and put reasonable limits on keep their Medicare benefits. It does the difference between our approach Medicare growth. not destroy the fee-for-service Medi- and yours. Democrats ignore reform. They lack care system that people are already in, Mr. GIBBONS. Mr. Chairman, I yield the courage to make commonsense and that they like, and it does not offer 1 minute to the gentlewoman from New changes to the system. They would pre- them these phony choices that will be York [Mrs. LOWEY]. fer to keep the current system, which, paid for by savaging the Medicare pro- (Mrs. LOWEY asked and was given if unreformed, will bankrupt this coun- gram fee-for-service. permission to revise and extend her re- try. To me, Mr. Chairman, the Demo- This amendment does not do what marks.) crat alternative is just a joke wrapped the Republicans do, which leaves peo- Mrs. LOWEY. Mr. Chairman, the in fraud and shrouded by farce. They ple unprotected if they are forced out Medicare cuts in the Republican bill save Medicare only enough to save of Medicare into these Medicare-plus will have a devastating impact on the their own political hides. In fact, se- plans for balanced budgets, and doctors quality of care New York seniors re- cretly, Democrats would rather do will charge them extra bills for their ceive. It is very clear that the cuts will nothing than to reform Medicare. services. Unlike the Gingrich bill, it double the premiums, eliminate protec- Mr. Chairman, political cowardice is does not take billions of dollars out of tions against higher medical fees, and no substitute for responsible policy. If Medicare to finance tax cuts, or to fi- make it harder for seniors to see their we do nothing to save Medicare, the nance deficit reduction. This substitute own doctor. For seniors living on fixed country faces a stark choice: Either we preserves Medicare without doing all incomes, this Republican plan will forget about ever achieving fiscal re- these onerous things, and for that rea- mean real hardship. sponsibility, or the government will be son, Mr. Chairman, we ought to sup- The Republican Members know that, forced to rapidly raise payroll taxes port it. and that is why Speaker GINGRICH has and income taxes. As we all know, even Mr. ARCHER. Mr. Chairman, I yield 2 been making back-room deals to win President Clinton now suffers from tax- minutes to the gentleman from Califor- votes. Unfortunately, when NEWT GING- er’s remorse over his last huge tax in- nia [Mr. THOMAS], chairman of the Sub- RICH plays ‘‘Let’s Make a Deal,’’ Amer- crease, so clearly, raising taxes is not a committee on Health of the Committee ica’s seniors lose. Frankly, all this serious alternative. on Ways and Means. deal-making is absolutely shameful. Mr. Chairman, as Edmund Burke Mr. THOMAS. Mr. Chairman, I would Let me just ask our Republican col- once said, ‘‘For evil to succeed, good ask the gentleman from California, leagues, if this is such a great bill, if it H 10458 CONGRESSIONAL RECORD — HOUSE October 19, 1995 is so good for seniors, why all the Mr. Chairman, I ask my Republican Mr. Chairman, I just received a copy deals? You do not have to make deals colleagues, what are your values? What of Congress Daily, and I want to call it to get votes for good bills, just bad do you stand for? Why are you here? Do to the particular attention of my dear ones. you believe in the future of this coun- friend, the gentleman from Virginia Mr. DINGELL. Mr. Chairman, I yield try, or do you want to play games with [Mr. BLILEY]. Under the subject 1 minute to the distinguished gentle- senior citizens, those people that sup- ‘‘Health’’, it reads ‘‘Bliley Hints At woman from Oregon [Ms. FURSE]. ported you in the prime of your life? Compromise On $270 Billion Medicare Ms. FURSE. Mr. Chairman, it is very Mr. DINGELL. Mr. Chairman, I yield Savings.’’ simple. If we need to save $90 billion, 1 minute to the distinguished gen- ‘‘Even as President Clinton suggested do it. We can do it with the Democratic tleman from New Jersey [Mr. he might be willing to meet Republican bill. The only difference is, the Demo- PALLONE]. demands that the budget be balanced cratic bill puts the savings in the trust Mr. PALLONE. Mr. Chairman, I want over 7 years rather than 10, a key fund, not into wealthy people’s pock- to urge my colleagues to get behind House Republican today hinted the ets. It does not cost seniors more, it this very rational Democratic sub- GOP might be willing to compromise protects the trust fund. stitute that cures the problems that on the previously inflexible $270 billion I believe that we can cure the Medi- will be created by the Republican Med- savings target for Medicare.’’ care system, but let us use a scalpel, icare plan. We will be saving Medicare It looks like my Republican col- not a meat ax. Let us vote for the with this $90 billion that the trustees leagues are being asked to walk the Democratic alternative. say that is all that is necessary. plank. I think that is a fine idea. But Mr. GIBBONS. Mr. Chairman, I yield We do not need the tax cut for the my friends over there should be told 3 minutes to the gentleman from Cali- wealthy. We will be eliminating the what they are facing and that maybe a fornia [Mr. MATSUI], a very fine mem- dramatic increases in the Part B pre- compromise is in the offing. ber of our Committee on Ways and mium, and there will be no forced Mr. BLILEY. Mr. Chairman, I yield Means. choices for seniors under this. They do myself 1 minute. Mr. MATSUI. Mr. Chairman, I thank not have to go into HMOs, they can Mr. Chairman, I thank the gentleman the gentleman from Florida [Mr. GIB- still choose their own doctors. from Michigan for his remarks, and I BONS] for yielding time to me. Even more important, it does not meant it sincerely. If the President Mr. Chairman, I have to say that this hurt the quality of health care. Hos- comes forward with a plan that saves notion that the bill, if in fact, it passes pitals will not have to close or cut Medicare until 2010, I am willing to does not pay for tax cuts is nonsense. back considerably. Payments to hos- look at it. I am certainly willing to sit What the Republicans plan to do, if pitals are reduced by less than one-half down and negotiate with him. There is this bill passes today, is to bring it the amount in the Republican bill. nothing wrong with that. I just wish he back and put it on the reconciliation Lastly, and just as important, this sub- would stop standing on the curb and bill, and that way, they will be able to stitute deals with prevention. throwing bricks and come to the table use the $270 billion in savings on Medi- If we can have more preventive care, and negotiate. That is all I ask for. care to pay for the $245 billion in tax which is provided in this substitute, we Mr. Chairman, with that, I yield the cuts. If, in fact, this Medicare bill goes can save a lot of money and seniors balance of my time to the gentleman down today, they will not be able to do will not have to be hospitalized, they from Pennsylvania [Mr. GREENWOOD]. the $245 billion tax cut, because they will not have to be institutionalized. Mr. GREENWOOD. Mr. Chairman, I will not be able to put it on reconcili- Mr. Chairman, I urge support for the thank the gentleman for yielding me ation. So it is obvious what is really Democratic substitute. this time. going on. Mr. DINGELL. Mr. Chairman, I yield Mr. Chairman, as has been so often I might also further point out what 1 minute to the gentlewoman from the case in this long day’s debate, Re- this debate is really all about. Every- California [Ms. PELOSI]. publicans have to come to the podium body says, well, this is really just slow- Ms. PELOSI. Mr. Chairman, in listen- time and time again to correct some of ing the growth of Medicare on the Re- ing to the debate I must ask our Re- the misapprehensions left by the other publican side. That is right. It is slow- publican colleagues, who are you try- party. ing the growth of Medicare. In the year ing to convince? In listening to the de- My good friend, the gentleman from 2002, just 6 years, 7 years from now, the fense of your Medicare cuts, methinks California talked about what a terrible average Medicare recipient will have thou doth protest too much. But it is thing it was that even though we keep $6,500 spent on them per year. Per cap- understandable, when it must be a bit- the part B premium at 31.5 percent, it ita, $6,500. ter pill to swallow to cut senior citi- goes up a little bit in dollars. It goes up Mr. Chairman, they do not tell you zens’ benefits, increase their premiums a little bit in dollars. Well, I think the the growth in the private sector. The to give a tax break to the wealthiest gentleman needs to be reminded of private sector growth will go up to Americans. Indeed, as the Speaker something. $7,600, a gap of $1,100. So I and anybody calls the tax cut, the crown jewel of During the 30 years that the Demo- 30, 40, 50 years old in the work force the contract. cratic Party presided over Medicare, will get $7,600, but if you are 60, 70, 80, America’s senior citizens and dis- the part B premium increased 1,500 per- 90 years old, you are going to get $1,000 abled people depend on Medicare for cent. It started out at $3. As the Demo- less. their health and security. The choice cratic Party allowed the cost of this Why do we have Medicare in the first before the House today is between the program to inflate and to inflate out of place? Medicare was passed in 1964 be- Republican plan, which would threaten control, it has been they who have cause seniors were not in the work- their security, and the Democratic caused the part B premium to increase. place, because seniors could not have plan, which would protect health and Another statement that I think access to private health insurance. As security for America’s seniors. needs to be made for the record: Re- a result of that, they were left unin- In summary, the Republican bill cuts peatedly today the Democratic Party sured. We had a 25 percent poverty rate $180 billion more than what is needed has tried to have it both ways. We are in senior citizens in 1964. It is down to to make the trust fund solvent, inflicts not paying doctors enough, they say. 11 percent now and we should be very excessive new premiums on bene- We are not paying doctors high enough proud of that. ficiaries, forces low-income seniors fees, we will drive them out of fee-for- What we are going to do is we are into managed care, repeals important service and into managed care, and going to bankrupt the senior citizens of Federal nursing home standards, deci- then 2 seconds later they turn around America. That poverty rate is going to mates the safety net in teaching hos- and say, we have made some sort of a go up. We are going to be doing major pitals, and weaken protections. deal with the doctors to pay them too damage to the senior citizens of this Mr. Chairman, I urge my colleagues much. country, and I think, as the minority to support the Democratic alternative The fact of the matter is that the leader said, this is really an issue of Mr. DINGELL. Mr. Chairman, I yield substitute before us treats physician values. myself three-quarters of a minute. fees almost precisely the way our bill October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10459 does. Physicians will make lower fees The CHAIRMAN. The Chair would Bachus Duncan Kennelly Baesler Dunn Kildee under the Republican bill than they like to inquire from the gentleman Baker (CA) Durbin Kim would have otherwise, and that is con- from Florida and the gentleman from Baker (LA) Edwards King sistent with what the Democrats have Michigan who seeks to use your last Baldacci Ehlers Kingston been trying to do. time? Ballenger Ehrlich Kleczka Barcia Emerson Klink Another inconsistency on fraud and Mr. GIBBONS. Mr. Chairman, I am Barr Engel Klug abuse. Our plan makes false statements down to my last speaker, the gen- Barrett (NE) English Knollenberg in health care a felony. The Demo- tleman from Michigan [Mr. BONIOR]. I Barrett (WI) Ensign Kolbe cratic substitute leaves it as a mis- am going to yield him all my time. Bartlett Eshoo LaFalce Barton Evans LaHood demeanor, just like a speeding ticket. Mr. DINGELL. Mr. Chairman, we Bass Everett Lantos After listening to the Democratic de- have one last speaker that I share with Bateman Ewing Largent bate today, I understand why they do the distinguished gentleman from Flor- Becerra Farr Latham not want to increase this penalty. ida and that would be to close. Beilenson Fattah LaTourette Bentsen Fawell Laughlin Mr. Chairman, this is a short-term The CHAIRMAN. That would be the Bereuter Fazio Lazio game for the minority party, because appropriate time to do that and that Bevill Fields (TX) Leach Bilbray Filner Levin the fact of the matter is that within a would give him 31⁄2 minutes to close. few short months the Republican lead- Bilirakis Flake Lewis (CA) The gentleman from Texas has 4 min- Bishop Flanagan Lewis (GA) ership in the Congress and the Presi- utes remaining. Bliley Foglietta Lewis (KY) dent of the United States will resolve Mr. DINGELL. Mr. Chairman, I be- Blute Foley Lightfoot this issue through negotiations, and I lieve that since we are offering the Boehlert Forbes Lincoln Boehner Ford Linder guarantee you that the negotiated amendment which is set forth in the Bonilla Fowler Lipinski product will look very much like the rule, that the right to close is on this Bonior Fox Livingston bill that we have presented to the side. That would leave my colleagues Bono Franks (CT) LoBiondo House today. on the other side to deal with that. Borski Franks (NJ) Lofgren Boucher Frelinghuysen Longley When that bill is signed, it will go The CHAIRMAN. The gentleman Brewster Frisa Lowey into effect, and very early next year from Texas has the right to close as Browder Funderburk Lucas the senior citizens of America will live the floor manager of the base bill. Brown (CA) Furse Luther under this proposal, this reform that Brown (FL) Gallegly Maloney Mr. DINGELL. Am I correct, Mr. Brown (OH) Ganske Manton we have brought to the floor, and they Chairman, that we get to close on this Brownback Gejdenson Manzullo will love it and they will thank us for side? Bryant (TN) Gephardt Markey it, and I think they will reelect us for The CHAIRMAN. You can close on Bryant (TX) Geren Martinez it as well. Bunn Gibbons Martini your side right now, and it will be fol- Bunning Gilchrest Mascara Mr. Chairman, I yield 30 seconds to lowed by the gentleman from Texas. Burr Gillmor Matsui the gentleman from Wisconsin [Mr. PARLIAMENTARY INQUIRY Burton Gilman McCarthy KLECZKA]. Buyer Gonzalez McCollum Mr. DINGELL. Mr. Chairman, I have Mr. KLECZKA. Mr. Chairman, I have Callahan Goodlatte McDade a parliamentary inquiry. Calvert Goodling McDermott just heard through the grapevine here The CHAIRMAN. The gentleman will Camp Gordon McHale that there is a meeting going on with Canady Goss McHugh state it. NEWT GINGRICH and Governor Wittman Cardin Graham McInnis Mr. DINGELL. Is it not in the rules from New Jersey and a side deal is Castle Green McIntosh that where the offeror of the amend- Chabot Greenwood McKeon being cut for the New Jersey Delega- ment is designated in the rule that it is Chambliss Gunderson McKinney tion. However, prior to that old rumor, Chenoweth Gutierrez McNulty the right of that individual to close? the old rumor was that the Repub- Christensen Gutknecht Meehan The CHAIRMAN. The Chair is in- Chrysler Hall (OH) Meek licans from New Jersey were voting formed by the Parliamentarian that it Clay Hall (TX) Menendez against the plan, so we will see wheth- is the manager of the bill who has the Clayton Hamilton Metcalf er or not this compromise works. Clement Hancock Meyers right to close. Mr. Chairman, if in fact my Repub- Clinger Hansen Mfume Clyburn Harman Mica lican friends think it is a cut, why are Mr. DINGELL. I am sure that is true in the case of the debate on the bill. I Coble Hastert Miller (CA) the New Jersey Republicans voting Coburn Hastings (FL) Miller (FL) against it because their hospitals, they note that this is not debate on the bill. Coleman Hastings (WA) Minge This is the debate on the amendment. Collins (GA) Hayes Mink contend, are cut too much? Something Collins (IL) Hayworth Moakley is inconsistent here. Maybe they I would note as a further parliamen- tary inquiry that the gentleman from Collins (MI) Hefley Molinari should take the floor and explain their Combest Hefner Mollohan stand. Florida [Mr. GIBBONS] and I are essen- Condit Heineman Montgomery tially the managers of the bill as the Conyers Herger Moorhead b 1630 managers of the amendment. Cooley Hilleary Moran Costello Hilliard Morella Mr. DINGELL. Mr. Chairman, I yield The CHAIRMAN. The Chair is in- Cox Hinchey Murtha 1 minute to the distinguished gentle- formed that when the committee chair- Coyne Hobson Myers man is defending the committee posi- Cramer Hoekstra Myrick woman from Michigan [Ms. RIVERS]. Crane Hoke Nadler Ms. RIVERS. Mr. Chairman, I am a tion, the committee chairman has the Crapo Holden Neal mom. I have got two kids, and I under- right to close on an amendment. Cremeans Horn Nethercutt stand how handling money goes on. My Mr. DINGELL. Mr. Chairman, I think Cubin Hostettler Neumann this is a novel ruling, but I will not Cunningham Houghton Ney older daughter says to me, ‘‘Can I bor- Danner Hunter Norwood row a dollar?’’ I say, ‘‘You can borrow challenge it. Davis Hutchinson Nussle a dollar, but you can’t spend it on Mr. Chairman, I make a point of de la Garza Hyde Oberstar order that a quorum is not present. Deal Inglis Obey candy.’’ She says, ‘‘I won’t.’’ Two hours DeFazio Istook Olver later I come back, and there are candy The CHAIRMAN. Evidently a quorum DeLauro Jackson-Lee Ortiz wrappers everywhere. I say, ‘‘I told you is not present. DeLay Jacobs Orton not to spend it on candy.’’ She said, ‘‘I Members will record their presence Dellums Jefferson Owens Deutsch Johnson (CT) Oxley didn’t. I used another dollar I had.’’ I by electronic device. Diaz-Balart Johnson (SD) Packard said, ‘‘Well, that was your lunch The call was taken by electronic de- Dickey Johnson, E.B. Pallone money.’’ She said, ‘‘I know, I used your vice. Dicks Johnson, Sam Parker The following Members responded to Dingell Johnston Pastor dollar for lunch money.’’ Dixon Jones Paxon Well, everybody knows what hap- their names: Doggett Kanjorski Payne (NJ) pened; everybody knows what you are [Roll No 728] Dooley Kaptur Payne (VA) trying to do; and, seniors of America, Doolittle Kasich Pelosi ANSWERED ‘‘PRESENT’’—419 Dornan Kelly Peterson (FL) the majority is trying to spend your Abercrombie Allard Archer Doyle Kennedy (MA) Peterson (MN) money on candy. Do not let them. Ackerman Andrews Armey Dreier Kennedy (RI) Petri H 10460 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Pickett Schumer Thurman The CHAIRMAN. The gentleman seniors of America. The same Repub- Pombo Scott Tiahrt from Texas [Mr. ARCHER] is still the licans who cut the backroom deals Pomeroy Seastrand Torkildsen Porter Sensenbrenner Torres manager of the bill under the terms of with the AMA, who promoted savings Portman Serrano Torricelli the rule. accounts that would benefit only the Poshard Shadegg Towns Mr. DINGELL. Mr. Chairman, further wealthy insurance companies, now Pryce Shaw Traficant parliamentary inquiry. I note H.R. want us to trust them to save Medi- Quillen Shays Upton Quinn Shuster Velazquez 2485, in its current form, is not re- care. Radanovich Sisisky Vento ported from either the Committee on It seems like my colleagues on the Rahall Skaggs Visclosky Commerce or the Committee on Ways Republican side of the aisle hope that Ramstad Skeen Volkmer and Means, and the amendment which we forget history. For 30 years, the Re- Rangel Skelton Vucanovich Reed Slaughter Waldholtz is offered by the gentleman from Flor- publican Party has not lifted a finger Regula Smith (MI) Walker ida [Mr. GIBBONS], and it is offered by to save Medicare, and for 30 years they Richardson Smith (NJ) Walsh Riggs Smith (TX) authority of the Committee on Rules. have waited for this moment to dis- Wamp Rivers Smith (WA) We are, therefore, the managers of that mantle the system, and we are not Ward Roberts Solomon Waters particular amendment and not my going to let them turn back the clock Roemer Souder Watt (NC) good friends on the Republican side of now. Rogers Spence Rohrabacher Spratt Watts (OK) the aisle. The Gibbons-Dingell-McDermott sub- Ros-Lehtinen Stark Waxman The CHAIRMAN. The base bill is still stitute proves you do not need $270 bil- Weldon (FL) Rose Stearns the bill that came through the two lion to shore up the Medicare system Roth Stenholm Weldon (PA) Roukema Stockman Weller committees and was joined in the Com- until the year 2,000, and it proves that Roybal-Allard Stokes White mittee on Rules, the Chair is informed you can do it without increasing pre- Royce Studds Whitfield by the Parliamentarian. The gen- miums, without forcing seniors into Wicker Rush Stump tleman from Texas [Mr. ARCHER] is HMO’s, without limiting the choice of Sabo Talent Wilson Salmon Tanner Wise still the manager of the base text. doctors, and without the massive tax Sanders Tate Wolf Mr. DINGELL. Mr. Chairman, I yield breaks for the wealthy. Sanford Tauzin Woolsey the balance of my time to the gen- We may be nearing the end of this de- Sawyer Taylor (MS) Wyden ONIOR Saxton Taylor (NC) Wynn tleman from Michigan [Mr. B ], bate on the floor today, and we just Scarborough Thomas Yates the distinguished minority whip. had a little skirmish here about who is Schaefer Thompson Young (FL) Mr. GIBBONS. Mr. Chairman, I yield going to close, but the debate in this Schiff Thornberry Zeliff the balance of my time to the gen- country is just beginning. It is not Schroeder Thornton Zimmer tleman from Michigan [Mr. BONIOR]. closing, and it will continue around the NOT VOTING—13 The CHAIRMAN. The gentleman kitchen tables of every home in Amer- Berman Gekas Tucker from Michigan [Mr. BONIOR] will be rec- ica where sons and daughters will Chapman Hoyer Williams ognized for 31⁄2 minutes. scrimp and save to care for their par- Fields (LA) McCrery Young (AK) Mr. BONIOR. Mr. Chairman, indeed Frank (MA) Stupak ents, and there will come a day when Frost Tejeda this is a historic debate, a historic they face the tough choices between vote. educating their kids and paying their b 1653 Supporters of this plan that we will parents’ medical bills, and they are The CHAIRMAN. With 419 Members be voting on on final passage say that going to ask, ‘‘Why, did you vote, why having answered to their names, a this will be a courageous vote, that did you vote for tax breaks for people quorum is present, and the committee somehow they are doing something on who did not even need them, instead of will resume its business. this floor that they will be proud of. helping us?’’ But there is nothing courageous about PARLIAMENTARY INQUIRY I urge my colleagues, Mr. Chairman, cutting Medicare to pay for tax breaks say ‘‘no’’ to these tax breaks. Say Mr. DINGELL. Mr. Chairman, I have for the wealthy, and there is no pride a further parliamentary inquiry. ‘‘yes’’ to this substitute and say ‘‘yes’’ in asking our senior citizens to pay to Medicare. The CHAIRMAN. The gentleman will more and get less so the wealthiest state his parliamentary inquiry. Americans can have it all. b 1700 Mr. DINGELL. Mr. Chairman, as I re- But there is one thing supporters of Mr. ARCHER. Mr. Chairman, I yield call the ruling of the Chair, it was that this bill are right about. This is a his- myself the balance of my time. if the committee has a position on the toric vote. With this vote, we turn The CHAIRMAN. The gentleman amendment, it is the right of the com- back 30 years of progress, 30 years of from Texas is recognized for 4 minutes. mittee to conclude the debate on that trust, 30 years of hope that our parents Mr. ARCHER. Mr. Chairman, for a point. Is that correct? and grandparents will always have the moment I must once again expose what The CHAIRMAN. The ruling was that health care that they need. many Democrats have repeated over the manager of the bill has the closing, Mr. Chairman, the seniors who stand and over today, that medical care sav- and that is how the Chair is instructed with us against this plan do not have ings will be used for tax cuts. They by the Parliamentarian. much money. They do not have expen- know it is not true. As the Washington Mr. DINGELL. Mr. Chairman, is it sive homes or fancy cars. But when Post said, it is medagoguery, political possible for the Chair to inform us Medicare premiums go up, these are medagoguery. what is the committee position? I the people who are going to have to They know that savings in the Medi- would note that the committee has choose between buying food and buying care Trust Fund, under law, cannot be taken no action on this particular pro- medicine. They do not want to be a spent for anything other than health posal. burden on their kids, and they do not care benefits for our seniors. They If I read the rule correctly, the want a handout. know that. They know that in this bill amendment is offered by authority of If these cuts go through, you are itself there is lockbox language that the Committee on Rules, which has going to take away the one thing, the prevents the use of these funds for any- empowered the gentleman from Florida one thing that they thought they thing other than paying medical bills. [Mr. GIBBONS] and I to offer this par- would never lose. You are going to take And, yes, finally, they know that in the ticular amendment. The amendment away their dignity, and that is unfor- budget reconciliation language, which was never considered in the Committee givable. will be before us next week, that Medi- on Commerce or in the Committee on Now, today, the same people who care has been taken completely out of Ways and Means. That being so, Mr. kept their plan hidden for 9 months, pay-go under all of the budget consid- Chairman, if the Chair could help us who refused to allow more than 1 day erations. greatly by informing us what is the po- of hearings, who actually had seniors This is truly nothing but an effort to sition of the committee so we can un- arrested when they tried to speak out, gain political advantage. They keep derstand if it qualifies under the are accusing us of trying to scare sen- saying it because they hope that they Chair’s prior ruling? ior citizens. That is an insult to the will divert Americans from the real October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10461 Medicare problems. Yes, the political Berman Hall (OH) Nadler LaTourette Peterson (MN) Solomon response, I say to my colleagues, would Bishop Hall (TX) Neal Laughlin Petri Souder Bonior Hamilton Oberstar Lazio Pickett Spence be to sidestep this issue. We have seen Borski Harman Obey Leach Pombo Stearns that happen over and over again in pre- Brown (CA) Hastings (FL) Olver Lewis (CA) Porter Stenholm vious Congresses. But our new major- Brown (FL) Hefner Ortiz Lewis (KY) Portman Stockman Lightfoot Pryce ity will not be typical Washington poli- Cardin Hinchey Owens Stump Clay Holden Pallone Linder Quillen Stupak Livingston Quinn ticians. Throughout the debate, many Clayton Hoyer Payne (NJ) Talent LoBiondo Radanovich Democrats spoke only of the past. We Clement Jackson-Lee Payne (VA) Tanner Clyburn Jacobs Longley Rahall will make the tough decisions and Pelosi Tate Collins (IL) Jefferson Lucas Ramstad Peterson (FL) Tauzin speak to the future. Collins (MI) Johnson (SD) Manzullo Regula Pomeroy Taylor (MS) Our plan is a serious solution to a Conyers Johnson, E. B. Poshard Martini Riggs Costello Johnston Mascara Roberts Taylor (NC) very real Medicare crisis. Their plan is Rangel Thomas Coyne Kaptur Reed McCollum Roemer politics of the past, temporary fixes McCrery Rogers Thompson Danner Kennedy (MA) Richardson McDade Rohrabacher Thornberry and Band-aids. Our plan is a long-term de la Garza Kennelly Rivers McHugh Ros-Lehtinen Thurman solution, a vision, hopes and dreams for DeLauro Kleczka Rose Dellums LaFalce McInnis Roth Tiahrt all Americans. Their plan bankrupts Roybal-Allard Dicks Lantos McIntosh Roukema Torkildsen Sabo Medicare well before the baby boomers Dingell Levin McKeon Royce Torres Sawyer Dixon Lewis (GA) Metcalf Rush Upton retire. Our plan saves Medicare Schroeder Doggett Lincoln Meyers Salmon Visclosky through the eve of baby-boomer retire- Schumer Dooley Lipinski Mica Sanders Volkmer ment. Scott Doyle Lofgren Miller (FL) Sanford Vucanovich Skaggs The latest actuary estimate that has Durbin Lowey Minge Saxton Waldholtz Spratt Edwards Luther Mink Scarborough Walker just been given to us, delayed because Stark Engel Maloney Molinari Schaefer Walsh of the unavailability of the specific Stokes Eshoo Manton Mollohan Schiff Wamp language of the substitute, is that Studds Moorhead Seastrand Evans Markey Waters Tejeda Morella Sensenbrenner their plan saves Medicare through the Farr Martinez Watts (OK) Thornton Myers Serrano year 2005, and our plan saves Medicare Fattah Matsui Weldon (FL) Fazio McCarthy Torricelli Myrick Shadegg Weldon (PA) through the year 2011. Six years longer. Fields (LA) McDermott Towns Nethercutt Shaw Weller When this bill passes in a few min- Flake McHale Traficant Neumann Shays White utes, Republicans will differ from poli- Foglietta McKinney Velazquez Ney Shuster Ford McNulty Vento Norwood Sisisky Whitfield ticians who came before us, because we Frank (MA) Meehan Ward Nussle Skeen Wicker will have kept our word. Frost Meek Watt (NC) Orton Skelton Wolf Mr. Chairman, I am proud of this bill. Furse Menendez Waxman Oxley Slaughter Wyden Young (AK) It has been called the Gingrich bill, but Gejdenson Mfume Williams Packard Smith (MI) Gibbons Miller (CA) Wilson Parker Smith (NJ) Young (FL) it is the product of the effort of many Gonzalez Moakley Wise Pastor Smith (TX) Zeliff of us in this body. And, yes, he deserves Gordon Montgomery Woolsey Paxon Smith (WA) Zimmer Green Moran Wynn credit for it. NOT VOTING—1 We said that we would save Medicare. Gutierrez Murtha Yates Tucker Today, we will. We said we would pre- NOES—283 serve Medicare. Today, we will. We said Allard Coleman Gillmor b 1725 we would protect Medicare. Today, we Archer Collins (GA) Gilman Mrs. SLAUGHTER and Messrs. will. Armey Combest Gingrich SERRANO, WYDEN, MINGE, and America is truly in a new world of re- Bachus Condit Goodlatte Baesler Cooley Goodling VOLKMER changed their vote from sponsibility on Capitol Hill; respon- Baker (CA) Cox Goss ‘‘aye’’ to ‘‘no.’’ sibility to seniors who have worked Baker (LA) Cramer Graham hard all their lives and deserve to know Ballenger Crane Greenwood Mr. RUSH changed his vote from Barr Crapo Gunderson that their health care benefits will be ‘‘present’’ to ‘‘no.’’ Barrett (NE) Cremeans Gutknecht So the amendment in the nature of a there for them; responsibility to mid- Bartlett Cubin Hancock dle age Americans who today are work- Barton Cunningham Hansen substitute was rejected. ing with the expectation that the bene- Bass Davis Hastert The result of the vote was announced Bateman Deal Hastings (WA) as above recorded. fits will be for them; and, yes, to our Bereuter DeFazio Hayes children and to their children, to show Bevill DeLay Hayworth The CHAIRMAN. Under the rule, the them that we will make the tough deci- Bilbray Deutsch Hefley Committee rises. Bilirakis Diaz-Balart Heineman sions in concern for them, and not Bliley Dickey Herger Accordingly the Committee rose; and leave it to them to simply have to pay Blute Doolittle Hilleary the Speaker pro tempore (Mr. LAHOOD) higher taxes. Boehlert Dornan Hilliard having assumed the chair, Mr. LINDER, Boehner Dreier Hobson Chairman of the Committee of the Mr. Chairman, I urge a ‘‘no’’ vote on Bonilla Duncan Hoekstra the substitute and an ‘‘aye’’ vote on Bono Dunn Hoke Whole House on the State of the Union, the bill. Boucher Ehlers Horn reported that that Committee, having The CHAIRMAN. The question is on Brewster Ehrlich Hostettler had under consideration the bill (H.R. Browder Emerson Houghton the amendment in the nature of a sub- Brown (OH) English Hunter 2425) to amend title XVIII of the Social stitute offered by the gentleman from Brownback Ensign Hutchinson Security Act to preserve and reform Florida [Mr. GIBBONS]. Bryant (TN) Everett Hyde the Medicare Program, pursuant to Bryant (TX) Ewing Inglis House Resolution 238, he reported the The question was taken; and the Bunn Fawell Istook Chairman announced that the noes ap- Bunning Fields (TX) Johnson (CT) bill back to the House with an amend- peared to have it. Burr Filner Johnson, Sam ment adopted by the Committee of the Burton Flanagan Jones Whole. RECORDED VOTE Buyer Foley Kanjorski Mr. GIBBONS. Mr. Chairman, I de- Callahan Forbes Kasich The SPEAKER pro tempore. Under mand a recorded vote. Calvert Fowler Kelly the rule, the previous question is or- Camp Fox Kennedy (RI) dered. A recorded vote was ordered. Canady Franks (CT) Kildee The vote was taken by electronic de- Castle Franks (NJ) Kim The question is on the committee vice, and there were—ayes 149, noes 283, Chabot Frelinghuysen King amendment in the nature of a sub- Chambliss Frisa Kingston stitute. not voting 1, as follows: Chapman Funderburk Klink [Roll No. 729] Chenoweth Gallegly Klug The committee amendment in the Christensen Ganske Knollenberg nature of a substitute was agreed to. AYES—149 Chrysler Gekas Kolbe The SPEAKER pro tempore. The Abercrombie Baldacci Becerra Clinger Gephardt LaHood Ackerman Barcia Beilenson Coble Geren Largent question is on the engrossment and Andrews Barrett (WI) Bentsen Coburn Gilchrest Latham third reading of the bill. H 10462 CONGRESSIONAL RECORD — HOUSE October 19, 1995 The bill was ordered to be engrossed b 1730 against this bill which is wrong for and read a third time, and was read the Mr. GEPHARDT. Mr. Speaker, I yield America and wrong for the American third time. such time as he may consume to the people. MOTION TO RECOMMIT OFFERED BY MR. gentleman from Georgia [Mr. LEWIS]. Mr. GINGRICH. Mr. Speaker, I rise in GEPHARDT Mr. LEWIS of Georgia. Mr. Speaker, opposition. Mr. GEPHARDT. Mr. Speaker, I offer I rise to urge my colleagues to support Mr. Speaker, I must say with some a motion to recommit. this motion to recommit. sadness that we are ending this debate The SPEAKER pro tempore. Is the Mr. Speaker, I said to my Republican in the same spirit of misinformation gentleman opposed to the bill? colleagues, they should not raise pre- that has characterized our opponents consistently. The fact is there is a pro- Mr. GEPHARDT. I am opposed to the miums for our seniors, not when they vision in the medigrant program which bill in its present form, Mr. Speaker. can find money to give tax breaks to provides that senior citizens at the The SPEAKER pro tempore. The the rich. That is not right. That is not fair. That is not just. poverty level, and below, have all of Clerk will report the motion to recom- their Part B premium paid for by the mit. How long? How long until they real- ize what they are doing to our seniors? taxpayers, 100 percent. The Clerk read as follows: Not long. Not long until our seniors So, the poorest of the widows that Mr. GEPHARDT moves to recommit the bill know what they have done. the gentleman from Massachusetts H.R. 2425 to the Committees on Ways and Mr. Speaker, on this day, let the [Mr. MARKEY] spoke of will pay zero Means and Commerce with instructions to word go forth from this place into under our plan. Not one penny. My report the same back to the House forthwith guess is the gentleman might even with the following amendment: every State, every city, every town, Strike section 15611 (and redesignate the every village, every hamlet, that it was have known that, had he done any re- succeeding provisions and conform the table the Republicans who voted to cut Medi- search, had he cared about the facts. of contents accordingly). care in order to give a huge tax break This characterizes the whole plan. Mr. Speaker, another colleague spoke The SPEAKER pro tempore. The gen- to the rich. about tax cuts. There are no tax cuts tleman from Missouri [Mr. GEPHARDT] The Republican plan is too radical, today. There is no budget today. This is recognized for 5 minutes. too extreme, it is too much. It is more is about Medicare. Mr. GEPHARDT. Mr. Speaker, I than wrong. It is a shame and a dis- grace. Do the right thing. Support the Now, we believe that saving Medicare would like to say to Members this mo- matters; matters for the most human tion is very simple. It knocks out the motion to recommit. Mr. GEPHARDT. Mr. Speaker, the of reasons. Matters because of my part B premium increases that our sen- action that is being proposed today, mother-in-law, Virginia Ginther, who ior citizens will face if this measure and the action that is being proposed is 80 and on Medicare. It matters be- passes. I think it is the least we can do next week in Medicaid, together are cause of my mom and dad, Bob and Kit before this measure passes. really the beginning steps of disman- Gingrich, who are on Medicare. Mr. Speaker, I yield to the gentleman tling these programs as we have known But Medicare is not just about the el- from Massachusetts [Mr. MARKEY]. them. derly. Medicare matters to the children Mr. MARKEY. Mr. Speaker, we will, Mr. Speaker, when these programs of those who have retired. To my wife with this one amendment, the only were born, they were born on a simple Marianne; to her brother, John; to my amendment we are allowed to make, premise that there would be a national sister, Rob and her husband Dave; to and it automatically goes into the bill, standard of benefits that everyone in my sister, Susan and her husband, Jim; ensure that Medicare part B premiums these programs would enjoy. With to my brother, Randy, an his wife, Jill; will only go up what current law re- these changes that are being called for to my sister, Kathy, and her brother, quires. Otherwise, of the 37 million sen- in Medicare today, and Medicaid next Jesse; to my sister-in-law, Marilyn, iors on Medicare, 11 million of them week, that premise is being taken and her brother, Ray. are widows living on under $8,000 a away. They love their parents and they also year. By the year 2000, by the year 2002, In Medicare, the so-called new ideas know that someday they are going to this is a $300 a year hidden tax on them on the other side mean that people can retire. And they wish somebody had in order to put together a pile of choose medical savings accounts, and if the guts in this city to start protecting money which will give someone mak- they decide that they are going to be the system, so it will not collapse when ing $350,000 a year 60 of these widows’ well for the rest of their life, they can the baby boomers retire. money each year for a $19,000 tax have money put into that account and But it is not even just about the baby break. have a high-deductible account. boomers. Medicare is also about our Mr. Speaker, it is the only vote we Mr. Speaker, there are many other children’s future. My daughter, Kathy, can ask our colleagues to make, the choices. The problem is the choices are and her husband, Paul; my daughter, only amendment we can make here for a different standard of benefits. Jackie, and her husband, Mark; my sis- today. We ask Republicans to give us a Then, Mr. Speaker, in Medicaid we ter Candace. My younger relatives, a yes vote on this one page out of 900 are going to have a competition now in number of them were here the day I be- pages that ensures that that premium the State legislatures. The elderly are came sworn in as Speaker. Young kids, increase is not unfairly used by 60 each going to be there pleading for their Lauren and Kevin; Emily and Susan; of these elderly widows to provide for a cause. The children of our country are my nephews, Mark and John, and my tax cut of $19,000 a year in the year 2002 going to be there pleading for their niece, Holly. for those that do not need it, making cause, and the disabled Americans who Do my colleagues know why it is im- over $350,000 in our society. now claim 15 percent of Medicaid will portant for them? Because if we contin- Mr. Speaker, they built our country. be there pleading for their cause. ued to go down the irresponsible, unor- They sacrificed for our country. They Mr. Speaker, is this the kind of com- ganized, inefficient, bureaucratic, would not mind sacrificing again, but petition that we want to have go on waste and fraud-filled system, the to ask for this sacrifice from the most around this country? These programs Health Care Financing Administration vulnerable elderly widow population, in have worked because we have gotten centralized bureaucracy, they would be my opinion, is beneath what this House everybody on a level playing field and crushed with taxes. They would be of Representatives should do here the competition is not between the crushed with debt. They would pay today. We ask for only one yes vote in companies that can find the well peo- higher interest on their student loans; the course of this entire debate, and it ple as opposed to the sick people. The higher interest on their house; higher is on this very simple amendment. On competition should be between those interest on their car; they would be this issue there is one thing that sepa- competitors who can most efficiently crushed in trying to open a business. rates the senior citizens from the Re- organize the resources of our medical And in the end, when their parents re- publican majority, on this issue the system. tired, the entire system would collapse senior citizens are right and they are In the name of human decency, vote and they would have to live through wrong. for this motion to recommit and vote the mess. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10463 Now, I am not going to abandon We met with the hospitals. We met Durbin Lantos Rangel those children because of a bunch of 30- Edwards Levin Reed with senior citizens. We held over a Engel Lewis (GA) Richardson second commercials that are dishonest thousand—I know it is hard for those Eshoo Lincoln Rivers demagoguery. who have always believed in a closed Evans Lipinski Rose Mr. Speaker, let me just say, and system to understand this—we held Farr Lofgren Roybal-Allard maybe this makes us different from the Fattah Lowey Rush over a thousand town hall meetings. Fazio Luther Sabo politicians who used to run this place, We reached out to people who knew Fields (LA) Maloney Sanders we want to solve problems for all how to deliver health care. We listened Filner Manton Sawyer Americans. We want no racial division. to our Members. Frankly, we would Flake Markey Schroeder We want no class warfare. We want no Foglietta Martinez Schumer have listened and worked with any Ford Mascara Scott conflicts between generations. Member, any Member willing to agree Frank (MA) Matsui Serrano The only solutions worthy of Amer- to the objective of saving this system Frost McCarthy Sisisky ica are solutions that try to help all for a generation. But we would not Furse McDermott Skaggs Americans. That is why the Medicare Gejdenson McHale Skelton work with any Member whose only Gephardt McKinney Slaughter Preservation Act takes the long view; goal was to break up the structure and Gibbons McNulty Spratt not just a Band-Aid to get through one design an amendment which was pa- Gonzalez Meehan Stark more election, and then have another Gordon Meek Stokes thetically incapable of saving this sys- Green Menendez Studds Band-Aid for one more election and tem. Gutierrez Mfume Stupak hope that for your career, we get by so That is why we worked the way we Hall (OH) Miller (CA) Tanner the collapse will occur after you retire. Harman Mink Tejeda worked. And I will say to my friends Hastings (FL) Moakley Thompson That is not what we are for. over here now, when we start the next We want a solution to preserve and Hefner Mollohan Thornton project, for those Members who truly Hilliard Montgomery Thurman protect Medicare for the current sen- want to help us get there, our door is Hinchey Moran Torres iors. We want a solution to set the Holden Murtha Torricelli open. For those Members who just stage for the baby boomers to retire Hoyer Nadler Towns want to oppose and distort, our door is Jackson-Lee Neal Traficant with safety and security. We want a so- closed. Jacobs Oberstar Velazquez lution to protect younger Americans Mr. Speaker, I will close with this Jefferson Obey Vento from higher taxes, higher interest Johnson (SD) Olver Volkmer rates, crushing debt, and a bankrupt line, because it goes back to the allega- Johnson, E. B. Ortiz Ward Johnston Owens Waters Government. tion of the gentleman from Massachu- setts. The poverty line for single per- Kanjorski Pallone Watt (NC) Let me mention just one other thing Kaptur Pastor Waxman about how we got here and what we sons is $7,551. That means that vir- Kennedy (MA) Payne (NJ) Williams did. The Medicare Preservation Act tually 90 percent of the widows that Kennedy (RI) Payne (VA) Wilson gentleman was referring to will, in Kennelly Pelosi Wise creates MedicarePlus. It was a team ef- Kildee Peterson (FL) Woolsey fort. We did things differently. We fact, have 100 percent of their part B el- Kleczka Pomeroy Wyden asked the chairman of the Committee igible for payment under medigrant, if Klink Poshard Wynn on Ways and Means, the gentleman they apply, and that is literally the LaFalce Rahall Yates way the system works. from Texas [Mr. ARCHER], and the NOES—249 chairman of the Committee on Com- That is why not a single one of those poor widows has to pay a penny more. Allard Cremeans Hastert merce, the gentleman from Virginia Archer Cubin Hastings (WA) [Mr. BLILEY], to form a joint task I only wish the gentleman from Massa- Armey Cunningham Hayes force, and also the subcommittee chusetts had one his homework before Bachus Davis Hayworth making such an absurd allegation. Baesler Deal Hefley chairmen, the gentleman from Califor- Baker (CA) DeLay Heineman nia [Mr. THOMAS] and the gentleman Mr. Speaker, I urge everyone to vote Baker (LA) Diaz-Balart Herger from Florida [Mr. BILIRAKIS] to join for the Medicare Preservation Act. Ballenger Dickey Hilleary that task force. The SPEAKER pro tempore (Mr. Barr Doolittle Hobson Barrett (NE) Dornan Hoekstra LAHOOD). Without objection, the pre- We had able help from a number of Bartlett Dreier Hoke Members, and I particularly single out vious question is ordered on the motion Barton Duncan Horn the gentleman from Illinois [Mr. to recommit. Bass Dunn Hostettler HASTERT] who was originally chosen by There was no objection. Bateman Ehlers Houghton Bereuter Ehrlich Hunter Bob Michel and lead the health care The SPEAKER pro tempore. The Bilbray Emerson Hutchinson project in 1993 and 1994, and the gentle- question is on the motion to recommit Bilirakis English Hyde woman from Connecticut [Mrs. JOHN- offered by the gentleman from Mis- Bliley Ensign Inglis Blute Everett Istook SON] who has expressed extraordinary EPHARDT souri [Mr. G ]. Boehlert Ewing Johnson (CT) skill in this area. The question was taken; and the Boehner Fawell Johnson, Sam We met as a team. Not by committee Speaker pro tempore announced that Bonilla Fields (TX) Jones jurisdiction, not by territorial bound- the noes appeared to have it. Bono Flanagan Kasich aries, not driven by ego, but as a group Brewster Foley Kelly RECORDED VOTE Brownback Forbes Kim working together. Mr. GEPHARDT. Mr. Speaker, I de- Bryant (TN) Fowler King Mr. Speaker, I have to say we could mand a recorded vote. Bunn Fox Kingston never have done this without the Bunning Franks (CT) Klug staffs. In particular, I want to mention A recorded vote was ordered. Burr Franks (NJ) Knollenberg Burton Frelinghuysen Kolbe Ed Kutler, Howard Cohen, Mary The vote was taken by electronic de- vice, and there were—ayes 183, noes 249, Buyer Frisa LaHood McGrane, Chip Kahn, and also the leg- Callahan Funderburk Largent islative counsels, Noah Wofsy and Ed not voting 1, as follows: Calvert Gallegly Latham Grossman, because the truth is we are [Roll No. 730] Camp Ganske LaTourette Canady Gekas Laughlin a team. We could not get the job done AYES—183 Castle Geren Lazio without the expert staff, and at the Abercrombie Browder Costello Chabot Gilchrest Leach same time we represent the legal au- Ackerman Brown (CA) Coyne Chambliss Gillmor Lewis (CA) Andrews Brown (FL) Cramer Chenoweth Gilman Lewis (KY) thority of our people. Baldacci Brown (OH) Danner Christensen Gingrich Lightfoot Mr. Speaker, we did one other thing Barcia Bryant (TX) de la Garza Chrysler Goodlatte Linder that seems to truly confuse the press Barrett (WI) Cardin DeFazio Clinger Goodling Livingston and shock our friends on the left. We Becerra Chapman DeLauro Coble Goss LoBiondo Beilenson Clay Dellums Coburn Graham Longley did not ask one particular genius to Bentsen Clayton Deutsch Collins (GA) Greenwood Lucas hide in a room and design an entire Berman Clement Dicks Combest Gunderson Manzullo thing. We did not have any Ira Bevill Clyburn Dingell Condit Gutknecht Martini Bishop Coleman Dixon Cooley Hall (TX) McCollum Magaziners on our side. Bonior Collins (IL) Doggett Cox Hamilton McCrery We actually practiced listen, learn, Borski Collins (MI) Dooley Crane Hancock McDade help, and lead. We met with everybody. Boucher Conyers Doyle Crapo Hansen McHugh H 10464 CONGRESSIONAL RECORD — HOUSE October 19, 1995 McInnis Radanovich Stearns The question is on the passage of the Clyburn Johnson, E. B. Pickett McIntosh Ramstad Stenholm bill. Under the rule, the yeas and nays Coleman Johnston Pomeroy McKeon Regula Stockman Collins (IL) Kanjorski Poshard Metcalf Riggs Stump are ordered. Collins (MI) Kaptur Rahall Meyers Roberts Talent The vote was taken by electronic de- Condit Kennedy (MA) Rangel Mica Roemer Tate Conyers Kennedy (RI) Reed Miller (FL) Rogers Tauzin vice, and there were—yeas 231, nays 201, not voting 1, as follows: Costello Kennelly Richardson Minge Rohrabacher Taylor (MS) Coyne Kildee Rivers Molinari Ros-Lehtinen Taylor (NC) [Roll No. 731] Cramer Kleczka Roemer Moorhead Roth Thomas Danner Klink Rose Morella Roukema Thornberry YEAS—231 de la Garza LaFalce Roybal-Allard Myers Royce Tiahrt Allard Frelinghuysen Montgomery Myrick Salmon Torkildsen DeFazio Lantos Rush Archer Frisa Moorhead Nethercutt Sanford Upton DeLauro Levin Sabo Armey Funderburk Morella Neumann Saxton Visclosky Dellums Lewis (GA) Sanders Bachus Gallegly Myers Ney Scarborough Vucanovich Deutsch Lightfoot Sawyer Baker (CA) Ganske Myrick Norwood Schaefer Waldholtz Dicks Lincoln Saxton Baker (LA) Gekas Nethercutt Nussle Schiff Walker Dingell Lipinski Schroeder Ballenger Geren Neumann Orton Seastrand Walsh Dixon LoBiondo Schumer Barr Gilchrest Ney Oxley Sensenbrenner Wamp Barrett (NE) Gillmor Norwood Doggett Lofgren Scott Packard Shadegg Watts (OK) Bartlett Gilman Nussle Dooley Lowey Serrano Parker Shaw Weldon (FL) Barton Gingrich Oxley Doyle Luther Sisisky Paxon Shays Weldon (PA) Bass Goodlatte Packard Durbin Maloney Skaggs Peterson (MN) Shuster Weller Bateman Goodling Parker Edwards Manton Skelton Petri Skeen White Bereuter Goss Paxon Engel Markey Slaughter Pickett Smith (MI) Whitfield Bilbray Graham Petri Eshoo Martinez Smith (NJ) Pombo Smith (NJ) Wicker Bilirakis Greenwood Pombo Evans Mascara Spratt Porter Smith (TX) Wolf Bliley Gunderson Porter Farr Matsui Stark Portman Smith (WA) Young (AK) Blute Gutknecht Portman Fattah McCarthy Stenholm Pryce Solomon Young (FL) Boehlert Hall (TX) Pryce Quillen Souder Zeliff Fazio McDermott Stokes Boehner Hancock Quillen Quinn Spence Zimmer Fields (LA) McHale Studds Bonilla Hansen Quinn Filner McKinney Stupak NOT VOTING—1 Bono Hastert Radanovich Flake McNulty Tanner Brownback Hastings (WA) Ramstad Foglietta Meehan Taylor (MS) Tucker Bryant (TN) Hayworth Regula Ford Meek Tejeda Bunn Hefley Riggs b Frank (MA) Menendez Thompson 1800 Bunning Heineman Roberts Frost Mfume Thornton Burr Herger Rogers Mr. DOOLEY changed his vote from Furse Miller (CA) Thurman ‘‘no’’ to ‘‘aye.’’ Burton Hilleary Rohrabacher Buyer Hobson Ros-Lehtinen Gejdenson Minge Torkildsen So the motion to recommit was re- Callahan Hoekstra Roth Gephardt Mink Torres jected. Calvert Hoke Roukema Gibbons Moakley Torricelli The result of the vote was announced Camp Horn Royce Gonzalez Mollohan Towns as above recorded. Canady Hostettler Salmon Gordon Moran Traficant Castle Houghton Sanford Green Murtha Velazquez (By unanimous consent, Mr. GEP- Chabot Hunter Scarborough Gutierrez Nadler Vento HARDT was allowed to speak out of Chambliss Hutchinson Schaefer Hall (OH) Neal Visclosky order.) Chenoweth Hyde Schiff Hamilton Oberstar Volkmer Christensen Inglis Seastrand WELCOME BACK TO THE GENTLEMAN FROM Harman Obey Ward Chrysler Istook Sensenbrenner Hastings (FL) Olver Waters TEXAS, FRANK TEJEDA Clinger Johnson (CT) Shadegg Hayes Ortiz Watt (NC) Mr. GEPHARDT. Mr. Speaker, I yield Coble Johnson, Sam Shaw Hefner Orton Waxman to the gentleman from Texas [Mr. Coburn Jones Shays Hilliard Owens Williams Collins (GA) Kasich Shuster Hinchey Pallone Wilson DELAY]. Combest Kelly Skeen Holden Pastor Wise Mr. DELAY. Mr. Speaker. I thank the Cooley Kim Smith (MI) distinguished minority leader for yield- Cox King Smith (TX) Hoyer Payne (NJ) Woolsey Jackson-Lee Payne (VA) Wyden ing to me. I just want the House to Crane Kingston Smith (WA) Crapo Klug Solomon Jacobs Pelosi Wynn know that one of our colleagues has re- Cremeans Knollenberg Souder Jefferson Peterson (FL) Yates turned today because he felt this was a Cubin Kolbe Spence Johnson (SD) Peterson (MN) Zimmer very important vote. He has been Cunningham LaHood Stearns through a very serious operation and Davis Largent Stockman NOT VOTING—1 Deal Latham Stump Tucker surgery, and he is just one of the neat- DeLay LaTourette Talent est guys, and he understands how im- Diaz-Balart Laughlin Tate b portant this is. The gentleman from Dickey Lazio Tauzin 1822 Doolittle Leach Taylor (NC) Texas [Mr. TEJEDA] has returned and is Dornan Lewis (CA) Thomas So the bill was passed. here today. Dreier Lewis (KY) Thornberry PARLIAMENTARY INQUIRY Duncan Linder Tiahrt The result of the vote was announced Dunn Livingston Upton as above recorded. Mr. MARKEY. Mr. Speaker, I have a Ehlers Longley Vucanovich parliamentary inquiry. Ehrlich Lucas Waldholtz A motion to reconsider was laid on The SPEAKER pro tempore (Mr. Emerson Manzullo Walker the table. LAHOOD). The gentleman will state his English Martini Walsh Ensign McCollum Wamp f parliamentary inquiry. Everett McCrery Watts (OK) Mr. MARKEY. Mr. Speaker, I am Ewing McDade Weldon (FL) making an inquiry as to when the prop- Fawell McHugh Weldon (PA) REPORT ON RESOLUTION PROVID- er point would be to make a point of Fields (TX) McInnis Weller ING FOR CONSIDERATION OF Flanagan McIntosh White personal privilege on the privileges of Foley McKeon Whitfield H.R. 2492, LEGISLATIVE BRANCH the House to clarify a number of erro- Forbes Metcalf Wicker APPROPRIATIONS ACT, 1996 neous statements made about my Fowler Meyers Wolf statements in the well of the House be- Fox Mica Young (AK) Mrs. WALDHOLTZ, from the Com- Franks (CT) Miller (FL) Young (FL) mittee on Rules, submitted a privi- fore the recommittal vote. Franks (NJ) Molinari Zeliff The SPEAKER pro tempore. Personal leged report (Rept. No. 104–283) on the privilege for that reason is not in order NAYS—201 resolution (H. Res. 239) providing for at this point. Abercrombie Bentsen Brown (CA) the consideration of the bill (H.R. 2492), Ackerman Berman Brown (FL) Mr. MARKEY. I would ask the Andrews Bevill Brown (OH) making appropriations for the legisla- Speaker as to what the proper time Baesler Bishop Bryant (TX) tive branch for the fiscal year ending would be. Baldacci Bonior Cardin September 30, 1996, and for other pur- The SPEAKER pro tempore. The gen- Barcia Borski Chapman Barrett (WI) Boucher Clay poses, which was referred to the House tleman will consult with the Chair at a Becerra Brewster Clayton Calendar and ordered to be printed. later point. Beilenson Browder Clement October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10465 PERMISSION TO HAVE UNTIL FRI- 1995, and H.R. 1114, the Paper Balers of time, and in consideration of that DAY, OCTOBER 20, 1995, TO FILE Act. interest, we did postpone Glass- CONFERENCE REPORT ON H.R. Once the corrections bills have been Steagall until a date to be determined 2002, DEPARTMENT OF TRANS- considered, we will turn to H.R. 716, a later. PORTATION AND RELATED bill to amend the Fisherman’s Protec- Mr. BONIOR. Mr. Speaker, I thank AGENCIES APPROPRIATIONS tive Act, which will be considered my colleague for his remarks, and I ACT, 1996 under suspension of the rules. Members wish him a very pleasant weekend in Mr. LIVINGSTON. Mr. Speaker, I ask should be advised, Mr. Speaker, that his district. I think we are all looking unanimous consent that the managers any recorded votes ordered will be forward to going back home and ex- may have until midnight tomorrow, postponed until 5 p.m. on Tuesday plaining our actions today on Medi- Friday, October 20, 1995, to file a con- next. care. I thank the gentleman. ference report on the bill, H.R. 2002, On Wednesday and Thursday, the House will meet at 10 a.m. to consider Mr. ARMEY. I thank the gentleman. making appropriations for the Depart- I know I am excited about going home. ment of Transportation and related H.R. 2492, the Legislative Branch Ap- agencies for the fiscal year ending Sep- propriation Act for fiscal year 1996, f tember 30, 1996, and for other purposes. which is subject to a rule. The SPEAKER pro tempore. Is there We will then consider H.R. 2491, the b 1830 objection to the request of the gen- fiscal year 1996 budget reconciliation, tleman from Louisiana? which is also subject to a rule. Mem- THE CLINTONS’ PARTNERSHIP bers are also reminded that conference There was no objection. (Mr. DORNAN asked and was given reports may be brought to the floor at f permission to address the House for 1 any time. minute and to revise and extend his re- DEFERRALS OF BUDGETARY RE- Mr. Speaker, there will be no legisla- marks.) SOURCES AFFECTING INTER- tive business on Friday of next week. NATIONAL SECURITY ASSIST- I thank the gentleman for yielding. Mr. DORNAN. Mr. Speaker, I have a ANCE PROGRAM, AND THE DE- Mr. BONIOR. Mr. Speaker, I thank 60 minute scheduled special order for PARTMENTS OF HEALTH AND my colleague for giving us the informa- later, but I am not sure that I will be HUMAN SERVICES AND STATE— tion. able to make an airplane and do that, MESSAGE FROM THE PRESIDENT Mr. Speaker, on the reconciliation so I will put it off until next week. OF THE UNITED STATES (H. DOC. bill for next week, to our knowledge it Mr. Speaker, an amazing victory on NO. 104–125) has not even been filed yet. We are the saving of Medicare for us senior wondering over here when we can ex- The SPEAKER pro tempore (Mr. citizens; I am 62. pect it next week. HAMBLISS I wanted to point out to my col- C ) laid before the House the Mr. ARMEY. If the gentleman will leagues one of these occasional col- following message from the President continue to yield, Mr. Speaker, the of the United States; which was read umns that comes along that has stay- gentleman from Ohio [Mr. KASICH], the ing power. This is by one of the better and, together with the accompanying chairman of the Committee on the writers at The New York Times, papers, without objection, referred to Budget, will file that bill tomorrow Maureen Dowd. She has the excellent the Committee on Appropriations and during the pro forma session. ordered to be printed: Mr. BONIOR. I assume the gentleman columns from Clinton’s photo ops on Normandy Beach. To the Congress of the United States: expects it to come up sometime in the In accordance with the Congressional latter part of next week, would that be She writes, and I think this one Budget and Impoundment Control Act relatively accurate? should be read by every Member of this of 1974, I herewith report three defer- Mr. ARMEY. We expect to take the body in the other chamber, rals of budgetary resources, totaling rule up on the floor on Wednesday, and Is Hillary Rodham Clinton playing the gen- $122.8 million. take up the bill on Thursday. der card from the bottom of the deck? These deferrals affect the Inter- Mr. BONIOR. Mr. Speaker, since it is national Security Assistance program, the only major bill that we will be tak- That is the way it starts, and she and the Departments of Health and ing up next week, I hope we can expect closes, Human Services and State. to have sufficient debate time on that. Mrs. Clinton seems to feel that if she occa- WILLIAM J. CLINTON. I would request that from my friend, sionally plays Pat Nixon, giving interviews THE WHITE HOUSE, October 19, 1995. the gentleman from Texas. It is, as he to food writers, inviting gossip columnists to lunch, watching children dance, she might f knows, one of the major bills of the legislative sessions, and it is far-reach- allay angst about her power. She thinks LEGISLATIVE PROGRAM Americans fear the partnership with her hus- ing. We hope that we will be afforded a band. What they really fear is a bargain that (Mr. BONIOR asked and was given little bit more time than we had on ignores accountability. It is not about being permission to address the House for 1 this bill today. We think it was woe- a woman. It is about not being elected. minute and to revise and extend his re- fully inadequate to have debated this The body of it is ever better. marks.) Medicare bill for just 3 hours. We hope Mr. BONIOR. Mr. Speaker, I would the gentleman from Texas will find suf- I will do that aforementioned 60 min- inquire from the distinguished major- ficient time for us to have a full and utes special order next week about the ity leader the schedule for next week. thorough debate on this. breakdown of our judicial system and Mr. ARMEY. Mr. Speaker, will the The other question I had, just one the fact that justice was not done in gentleman yield? other one for my friend, the gentleman Los Angeles, and I will send $1,000 to Mr. BONIOR. I yield to the gen- from Texas, is an earlier version of the Mr. Ron Goldman who said today that tleman from Texas. floor schedule indicated that we would he wished his son had been able to play Mr. ARMEY. Mr. Speaker, this is the be considering the Glass-Steagall golf this week as O.J. Simpson has last recorded vote of this week. We will banking bill. I notice it has dis- been playing golf in our face. appeared. I am just wondering when we not be in session tomorrow, except for f pro forma. can expect to see that particular piece On Tuesday, October 24, the House of legislation. SPECIAL ORDERS will meet at 12:30 p.m. for morning Mr. ARMEY. I thank the gentleman. hour, and at 2 p.m. for business. The gentleman is absolutely correct, The SPEAKER pro tempore (Mr. We plan to take up three bills under the budget reconciliation bill, which CHAMBLISS). Under the Speaker’s an- Corrections Day procedures: H.R. 782, we will consider on Thursday, is an im- nounced policy of May 12, 1995, and the Federal Employee Representative portant piece of legislation. We wanted under a previous order of the House, Improvement Act of 1995; H.R. 117, the to be sure that in fact we had an oppor- the following Members will be recog- Senior Citizens Housing Safety Act of tunity to talk about it for a great deal nized for 5 minutes each. H 10466 CONGRESSIONAL RECORD — HOUSE October 19, 1995 PROTECTING OUR IMPOVERISHED have put on the books to protect those costs, the premium, the co-insurance SENIORS elderly seniors. costs, will be picked up. If we do not The SPEAKER pro tempore. Under a Mr. HOYER. Mr. Speaker, if the gen- have that kind of protection, a lot of previous order of the House, the gen- tleman will yield further, does the gen- people will not be able to buy part B. tleman from Massachusetts [Mr. MAR- tleman then mean that the only way to They will not be covered under Medi- KEY] is recognized for 5 minutes. have ensured that seniors under $7,900 care. Low-income elderly just will not Mr. MARKEY. Mr. Speaker, I thank would not have their premium in- be part of the Medicare program that you for recognizing me. creased was to vote for the motion to assures their physicians’ fees. In my 19 years in Congress, Mr. recommit? Now, let me go through what their Speaker, I have never taken a special Mr. MARKEY. Mr. Speaker, the gen- bill does. In their Medigrant bill, they order before. This is the first time I tleman is correct. The only way to repeal Medicaid completely. Their bill have ever done so. The reason that I do guarantee that they will be protected. does not ensure people below the pov- it is that unfortunately, the Speaker of Now, let me add as well that in our erty line will have their Medicare pre- the House, the gentleman from Georgia committee we had a vote on an amend- mium paid. [Mr. GINGRICH], in making his final re- ment made by the gentleman from New What they say to the States is, spend marks for the Republicans to this great Jersey [Mr. PALLONE] to protect them. some portion of your block grant funds House on the historic Medicare bill, in- On a party line vote all Republicans to pay Medicare premiums for poor voked my name several times and at- voted not to protect the seniors. On the people. But the amount they are sup- tributed to me a motive to deliberately Medicare bill we did the same thing posed to spend for that purpose, and let mislead this House with regard to the with an amendment by the gentleman us be clear. There is no way to enforce fact of whether or not the 11 million from Illinois [Mr. RUSH] to protect the even that requirement, there is not widows in the United States who live senior, more impoverished elderly, enough to cover people up to the pov- on an income of under $8,000 a year those widows, so that they would not erty level, let alone to the 120 percent have protection, to ensure that they have to pay the premium. of poverty we require the States to pay will not have to shoulder the burden of So I assume, to be quite frank with now. the gentleman, the Speaker is a busy the dramatic increase in their part B With the cuts in the growth of the man and he does not have time to pe- premiums that has been included in the funds for the Medigrant program, with ruse each and every piece of legisla- Republican Medicare reform. the growth in the eligibles for Medi- tion. That is the only conclusion that I The Speaker stated that, in fact, I care, which is a growing elderly popu- can reach and be, I think, should have done my homework in lation in this Nation, with the big in- noncontentious in terms of what he order to know that they are covered, creases in premiums absolutely guar- might have intended. and that in fact it was misleading to anteed by the passage of this Medicare Mr. Speaker, next week the Medicaid say that they were not covered, and bill, which will require more pre- bill goes before the Committee on that all who are below the poverty miums, maybe even doubling of the Rules, and we intend on making this level have their premiums covered premiums to be paid by the elderly, we amendment, one that we request the under the law of the United States. will never be able to see the States Committee on Rules to put in order on Well, technically speaking, the cover the people who are below the the floor next week as part of the Med- Speaker is correct. They are covered poverty line. under existing law, and the Speaker icaid bill. If the Speaker wants to en- sure that every senior impoverished I would like to give some numbers. will continue to be correct for at least The Republican Medicaid block grant 5 more days, or until next Tuesday widow in America is protected, we will have an opportunity in the committee repeals the requirement that States when the Republican Medicaid bill pay cost-sharing for low-income Medi- comes on to the floor which strips out on Rules to have that amendment put in order, and every Member out here on care beneficiaries. However, the Repub- the protection and the extra subsidy lican proposal requires that States set which those below the poverty level re- the floor, if the Republicans put that amendment in order, will have a aside 85 percent of what the States ceive for their Medicare part B pre- would have spent on premiums, not all mium. At that point at which the Med- chance to make true what it was the Speaker said on the floor today. Other- cost-sharing, from 1992 to 1994. The pre- icaid bill of the Republicans hits the mium for 1992 was $31.80; in 1993, $34.60; floor, there will be no protections for wise, there will be no protection. 1994, $41.10. NEWT GINGRICH himself es- those widows across this country num- Mr. HOYER. Mr. Speaker, I thank the gentleman for clarifying that issue. timates that the premium will be $88 in bering 11 million who are on Medicare the year 2002. and who will see their premiums in- Mr. MARKEY. I thank the gentleman With that kind of an increase in the crease over the next 7 years by a trau- from Maryland very much. premium, with a growing increase in matic amount in order to put aside a f the number of the elderly, the States huge fund for the tax breaks for the SPEAKER WILL DO HONORABLE are setting aside only 85 percent of the wealthy. Mr. HOYER. Mr. Chairman, will the THING amount for the 1991–1992 levels. They gentleman yield? The SPEAKER pro tempore. Under a are not going to be able to pay for the Mr. MARKEY. I yield to the gen- previous order of the House, the gen- out-of-pocket costs for the elderly. tleman from Maryland. tleman from California [Mr. WAXMAN] Furthermore, once they repeal Med- Mr. HOYER. Mr. Speaker, I have is recognized for 5 minutes. icaid, which is what they seek to do been listening to the gentleman. Is the Mr. WAXMAN. Mr. Speaker, it is ob- next week and replace it with a gentleman telling me when the Speak- vious that the Speaker of the House, Medigrant, a block grant bill, the er got up on the floor and said that in Mr. GINGRICH, did not understand the States will get money. They can use it their bill there was a guarantee that bill that the Republicans reported out as they see fit. There will be a set-aside anybody under $7,900 would have there of the Committee on Commerce; but of money for this purpose, but it will Medicare premium part B paid, that he since he made the claim that the bill be grossly inadequate, and the States was not accurate? would protect those individuals, low- will have to use that money as they see Mr. MARKEY. Mr. Speaker, he was income individuals, to help them pay fit. not accurate because the Republican for their Medicare out-of-pocket costs, They could say to people, ‘‘We will Medicaid bill, which will be out here on I would expect that he will support the cover you if you are in line, but when the floor next week, will strip out that amendment that was offered in our we run out of money you will not get guarantee. In the Republican Medicaid committee by the gentleman from New covered.’’ They could say, ‘‘We will bill, as you know, they block-grant the Jersey [Mr. PALLONE]. only cover 10 percent of the costs in- Medicaid program, cut the whole pro- The Pallone amendment would have stead of 100 percent of those premium gram by 20 percent, send it back to the given an assurance, an absolute guar- and out-of-pocket costs.’’ They can States, and in fact repeal every re- antee, that if you are below the pov- refuse to pay people for their out-of- quirement that we in this Congress erty line, your out-of-pocket Medicare pocket costs entirely. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10467 There is no guarantee, if you are an whatsoever, without testimony from lack of proper information on how the individual below the poverty line, dis- any agency of the Federal Government, legislation has been constructed or abled or under Medicare because of without hearing from any governor, what will be its impact. your age, that you will be protected. from any citizen, or without hearing I think we need only to look forward There is no guarantee to the individ- from any Federal agency as to how this now to see what fresh new surprises are ual, only some money to the States, to would impact the people of the coun- going to plague this body, are going to do the best job they can, and whatever try. plague the senior citizens, are going to they do will be acceptable. There is no understanding of what is plague the administrators on a State Now, the Speaker did incorrectly in the bill, including whether or not and Federal level and are going to state what was in his bill. I believe the fraud provisions are in fact ade- plague the people who would be bene- that he genuinely did not understand quate, which in fact, by the way, they ficiaries under Medicare who today his legislation. When he reads it, when are not. would enjoy benefits which are going he finds out what they did in the Com- The bill was passed out of committee to be taken away from them tomorrow. mittee on Commerce, well, I would not without being read. On at least three I think that the surprises are going to want to be the chairman of that com- separate occasions, different versions be substantial. mittee since the Speaker now has deci- of the legislation were presented to the It is regrettable that we have done sionmaking power over who is chair- House or to the committee. Last night, this this way. It is to be hoped that we man of the committee or not. the third or fourth version of the bill will at least learn from it, will not re- But I suspect what he will do, which was presented to the House. It again peat this kind of abuse. But a greater is the only honorable thing to do, is to was not read. The Committee on Rules hope is that we might take the time to support the Pallone amendment when had no opportunity really to under- scrutinize the evil that we have done it is offered to the legislation. stand what was presented to them. today and set about trying to correct The SPEAKER pro tempore. Under a Today, we saw a discussion of the it. previous order of the House, the gen- legislation in which there appeared to f tleman from California [Mr. RIGGS] is be great confusion and in point of fact The SPEAKER pro tempore (Mr. recognized for 5 minutes. there was, because no Member had had CHAMBLISS). Under a previous order of opportunity to know or understand [Mr. RIGGS addressed the House. His the House, the gentleman from Califor- what is in this bill. remarks will appear hereafter in the nia [Mr. HORN] is recognized for 5 min- Extensions of Remarks.] The process could have been abated by the ordinary way in which legisla- utes. f tion is considered. Hearings could have [Mr. HORN addressed the House. His A BAD MEDICARE BILL been held. Proper markups could have remarks will appear hereafter in the Extensions of Remarks.] The SPEAKER pro tempore. Under a been held. This matter was reported to previous order of the House, the gen- the House by our committee with mini- f mum consideration of the legislation, tleman from Michigan [Mr. DINGELL] is A DISASTROUS MEDICARE BILL recognized for 5 minutes. and similar activities took place in the Mr. DINGELL. Mr. Speaker, there Committee on Ways and Means. The SPEAKER pro tempore. Under a are some facts that are very clear now. My colleagues on the Republican side previous order of the House, the gen- Let me go over the situation. Under will tell us how hearings were held on tleman from Ohio [Mr. BROWN] is rec- current law, Medicaid beneficiaries are Medicare. Hearings are routinely held ognized for 5 minutes. guaranteed coverage for premiums and on Medicare and on Medicaid here- Mr. BROWN of Ohio. Mr. Speaker, co-pays and deductibles. The House Re- abouts in this body, but it must be ob- today in this House many of us opposed publican bill repeals that law. served that not one hearing was held a very bad bill, the Medicare ‘‘reform’’ The Democratic amendment in the on this bill. The only hearing which bill that cut Medicare $270 billion to House Committee on Commerce offered was held on this subject in connection give tax breaks to the wealthiest by my colleague, the gentleman from with this particular process was to Americans. It weakened fraud provi- New Jersey [Mr. PALLONE], to restore hold a hearing in the Committee on sions in a series of back-room deals this current guarantee was rejected by Ways and Means on a press release, with the AMA and with other organiza- a vote of 24 to 18. Every member of the hardly a matter which merits congres- tions to roll back a lot of fraud provi- committee on the Republican side of sional consideration. sions that would have allowed us to the aisle voted against it. The result is that the House has more aggressively go after those people Under the Republican block grant, acted upon this legislation in great that cheat the system. Federal payments are cut by 20 percent confusion. The Speaker has been led The Inspector General’s office has over the next 7 years. No State is re- into the unfortunate position where I said that 10 percent of Medicare ex- quired to cover any elderly. There are am sure unknowingly he misrepre- penditures go to fraud, waste and no requirements to provide anything to sented the facts as regards the content abuse. We need to aggressively go after the current Medicaid eligibles. Only 7 of the legislation on a point which is that. Instead, this House today turned percent of State dollars have to be extremely important to the American its back on that. So, at the same time spent on low-income seniors. people. That is, that 11 million widows as this House made Medicare cuts, it will not have their Medicare payments weakened fraud provisions. It gave $245 b 1845 paid on their behalf on Part B because billion in tax breaks to the wealthiest This is simply not enough, and there of the way the law is going to work out individuals in this country and the is no guarantee. when the consideration of this matter largest corporations in this country. Now, the House has already found, re- is at conclusion. Perhaps equally disturbing as the bill grettably, that no one here really un- I say this is a sad and intolerable itself, which I think is a disaster, was derstands the entirety of the bill. The event. I say it is an event which has the process that led up to this vote Speaker in a rather powerful statement been created by a deliberate deter- today right up until we actually cast has been proven to be entirely in error. mination on the part of the Republican our votes. How many other Members who have leadership of this body to present this Some weeks ago, the Speaker and the talked about the wonders of this legis- matter to the House without giving Republican leadership simply said lation we passed today or the legisla- adequate opportunity for this body to there were going to be no hearings on tion that we are going to pass to be properly informed through the or- this issue, no hearings in committee on amend Medicaid are going to be wrong? derly and regular process of this body Medicare, no hearings on this issue on The process under which this was which go back to the earliest days of Medicaid. We tried over and over ask- conducted was intolerable. The bill was the Republic. I think that this is a ing for hearings, requesting of my com- put in the committee, hearings were shameful way to proceed on legislation. mittee chairman, the gentleman from requested, none were given. The matter It results in intolerable surprises to Virginia [Mr. BLILEY], in the Commit- was considered without any hearings the Members of this body, results in tee on Commerce. The same went on in H 10468 CONGRESSIONAL RECORD — HOUSE October 19, 1995 the Committee on Ways and Means. The gentleman from Illinois [Mr. H.R. 2259 They simply turned a deaf ear not just RUSH] offered the same amendment on The SPEAKER pro tempore. Under a to us, maybe we do not matter much, the Medicare bill in the Committee on previous order of the House, the gen- but turned a deaf ear to the American Commerce, the bad bill that we consid- tleman from Oklahoma [Mr. WATTS] is people, the people that wanted to come ered today; and I went before the Com- recognized for 5 minutes. in and talk about what this Medicare mittee on Rules yesterday and asked Mr. WATTS of Oklahoma. Mr. Speak- bill was really about. that the amendment be considered as er, as the son of a policeman and a fer- So while there were back-room deals, part of the bill today, had a dialogue vent supporter of strong anticrime the American Medical Association and with the members of the Committee on measures, I believe that we must at- other groups got into the back room Rules, including the gentleman from tack the root problems that cause with the Republican leadership, the el- Georgia [Mr. LINDER] who was there, crime in America and that we must derly were not even allowed in the and explained that we wanted to make punish equal crimes with equal justice hearing rooms to testify on this bill. sure that there was a guarantee in the regardless of a person’s color or eco- One lady in the Committee on Com- Medicare bill for these widows and nomic class. merce a couple of weeks ago came in, these low-income senior citizens for Last night we considered a well-in- tried to testify, was gaveled down. which the Federal Government now tentioned bill, H.R. 2259, that sought to Eventually, within a few minutes, 15 pays their part B premium. address one part of the Nation’s crime elderly people, some in wheelchairs, It is true, it may very well be that problem, but unfortunately, it missed some with canes, all of them I believe the Speaker misunderstood, but there the mark by a mile and sent the wrong over 70 years old, were arrested and is no excuse for it. Because in fact on message to the Nation’s drug traffick- hustled out of the committee room, three different occasions we have asked ers and drug abusers. taken down into the basement. Several for this to be considered, on two occa- The U.S. Sentencing Commission re- of them were handcuffed. All of them sions in this bill. The Committee on cently recommended that sentences for were taken to the police station in Rules denied the opportunity to have possessing and trafficking in crack co- paddy wagons and fingerprinted and that amendment considered. The bill caine should be the same as for possess- mug-shotted. It was a pretty amazing that we had today did not have the ing and trafficking in powder cocaine. spectacle. guarantee that those Part B premiums Then today, almost as disturbing, the The Commission is right to seek to for those low-income seniors would be equalize punishment. It is essentially Speaker of the House stood on this paid. floor and said something, and I am sure unjust to have one standard of justice he did not knowingly do this, but said I think what the gentleman from for the type of cocaine that is abused something that clearly was not true Massachusetts [Mr. MARKEY] said is ab- in the expensive homes of our finest about a provision in the bill that the solutely correct. We should go back to suburbs and a different standard of jus- gentleman from Massachusetts [Mr. the Committee on Rules next week, tice for the type of cocaine that is ask that it be considered again in con- abused in the abandoned crack houses MARKEY] had talked about, a provision in the bill that has been removed from cert with the Medicaid bill. But I am of our worst ghettos. the Medicaid bill that allowed elderly really outraged over the fact that the The Commission should have sought widows, some 11 million in this country suggestion was made today that some- equalization by raising the sentences that literally had their Medicare pre- how this guarantee was in the bill. It is for powder cocaine. My view is that miums paid for because they were so not in the bill; it is not in the Medicaid higher sentences, at equal levels, are poor that they could not pay for them, bill; and we, all of us collectively, have needed in these cases. and particularly when they go from $46 tried very hard to make sure the guar- Unfortunately, procedural rules did to $90 or $100, whatever the Gingrich antee was there and it is not there. not allow that vote, so I voted to re- Medicare bill ends up raising them to, Mr. BROWN of Ohio. None of this commit H.R. 2259 with that goal in that money was taken away from would have happened, I think, if we had mind. When that failed, I had no choice them. had hearings. There were dozens of but to vote against final passage. The Speaker may have been confused hearings on Waco and Randy Weaver We must punish the drug possessor, or it may have been bad staff work. It and Whitewater but no hearings on and work to rehabilitate him. But we may have simply been all the late- Medicare and Medicaid which affect ev- must imprison the drug distributor and night deals that were cut as the bill erybody in this country. throw away the key. He haunts our Na- was changed as late as last night in the I think the Speaker misspoke and tion’s schoolyards and makes his for- middle of the night, and he was simply was probably confused but sort of at- tune off his poverty stricken and ad- confused. tacked our friend from Massachusetts dicted buyer. He condemns his victims I have only been here 3 years, but by name. Surely if we had had hearings to a life of poverty and an early death. there is this new arrogance to this and not had these late-night deals and And his victims are disproportionately place that I have never seen and heard really, as a country, really discussed inner-city kids—young black Ameri- of before, but it is particularly disturb- Medicare, Medicaid and what it means cans. ing when those kinds of things are said to senior citizens, you do not cut $270 According to the Department of on the floor because of either confusion billion to give tax breaks to the rich. Health and Human Services [HHS], or bad staff work, but the process has black Americans are being dispropor- been so closed that people have not had f tionately affected by sentencing dis- a chance to really learn about what is The SPEAKER pro tempore. Under a parities. Only 4 percent of those sen- in this bill. previous order of the House, the gen- tenced for violating crack laws are Mr. Speaker, I yield to my friend, the tleman from Colorado [Mr. MCINNIS] is white although 51 percent of crack gentleman from New Jersey [Mr. recognized for 5 minutes. users are white. In contrast, 88 percent PALLONE]. of those sentenced for crack violations Mr. PALLONE. I appreciate the gen- [Mr. MCINNIS addressed the House. are black Americans, while only 38 per- tleman yielding. His remarks will appear hereafter in cent of crack users are black, accord- Mr. Speaker, there was obviously the Extensions of Remarks.] ing to the HHS study. confusion in the Speaker’s mind, but f I have said numerous times that this there really should be no confusion country’s laws must deal with racial about this issue. Because, as the gen- The SPEAKER pro tempore. Under a discrimination in as aggressive a man- tleman knows, I offered this amend- previous order of the House, the gentle- ner as possible. I believe that implicit ment in our Committee on Commerce woman from Connecticut [Ms. in that philosophy is a mandate to to make sure that in Medicaid these DELAURO] is recognized for 5 minutes. change any law that results in de fac- qualified Medicare beneficiaries were [Ms. DELAURO addressed the House. tor racial discrimination. going to have their part B premiums Her remarks will appear hereafter in As the father of young children, I am covered. the Extensions of Remarks.] committed to passing the strongest October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10469 antidrug measures possible. H.R. 2259 do not have Medicare. They do not fits of those that are receiving them did not meet that standard. have Medicaid. They do not have a pri- and we are usually ahead about a year. f vate health insurance plan through That is what current funding is, but their employer or through their own they do not understand it. They cannot MEDICARE BILL HAS WRONG means. They are without. predict it. But yet they are up here PRIORITIES What is happening today is we are cutting $270 billion in Medicare bene- The SPEAKER pro tempore. Under a not talking about meeting the needs of fits to give tax breaks to their wealthy previous order of the House, the gen- those 40 million plus in American contributors and their special inter- tleman from Minnesota [Mr. VENTO] is working families. We are talking about ests. It is wrong and it should have recognized for 5 minutes. reneging, pulling back on the Medicare been defeated today, not passed. Mr. VENTO. Mr. Speaker, today, the system today to the tune of $270 billion f process did not afford the opportunity today for tax breaks for the rich; and The SPEAKER pro tempore (Mr. for a very full discussion of the Medi- we are talking about next week taking CHAMBLISS). Under a previous order of care bill on the House floor, and so I $182 billion out of the Medicaid system. the House, the gentleman from Florida wanted to take this opportunity to ex- That is a system for the kids in this [Mr. GOSS] is recognized for 5 minutes. press my dismay and disappointment country, 16 million children, other mil- with the action of the House today, re- lions of other people that would be de- [Mr. GOSS addressed the House. His neging on the basic health care protec- nied the opportunity for dignity, for remarks will appear hereafter in the tion that has existed for older Ameri- health care. Extensions of Remarks.] cans and for others that are the bene- These are programs that are for the f ficiaries of Medicare for the past 30 American family. These are the pro- THE BILL WAS WRITTEN IN THE years. grams that were put together so that SPEAKER’S OFFICE The fact is that Medicare is in trou- we could meet the needs of our fami- ble today, my colleagues. It is in trou- lies, for my parents, and for others The SPEAKER pro tempore. Under a ble because the Republicans, this new that might be disabled, that have the previous order of the House, the gen- majority that is in control, has not fortune to have a good, long life. tleman from Texas [Mr. DOGGETT] is given the type of consideration, the The funny part about it is I keep recognized for 5 minutes. type of deliberation, that has been the talking about all the trust funds today, Mr. DOGGETT. Mr. Speaker, the hallmark of much of what has been trust fund A and B, but the trust fund rules of debate here in the House are considered in the past in this Congress. A has never been responsible for one rather constrained at times, and they I think we are seeing a breakdown dime of our deficit in this country, and were constrained this evening as we really of the committee system here, the same is true of most of the Social had the opportunity to witness at the where the committees, even though Security programs, are not responsible close of this great debate a bit of grace- this proposal has made some 8 months for the deficits in this country. That is less gloating from the Speaker of the ago, 7 months ago, no proposal was not what has created the deficit. Part House, Mr. GINGRICH, about the victory forthcoming; and we end up with a 1,000 B because of the health care costs is a that everyone on all sides knew was page bill on this floor that dramati- contributor. going to occur here today. They pro- cally and drastically changes the pol- vided no opportunity, of course, to ask b icy. 1900 him a question, much less to respond I think, for starters, that the prior- But the fact is that we cannot just, immediately to his comments, but ities are all wrong in terms of what is when the cuts are made, they are not those comments deserve a response. happening with the budget. The fact is just cuts. They are cuts that are made It is true that this Chamber is almost that the $270 billion, it has been re- with no opportunity. You are not em- empty at this moment. Of course, our peated today, that is saved in Medicare powering senior citizens to challenge Republican friends are out popping the is not necessary for the Medicare trust the system simply by giving them champagne corks, celebrating as is fund. In fact, of course, much of it will choice. You do not give them choice in their right the fact that they really got be used for other Republican priorities this bill. They have choice today. They those seniors. They are able to be out that are in the budget. This is not a bi- have HMO’s, they have preferred physi- there saying, well, our buddies are partisan budget, this is very much a cian options. They have those types of going to really like that tax break we partisan effort in this House, and I sus- choices already today. are able to provide now, and we taught pect the same reaction in the Senate. This offers nothing new. What you those seniors a lesson when we took There are 245 billion dollars’ worth of take is you are taking away the very $270 billion out of Medicare so we could tax breaks and not tax cuts, tax breaks tools they need to challenge the cost of fund our tax break for the rich. that go specifically to some people in what health care is today, taking away But Members will recall specifically, our society, taking away tax breaks the ability to pursue fraud, taking though they are celebrating now, that from others. In fact, an article in the away the legal system, the ability to when the Speaker spoke he began by Wall Street Journal today indicates challenge the medical doctor when in reading to us the names of the family that those that have incomes less than fact they make a mistake, when they members in his family and how much $30,000 under the Republican tax plans do something wrong, taking away the they were interested in what was oc- will actually end up spending or actu- accountability in this bill, taking away curring here today. Then he proclaimed ally end up paying more in taxes. $270 billion and any ability or most of with the greatest magnanimity there Those under $30,000 will pay more in the ability for older Americans and for were so many who had contributed to taxes under the tax plans that have others in this health care system to the raiding of the Medicare system been advanced by the House and by the really deal with that. today, it is peculiar that omitted from Senate. That is wrong. I think these In other words, you are making them that list of all those who helped was are the wrong priorities. pay more, considerably more for the the Golden Rule Insurance Co. You will I think the right priorities are to part B premiums and giving them less recall that it was only a week ago that deal with health. If anybody wants an in benefits, capping the benefits. Read CBS Evening News reported that Gold- example of what is wrong and where we what is in your bill. Read what is in en Rule, which had complied with the are today as compared to some time your particular proposals. You have golden rule by contributing over a mil- ago, this last year we were talking not done so. You do not know what it lion dollars to the Republican party, about extending health care to those is. stood to be one of the major bene- that did not have it. We found that I think there are many Members in ficiaries of this so-called Medicare re- there are 40 million Americans from this body from what I can see that do form since they are the prime promoter working families that had no health not even understand what current of the so-called Medisave Program. care. Today, that number has risen by funding means with regard to Social The truth of the matter is that this nearly 1.5 million. There are more fam- Security and Medicare, where the particular bill, not 10 Members of this ilies that do not have health care. They workers today are paying for the bene- House knew what was in it until about H 10470 CONGRESSIONAL RECORD — HOUSE October 19, 1995 the time the debate began. And all this done today in secret working with var- The answer, Mr. Speaker, is that the hoopla about how we had everybody in- ious special interest lobbyists to get Clinton administration talks about the volved and there were task forces and the law written their way. The Amer- need for reform but at the same time so forth. The truth of the matter is this ican people deserve to have this out in they are using taxpayers’ dollars to bill was written by one person, Speaker the public. We need to reform this Con- campaign for reelection. GINGRICH, sitting in his office with one gress and change business as usual as He called to talk about how much the special interest lobbyist after another much as we need to protect the seniors Clinton administration cares about coming in. These task forces that ex- of our Nation and prevent these kinds rural North Carolina, but at the same isted, they were just an excuse for de- of Medicare raids. time the Clinton administration is rec- mocracy. Instead of having the normal f ommending policies that would destroy committee process operate, little task The SPEAKER pro tempore. Under a the economy of rural eastern North forces would meet and go in and out of previous order of the House, the gen- Carolina. the Speaker’s office, in secret, where tleman from Louisiana [Mr. TAUZIN] is As Gene Price, the editor of the the American people had no oppor- recognized for 5 minutes. tunity to observe what was happening. Goldsboro News-Argus stated in an edi- [Mr. TAUZIN addressed the House. Can you imagine raiding the Medi- torial, and I quote: His remarks will appear hereafter in care trust fund to the extent of $270 bil- the Extensions of Remarks.] Bill Clinton is the biggest enemy of the to- lion and not allowing one senior citi- bacco farmer ever to sit in the White House. zens in this country to testify on the f specifics of the bill that provided for The SPEAKER pro tempore. Under a Tobacco farmers aren’t stupid. The man previous order of the House, the gen- who has been going for their jugular ever that raid? since he has been in Washington now has the Yet, my colleagues, that is precisely tleman from Florida [Mr. DEUTSCH] is gall to send his emissary on a scare-the-hell- what happened with this new spirit of recognized for 5 minutes. out-of-’em mission telling North Carolina democracy and all the task forces and [Mr. DEUTSCH addressed the House. farmers the Republicans are threatening all the inclusion. The bill was written His remarks will appear hereafter in their tobacco program. in the Speaker’s office. The committee the Extensions of Remarks.] I further quote Mr. Price: process was basically eliminated. I un- f derstand they are even considering the The SPEAKER pro tempore. Under a Republicans and conservative Democrats possibility of eliminating committees previous order of the House, the gen- in Congress should not be fooled. Certainly and perhaps just substituting a com- the Third District’s WALTER JONES, Jr. sees tleman from California [Mr. DORNAN] is the President’s campaign for what it is. mittee of one to write all of the legisla- recognized for 5 minutes. tion in this House. [Mr. DORNAN addressed the House. Mr. Speaker, the Goldsboro News- You know, I have discussed this Argus is right. The President’s cam- morning a bit tongue in cheek the fact His remarks will appear hereafter in the Extensions of Remarks.] paign is exactly that, a political cam- that there was a painting that kind of paign paid for with your tax dollar. f summarized what was happening to Every single Member of Congress from seniors today, a painting by a famous The SPEAKER pro tempore. Under a North Carolina, Republican and Demo- American artists of the last century previous order of the House, the gen- crat alike, voted for the agriculture ap- called plucked clean. It seemed to me tleman from New York [Mr. TOWNS] is propriations bill. It is the Clinton ad- that it symbolized what was happening recognized for 5 minutes. ministration, not Congress, that is try- [Mr. TOWNS addressed the House. here as our seniors were plucked clean ing to destroy the tobacco farmers. and having to face higher deductibles His remarks will appear hereafter in and higher premiums and higher costs the Extensions of Remarks.] Mr. Speaker, it is the Clinton admin- for health care at the time they were f istration that is now trying to classify stretched to the limits. nicotine as a drug. It is the Clinton ad- Well, really, I think this same paint- POLITICAL APPOINTEES ABUSING ministration that is trying to put fami- ing is a little bit symbolic of what is THEIR POSITIONS lies that have grown tobacco for gen- happening to democracy in this House. The SPEAKER pro tempore. Under a erations into the same category as Instead of a proud eagle of democracy, previous order of the House, the gen- Asian poppy growers. democracy is being plucked clean in tleman from North Carolina [Mr. Now this same Clinton administra- this House, because next week we are JONES] is recognized for 5 minutes. tion has the gall to have its political about to have the same thing happen. Mr. JONES. Mr. Speaker, there is appointees call my district to say that We have got something called rec- much talk throughout our Nation he, Bill Clinton, is worried about what onciliation that is coming up, not the about reforming the way Washington, the Republicans might do to tobacco. kind of reconciliation that happens be- DC operates. The people are upset The bad news, Mr. Speaker, is that this tween husband and wife. This is not a about the way politicians have been kind of hypocrisy only adds to the cyn- divorce unless it is the divorce between conducting business. One reason that icism about all people in public life. the reality of the real lives of the mid- people are upset is because they see po- The good news is that the people of dle-class families that are working to litical appointees abusing their posi- eastern North Carolina have long ago make ends meet in this country and tion using tax dollars to work on re- figured out the Clinton crowd. The the Republican rhetoric that we hear election campaigns instead of doing working people of eastern North Caro- on this floor. the jobs they are paid to do. lina who pay their taxes, go to church No, indeed, we are talking about a Mr. Speaker, last week the people of and play by the rules know that there bill that is going to do all kind of mys- eastern North Carolina got a firsthand is very little relationship between what terious things that have never received example of that abuse. A Clinton polit- this administration does and says and a hearing. It is going to rewrite laws ical appointee in the Department of really what it does and says in reality. that committees refuse to pass, and all Agriculture was assigned to contact of that is about to occur next week one of the newspapers in my district. Mr. Speaker, no matter how many without the Members ever having seen He not only called to use the agricul- Clinton political appointees call my the bill and without there ever having tural appropriations bill to campaign district to say otherwise, the people of been even a final hearing. against Republicans, he also called to eastern North Carolina know that an What we should be talking about campaign against Medicare, student administration that is trying to de- next week is a gift ban on the gifts loans, and other issues. stroy the tobacco farmer does not care that tie lobbyists and legislators and a What in the world is an Under Sec- about rural North Carolina. reform of the lobby process. Appar- retary of Agriculture doing campaign- In the future, Mr. Speaker, I would ently under this Speaker we are going ing about programs that have abso- advise the President to have his politi- to continue to write laws in secret that lutely nothing to do with his job on cal appointees confine their campaign- bind the American people, like was taxpayers time? ing to Hollywood or to San Francisco October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10471 or to some other place where the peo- ment, which was defeated on a partisan ure about how much is being block- ple have not yet figured out that this line, vote with the Republicans all vot- granted to the States is based on the administration’s word means very lit- ing against it. current premium, and, as we know and tle. When the Medicare bill came up in as the gentleman from Massachusetts But he is going to have his govern- the Commerce Committee, my col- [Mr. MARKEY] pointed out, the pre- ment employees do his campaigning for league, the gentleman from Illinois mium under the Medicare under the him. At least have them do it on their [Mr. RUSH], offered a similar amend- Republican bill that was passed today own time. That would be the beginning ment on Medicare on the theory that if doubles over the next 7 years, so in- of real reform. it is no longer going to be covered stead of being 40-something dollars a f under Medicaid, let us try to cover month, it is going to be $90 a month by these poor seniors, these widows, these the year 2002. So what likelihood is MEDICAID elderly under Medicare. And again, on there that those widows and those poor The SPEAKER pro tempore. Under a partisan line vote, that amendment senior citizens are going to have the the Speaker’s announced policy of May was defeated, defeated by the Repub- States covering them for their part B 12, 1995, the gentleman from New Jer- licans, by the majority. premium when the premium doubles, sey [Mr. PALLONE] is recognized for 60 Yesterday I went before the Commit- when the amount they are getting is minutes as the designee of the minor- tee on Rules on the Medicare bill. I based on current levels, and when they ity leader. asked the Committee on Rules to con- are getting only 85 percent of essen- Mr. PALLONE. Mr. Speaker, I want- sider an amendment on the floor today tially what is necessary? I would main- ed to start out this evening by going that would have guaranteed that those tain that the likelihood is almost nil. over and trying to explain a little bet- seniors would be covered. I had a dialog This, what the Speaker said today, ter some of the statements that were with the gentleman from Georgia [Mr. there is no question that he was mis- made by my colleagues on the Commit- LINDER] and perhaps other members of understood, but I have very little doubt tee on Commerce with regard to low in- the Committee on Rules where I ex- that he intends to do anything to make come seniors who, under current law, plained what this was all about. And sure that those people are covered. We under the Medicaid program, are guar- again, that request was denied. are going to do something about it anteed that the Medicaid program or So that in fact when the Medicare though. We are going to go to the Com- the Federal Government will pay the bill came up today for consideration, mittee on Rules next week on the Med- full amount of their part B premium. contrary to what the Speaker said, it icaid bill on the reconciliation bill, Part B is that part of Medicare which does not guarantee that those widows which the gentleman from Texas [Mr. covers doctors’ bills. And in the motion and the people, those low income elder- ARMEY] said is going to come up next to recommit that we had today on the ly, it does not have to just be widows, Thursday on the floor, and when the Medicare bill, the gentleman from Mas- it is anyone who is 100 percent of the Committee on Rules considers amend- sachusetts [Mr. MARKEY] addressed the poverty line whether they are male or ments next Tuesday or Wednesday, Mr. issue and pointed out that there will be female, whatever their marital status, Speaker, myself and the others are no guarantee that widows and other it does not guarantee, the bill that was going to be before it and ask that this seniors who are low income will receive passed today by the majority, that amendment be considered to basically coverage by the Federal Government of those poor and elderly people are cov- make it so that the Speaker has to an- their part B premium in the future be- ered for the part B premium. nounce whether he is going to include cause of the repeal of that provision in b 1915 this provision or not for the widows Medicaid. What does this mean for these senior and for the poor elderly. I doubt that The Speaker, Speaker GINGRICH, later citizens? Well, essentially it means we will see it, but we are certainly this evening spoke and basically criti- that they are going to go without phy- going to try. cized Mr. MARKEY because he suggested sicians coverage. Part B pays for their I just wanted to point out again that that was not true, that somehow doctor bills. today when I went to the Committee Medicare under the Republican pro- Now the other side said in commit- on Rules yesterday many of us, many posal, under the Gingrich proposal, tee, ‘‘Well, you shouldn’t worry about Members of this body, not only Demo- would continue to cover those recipi- that, Congressman PALLONE, because crats, but also some Republicans be- ents. Well, I do not know what the we have included in the block grant cause I was there for a good deal of Speaker had in mind, but he clearly that we are going to now give to the time, asked that amendments be con- was misinformed. He clearly has not States, even though there is no entitle- sidered today because they did not like read the bill or had not followed what ment, no guarantee that these senior the provisions of the Medicare bill that had been happening both in committee citizens get their part B paid, we are we considered, and I am sure it was no- as well as in the Committee on Rules going to send in a block grant to the ticed that the reality was that no as well as on the floor of this House State under Medicaid, and, as the amendments were considered. The only when the bill came up. States want to do that, they can cover thing that was allowed was a sub- The reality is that that guarantee for them.’’ Well, that is very nice, but the stitute amendment, one substitute. low income seniors, including the wid- reality, as the gentleman from Califor- We also asked for at least a week’s ows, was struck from the Medicaid bill nia [Mr. WAXMAN] said before, is the debate because, as you know, there in the Republican proposal that came amount of money that is going to be have been no hearings on this bill in out of the Committee on Commerce as available pursuant to that block grant any committee. The Committee on well as out of the Ways and Means is about 85 percent of what is going to Ways and Means had one day of hear- Committee. And I had actually pro- be needed. ings on the draft of the bill on a press posed an amendment to bring that pro- In addition, there is no guarantee or release, but there were never any hear- vision back, to guarantee that those requirement that the State pay that ings on the actual bill that we voted on low income seniors would have their part B premium, so they are going to today, so we asked there be at least a part B premium paid. I brought up the get 85 percent of what they need, but, if week’s worth of debate. What we were amendment not out of the sky but be- they decide not to spend it, not to even given today was 1 hour on the rule, cause when I went back to my district cover those widows and elderly, they which was a very closed rule, 3 hours’ in central New Jersey, I had many sen- do not have to. They can decide to general debate on the bill, and one sub- ior citizens who were what we called cover 10 percent of them, 50 percent of stitute amendment in which we were qualified Medicaid beneficiaries who them, or none of them, and the dis- allowed 1 hour of debate. I would main- received this benefit who came to incentive for not having the money to tain that the biggest problem, or one of meetings and forums that I had and do it is certainly going to be there, so the biggest problems, that exists in were seriously concerned about the it is likelihood that they will not be this whole Medicare debate and with fact that this was being repealed. covered. the whole Republican proposal is that And so I went back to the Commerce Another reason why they are not most of my colleagues really do not Committee and offered that amend- likely to be covered is because that fig- even know what is in the bill because H 10472 CONGRESSIONAL RECORD — HOUSE October 19, 1995 there has not been the opportunity to Gibbons and Ben Cardin, will provide the Mr. DOGGETT. This is the organiza- have hearings or to have adequate de- chance for Congress to seek a consensus so- tional chart. We will now have at a bate. lution to preserve Medicare for our parents time we have been told we need less and grandparents. Now, before I go into my concerns Thank you for your thoughtful attention government we are now going to have a about how this bill is going to essen- to this appeal on behalf of the Senior Citi- new baby-boom commission set up. We tially eliminate and destroy the Medi- zens of Ocean, Burlington and Atlantic coun- will have a variety of other new com- care system, I wanted to introduce a ties. missions, and boards, and agencies, and few things into the RECORD, Mr. Speak- Sincerely, our seniors of course will face a wide er, that I did not have the opportunity LEONARD T. CONNORS,Jr. range of new choices. to do in the Committee of the Whole Senator—9th District. What it all boils down to, of course, today the way the rules are. You can- JEFFREY W. MORAN Assemblyman—9th is the choice to pay more and get less, not do that in the Committee of the District. but the way it is spread out, it is an or- Whole. The first is a letter that was CHRISTOPHER J. CONNORS ganizational chart that is really an or- sent to me by three Republican State Assemblyman—9th ganizational nightmare. The lines that legislators in New Jersey from the Jer- District. seem to me to be the most important sey shore who previously had sent a Now I point this out, Mr. Speaker, though are the taking from the two letter to all the New Jersey Members because that is the way I voted today. funds that the gentleman is familiar of this House indicating their opposi- I voted against this terrible Medicare with, part A and part B of Medicare, tion to the Republican leadership Med- bill, and I voted for the Democratic the taking from those funds, and tak- icare bill that we voted on today and substitute sponsored by the gentleman ing that money out and really giving who today, or earlier this week, sent from Florida [Mr. GIBBONS] and also it, as you have been saying, to a tax another letter to all of my colleagues the gentleman from Michigan [Mr. DIN- cut for the most privileged members of in the New Jersey delegation asking GELL], and it just pleases me to see not our society, and I wanted to add to this them to vote against the Republican only that there are three State legisla- very important debate, but I also Gingrich bill and also to vote for the tors at the Jersey shore that agree would like at this point to comment on Democratic substitute instead, and I with that position and clearly under- another topic that really related to my just wanted to read part of this, or stand why my position is accurate, but district. even all of it, because it is not that also that I believe that they and others Mr. PALLONE. Sure, I yield to the long, if I could, Mr. Speaker, because I like them in New Jersey influenced gentleman. think it says a lot about the debate four of my colleagues on the Repub- Mr. DOGGETT. This is about that we and backs up what I have been saying lican side, half of our New Jersey Re- have been involved in a great debate today, but in this case this is coming publican delegation in Congress, to today about the Medicare system and from Republicans, Republican State cast votes against the Gingrich Medi- many of the important public policy is- legislators in New Jersey, and they care plan today, and I think that we sues. It is about another great debate write to the House Members, and they have worked very hard and essentially and another debator. say: the vote today against the Medicare Like many of the Members of this STATE OF NEW JERSEY, plan, against the Gingrich plan, as far body of Congress on both sides of the October 13, 1995. as New Jersey goes, was really on a bi- Re: Medicare. aisle, Republican and Democrat, I had partisan basis. an opportunity early in my life to par- DEAR HOUSE MEMBERS: It is our under- Mr. Speaker, I am very proud of that ticipate in the forensic program, and I standing the House Ways and Means Com- fact. I hope that in the future we will mittee has voted 22–14 to send the Medicare rise tonight with the unhappy task of reform package to the House floor next see more Republican Congressmen calling attention to a recent tragedy week. coming out against this proposal and that befell members of the Texas Fo- Our 9th District Delegation, which rep- also more State legislators coming out rensic Union, an award-winning debate resents the largest Senior Citizen population against the proposal. and speech team of my alma mater at in New Jersey in Ocean, Burlington and At- I want to yield, if I could, some time the University of Texas, Austin. lantic counties, issued a letter on September to the gentleman from Texas [Mr. On a single weekend students were 22, 1995 to House Speaker Newt Gingrich and OGGETT]. D participating from the University of Senate Majority Leader Bob Dole, urging Mr. DOGGETT. Would it be appro- Texas along with their colleagues at them to scrap this plan. priate at this time to touch on another Copies of our correspondence to Speaker debate tournaments in Kentucky and subject? Have you concluded most of Gingrich and Senator Dole were conveyed to in Nevada. Unfortunately as one group New Jersey’s Congressional Delegation. For your remarks? Mr. PALLONE. Yes. of these young Texas students were re- your convenience, a second copy of this ap- turning from Nevada, their van was in- peal is enclosed. Mr. DOGGETT. I note first in this Please allow our Delegation this oppor- great Medicare debate, as I pointed out volved in a terrible accident just out- tunity to reiterate our profound concerns earlier today, we are about to sub- side of Las Cruces, NV. A young man about these cuts in Medicare services for our stitute for the Medicare card a giant was killed in that mishap, Jason G. elderly. maze that looks somewhat like the Wilson of Boca Raton, FL. As you are aware, alternative proposals maze that our Republican colleagues Mr. Speaker, although I did not have have been offered that would maintain the the good fortune of knowing Justin solvency of the Part A and Part B trust criticized President Clinton on last funds until 2006. This $90 billion compromise year on health care for the company. personally, I know that the hearts of package would provide a decade for Congress We are about to have a maze of that people in this body, as were my friends and the White House to achieve a well- type presented to senior citizens. I at the University of Texas, go out to planned and balanced proposal to resolve wonder if some of them are not going his friends at the University of Texas, Medicare’s financial problems. This com- to need to go back for a little late life go out to his family, and to his friends, promise would also provide the opportunity education to get and understand the and to the entire University of Texas for a bipartisan consensus. community. Our Delegation is genuinely sensitive to full maze of this, and I know you are the difficult decision you face and have had familiar with this from your work This was from all of the reports that our own feet roasted by the hot coals of there on the Committee on Commerce, I get from my friends at the University Leadership. We feel very strongly that a rush but there are new commissions set up of Texas an exceptional young man, an to judgment on this issue is bad public pol- under this bill; are there not? excellent student, well liked by his icy. America must never turn its back on our Mr. PALLONE. Yes, I wanted to com- peers and a very noteworthy debater parents and grandparents. mend the gentleman because I think he who one day might have been partici- We, respectfully, urge New Jersey’s House has pointed out that this bill has cre- pating in the Halls of this Congress. Members to oppose this $270 billion Medicare cut. Your leadership, in targeting Medicare ated such a bureaucracy over and Justin’s life was tragically cut short. fraud, the staggering costs of health care and above what, you know, what we have Mr. Speaker, all too often these days in building a bridge to the future with the al- already, and I am glad he is pointing it we hear of slipping academic standards, ternative proposals set forth by Reps Sam out. of deterioration of education, and a October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10473 lack of caring by our colleges and uni- essentially on a bipartisan basis today, of Medicare to pay for a $245 billion tax versities. By contrast, the young peo- is because of concerns that were ex- cut, mostly for the wealthy. ple who are involved in this tragedy, pressed in the State legislature in I know my colleagues on the other and particularly Justin Wilson, em- Trenton earlier this week about how side have said, ‘‘We are not really bodied a real commitment to excel- much money the State would have to doing a tax cut. This is not budget- lence. He should be honored, and I provide if we wanted to continue mak- driven.’’ It is simply not true. We know know that he will be missed. ing sure that our senior citizens were that the trustees that the Republican Justin and his colleagues were re- to receive adequate health care. leadership cite often, the Medicare turning from intercollegiate competi- If I could just read some excerpts trustees, basically said that there was tion, and I can remember attending from an article which appeared in the only a need to save about $90 billion in similar events at an earlier time that Asbury Park Press, which is my home- the Medicare program over the next 10 were really significant in my life and town daily, wherein the Democratic years in order to keep the Medicare in the lives of many others. leaders in the State legislature, on Oc- program solvent. The trustees have ba- tober 18, basically pointed out that the sically indicated that repeatedly. b 1930 Republican plan to slash Medicare and The substitute that the Democrats I can remember the camaraderie, the Medicaid funding ‘‘* * * would force had would have saved $90 billion. The mutual respect that characterizes New Jerseyans to pay far more for rest of the money, the rest of that $270 these events, and the opportunity to health care.’’ billion cut, is going for tax cuts, tax compete and achieve excellence is real- In the attack they made on the GOP cuts mostly for the wealthy. Also, sen- ly very important to the future of our proposals, assemble minority leader, iors are going to have to pay more democracy. Our sympathies go out to Joseph Dorian, and Senate minority under this bill. Essentially, they are all of those who were involved in this leader, John Lynch, Mr. Lynch happens going to be paying more to get less. tragedy. It is an event that reminds us to be from my district, ‘‘* * * insisted The part B premiums will double with- that every year there are thousands of that the cuts could force State taxes to out a penny of that increase going back committed young students of all types soar because of New Jersey’s commit- into the part A Medicare hospital trust of political philosophies and outlooks, ment to offer health care for all resi- fund. and their coaches and their faculty dents.’’ There are essentially two parts to members representing with pride their What Senator Lynch is essentially Medicare: There is the hospital trust particular college or university, indi- saying here, we have two choices in fund, which the trustees have said does viduals like Justin Wilson that try to New Jersey if this bill becomes law. We face problems over the next few years make a difference in the academic either provide the services for the sen- unless something is done, and then community and in the broader life of iors at the level of care they have been there is the part B program, which democracy in our country. accustomed to, and we pay more in pays for physicians or doctors’ bills, Ironically, in my year of debating, State taxes to do so, or we do not offer which is not really in any trouble at the subject was whether the United the health care. this point. States should have a Medicare System. What Senator Lynch is saying, essen- Here we have the Speaker, the gen- Today, we have been debating this tially, is that New Jersey, because of tleman from Georgia [Mr. GINGRICH] same topic, as the other young debat- its tradition of wanting to provide and the Republicans redoubling the ers like Justin were participating in quality health care to all its residents, premiums on part B, which is not fac- considering topics of important na- is likely, and hopefully would opt to ing insolvency. The only reason they tional interest this year. continue to provide the same level of are doing that is so they have money These individuals make great sac- care, but that is going to cost more in left in order to pay for a tax cut. rifices. They often go unnoticed, but State taxes. The other thing that is extremely their work is very important. Justin’s If I could just quote from Mr. Doria, troubling about the bill is that seniors too-short life is appropriately remem- the assembly minority leader, he says, will ultimately be forced into HMO’s bered here tonight in the halls of our ‘‘The cuts as presented are unreason- and other managed-care systems, and Nation’s Capitol. We strive to be more able and irrational.’’ He urged the that means in many cases they have to aware of the contribution that these State’s congressional delegation to give up their own doctors. Again, my unique students, and particularly Jus- vote against the gentleman from Geor- Republican colleagues have said, ‘‘We tin Wilson, have made to our country. gia, NEWT GINGRICH, and the madness, are not telling the seniors they have to I thank the gentleman for yielding. to vote against the mean-spiritedness. go into an HMO or a managed-care sys- Mr. PALLONE. I thank the gen- He even said New Jersey should not be- tem,’’ and that is true. tleman. come ‘‘Newt’s Jersey,’’ as I quoted. The law does not say that they have Mr. Speaker, when I left off, I was Obviously, many of my Republican to choose the HMO, but the reality is talking about the letter I had received colleagues on the other side today felt that the amount of money that is being from the three Republican State legis- strongly they did not want New Jersey cut here is disproportionately hitting lators at the Jersey shore indicating to become Newt’s Jersey, and thank- the traditional fee-for-service system, opposition to the Medicare bill that fully, decided to vote against this very where people go to any doctor that was passed today, and asking all of our ill-advised piece of legislation. they choose and the doctor gets reim- colleagues in New Jersey to vote Mr. Speaker, I just wanted to, if I bursed. against it, and to vote for the sub- could, in some of the time that I have Therefore, this money that is being stitute. here, to go over some of the reasons in cut out of the system, this $270 billion, I believe that those State legislators a little more detail about why the Med- is being distributed in a way over the and others influenced, as I said, half, icare bill that was passed today, the next 7 years, so that a significant four of the eight Republican Members Republican bill, is so damaging to sen- amount of it goes to pay for HMO’s and from New Jersey, to vote against the ior citizens and to the Medicare Sys- managed care, but less and less of it Gingrich Medicare bill today, because tem, and to the health care system in will go to pay for the traditional Medi- they realize it is not in the interests of general, and why the Democratic sub- care system, where you can choose the State of New Jersey. stitute, which I supported, would have your own doctor. Mr. Speaker, I also wanted to enter corrected many of those problems that Therefore, even though the Repub- into the RECORD a letter from the Na- the Republican Medicare bill presents licans are not saying that you have to tional Conference of State Legisla- for the future of seniors’ health care. join an HMO, what you will find hap- tures, in which they express serious The biggest item, of course, and this pening is that less and less seniors will concerns about certain provisions in is one of the things that my colleagues find that their own doctors will stay in the House Medicare legislation. on the Democratic side have continued the traditional fee-for-service system, Mr. Speaker, I also wanted to point to stress, is that this leadership pro- because they will not get reimbursed out that one of the reasons New Jersey posal, this Republican leadership pro- enough for it to be worth their while to Members opposed this Medicare bill, posal, essentially cuts $270 billion out continue to operate that way, so fewer H 10474 CONGRESSIONAL RECORD — HOUSE October 19, 1995 and fewer doctors will be available to security for the Medicare trust fund than half of what the Republican Ging- seniors, and take Medicare, under the that the Republicans claim they were rich bill proposed today. The hospital traditional fee-for-service system. providing? association and the various hospitals The Republican plan also essentially Mr. PALLONE. Absolutely, there is that I have talked to in my area have destroys the high quality of care that no question that not only Secretary indicated that they could absorb that we have in America’s hospitals, be- Rubin, Secretary of Treasury, but also level of cut, unlike the level of cut in cause so much of the savings is in cuts several other trustees, I think there the Republican proposal. to the reimbursement rate for hos- were four that put out a letter saying Mr. DOGGETT. I know you have put pitals, hospitals in inner cities, hos- that $90 billion was necessary to shore in a long day and have been participat- pitals in suburbia, hospitals in rural up the trust fund. ing here on the floor all day during this areas. It depends to what extent those Mr. DOGGETT. How in the world debate, and I want to thank you for hospitals are dependent upon Medicare could you do it for $90 billion when your efforts. I know with the kind of and Medicaid. they said they would need $270 billion leadership that you have provided In other words, if you have a hos- to assure that the Medicare trust fund today, that New Jersey will never be pital, as you do for most of the hos- was there? How is it that you are able Newt Jersey. In fact, it was interesting pitals in my part of New Jersey, where to do it for one-third the cost that they to see that even at least one of our Re- the majority of the money that they say they need in billions of dollars publican colleagues from the apparent receive comes from either Medicare or from Medicare? Newt Jersey, who had voted in favor of Medicaid, if they are heavily dependent Mr. PALLONE. It is very simple. As the Newt plan in committee, appar- on Medicare and Medicaid and they the gentleman from Texas [Mr. ently had a change of heart our here have to face severe cuts in their reim- DOGGETT] has pointed out, and pre- today, perhaps hearing the words of the bursement rates, they are going to be viously, they are using that extra many Republicans who have spoken squeezed so much that essentially money for a tax cut. It is primarily out from New Jersey saying that they many of them will close, we estimate going to the wealthy Americans. would exercise their independence and about 25 percent, and the others are Mr. DOGGETT. So you could secure would stand up for seniors. If we can going to significantly cut back on serv- the entire Medicare trust fund for a just get the Members of the Senate to ices. That is how the quality of care third as much of what they took out do the same thing, there is yet hope, will suffer. That is how what probably today? and if President Clinton will stand firm is, and I would say is, no doubt in my Mr. PALLONE. Over the next 10 on this, there is yet hope that our sen- mind, the best health care system in years, that is right. iors will not find themselves plucked the world, probably the best health Mr. DOGGETT. Under your plan, the clean. substitute, would seniors have seen care system that has ever existed on Mr. PALLONE. I want to thank the this rapid increase in their premiums, this planet, will all of a sudden see sig- gentleman. I think the gentleman also and when the Senate finishes, an in- nificant cutbacks in quality of care. brings up an important point, which is crease in deductibles? Would they have Again, none of this would be nec- that I think a lot of people think that had out-of-pocket costs if your $90 bil- essary if the Speaker was not insisting today was the end of this process. In lion had been adopted today? on this tax break, primarily for fact, today is the beginning of the proc- wealthy Americans. I wanted to point Mr. PALLONE. Absolutely not. The way the current law provides, I would ess, because the Medicare bill, the Re- out, if I could, that the Democratic publican bill, still has to be addressed substitute, which I supported today, estimate that the monthly part B pre- mium by 2002 over 7 years would go up in the Senate. It will still go to con- which unfortunately did not pass, basi- ference. The President has already said cally cured these problems, and ad- to about $60 a month. It is now about $46, I think. that he intends to veto the bill. It will dressed each of the concerns that I just come back to the House, back to the brought up tonight about the Repub- Under the Gingrich plan, it goes to over $90 a month. Under the substitute, Senate, and we will probably be here lican Medicare bill, and still managed for several weeks, if not several to keep Medicare solvent and whole for it would be less than the $60 under cur- rent law, so we would actually be pro- months, continuing to debate this the next 10 years. issue, and hopefully there will be an Basically, what the Democratic sub- viding for less of an increase in the pre- opportunity to persuade more Members stitute says is that, ‘‘We will cut $90 mium than current law. from the other side of the aisle to ei- billion out of the Medicare Program Mr. DOGGETT. You are advancing, ther not support this, or change it, con- and we will save $90 billion, instead of then, a proposal that would cost less to sistent with the Democratic substitute. $270 billion,’’ which is exactly the seniors than they would be facing amount that the trustees say is needed under existing law, and yet it would b 1945 to shore up the trust fund for the next provide every bit of the security of the 10 years, but a consequence of that is Medicare trust fund that we heard one The other thing I wanted to point out that much of the tax cut for the person after another out here proclaim- about the substitute is that this whole wealthy is eliminated. ing that they were the defenders of, shifting, if you will, of seniors into The Democratic substitute, which I and that though these reports had HMO’s or into managed care where supported, again, also eliminates the come out year after year after year, they do not have a choice of doctors is dramatic increases in part B premiums they just discovered them this year, basically eliminated. There is no forced that double under the Republican plan. right after they raided the Medicare choice, because the system under the This is the thing, this is the part of trust fund for millions of dollars, and Democratic substitute is not changed Medicare that is going to hurt seniors added to its insecurity, but you have a in that there is no discrepancy in the on fixed incomes, because they are way to secure it fully, to the extent the reimbursement rate and the amount of going to have to pay twice as much as Republicans are securing it, at a third money that is going to go, whether you they pay now. of the cost and without costing seniors are in an HMO or you are in the tradi- Under the Democratic substitute, the any additional premium; in fact, less tional fee-for-service system. So doc- premiums for part B will actually in- premium than they would face under tors will still be available under the crease less than the current law, and so existing law? traditional fee-for-service system and there is an effort to really ease the Mr. PALLONE. Exactly, and not only will continue to accept Medicare. problem for seniors on fixed incomes. that, I would point out that the sub- The other thing that I think is so im- Mr. DOGGETT. Mr. Speaker, will the stitute also does not decrease the qual- portant about the substitute, which gentleman yield on that point? ity of health care from the point of has not really been debated a lot be- Mr. PALLONE. I yield to the gen- view of the hospitals, which I talked cause so much of this debate on the Re- tleman from Texas. about before, because even though that publican side has been subject-driven, Mr. DOGGETT. Under that sub- $90 billion is coming from the reim- is that the substitute seeks to include stitute, would the gentleman have es- bursement rate to hospitals, the reduc- more of what I call preventive meas- sentially provided the same amount of tion in the reimbursement rate is less ures in Medicare. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10475 I was hopeful, maybe I was naive, have a hearing before the Committee gram money, they are going to cost the that when I took up Medicare reform on Commerce, some of the Democrats program more money. this year that, rather than focus on the got together and had their own hear- The CBO, the Congressional Budget budget aspects and have a whole debate ing; and we had testimony from the in- Office, estimates show that medical be driven by budget dynamics, that we spector general, June Gibbs Brown of savings accounts would essentially rob would try to look to include in Medi- the Department of Health and Human the program of $2.3 billion over 7 years. care preventive measures which ulti- Services, and she pointed out some In other words, it would cost that mately save money, because they pre- major flaws in the bill in terms of the much more to the Medicare Program to vent senior citizens from having to be effort to weed out fraud and abuse. have these Medicare savings accounts hospitalized or institutionalized. Mr. Speaker, I just wanted to quote in effect. Now, just to give you an example, the some of the things that she said that I It says that under the MSA’s, as they Democratic substitute today makes a thought were most important. are called, under the medical savings good start in that direction, because it She said that we believe that H.R. accounts, the Medicare Plus voucher includes programs like prostate screen- 2425 contains several provisions which could be used to buy a catastrophic ing. The whole idea is, let us do some would seriously erode our ability to ad- health insurance policy with a deduct- things, whether it is prostate screening dress Medicare and Medicaid fraud and ible as high as $10,000. Any difference or it is other kinds of tests, so that we abuse. Most notably, these troublesome between the cost of that policy and the can detect problems that seniors might proposals include the following: voucher amount will be placed in a tax- have at an early date so that they can One, the bill would make the existing deferred medical savings account. But have treatment on an outpatient basis, civil monetary penalty and only the wealthiest and healthiest sen- so that they can stay home and not antikickback laws considerably more iors could afford to gamble with such a have to be institutionalized. lenient. high-deductible policy. When these in- So much of the cost, not only to the Two, the bill would substantially in- dividuals buy MSAs, the average costs Medicare system but also to the Medic- crease the Government’s burden of of those remaining in Medicare would aid system, which we will be dealing proof in cases under the Medicare-Med- increase. with next week comes from having to icaid antikickback statutes. For the So what essentially we are saying institutionalize senior citizens in hos- vast majority of present-day kickback here is that the people that are going pitals, nursing homes. Something like schemes the proposed legislation would to take advantage of these medical 70 percent of the money that the Fed- place an insurmountable burden of savings accounts are the healthiest and eral Government spends on Medicaid in proof on the Government. wealthiest seniors, the ones that essen- the State of New Jersey goes to pay for Next, the bill would create new ex- tially we are not paying a lot of costs nursing home care. emptions to the Medicare-Medicaid for under the current Medicare law in If we could include preventive meas- antikickback statute which would be order to cover. If they are taken out of ures like this Democratic substitute readily exploited by those who wish to the system and the system has to pay that unfortunately was defeated today pay rewards or incentives to physicians out money into these medical savings in our Medicare program, we could save for the referral of patients. accounts, what is going to happen is a lot of money and come up with a bet- Finally, a fund was created directing that the cost to Medicare is going to be ter system without having to make the moneys recovered from wrongdoers more and not less, because the healthi- drastic changes and negative changes under the bill, but instead of the fund- est people that cost Medicare the least that the Republicans have proposed. ing of that money going to fund law en- amount of money are the ones that are Mr. Speaker, I just wanted to bring forcement, the moneys could go to pri- going to opt for it. up a couple of other points on the Re- vate contractors. No funds would be Mr. Speaker, the CBO says that. I publican bill today in the time that I made available to enhance existing mean it is not something that I am have left, because oftentimes, obvi- government law enforcement activi- making up; it is something that is ously, since debate was limited to only ties. clearly indicated by the Congressional 3 hours today and only half of that was I know that on the other side today Budget Office. on the Democratic side, there were sev- they tried to, and did, in fact, include The last thing I wanted to say, Mr. eral points that were made by Repub- some provisions to try to improve on Speaker, because I think my time is al- lican Members that I just thought were the fraud and abuse, but not every one most up, is that there were many sug- inaccurate or at least did not give a of these concerns that was addressed gestions, most notably by Speaker true picture of some of the things that by the inspector general was addressed, GINGRICH this evening when he gave his are in this bill that the Republicans and so the bill, in my opinion, contin- speech on the floor, that this whole passed today. ues to provide loopholes and make it idea that Democrats were saying, and One of the things that I thought more difficult for us to enforce fraud that I say, that this $270 billion in cuts needs to be addressed is this whole and abuse. I think that is totally un- to the Medicare Program is going to be issue of fraud and abuse. In my com- conscionable in the context of the fact used for a tax break for the wealthy, mittee, the Committee on Commerce, that we are trying to squeeze so much the Speaker said that that is simply there was at least one day or perhaps money out of this Medicare Program in not true. He said that we are not going several days of hearings not on this bill order to achieve a tax cut. to do that, that is not our intention, but just on the problem in general of Mr. Speaker, the other thing that I and so forth and so on. fraud and abuse; and I know that I at- wanted to point out is a lot of atten- Well, my contention, Mr. Speaker, is tended at least one of those hearings tion was paid by Republicans today to that if that were not true, if this whole where a lot of attention was paid to the the medical savings accounts. It was debate was not budget-driven for the fact that tremendous amounts of termed by my colleagues on the other purpose of creating these tax cuts, then money could be saved in the Medicare side that this was a new and innovative there was absolutely no reason for this program and we would not have to cut program that was going to sort of be Medicare reform, as it is termed, to be other aspects of the program if we the wave of the future. I forget all of linked with the budget reconciliation, could weed out the fraud and abuse. the adjectives that were used to say which it will be next week. Next week But, lo and behold, when the bill how wonderful the Medicare savings we are going to take up the budget rec- came up in the Committee on Com- accounts were going to be. onciliation and we are told that the merce, we found that there were some I would point out that there is no Medicare is going to be clearly linked provisions in the bill that, if anything, question in my mind, first of all, that to that. Although it was voted on sepa- made it more difficult for the Federal these medical savings accounts are not rately today, that is essentially a ruse, Government, the prosecutors, the in- going to be available to a lot of senior because it will be included in the budg- vestigators, to go after fraud and abuse citizens, but also, that it essentially is et reconciliation. in the Medicare system. Specifically, going to cost more for the program. In If the Speaker and the Republican we had testimony at an alternative other words, the Medicare savings ac- leadership were going to be honest with hearing. Since we were not allowed to counts will not save the Medicare Pro- us and say that they are not going to H 10476 CONGRESSIONAL RECORD — HOUSE October 19, 1995 use this for a tax cut, then they would sumers currently benefit from the necessary heard through the last hour or so about have supported some of the amend- protections within current state law. It is some of the proposals that were sup- ments that we made in the Committee highly unlikely that the proposed federal posedly proposed in the Medicare bill, on Commerce and also tried to get in- regulatory structure would come close to and in the next hour I would like to providing elderly consumers with the ability cluded in the Committee on Rules that to lodge complaints currently available for talk about some of those fallacies that would have not allowed the savings to enrollees in state licensed plans. Most sig- were presented here and talk about be scored for budgetary purposes. nificant of all, it is unlikely that a new fed- why Republicans decided that we had We had such an amendment in the eral bureaucracy could deal effectively with to look at a system that has been in Committee on Commerce, and again, it solvency problems, thus leaving the finan- place for 25 years, or actually 30 years, was defeated along partisan lines with cial stability of the entire system at risk. since 1965. the Republicans voting against it, be- Contrary to the assertions of some, the re- quirements in state law are not a stumbling Mr. Speaker, what happened last cause they do, indeed, intend to score April, the President’s Board of Trust- these Medicare savings of $270 billion block to market innovation. Many provider- sponsored entities already operate and com- ees for Medicare came forward and said to pay for the $245 billion in tax cuts. pete under the existing state regulatory that Medicare is going to go broke, Those tax cuts, again, will go mostly structure. We question the viability and that we start going into arrears next to wealthy Americans and other cor- quality of those entities which could not year, in fiscal year 1996, and by the porations. withstand the test of state regulation. year 2003 or 2004 Medicare would be to- Mr. Speaker, I think it is a very trag- Second, it is perplexing that the 104th Con- tally bankrupt. So we had a choice. Ba- ic day for America’s seniors that this gress, which is to be commended for cham- sically, Democrats and others today Medicare bill was passed, and that the pioning the states in so many respects, had a choice in this Chamber. You Democrat substitute was defeated, but would intrude in this instance on states’ could vote for a program that was hopefully, there will be more debate, if rights—particularly in an area where the states clearly have superior expertise and ex- going to save Medicare, preserve Medi- not here, then certainly in America as perience: insurance regulation. The proposed care and give seniors choices, or you a whole over the next few weeks and legislation exempts association plans, as could vote no and let Medicare go the next few months to bring to light well as PSOs, from state regulation. Pres- bankrupt so there would be no Medi- how terrible and devastating this bill, ently, both types of entities are largely sub- care system in the next year or 2 years this Republican bill is, and that we will ject to state law. or 7 years, and let seniors down, take eventually see changes so that it does You must recognize the threat to the state away a promise that has been there for ultimately make it possible to con- insurance regulatory mechanism that this provision in the reform legislation presents. a number of years. tinue to have a quality health care pro- The proposed uneven regulatory playing field In developing the Medicare plan that gram for the poor senior citizens in where PSOs are subject to different, and pos- this country. we had before us today, I would just sibly less stringent, requirements is a dis- like to take a minute and say that I NATIONAL CONFERENCE OF STATE criminatory system. Once created, it will not LEGISLATURES, NATIONAL ASSO- be easily stopped. Every other type of orga- think we went beyond the traditional CIATION OF INSURANCE COMMIS- nization in the health care delivery system square of how politicians think. We SIONERS, will want the same treatment. Importantly, brought in health care recipients, orga- October 18, 1995. under the terms and definitions of the bill, nizations like AARP and other Hon. NEWT GINGRICH, this will be easy. All entities will consumer organizations for seniors. We Speaker of the House, The Capitol, Washington, reconfigure themselves or form subsidiaries brought in management, risk managers DC. to become PSOs. We urge you to avoid this DEAR MR. SPEAKER: On behalf of the Na- of the Fortune 500 companies, we prospect that could lead to the effective fed- brought in hospital folks, we brought tional Conference of State Legislatures eralization of health insurance regulation. (NCSL), and the Special Committee on In summary, we strongly object to any in nursing home folks, we brought in Health Care Reform of the National Associa- provisions in Medicare reform legislation doctors and other providers to listen to tion of Insurance Commissioners (NAIC), we which exempt PSOs from state regulatory what their problems were and how to are writing to express serious concerns about authority. All Medicare beneficiaries deserve design a Medicare system for the fu- provisions in the House Medicare reform leg- the same protections afforded other citizens ture. islation currently under consideration. In of the states. The erosion of traditional state We asked people to do one thing, and particular, we urge you to reconsider provi- authority contained in the proposal is sim- sions in the bill that exempt provider-based ply not justified and could worsen, rather that was to think beyond either cut- organizations (sometimes called provider- than improve, the health care system. ting down the benefits that have al- sponsored organizations (PSOs) or provider- Thank you for your consideration. Please ways been there to squeeze down the sponsored networks (PSNs)) from the re- contact us if you have any questions. dollars that we spend on Medicare and quirements of state regulation. Sincerely, hold back those benefits, or hold back The proposal presents significant problems BILL POUND, the dollars that the providers got, or for the states and the current privately- Executive Director, NCSL. based health insurance market in two fun- those types of traditional ways that LEE DOUGLAS, the previous leadership in this House damental respects. First, consumers could be President, NAIC and Chair, Special Committee harmed greatly by the loss of state-level pro- on Health Care Reform, Commissioner of has behaved towards Medicare, or to tections resulting from the bill. Secondly, Insurance, State of Arkansas. try to think beyond the traditional the proposal could eviscerate state regula- f square. How do you create a new sys- tion of health insurance overall. tem, how do you create a Medicare sys- By preempting state laws that otherwise REPUBLICANS PRESERVE MEDI- tem that will reach into the future apply to PSOs, in one fell swoop, the pro- posed legislation completely blocks the ap- CARE FOR GENERATIONS TO that will give people better services, plication of state insurance laws to these en- COME better choices, and be a system that tities. These laws currently include financial The SPEAKER pro tempore. Under really starts to move towards the pri- and market conduct requirements, as well as the Speaker’s announced policy of May vate sector? other consumer protections, for many types 12, 1995, the gentleman from Illinois Well, we decided that the fee-for- of health plans which are similar to, if not [Mr. HASTERT] is recognized for 60 min- service system that has always been identical in form and operation to, PSOs. the traditional Medicare delivery sys- Thus, state requirements—which have utes as the designee of the majority worked effectively for a substantial period of leader. tem in this country was near and dear time—would be entirely eradicated for a Mr. HASTERT. Mr. Speaker, I to many people. We did not want to growing and substantial segment of the thought we would take some time this upset seniors, and we wanted to make health insurance market. evening to talk about the bill that we sure that that system was always there In order for the federal government to passed today, the Medicare bill where if people chose to take it. Also then, we begin to provide the consumer protections the Republican proposal to save and wanted to offer an array of choices, and deserved by all health care recipients, it those choices, one of them is about 10 must create a bigger and better Health Care preserve Medicare for generations to Financing Administration to oversee these come was passed in this House. percent of our seniors in Medicare new organizations. This would result in bi- It was interesting to listen to some today already take the choice of man- furcated and potentially duplicative state of the previous speakers and some of aged care, or what we call HMO’s, or and federal regulatory system. Further, con- the shameless rhetoric that we have Health Maintenance Organizations. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10477 b 2000 legislation for well over a year, be- I am in a credible position to talk Along with that, they do not have cause we started, in fact, when we were about that since I personally did not those choices today, but PPO’s are also in the minority to deal with this very vote for the tax cut. part of that choice system. In this sys- serious problem of reforming our It is important to emphasize on the tem, a health maintenance organiza- health care system and making it a gentleman from Connecticut’s use of tion may offer somebody prescription better system for all. the word cuts in explaining that, that drug benefits, prepaid, and they offer One of the first fallacies, and there our colleagues on the Democratic side to do away with copayments and they are going to be a lot of fallacies that are using the word cuts or have used even offer to pick up part B premiums. we have to deal with, is this whole con- the word cuts to mean spending less So there is a real incentive to give peo- cept that we are in fact cutting Medi- than a projected increase, even though ple a better product at a lower price. Of care. You can look at it in three dif- you are still spending more. course, that is the real market system ferent ways. Each way it is a signifi- Only in Washington, of course, is starting to develop. cant increase. spending more called a cut. But here is People also might want to develop In the last 7 years, we spent $926 bil- what I want to emphasize. The original what we call a provider service organi- lion on Medicare. We expect to spend in position of many of our colleagues on zation, where doctors and hospitals get the next 7 years $1.6 trillion. It is about the Democratic side was that nothing together and offer a new system to a $675 billion increase in new money needs to be done with Medicare, every- health care recipients, to the Medicare over the next 7 years. We are going to thing is fine, everything the Repub- recipients in this country. Of course, spend 73 percent more money in the licans are proposing is simply to fund a people may want to go to a medical next 7 years than we spent in the last tax cut for the wealthy. savings account that we are going to 7 years. Only in this place, in Congress Now, this morning they changed that talk about here tonight, where people and in Washington, when you spend 73 position. This morning, or this after- can make choices of where they want percent more during the next 7 years noon, I guess I should say, in their sub- to keep their traditional doctor, what do people call it a cut. stitute that they offered here they are kind of health care they want to buy, We could look at it in terms of how proposing to cut Medicare using the and if they do not spend a prescribed much we spend today on Medicare. We word cut as they use it. They them- amount of money they get to keep it. spend $178 billion. In the 7th year we selves have proposed spending less than That is certainly a unique idea in this are going to spend $274 billion, esti- certain target figures that have existed country, especially when you deal with mated. That is a 54 percent increase in in government projections. huge bureaucracies that formerly con- the 7th year. So we are going to spend Why would they propose cutting trolled the health care in this country. in the 7th year 54 percent more than we Medicare unless they now acknowledge Then, finally, the seamless coverage, spend today. Only in Washington when there is a real problem here, that Medi- that if you have had a health care in- you spend 54 percent more would peo- care faces bankruptcy unless action is surance system where you worked for ple call it a cut. taken? That is something that they the last 30 years, you liked that system But then people said, Well, wait a have largely denied through the past but all of a sudden you are reaching 65 second. There are a lot more bene- several months. years of age and, my gosh, you have to ficiaries. So we said, Yeah, let us see Mr. SHAYS. If the gentleman would give up the insurance you have always the impact on each individual bene- yield, the President came in with this known and try to find some other kind ficiary. We put aside for every senior 10-year plan. In this 10-year plan, he of a fee-for-service system in the Medi- approximately $4,800 per beneficiary, said we needed to reduce the growth, care system, that is a very traumatic per senior. In the 7th year, that is which is the proper term, of Medicare, experience to some folks. If your insur- going to go up to $6,700. That is a 40 $127 billion. And what he did not ac- ance company has agreed to stay with- percent increase per beneficiary in the knowledge, though, that was scored by in the system, now you can have that kind of money we are putting into the OMB. The President, in fact, I just seamless coverage and stay with that system. want to add weight to it, was suggest- traditional insurance that you have al- Mr. HASTERT. So what the Demo- ing by reducing $190 billion the growth ways had. crats are saying, that we are cutting in Medicare. Those are the choices. But some of Medicare, actually, we are expanding Mr. SCHIFF. I wanted to make the the things we want to talk about here Medicare 40 percent over the next 7 point that on the House floor today the tonight, talk about some of the fal- years, is that correct? Democratic counterproposal called for lacies that one friends on the other Mr. SHAYS. Per beneficiary. We are a cut in Medicare as they have used the side of the aisle have brought up but putting in 73 percent more money in term cut for the last number of also some of the positive things about the next 7 years over the past 7 years. months, spending an increase but not those positive choices that people will We are spending 54 percent more in the as much of an increase as projected enjoy and at the same time trying to 7th year than we are spending today. targets. I thinks that that is an impor- squeeze out the fraud and abuse that Any way you look at it, we are spend- tant concession that Medicare indeed is we have in health care. We think up to ing a colossal amount of increased in serious projected financial trouble, 10 to 15 percent of the dollars that we funds in this program. and somebody had to come forward and spend in Medicare today are wasted in Mr. SCHIFF. If the gentleman would start taking the lead on this. fraud and abuse under the present sys- yield on the same point, I want to say I am going to yield back to the gen- tem. We need to change that. We have that I voted against the tax cut when it tleman, but at some point I would like brought in tough new provisions to was first proposed; and I did not vote to analyze their current argument make that happen. against it because I do not agree with which is the difference is now to fund a I would like to defer, first of all, to tax cuts. I did not buy the class war- tax cut. my friend, the gentleman from Con- fare argument being offered by the Mr. HASTERT. If the gentleman necticut [Mr. SHAYS], who has also other side. I do not believe the pro- would yield, one of the interesting been on the ground floor of putting this posed tax cuts go primarily to the rich; things when they are talking about a program together; and we are going to and, in any event, I think people keep- $270 billion cut, what they are talking talk about the inception of the change, ing the money they have earned is de- about is they want the inflationary the new system of Medicare. Plus we sirable. rate of over 10.5 percent to go on unfet- have with us the gentleman from New I voted against it for one major rea- tered. Our good Democrat friends on Mexico [Mr. SCHIFF] and the gentleman son. That is, that I simply felt that we the other side of the aisle, who just got from Oklahoma [Mr. COBURN]. It will should concentrate on deficit reduction done speaking, are saying, let us not be interesting to hear from these gen- first. I make that point because the ar- try to hold in inflation. Of course, we tlemen as well. gument that is being made from the know what inflation does, especially to Mr. SHAYS. I thank the gentleman other side is that everything we are seniors. But they want that inflation for yielding and want to say that I doing is simply for a tax cut and a tax to go at 10.5 percent. That is how they have seen our conference work on this cut for the wealthy. Therefore, I think get to $270 billion more spending. H 10478 CONGRESSIONAL RECORD — HOUSE October 19, 1995 Mr. SCHIFF. If the gentleman would the $270 billion. That is wasted money. gram, and why not just get that family yield for one moment, and I will not That is inflation. That is money that the money? A major part of it is the belabor this, but I want to make the never was, never will be, but people $500 tax credit, $500 for each child. point that, of course, more spending is would have to pay extra out of their b 2015 not a cut. But to the extent that some pockets and not get any more in re- of our colleagues on the other side have turn. Mr. HASTERT. Can I ask you a ques- said we are cutting Medicare, they pro- Mr. COBURN. If the gentleman would tion and then let the gentleman from posed today to cut Medicare, too. That yield, I think one other critical point, New Mexico ask, too? The Democrats is a concession that there really are is it morally right to allow Medicare to are saying this is a tax break for the Medicare problems that we have to ad- grow faster than what it should, to be rich. You are saying tax breaks here dress. more inefficient than what we can are for families with children. They now say, well, the difference be- make it? It is morally wrong to do Mr. SHAYS. Anybody can just ask tween our cut and your cut would fund that, and we should do everything in themselves, if you have a child that is the tax reduction for the wealthy. That our power to make this an efficient under 18, you would get a $500 tax cred- is not true, either. I hope to address system that delivers affordable quality it. If you are listening today and you that when I get the floor again. health care with choice for our seniors. feel you are rich, then you would qual- I yield to the gentleman from Okla- We can do that. But we have to do ify under their definition. And the Sen- homa [Mr. COBURN]. that by being honest with what the ate, on this $500 tax credit, has said it Mr. COBURN. I heard a wonderful ex- problem is, being honest with what the should only go, Republicans in the Sen- ample on how to explain this. I have numbers are, and then carrying that ate said it should only go to families three grown daughters. But I did have honesty out and say, yeah, we made under $75,000. But 75 percent of all fam- teenage daughters. If I gave one of the hard votes to do the right thing. To ilies make less than $75,000. them $20 a week allowance and we do anything else, we would be shirking So the biggest part of our tax cut come to negotiate again the next year our responsibility. will go to individuals with families and she wants $40 a week and I say I Mr. SHAYS. If the gentleman would with children. If they have three chil- will give you $25, then she comes to tell yield, what we are really going to do is dren, they get $1,500. If they have four, me that I have given her a cut? No, I we are going to just take each of the they get $2,000. have given her a $5 increase. When you points that were made by our col- I just would love to make this point, put it in the terms, it is what it would leagues on the other side of the aisle if I could. I would like to make the be versus what it should be. and just talk about how valid they point that when my parents were rais- I want to go back to the real point of were, if they had any validity. ing me and my older brothers, they why we are doing what we need to do. I just make this point. Of the $270 bil- were able to take a deduction in to- We are not getting value for our dollars lion of savings to the growth, $133 bil- day’s dollars off their income of $8,000, in Medicare today. If we are going to lion are going to go into the Medicare and they could reduce their income. assume a 10.5-percent growth, then we part A trust fund. That is the trust My family, in today’s dollars, could re- are going to assume that we are going fund that individuals pay in their pay- duce $32,000 from their income and not to continue to not get value for our roll tax, the 2.9-percent if you are self- pay tax on that $32,000. You have seen dollars. employed, 1.45 percent that you pay if what was then equated to today. So we have to ask the question, do you have an employer; and the other And my family, when they were hav- we have an obligation to the seniors $137 billion are going into the Medicare ing to, my mom and dad were raising that are on Medicare today, to those of Part B trust fund. That is the fund that us, they had to pay less than 20 percent us that are working, paying for Medi- funds all the health services. in taxes to Federal, State, and local care through our payroll deductions My colleague just brought up the governments. A family today pays ap- and to the children that are going to issue of taxes; and since I serve on the proximately 40 percent in Federal, have to pay for it in the future to get Committee on the Budget, I would just State, and local. So what we are trying the best value for every dollar that we like to respond to this issue and deal to do is focus the bulk of that tax on spend? If you look at this plan, that is with this other issue that somehow families and families that need it. an attempt to move in that direction. they are linked. They are not linked at Mr. HASTERT. The other part of the We are giving an allowance. It is all. tax cuts for the wealthy that our going up. It is not going up as much as When the tax cut passed, and this is friends on the other side talk about, it has in the past in terms of inflation. a plan that I voted for, we paid for it and it is somewhat laughable, because Mr. SHAYS. Thank goodness it is not through the fiscal dividend of getting part of those tax cuts are for senior going up as much our financial house in order. The Con- citizens who want to work that earn Mr. HASTERT. It is interesting. gressional Budget Office said we had a under $30,000 a year and ones who do When we talk about growing Medicare, fiscal dividend of $170 billion by imme- not have all the income coming in and and the gentleman from Connecticut diately getting our financial house in rents or interest rates or dividends [Mr. SHAYS] talked about how much order. We saved the taxpayers $170 bil- from stocks or people who have to real- more dollars that we are going to put lion on unnecessary interest payments ly go out and work for a living and peo- in the system over the next seven and so on. ple who have done that their whole life. years, we base that at about 5.5 per- Mr. HASTERT. If the gentleman But if you earn under $30,000, you do cent, which is even less than what the would yield, we paid for those tax cuts. not have to pay that extra income tax private sector medical growth has Mr. SHAYS. That is the point I want or that deduction that you get on your been. to make. I want to say that before we Social Security. When you look at the rate of infla- even took up Medicare, we paid for Mr. SHAYS. Even taking into ac- tion that the Federal Employees Bene- each part of those tax cuts. We paid for count the capital gains exemption, fit Plan has had across the country, them in cuts in discretionary spending, which we have to score as a loss in rev- they have had an average under 5 per- in slowing the growth of our entitle- enue, which most economists say will cent in the last couple of years. We are ment programs that we specified and actually generate revenue, this is how giving the people the benefit of the through our fiscal dividend. So it was Democrats equate it to a wealthy man. doubt, and we are letting Medicare paid for through very serious and in If you make $40,000 and you have a one- grow at about 5.5 to 6.3 percent. some cases difficult votes. time capital gain of say 100,000 on the But the amazing thing is when we Our logic was, why have a program, sale of a home or something else and say that, no, we are not going to hold for instance, a government program you, therefore, have earned $40,000 in in inflation completely, that we are that is supposedly helping a family income and then you have this capital going to let it go, our friends on the when 20 to 30 percent get taken off by gains of 100,000, they say, see, you are other side have said, ‘‘Well, we will let the bureaucracy before it gets to the a wealthy person, you made $140,000. it go, we will let inflation go up to 10 family, with all the bureaucratic re- And they put you on that equation of or 15 percent.’’ That is where they get quirements of the government pro- $140,000. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10479 Mr. SCHIFF. I want to stay on the you do not fund a multibillion dollar Mr. SCHIFF. The gentleman has just subject of the relation of our Medicare tax cut out of a $7 a month difference. made an extremely important point, bill to the tax cuts. As I indicated, I Mr. HASTERT. One of the things that the part B program has been cost- did not support the tax cut only be- that when we looked at our system and ing more every year and the amount cause I would like to see some real what we have tried to do, the rate that beneficiaries pay has gone up time history of budget savings rather today is 31.5 percent. And we keep that every year. What the other side argued than go on a plan. But the point is, for tax rate in place. was the entire projected increase in the the purpose of this debate, on Medi- Now, there is a proposal or under law part B premium was a result of the Re- care, I very strongly argue that the ac- that this would drop to 25 percent. And publican bill and for tax reduction. The cusation made that this is to fund any if it did, indeed, drop to 25 percent, point is, the increases are coming any- tax cut for any purpose is simply incor- then taxpayers would have to pick up way. The increases are posed in the rect. that extra amount and taxpayers President’s budget. The difference is I would just like to say that we start would be subsidizing the part B pre- very small, and the difference is the re- at the same place now. We have pro- mium about 75 percent. So the other sult of do you want, in this season, in posed reducing the rate of growth of side of the story, as some people use this time frame of deficits, do we want Medicare, which they have called a cut. that terminology, our friends on the to be increasing the amount of subsidy They now propose reducing the rate of other side would actually have a tax from the general Treasury. growth in Medicare, which they call a increase for those people. Mr. HASTERT. I think one of the cut. So we are now heading in the same Mr. SCHIFF. It is my understanding most important things that we want to direction. that explains the difference between get to and I think we should walk They have conceded the fact that the Republican plan and the Presi- through the choices that people have. Medicare is heading towards insol- dent’s plan. We would keep the subsidy traditional fee-for-service and the vency. The argument that we heard for level of part B the same and not in- other choices are there, part of this the last hour was the difference be- crease it out of the Treasury. But the Medicare Program. tween the two figures, the amount of difference is still too small, is still too Mr. SHAYS. Is it true that you will additional reduced growth, which we small for anyone to say that is funding be forced to get out of your fee-for- say is necessary for the long-term fis- a multibillion dollar tax cut. It is just service program? cal health of Medicare, they say is to not correct. Mr. HASTERT. Absolutely not. The fund the tax cut. I want to take a cou- Mr. SHAYS. I just would love to fee-for-service, we believe that our CBO ple moments to say to my colleagues make sure that we just establish the tells us about 75 percent of seniors will why that is just not true and why in arguments that are being made and stay in the traditional fee-for-service. fact the tax cut in the plan is funded in whether they are credible. We think that there is too good an op- other ways. First, we are not cutting Medicare. portunity out there for seniors and sen- We are allowing it to grow signifi- In the first place, part A of Medicare, iors who really look at the opportuni- cantly per beneficiary over 40 percent a the hospital trust fund, which is the ties they have will move from fee-for- year. The second argument is that larger portion of Medicare spending, is service. somehow the tax cut is related to what funded by a payroll tax. That payroll Mr. SHAYS. But they do not have to. we are looking to do to save, strength- Mr. HASTERT. It is their choice if tax is not affected by other taxes. In en Medicare. There is absolutely no re- they want to. other words, other taxes can be raised lationship. Mr. COBURN. There is 9 percent al- or other taxes can be lowered. The fact The next argument they make is ready in a managed care option who of the matter is, the Medicare trust they say we are increasingly co-pay- are very satisfied. fund has the exact same source of in- ments, which simply is not true. Co- Mr. HASTERT. Nine to ten percent come which is the payroll tax. So noth- payments remain the same. They say are there and looking at that. When ing we do in lowering or in fact raising we increased deductibles. That simply those folks get involved, they have op- taxes elsewhere has anything to do is not true. The deductible remains the tions of getting prescription pharma- with part A. same. ceuticals paid for. They get co-pay- Part B of Medicare that deals with Then their argument is that we in- ments paid for in many of those plans, funding physician and other services is crease premiums. We are keeping pre- and we talked about part B premiums. paid for, approximately 31 percent, by miums in fact at 31.5 percent, and 7 These options are that the system can beneficiaries and approximately 69 per- years from now they will stay at 31.5 even pick up the part B premium for cent is subsidized by the general treas- percent. As health care costs grow, the Medicare recipients. So there are ury. So the argument can be made, that 31.5 percent will cost slightly some real pluses there. well, the tax cut is being funded by re- more as it has during the last 7 years. Mr. COBURN. Mr. Speaker, one of duced spending in part B, because that There has been that growth. the advantages that I have had in deal- is general funds. So what gets us into this is the excit- ing with Medicare is I am a practicing The problem with that argument is ing fact that we have an option beyond, physician. I continue to practice on the that every Medicare beneficiary knows you can say, in this fee-for-service pro- weekends. I know Medicare both from a that part B regularly, I think annually, gram. You are not being forced out. No patient perspective and as well as a goes up in cost as the cost of the pro- new co-payment, no new deductible, no provider perspective. It is unique to be gram goes up. increase in premium, no relationship able to understand; it is very, very The current system is projected to between our effort to slow the growth complicated. That is one of the reasons raise the part B premiums for bene- in spending in the tax cut. In fact, no our seniors are so concerned, not only ficiaries for the general fund in the cut in this program, an increase. And it because of the rhetoric but because it next several years. The President’s pro- gets into this extraordinary oppor- is very difficult to understand. As we posal will raise the contribution of tunity we have with Medicare-plus. have changed Medicare, we really are beneficiaries and the general fund for Mr. COBURN. I just wanted to add, 7 going to give four very simple options. part B in the future. years ago the part B premium was Mr. HASTERT. I would like the gen- The point is, as I have seen the fig- about $26. And it is $46 and 10 now. It is tleman as a physician and a practi- ures, the final figures projected to exist going to rise. It is going to rise a small tioner, a person who deals with both in 7 years for part B for beneficiaries amount each year for the next 7 years. patients and the system, one of our op- are very close together. I think the But it is still going to stay at 31.5 per- tions is a medical savings account. widest range difference I have seen pro- cent of the total cost for the part B Why do you not talk about that medi- jected is that the Republican plan will, program. I think it is important for cal savings account and how that can in seven years, not for seven years but people to realize that the rate of rise is affect patients and the system itself. in seven years would be $7 a month not going to be significantly different Mr. COBURN. I would be happy to. higher per beneficiary than the Presi- than what the rate of rise has been in First of all, I think we need to correct dent of the United States. The point is, the past. what we heard a minute ago, that there H 10480 CONGRESSIONAL RECORD — HOUSE October 19, 1995 was a $20,000 deductible. That is not Medicare premium that seniors are as much as we think it will, we will even allowed under this plan. So it is paying would buy much more for them have to make deeper cuts later on. not going to be one of the options, and than Medicare is giving them. In the Well, our Budget Office thinks that the information stated was incorrect. Boston area, there were two HMO’s. over 7 years only 15 percent more sen- A medical savings account is an ac- Seniors have the right to choose to join iors will choose MedicarePlus plans count like I presently have as a physi- an HMO. Not everybody wants to be in like this. Ten percent are in HMO’s cian. I have a deductible, and I pay a an HMO. If you do not like the staff or now, and they think that, when we premium each year for that deductible. the doctors in the HMO, you cannot go offer them all these choices, Medicare- It is a high dollar deductible. It is outside. plus plans, medical savings accounts, $10,000 for my entire family. I am fortu- b that only 15 percent more over 7 years nate enough to be able to have that 2030 will join. kind of deductible. I am responsible for I personally am not high on joining In Boston they have already in- the bills in between it. an HMO, but they had two very good creased it in 2 years by 5 percent. I Under the Medicare Program, we will HMO’s in the market in Boston. One of mean the Budget Office cannot take have deductibles, high deductible medi- them was the Harvard Health Plan, and into account human choice and human cal savings account available, which the other was the Fallon Plan. Each of motivation, and so they use old data to the Government will place into that those HMO’s had developed quite large make old projections, and then they account, the average payment for that senior participation, but they were not try to force us to make irrational deci- area to purchase a high deductible pol- growing. sions. icy; and what is left over can be used Well, into the market came three Mr. SHAYS. If the gentlewoman for medical care for that person for new managed-care plans offering not would yield, I would just love to em- that period of time. only all Medicare services, but addi- phasize again because we just contin- Mr. HASTERT. So basically, let us tional services, for a zero premium. ually, I think, need to based on what say that next year the Federal Govern- That is just the Medicare premium. was said on the other side of the aisle. ment, and we are just using numbers Now thousands of seniors every month Any senior who wants to can stay in generally, but next year the Govern- are joining one of these five plans be- their traditional fee-for-service and ment will pay 5,000, average payment cause what did the Harvard plan do? have the same doctors they have pres- per person will be about $5000 in the They dropped their premium from $89 a ently, and I want to continue to make next fiscal year. So a person could buy month to $15 a month. What did the the point that they are never taken out a $3000 deductible catastrophic health other plan do? Its premium was over unless they choose to be transferred to care policy for about $2,000. Then the $50. They dropped their premium to a private plan. Government would put the balance of zero. Now the seniors in the Boston Now I just think there is one cau- that $3000, the balance of 2000 from 5000 area have the choice of four plans, four tionary element that we need to make, average, into their medical IRA. That zero-premium plans, the Harvard $15-a- especially coming from our area. It is money would be there. month plan, and for that they get all probably going to be easier for people They would choose where they want Medicare services plus copayments and in the Boston, and New York, and to go for health care. They would deductibles plus some other, in some Miami area to see greater opportuni- choose their doctor, what kind of care cases, prescription drugs, in some cases ties in private health care plans. I sus- they wanted. They would also be pretty preventive-care coverage. pect in an area like Oklahoma they responsible then for looking at what Mr. HASTERT. So you are saying may not see all the same ability to get the cost of that health care is. They ac- that deductibles, this is something some of those plans because we are tually would go out and shop because, if they do not spend it, they get to plus. I mean before a traditional fee- dealing with high-cost areas and low- keep it. That is one of the things that for-service health care and Medicare cost areas, and we have not yet fully would rolL over in that medical IRA seniors have to pick up a copayment; is resolved that issue, but I think we are account. Then eventually, if they want that right? on the way to doing that. Mr. HASTERT. The gentleman from to use that for long-term care insur- Mrs. JOHNSON of Connecticut. ance or some other type of health care, Right. Oklahoma, if I could yield to him for a they could. But the thing is, it is their Mr. HASTERT. They would have to minute, I would like him to talk about money. What a unique situation. All of pay, pick up a deductible; is that right? that difference and also one of the new a sudden, people are protective of those Mrs. JOHNSON of Connecticut. innovations we have called provider dollars and looking into that when it is Right. service organizations. their money. Mr. HASTERT. They have to pay for Mr. COBURN. Thank you. I would I know we have been joined by one of their own prescription drugs; is that like to make one point so that seniors our colleagues who has been a leader in right? know a provision of this bill is that, if health care for many, many years here, Mrs. JOHNSON of Connecticut. Cor- you would decide you wanted to go into the gentlewoman from Connecticut. rect. an HMO and did not like it for the first Mr. SHAYS. The distinguished gen- Mr. HASTERT. And sometimes pay 2 years, you can get out any time you tlewoman from Connecticut is an ex- for their own eyeglasses? want. So what we have also done is in- pert on this issue. Mrs. JOHNSON of Connecticut. Cor- creased—— Mr. HASTERT. I would like to yield rect. Mrs. JOHNSON of Connecticut. Be- to the gentlewoman at this time. Mr. HASTERT. And under these pro- yond that, every single year you can Mrs. JOHNSON of Connecticut. I grams you are saying that they are get out, every single year you get a thank the gentleman for the oppor- more efficient, a better system of de- new choice, and you can stay in the tunity to join him at this special order livery, and that the can pick up these plan you are in, you can change plans, to discuss the Republicans’ approach to costs so seniors really save. or you can go back to Medicare, and in reforming Medicare in order to secure Mrs. JOHNSON of Connecticut. Abso- every single market there are medigap for current seniors and to ensure that lutely. Not only do seniors really save, insurance plans that do not discrimi- it is going to be there for future retir- but they choose these plans, they nate so you can always go back to that ees. choose to go to a system that they be- combination of Medicare and medigap I wanted to pick up on what the gen- lieve serves their needs better, and if you prefer it. tleman is talking about. One of the they are choosing at such a rapid rate So this is a totally voluntary choice things that was very distressing about that while Medicare managed care used plan that we are providing, and we do the debate this afternoon was the to be 5 percent of that market, it is have overwhelming actual experience claims by opponents that we could not now 10 percent that shows that the Medicare-plus fund a premium that would buy a good Now what does that tell you about plans will be able to provide a lot more plan in the market. our plan? Some people have been con- benefits for the same dollar, and if I When we look at what is really hap- cerned, including some of our col- could just add one thing before unfor- pening out there right now already, the leagues, that if our plan does not save tunately I have to catch a plane, it is October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10481 that, you know, both for the people the level of services, that the projected chose of the highest quality that you who stay in Medicare and for the peo- rate of growth that we are talking think are good practitioners of health ple who choose MedicarePlus, we are about and that we have to avoid as- care, and then you found one of the going to increase funding for both the sumes that it is business as usual with- hospitals that was the best orthopedic premiums and for the fee-for-service out change year after year, and we can hospital and another hospital that system by $2,000 per recipient in the explore ideas that might through alter- maybe is the best cardiac hospital, if next 7 years. That is exactly as much native approaches, through just com- you join together to provide those serv- as we increased it in the preceding 7 petition, reduce the rate of growth and ices to seniors, then you can give the years. still keep the level of service at at seniors the best service at the lowest So we are planning a healthy, reason- least what it is today. costs. able, responsible, practical increase in Mr. HASTERT. I thank the gen- Is that the whole idea behind this? spending in Medicare. We are simply tleman. Mr. COBURN. That is right, and do not going to overpay for fraud and I yield to the gentleman from Okla- that in a unified package that we abuse. We are not going to overpay for homa. would know up front what their costs unnecessary care. We are not going to Mr. COBURN. I was going to discuss are, know what to expect, and know overpay because, if we overpay in Med- another one of the options, Medicare- that they had quality and service. icare, then people who are working plus, and that is the opportunity. Here- Mr. SHAYS. What I think is exciting have higher taxes. tofore physicians as groups have not is that, you know, we are affecting the Mr. HASTERT. I certainly appreciate been allowed to get together and offer hospitals and doctors, and we are ask- the gentlewoman from Connecticut their services as a group in hopes to ing them to deal with lesser payments joining us for a few minutes. Your lowering the costs and attracting more in some instances, but on the other work and contribution to health care patients, and one of the options under hand we are also allowing them to reform in this country has been legend, the Medicare Preservation Act is to compete directly with HMO’s, directly and we certainly appreciate you spend- allow us in conjunction with inpatient with insurance companies, and provide ing a few minutes with us. hospital facilities and outpatient hos- their own organization of health care, Mrs. JOHNSON of Connecticut. pital facilities to offer a provider serv- and I have heard from so many doctors Thank you. It is interesting for the ices network program where we go and and hospitals that they feel they can people who are watching to see the offer our services for a fee which would reduce costs significantly and provide gentleman from Illinois [Mr. HASTERT] be paid through the Medicare program extra benefits to attract people into is a member of the Committee on Com- where we can vastly expand the bene- that system, and I think it is very ex- merce, I am a member of the Commit- fits and also lower the costs. citing that we are allowing that to tee on Ways and Means, two commit- Doctors for years were saying, ‘‘Let happen. tees that have direct responsibility for use compete, let us go in. We’ll show Mr. SCHIFF. If the gentleman would Medicare and Medicaid. The gentleman you that we can deliver the service.’’ yield for just a moment, the point that from Oklahoma [Mr. COBURN] is also a And now it is time for the doctors to our colleague from Oklahoma is mak- member of the Committee on Com- show that in fact they do that, and I ing is that under existing antitrust merce, but he is a physician. He brings believe that they will. It will allow you laws physicians talking to each other a special perspective. The gentleman to keep your doctor and still go into a and talking about joining together in from New Mexico [Mr. SCHIFF] is a Medicare-plus, if that is fact is what the providing of services and offering member of the Committee on the Judi- you want to do. joint rates is very restricted under the ciary. He brings special knowledge of Mr. SCHIFF. I believe the gentleman antitrust laws, but given the fact that the fraud and abuse problems. And my is talking about proposals to relax the the HMO’s represent a group kind of colleague, the gentleman from Con- antitrust laws as it refers to physi- practice which do exactly that, it necticut [Mr. SHAYS], is from the Budg- cians. makes very good sense to me to allow et Committee, and he has the respon- Mr. COBURN. That is true. other groups to form together to offer sibility to look at these issues in the Mr. SCHIFF. And as a member of the their packages and then let the bene- context of America’s future and how do Committee on the Judiciary, I very ficiaries in Medicare, and other pa- we get to a balanced budget in 7 years, much support that. tients, make their own selection. and he, of course, is on the Health Sub- The fact of the matter is for the sys- Mr. HASTERT. One of the things committee of the Committee on the tem to operate there has to be a bal- that we talked about as well as the Budget and, therefore, is a special part ance of competition, and we have seen choices that seniors have, and we of our team. the rise of HMO’s health maintenance talked about a couple of those choices This is the first time in Congress’ organizations, which essentially are out here, medical savings accounts, history that there has been this level conglomerates of offering services from HMO’s and PPO’s, and then now the of integrated committee cooperation an unified place. Many citizens like provider service organizations that we and action to solve a major problem HMO’s and they enroll in them. Other just got done talking about, we always that we face, and right here amongst citizens do not want to enroll in thought also that there is a huge and the five of us you can see that whole HMO’s, but the point is, given their ex- historically huge amount of dollars, of body of the Congress, and how it has istence, there is now a justification to Federal tax dollars, that go into Medi- come together to think about this allow physicians with each other and care that are wasted because of fraud problem and produce an answer that we physicians with hospitals and other and abuse. We estimate between 10 and know is going to serve our seniors. So health care institutions to unite to 15 percent. That is a huge amount of I am proud to have joined you for a few offer a group-practice kind of policy to money when you are talking about minutes and regret I have to leave. citizens that would compete with hundreds of billions of dollars. Mr. HASTERT. I yield to the gen- HMO’s to give the citizens choices on Now we have two experts here on tleman from New Mexico [Mr. SCHIFF]. an equal playing field. fraud and abuse, certainly the gen- Mr. SCHIFF. Mr. Speaker, I just So, I very much support that change tleman from New Mexico [Mr. SCHIFF] think it is important to emphasize the in the antitrust laws. from the Committee on the Judiciary main purpose of that last entire discus- Mr. COBURN. I think we might just who looks at that type of issue all the sion. We have been talking about the talk about fraud and abuse for a time, and our friend from Oklahoma is fact that both parties recognize that minute. an expert on that, but let us talk, talk we have to reduce the rate of growth of Mr. HASTERT. Let us make it per- to us a little bit about the provisions Medicare. If we do not, there will not fectly clear for everybody here so we in this bill and how we start to curtail be a Medicare. The costs would not be can understand a little bit about our fraud and abuse. sustainable. provider service organizations. I am happy to yield to the gen- What the last discussion has meant is For instance, if you had 25 or 30 doc- tleman. the fact that reducing the rate of tor in a large community, all special- Mr. COBURN. I think the first thing growth does not have to mean reducing ists and general practitioners who you we do is realize we have a problem, and H 10482 CONGRESSIONAL RECORD — HOUSE October 19, 1995 every Federal Government agency that ment, a huge bureaucracy that has less of a loss to the system, but the has testified before the House Commit- grown in the last 40 years here in gentleman from Oklahoma [Mr. tee on Commerce admitted that we had Washington, they have not been very COBURN] was right on point when he significant problems. Anywhere from 5 effective in weeding out fraud and said that the system that Medicare to 15 percent was common, with most abuse, have they? uses just to check billings is anti- saying 10 to 11 percent. We have to ask Mr. COBURN. No, they have not. I quated compared to private industry ourself the question why have we not think the important thing, everybody doing the same thing, as I understand been able to attack the fraud and abuse that has a credit card, whether it is a it. that is there. I mean why for the last 15 BankAmericard or Visa card, when In fact, the number one complaint I years have we allowed 10 percent of the they use that today their bank knows heard from senior citizens meeting in dollars for Medicare to go to fraud? I it tonight. If they use it in Japan, they my district on this subject is many of mean it is inexcusable. It is also inex- know it tonight. If they use it in South them would spot something wrong in a cusable for us to now when we start to America, they know it tonight. bill, a service was listed that was not change it for the Attorney General’s Our Medicare computer system, we provided to them, and this may not be office and the Inspector General’s of- do not know it and we will never know fraud in a criminal sense, it could sim- fice to say, ‘‘Oh, wait, wait, don’t it if it is between two different divi- ply be an error in billing, but they change it,’’ because obviously we have sions. It will never be tracked together, would contact the Medicare Program not put into effect what we need to put so in fact, we have in the past, through through whichever contractor was ad- into effect to correct the problem. this bureaucracy, not even kept up the ministering it and tell them about it, pace with 1970’s computer knowledge b and the contractor would simply say, 2045 and placement. We have spent the last ‘‘It is not enough to bother about.’’ Our goal is to eliminate fraud and 9 years trying to get a tracking system Yet, I heard citizen, after citizen, abuse. The way we do that is to make that will not be available for 3 or 4 after citizen, enunciate this kind of sure we change the expectation of more years. problem that they encountered with those who are defrauding and abusing; Mr. HASTERT. That is one of the the system. If we can set up a bene- that we, in fact, will catch them. If we reasons in this bill, instead of throwing ficiary reward program where any kind change that expectation, then we will billions of dollars, again, at a huge of overbillings, assume the most acci- limit greatly the amount of people, and Federal bureaucracy that is not very dental and inadvertent, if identified, number of people, who attempt to de- effective and certainly not efficient, results in a reward to that beneficiary, fraud. that we have been going out in the pri- then that will force the system to re- That requires two main things: First, vate sector and finding those private spond. you have to clarify the rules; and sec- CPA’s who do a good job, who make a Mr. SHAYS. I think the gentleman ond, you have to have an aggressive living doing that day in, and day out, really needs to get into the whole fraud and abuse program. I think this and have to produce in order to be part criminal side. We have only about 5 program that is in this bill is a very of the system, to go out and do that job minutes left before we lose our time. aggressive program. in fact also; is that correct? Mr. SCHIFF. Time goes fast, as they Mr. HASTERT. We hear stories all Mr. COBURN. That is correct. say. the time, Mr. Speaker, that a senior Mr. SHAYS. If the gentleman will I want to say that included in the bill will get a bill, they usually do not get yield, and then I would like to yield to through the Committee on Rules was a the bills from Medicare, hospital bills, the expert on this very issue, my com- provision in the bill that I and the gen- but when they do get those bills and mittee and the Committee on Govern- tleman from Connecticut [Mr. SHAYS] they look through there and they see ment Reform and Oversight, the Sub- wrote, which contains a number of that they have been charged a great committee on Human Resources and criminal provisions. deal of amount. Some of those dollars Intergovernmental Relations, has con- We are talking about, here, that are cost-shifting, but actually, of ducted a number of hearings on health small group, but nevertheless, a group course, the story that is going around care fraud. that causes a lot of damage that delib- the Capitol is the lady who looks at her We have learned incredible misuses, erately and fraudulently overbills the bill and sees that she has been charged finding people who have been kicked system. The essence of these provisions for an autopsy, and obviously, she did out of the system, but they continue to are to make health care fraud a crime. not receive the autopsy. be able to do business with the govern- Right now health care fraud is not a She calls in and says, ‘‘I did not re- ment. We know of agencies that have crime under Federal law. If the U.S. at- ceive this autopsy.’’ And the person on been fined $150 million because they torneys want to prosecute, they have the other end of the line says, ‘‘It must have been so crooked, different organi- to prosecute under wire fraud, mail have been for your quadruple heart by- zations, but they are still allowed to fraud, or any other type of statute. pass.’’ She said, ‘‘I did not receive one participate. That is one of the things This requires a kind of a circular of those, either.’’ What would a senior we are pressing our government to means of prosecuting. do under this bill when he gets into a start to put an end to. Included in the bill now, based upon situation like that? More importantly, we are learning our bill, are provisions that make Mr. COBURN. The program is de- the incredible fraud that exists and the theft, fraud, kickbacks related to signed to allow the senior to, first, be failure to really get at it with some health care, a Federal offense, and fur- involved, to encourage them to report strong laws. ther, it does not matter who the pro- it, and also to benefit, if in fact they One of our efforts has been that the vider of the health care is, whether it benefit—— gentleman from New Mexico [Mr. is a government program or a private Mr. HASTERT. How do they benefit? SCHIFF] and I have introduced legisla- insurance company, because that small Mr. COBURN. They benefit in that if tion that was incorporated into our group that engages in really criminal the savings, I believe, are above $1,000, Medicare bill. I thought the gentleman fraud will defraud anybody. As soon as they share in the savings. They also from New Mexico could describe that a we can convict them, as soon as we can benefit because they put on notice pro- bit. take them off the street, the better we viders that are not honorable, that Mr. SCHIFF. If the gentleman will all are. they are going to be caught, and it will yield, I want to say first, though, Mr. Since we are winding down, I will not take long for the people who are Speaker, that the term ‘‘fraud and yield to the gentleman from Okla- presently abusing this system to recog- abuse’’ in this context is used as a homa. nize that we are going to have 36 mil- broad umbrella for many things. It, of Mr. COBURN. Mr. Speaker, first of lion people out there helping us help course, includes criminal conduct, all, I want to thank the gentleman for them do the right thing. which I would like to talk about in a the criminal provisions put in there. I Mr. HASTERT. Is it not a fact, too, moment, but it includes many other also would add that we doubled the that HCFA, the huge Health Care Fi- things which might be recorded as inef- money penalties, we put mandatory nancing Agency of the Federal Govern- ficiencies. It does not mean there is sanctions on providers so they could October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10483 not continue to participate in the Med- leave there, so that they do not have to Ms. VELA´ ZQUEZ. icare system, and we are trying to pay those extra dollars out of what Mr. BROWN of California. straighten out the computer problem money they have to earn. Mr. LANTOS in two instances. as well. It is estimated that a child that is Mr. MENENDEZ. I just want to say, as a practicing born today has about $186,000 of debt Mrs. SCHROEDER. physician, although physicians will, in that he has to work off or she has to Mr. REED. fact, get less money than what they work off in her adult lifetime. Let us Mr. STOKES. (The following Members (at the re- would have, which is a cut, or a slow- hold that down. Let us be prudent in quest of Mr. CHRYSLER) and to include down in growth, as we hear from the how we spend the taxpayers’ money. other side, that to act irresponsibly I think this bill gives seniors choices. extraneous matter:) Mr. GALLEGLY. and not save this program is wrong. It secures health care and Medicare for Mr. DUNCAN. This bill has lots of things that I do their decision-making process for the Mrs. ROUKEMA. not agree with in it in terms of detail, rest of their lifetime, and it establishes Mr. GILMAN in two instances. but the underlying bill is a good bill, to and holds firm a principle of Medicare, Mr. CRAPO. do what the American people want something that seniors have had in Mr. BUNNING of Kentucky. done; that is, control the growth and this country for years to come. I cer- Mr. STUMP. make sure a quality health care pro- tainly appreciate your participation in Mr. SMITH of New Jersey. gram for our seniors that has choice this special order tonight, and I know Mr. SMITH of Texas. and is affordable is there. I think this that the seniors of this country will Mrs. MORELLA. bill does it. join me in thanking you very much. Mr. BOEHNER. Mr. ZIMMER. I can say to all providers, not just f doctors, but hospitals and others, that Mr. PORTMAN. we will have to work harder to be more SPECIAL ORDERS GRANTED Mr. CASTLE. efficient, to do the right thing, to be Mrs. VUCANOVICH in two instances. By unanimous consent, permission to (The following Members (at the re- careful and to work in a constructive address the House, following the legis- manner to change the system, to make quest of Mr. SCHIFF) and to include ex- lative program and any special orders traneous matter:) it more efficient, but we can do it. We heretofore entered, was granted to: owe it to our children and our grand- Mr. ROTH. (The following Members (at the re- Mr. FRELINGHUYSEN. children to make sure we do that. quest of Mr. MARKEY) to revise and ex- Mr. MATSUI. Mr. HASTERT. Just the provisions tend their remarks and include extra- Mr. SKAGGS. that you gentlemen put in the bill on neous material:) Mr. ALLARD. fraud and abuse, if you can squeeze $10 Mr. MARKEY, for 5 minutes, today. Mr. MORAN. billion or $12 billion out of fraud and Mr. WAXMAN, for 5 minutes, today. Mr. EDWARDS. abuse every year and put that back Mr. DINGELL, for 5 minutes, today. Mr. ABERCROMBI. into health care for seniors, what a Mr. BROWN of Ohio, for 5 minutes, Mr. HALL of Ohio. positive thing this is, just in that one today. Mr. VISCLOSKY. small aspect. Ms. DELAURO, for 5 minutes, today. Mr. STENHOLM. Mr. SHAYS. That is $50 billion of Mr. VENTO, for 5 minutes, today. Ms. DANNER. your 270. Mr. DOGGETT, for 5 minutes, today. Mr. MCGINNIS. Mr. EVANS. I would love just to weigh in and say Mr. DEUTSCH, for 5 minutes, today. Mr. RICHARDSON. that we as a Republican majority have Mr. TOWNS, for 5 minutes, today. Mrs. FOWLER. three basic desires to accomplish dur- Mr. PALLONE, for 60 minutes, today. Mr. ORTON. ing the course of the next 2 years: We Mr. OWENS, for 60 minutes, today. want to get our financial house in (The following Members (at the re- f order and balance the budget. We want quest of Mr. CHRYSLER) to revise and SENATE ENROLLED BILLS SIGNED to save our trust funds, particularly extend their remarks and include ex- Medicare, and we want to transform traneous material:) The SPEAKER announced his signature to the social and corporate welfare state enrolled bills of the Senate of the following Mr. RIGGS, for 5 minutes, today. titles: into an opportunity society. Mr. HORN, for 5 minutes, on October Today, we began that journey very S. 268. An act to authorize the collection of 19, 20, and 23. fees for expenses for triploid grass carp cer- significantly in our effort to save and Mr. MCINNIS, for 5 minutes, today. tification inspections, and for other pur- strengthen and preserve our Medicare Mr. WATTS of Oklahoma, for 5 min- poses. trust fund, and we did it by allowing utes, today. S. 1111. An act to amend title 35, United this program to continue to grow. We Mr. GOSS, for 5 minutes, today. States Code, with respect to patents on are going to put $1.6 trillion in in the Mr. TAUZIN, for 5 minutes, today. biotechnological processes. S. 227. An act to amend title 17, United next 7 years, and spend $73 billion more Mr. DORNAN, for 5 minutes, today. than in the past 7 years. I will turn to States Code, to provide an exclusive right to f perform sound recordings publicly by means my colleague, if he could just conclude. of digital transmissions, and for other pur- Mr. HASTERT. I certainly appreciate EXTENSION OF REMARKS poses. my colleagues joining me tonight to By unanimous consent, permission to f talk about this, Mr. Speaker. I think revise and extend remarks was granted the bottom line is that we have our to: BILLS PRESENTED TO THE parents and grandparents, and we want (The following Members (at the re- PRESIDENT to make sure Medicare is there for quest of Mr. MARKEY) and to include Mr. THOMAS, from the Committee them, a good Medicare Program that extraneous matter:) on House Oversight, reported that that could go beyond the bounds of what has Mr. LEVIN. committee did on this day present to traditionally been there and give them Mr. LAFALCE. the President, for his approval, bills of some choices, but most of all, to give Ms. WOOLSEY. the House of the following title: them quality health care and give Mr. JOHNSON of South Dakota. H.R. 1976. An act making appropriations them the assurance that that health Mr. KLECZKA. for Agriculture, rural development, Food and care is going to be there for the rest of Mr. HAMILTON. Drug Administration, and related agencies their lives. Mr. STUDDS. programs for the fiscal year ending Septem- Then on the other side, we have out Mr. ROEMER. ber 30, 1996, and for other purposes. children and our grandchildren, that Mr. SKELTON in two instances. f we want to make sure that we are not Mr. ACKERMAN. wasting their dollars. That is why we Mr. FAZIO of California. ADJOURNMENT are cutting that inflationary $270 bil- Mr. MFUME. Mr. SHAYS. Mr. Speaker, I move lion that the Democrats just want to Mr. WARD in four instances. that the House do now adjourn. H 10484 CONGRESSIONAL RECORD — HOUSE October 19, 1995 The motion was agreed to; accord- H.R. 994. Referral to the Committee on the Mr. MCCOLLUM, Mr. FRANK of Massa- ingly (at 8 o’clock and 56 minutes p.m.) Judiciary extended for a period ending not chusetts, Mr. GEKAS, Mr. SMITH of the House adjourned until tomorrow, later than November 3, 1995. Texas, Mr. COBLE, Mr. CANADY, Mr. Friday, October 20, 1995, at 10 a.m. f BONO, Mr. HEINEMAN, Mr. FLANAGAN, and Mr. DAVIS): f PUBLIC BILLS AND RESOLUTIONS H.R. 2511. A bill to control and prevent commercial counterfeiting, and for other EXECUTIVE COMMUNICATIONS, Under clause 5 of rule X and clause 4 purposes; to the Committee on the Judici- ETC. of rule XXII, public bills and resolu- ary. Under clause 2 of rule XXIV, execu- tions were introduced and severally re- By Mr. JOHNSON of South Dakota: tive communications were taken from ferred as follows: H.R. 2512. A bill to provide for certain ben- the Speaker’s table and referred as fol- By Mr. BUNN of Oregon: efits of the Missouri River basin Pick-Sloan project to the Crow Creek Sioux Tribe, and lows: H.R. 2507. A bill to disapprove amendment No. 8 of the ‘‘Amendments to the Sentencing for other purposes; to the Committee on Re- 1538. A letter from the Secretary of En- sources. ergy, transmitting the Department’s eighth Guidelines, Policy Statements, and Official Commentary,’’ submitted by the U.S. Sen- By Mr. STUMP (for himself, Mr. MONT- annual report to Congress summarizing the GOMERY, Mr. EVERETT, and Mr. Department’s progress during fiscal year 1994 tencing Commission to Congress on May 1, 1995; to the Committee on the Judiciary. EVANS): in implementing the requirements of the H.R. 2513. A bill to amend title 38, United By Mr. ALLARD (for himself, Mr. Comprehensive Environmental Response, States Code, to expand eligibility for burial KLUG, Mr. STENHOLM, Mr. DINGELL, Compensation, and Liability Act, pursuant benefits to include certain veterans who die Mr. GANSKE, Mr. BARRETT of Ne- to Public Law 99–499, section 120(e)(5) (100 in State nursing homes; to the Committee on braska, Mr. BEREUTER, Mr. BOEHNER, Stat. 1669); to the Committee on Commerce. Veterans’ Affairs. Mr. BROWN of California, Mr. BRYANT 1539. A letter from the Acting Director, De- By Mr. ZIMMER (for himself, Mr. of Texas, Mr. BURTON of Indiana, Mr. fense Security Assistance Agency, transmit- LEVIN, and Mr. CAMP): BUYER, Mr. CHAMBLISS, Mrs. ting notification concerning the Department H.R. 2514. A bill to amend the Internal Rev- CHENOWETH, Mr. COBLE, Mr. COMBEST, of the Army’s proposed Letter(s) of Offer and enue Code of 1986 to make the research credit Mr. CONDIT, Mr. COOLEY, Mr. Acceptance [LOA] to Italy for defense arti- permanent and to allow such credit for ex- COSTELLO, Mr. CRAPO, Mrs. CUBIN, cles and services (Transmittal No. 96–04), penses attributable to certain collaborative Mr. DE LA GARZA, Mr. DOOLEY, Mr. pursuant to 22 U.S.C. 2776(b); to the Commit- research consortia; to the Committee on EHLERS, Mr. EMERSON, Mr. ENSIGN, tee on International Relations. Ways and Means. Mr. EWING, Mr. GOODLATTE, Mr. GOR- 1540. A letter from the Administrator, En- By Mr. SCHUMER: DON, Mr. GUNDERSON, Mr. HAMILTON, vironmental Protection Agency, transmit- H. Res. 240. Resolution providing for the Mr. HEFLEY, Mr. HOLDEN, Mr. ting the Agency’s annual report summariz- consideration of the bill (H.R. 1710) to com- HOSTETTLER, Mr. JOHNSON of South ing actions taken under the Program Fraud bat terrorism; to the Committee on Rules. Civil Remedies Act [PFCRA] for the year Dakota, Mr. KLECZKA, Mr. LAHOOD, ending September 30, 1995, pursuant to 31 Mrs. LINCOLN, Mr. LARGENT, Mr. f LATHAM, Mr. LEACH, Mr. LEWIS of U.S.C. 3801–3812; to the Committee on Gov- PRIVATE BILLS AND ernment Reform and Oversight. Kentucky, Mr. LIGHTFOOT, Mr. 1541. A letter from the Administrator, Gen- LUCAS, Mr. MCINNIS, Mr. MCINTOSH, RESOLUTIONS eral Services Administration, transmitting a Ms. MCKINNEY, Mr. MILLER of Flor- Under clause 1 of rule XXII, private draft of proposed legislation to amend title ida, Mr. MINGE, Ms. MOLINARI, Mr. bills and resolutions were introduced 31, United States Code, to require executive MYERS of Indiana, Mr. NORWOOD, Mr. and severally referred as follows: agencies to verify for correctness of trans- PASTOR, Mr. PAXON, Mr. PETERSON of portation charges prior to payment, and for Minnesota, Mr. POMBO, Mr. POMEROY, By Mr. BRYANT of Tennessee: other purposes; to the Committee on Govern- Mr. POSHARD, Mr. ROBERTS, Mr. ROE- H.R. 2515. A bill for the relief of Florence ment Reform and Oversight. MER, Mr. ROSE, Mr. SCHAEFER, Mr. Barrett Cox; to the Committee on the Judici- ary. f SKEEN, Mr. SOUDER, Mr. STUMP, Mr. TAYLOR of North Carolina, Mr. By Mr. UNDERWOOD: H.R. 2516. A bill for the relief of Vincente REPORTS OF COMMITTEES ON THORNBERRY, Mr. THORNTON, Mrs. Babauta Jesus and Rita Rios Jesus; to the THURMAN, Mr. WALSH, Mr. WATTS of PUBLIC BILLS AND RESOLUTIONS Committee on the Judiciary. Oklahoma, and Mr. WHITFIELD): Under clause 2 of rule XIII, reports of H.R. 2508. A bill to amend the Federal f committees were delivered to the Clerk Food, Drug, and Cosmetic Act to provide for for printing and reference to the proper improvements in the process of approving ADDITIONAL SPONSORS calendar, as follows: and using animal drugs, and for other pur- Under clause 4 of rule XXII, sponsors Mr. DIAZ-BALART: Committee on Rules. poses; to the Committee on Commerce. were added to public bills and resolu- House Resolution 239. Resolution providing By Mr. CRAPO (for himself, Mr. tions as follows: for consideration of the bill (H.R. 2492) mak- POMEROY, Mrs CHENOWETH, and Mr. H.R. 42: Mrs. MALONEY, Ms. EDDIE BERNICE ing appropriations for the legislative branch BROWN of California): JOHNSON of Texas, and Mr. FILNER. for the fiscal year ending September 30, 1996, H.R. 2509. A bill to finance and implement H.R. 65: Mr. PICKETT. and for other purposes (Rept. 104–283). Re- a program of research, promotion, market H.R. 72: Mr. DIAZ-BALART. ferred to the House Calendar. development, and industry and consumer in- H.R. 103: Mr. CONDIT. Mr. CLINGER. Committee on Government formation to enhance demand for and in- H.R. 303: Mr. STUDDS. Reform and Oversight. H.R. 994. A bill to re- crease the profitability of canola and H.R. 356: Mr. HORN and Mr. POSHARD. quire the periodic review and automatic ter- rapeseed products in the United States, and H.R. 528: Mrs. FOWLER, Mrs. MEYERS of mination of Federal regulations; with an for other purposes; to the Committee on Ag- Kansas, Mr. VOLKMER, Mr. JOHNSON of South amendment (Rept. 104–284 Pt. 1). Ordered to riculture. Dakota, Mr. WICKER, Mr. ZIMMER, Ms. WOOL- be printed. By Mr. FOX (for himself, Mr. SMITH of SEY, Mr. BOUCHER, and Ms. MCKINNEY. New Jersey, Mr. SOLOMON, Mr. MONT- f H.R. 585: Mr. PASTOR, Mr. BEVILL, Mr. ZIM- GOMERY, Mr. FRAZER, Mrs KELLY, Mr. MER, Mr. PETRI, and Mr. TANNER. WELLER, Ms. RIVERS, Ms. FURSE, Mr. SUBSEQUENT ACTION ON A RE- H.R. 773: Mr. BENTSEN. UNDERWOOD, Mr. KING, Mr. PETERSON PORTED BILL SEQUENTIALLY H.R. 784: Mr. PACKARD and Mr. RAHALL. of Minnesota, Mr. BUNN of Oregon, REFERRED H.R. 838: Mr. KILDEE. Mr. WATTS of Oklahoma, Mr. ACKER- Under clause 5 of rule X the following H.R. 862: Mr. CRANE. MAN, Mr. SERRANO, Mr. FROST, Mr. H.R. 903: Mr. JACOBS, Mr. SENSENBRENNER, action was taken by the Speaker: LIPINSKI, Mr. WELDON of Pennsylva- and Mr. DOYLE. H.R. 1020. Referral to the Committees on nia, Mr. DORNAN, and Mr. HOKE): H.R. 931: Mr. PAYNE of Virginia and Mr. Resources and the Budget extended for a pe- H.R. 2510. A bill to amend title 5, United ENGLISH of Pennsylvania. riod ending not later than October 24, 1995. States Code, to provide veterans’ preference H.R. 1024: Mr. CRAPO. f status to certain individuals who served on H.R. 1090: Mr. EHRLICH. active duty in the Armed Forces in connec- H.R. 1131: Mr. CRAPO. TIME LIMITATION ON REFERRED tion with Operation Desert Shield or Oper- H.R. 1251: Mr. MCCRERY. BILL ation Desert Storm, and for other purposes; H.R. 1329: Ms. WOOLSEY. to the Committee on Government Reform H.R. 1353: Mr. ZIMMER. Pursuant to clause 5 of rule X the fol- and Oversight. H.R. 1462: Mr. DOYLE, Mr. GOODLING, Mr. lowing action was taken by the Speak- By Mr. GOODLATTE (for himself, Mr. FOGLIETTA, Mr. TORRES, and Mr. RICHARD- er: HYDE, Mr. CONYERS, Mr. MOORHEAD, SON. October 19, 1995 CONGRESSIONAL RECORD — HOUSE H 10485

H.R. 1464: Mr. CUNNINGHAM, Ms. LOFGREN, H.R. 2190: Mrs. SEASTRAND, Mr. PACKARD, Mr. MCCRERY, Mrs. THURMAN, Mr. PETERSON Mr. MCCOLLUM, Mr. PACKARD, and Mr. and Mr. RAMSTAD. of Florida, Mr. POSHARD, Mr. PAYNE of Vir- STUMP. H.R. 2202: Mr. FRANKS of Connecticut. ginia, Mr. TANNER, Mr. UNDERWOOD, Mr. LI- H.R. 1499: Mr. DEFAZIO and Ms. ROYBAL-AL- H.R. 2211: Miss COLLINS of Michigan, Mr. PINSKI, Mr. BREWSTER, Mr. WAMP, Mr. GENE LARD. LIPINSKI, Ms. NORTON, Ms. ROYBAL-ALLARD, GREEN of Texas, Mr. KNOLLENBERG, Mr. H.R. 1513: Ms. LOFGREN and Mr. PASTOR. and Ms. WATERS. FOLEY, Mr. SKEEN, Mr. BALDACCI, and Mr. H.R. 1535: Mr. OLVER. H.R. 2223: Mr. FRANK of Massachusetts, HASTERT. H.R. 1627: Mr. PETRI and Mr. HANSEN. Miss COLLINS of Michigan, and Mr. KENNEDY H.R. 2326: Mr. KLUG, Mr. GOSS, Miss COL- H.R. 1711: Mr. CANADY of Florida. of Massachusetts. LINS of Michigan, and Mr. CHABOT. H.R. 1713: Mrs. SEASTRAND. H.R. 2224: Ms. KAPTUR. H.R. 2338: Mr. LIPINSKI and Mr. TORRES. H.R. 1846: Mrs. MALONEY. H.R. 2244: Mr. FUNDERBURK, Mr. CHRYSLER, H.R. 2351: Mr. COBURN and Mr. RADANOVICH. H.R. 1856: Mr. HALL of Ohio, Mr. SABO, Mr. Mr. GANSKE, Ms. LOFGREN, Mr. FOX, and Mr. H.R. 2357: Mr. POMEROY. HANCOCK, Mr. JOHNSON of South Dakota, Mr. PACKARD. H.R. 2372: Mr. HOSTETTLER and Mr. FATTAH, and Mr. BARTON of Texas. H.R. 2245: Miss COLLINS of Michigan. WHITFIELD. H.R. 1882: Mr. JOHNSON of South Dakota H.R. 2247: Mr. ACKERMAN, Mr. ANDREWS, H.R 2396: Miss COLLINS of Michigan, Mrs. and Mr. PETERSON of Florida. Ms. BROWN of Florida, Mr. GUTIERREZ, Mr. CUBIN, Mr. FALEOMAVAEGA, Mr. FILNER, Mr. H.R. 1883: Mr. MCKEON and Mr. STEARNS. HINCHEY, Mrs. MINK of Hawaii, Ms. PELOSI, FOLEY, Mr. FOX, Mr. FROST, Mr. GENE GREEN H.R. 1909: Mr. BARTLETT of Maryland. Mr. RANGEL, Mr. SANDERS, Ms. VELAZQUEZ, of Texas, Mr. LIPINSKI, Mrs. MINK of Hawaii, H.R. 1933: Mr. PALLONE, Mr. BEVILL, and and Mr. WARD. Mr. OWENS, Mr. PALLONE, Mr. SAXTON, Mr. Mr. ROMERO-BARCELO. H.R. 2264: Mr. OBERSTAR, Mr. DUNCAN, Ms. THOMPSON, Mr. TORRES, Mr. UNDERWOOD, and H.R. 1960: Mr. PAXON, Mr. HUTCHINSON, Mr. RIVERS, Mr. JACOBS, Mr. DEFAZIO, Mr. Mr. WATT of North Carolina. WELLER, Mr. GENE GREEN of Texas, Mrs. BARRETT of Wisconsin, and Ms. BROWN of H.R. 2416: Mr. GREENWOOD. KELLY, and Mr. SMITH of New Jersey. Florida. H.R. 2071: Miss COLLINS of Michigan. H.R. 2276: Miss COLLINS of Michigan, Mr. H.R. 2433: Mr. RAHALL, Mr. GENE GREEN of H.R. 2089: Mrs. SMITH of Washington, Mr. LAHOOD, Mr. HASTERT, Mr. SKEEN, Mr. PETE Texas, Mr. MILLER of California, Mr. HORN, EHLERS, Mr. THORNBERRY, Mr. HALL of Ohio, GEREN of Texas, Mr. KLECZKA, Mr. HANCOCK, Mr. MORAN, Mr. SOLOMON, Mr. LANTOS, Mr. Mr. HUTCHINSON, Mr. WHITFIELD, and Mr. Mr. WAMP, Mr. HAYES, Mr. PETRI, Mr. ACKERMAN, Mr. JACOBS, Ms. FURSE, Mr. CALVERT. ZELIFF, Mr. MARTINI, Mr. YOUNG of Alaska, BROWN of California, Mr. SPENCE, Mr. NEY, H.R. 2090: Mr. RAMSTAD. Mr. POSHARD, and Mr. QUINN. Mr. ROSE, Mr. DEUTSCH, Mr. MANTON, Mr. H.R. 2143: Mr. SHAW. H.R. 2280: Mr. DURBIN, Mr. DEUTSCH, and CLYBURN, and Mr. ABERCROMBIE. H.R. 2167: Mr. KENNEDY of Massachusetts, Mr. TOWNS. H. Con. Res. 36: Mr. SCHIFF. Mr. FILNER, Miss COLLINS of Michigan, Mr. H.R. 2320: Mr. FRAZER, Mr. BARRETT of Wis- H. Con. Res. 37: Mr. SCHIFF. PAYNE of Virginia, Mr. TRAFICANT, Mr. consin, Mr. HANCOCK, Mr. TAYLOR of North H. Con. Res. 50: Mr. DEFAZIO and Mrs. WYNN, Ms. KAPTUR, Mr. RAHALL, Mr. BONIOR, Carolina, Mr. SOUDER, Mr. INGLIS of South THURMAN. Mr. COLEMAN, Mrs. MINK of Hawaii, Mr. Carolina, Mr. LUTHER, Mrs. CHENOWITH, Mr. H. Con. Res. 51: Mr. KIM, Mr. STEARNS, and HINCHEY, and Mr. OWENS. LAHOOD, Mr. HOEKSTRA, Mr. PETE GEREN of Mr. FRANK of Massachusetts. H.R. 2181: Ms. FURSE. Texas, Mrs. LINCOLN, Mr. BACHUS, Mr. RIGGS, H. Res. 36: Mr. MCCOLLUM. E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 104 CONGRESS, FIRST SESSION

Vol. 141 WASHINGTON, THURSDAY, OCTOBER 19, 1995 No. 162 Senate (Legislative day of Wednesday, October 18, 1995)

The Senate met at 10 a.m., on the ex- At 10:30, the Senate will resume consid- who would otherwise be unable to at- piration of the recess, and was called to eration of H.R. 927, the Cuba sanctions tend. Over the past 50 years, the scope order by the President pro tempore bill, with Senator DODD to be recog- and variety of Federal student aid pro- [Mr. THURMOND]. nized to offer his two amendments. The grams have expanded considerably. only remaining amendment in order to Today, any student in need of financial PRAYER the bill is the Simon amendment No. help can obtain it. The Chaplain, Dr. Lloyd John 2934, which has a 20-minute time limi- My reason for addressing the Senate Ogilvie, offered the following prayer: tation. now is to dispel the notion that, some- Almighty God, Sovereign of this Na- Therefore, it is expected that the how, all this will change if Congress tion and Lord of our lives, our purpose Senate will complete action on the bill enacts student loan changes as part of is to glorify You by serving our Nation. early this afternoon. the budget reconciliation bill. Unfortu- We want to express an energetic ear- f nately, misconceptions about this leg- nestness about our work today. Help us islation are widespread, and I believe it to know what You want and then want MORNING BUSINESS is important to set the record straight. what we know; to say what we mean, The PRESIDING OFFICER (Mr. A few weeks ago, the Senate Commit- tee on Labor and Human Resources re- and mean what we say. Give us reso- COATS). Under the previous order, there ported its portion of this legislation, luteness and intentionality. Free us to will now be a period for the transaction providing Federal student loan savings listen to You so intently that we can of morning business not to extend be- of $10.85 billion over 7 years. Because speak with intrepidness. Keep us in the yond the hour of 10:30 a.m., with Sen- the Federal student loan program is battle for truth rather than ego-skir- ators permitted to speak therein for up one of the few mandatory spending pro- mishes over secondary issues. Make us to 5 minutes each. grams under the jurisdiction of the party to Your plans so we can give Under that previous order, the Sen- Labor and Human Resources Commit- leadership to our parties and then help ator from Kansas [Mrs. KASSEBAUM] is tee, it was the only place we had to our parties to work together to accom- recognized to speak for up to 10 min- turn in order to comply with our in- plish Your purposes. Make us one in utes. the earnestness of our patriotism. struction. Mr. WELLSTONE. Will the Senator Granted, $10.85 billion is a substan- Thank You for calling this Senate yield for a moment? tial sum over 7 years. However, to hear family to be a caring community in Mrs. KASSEBAUM. Yes. some describe our package, one would which we share each other’s joys and Mr. WELLSTONE. Mr. President, I assume that it spells the end of higher sorrows. Today, we ask for Your ask unanimous consent that I might be education as we know it. Mr. Presi- strength and comfort for Senator granted 10 minutes to speak as in dent, that is simply not the case. CHARLES ROBB now at the time of the morning business. Federal student loan programs were death of his father. Help us all to live The PRESIDING OFFICER. Is there established to assist students and their today with an assurance that this life objection? parents in financing postsecondary is but an inch on the limitless meas- Without objection, it is so ordered. education. These programs have been urement of eternity. In the name of the The Senator from Kansas is recog- successful in achieving that goal. Ap- Resurrection and the Life. Amen. nized. proximately $26 billion in loan funds f f have been made available this year. The figure will grow next year. Even if RECOGNITION OF THE ACTING STUDENT LOANS AND BUDGET the Labor Committee package is ap- MAJORITY LEADER RECONCILIATION proved intact, that volume will grow. The PRESIDENT pro tempore. The Mrs. KASSEBAUM. Mr. President, The reason is that the savings in this able Senator from Kansas is recog- the other evening, the majority leader, package were achieved without re- nized. Senator DOLE, spoke about the oppor- stricting a student’s ability to borrow. f tunities which the GI bill provided to In short, there is nothing in the pack- thousands of Americans following age which limits the amount of loan SCHEDULE World War II. Enactment of the GI bill funds available. Loans will continue to Mrs. KASSEBAUM. Mr. President, in 1944 marked the beginning of Fed- be available to all who qualify. There is today, there will be a period for morn- eral efforts to open the door to post- nothing in the package which limits ing business until the hour of 10:30 a.m. secondary education for individuals the ability of a student to qualify for a

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

S 15297 S 15298 CONGRESSIONAL RECORD — SENATE October 19, 1995 Federal loan. The rules are exactly the able to their students. This proposal NATIONAL AERONAUTICS AND same as they have been. produces about $1.9 billion over 7 years. SPACE ADMINISTRATION APPRO- There is nothing in the package Some have argued that these costs PRIATIONS AUTHORIZATION, FIS- which increases the cost of the loan to will be passed directly on to the stu- CAL YEAR 1996 a student who is in school. The only di- dents rather than being absorbed Mrs. KASSEBAUM. Mr. President, I through the efficiencies in other school rect cost to students included in the ask unanimous consent that the Sen- operations. Perhaps that will be the package applies to new borrowers after ate proceed to the immediate consider- case. Even if the entire cost is passed they leave school. At that point, they ation of Calendar 204, S. 1048. on to the student, it would amount to will continue to be able to defer loan The PRESIDING OFFICER. The an average of $20 to $25 per student per payments for 6 months—the so-called clerk will report. The legislative clerk year. That is at the high end. Others grace period—but the Federal Govern- read as follows: ment will no longer subsidize interest would be about $11 to $12 to $13 per A bill (S. 1048) to authorize appropriations payments during that period of time. year. Finally, approximately $700 million for fiscal year 1996 to the National Aero- That, I believe, Mr. President, is rea- nautics and Space Administration for human sonable. This package was developed in savings is achieved by increasing the space flight; science, aeronautics, and tech- with the clear intention of minimizing interest rate and the interest rate cap nology; mission support; and inspector gen- costs to students. I believe that pur- on parent loans. eral; and for other purposes. When one looks beyond the hype to pose was accomplished. It is, therefore, The PRESIDING OFFICER. Is there see the facts, Mr. President, it is clear particularly disturbing to me that stu- objection to the immediate consider- that this reconciliation package does dents and their families are being in- ation of the bill? not spell disaster for secondary edu- tentionally misled about the impact of There being no objection, the Senate cation in this country. Blaming a Re- the proposed changes. I fear that this proceeded to consider the bill, which publican Congress for reducing access misinformation will discourage some had been reported from the Committee to postsecondary education by increas- students from even exploring post- on Commerce, Science, and Transpor- ing its costs may be convenient, but it secondary education, and that, I be- tation, with an amendment to strike does not explain away the fact that lieve, would be a real tragedy. all after the enacting clause and insert- college tuitions have been growing at a I would like to explain briefly how ing in lieu thereof the following: the $10.85 billion in savings is achieved. rate surpassing inflation for well over a decade. That is what has caused such SECTION 1. SHORT TITLE. First of all, about $4 billion of the sav- This Act may be cited as the ‘‘National Aero- ings comes from reductions to entities enormous problems for students and nautics and Space Administration Authoriza- involved in the guaranteed loan pro- their families, is the escalating cost of tion Act, Fiscal Year 1996’’. college education due to increased tui- gram, such as banks and guaranty SEC. 2. DEFINITIONS. agencies. tion. For the purposes of this Act— The elimination for new borrowers of Figures recently released by the col- (1) the term ‘‘Administrator’’ means the Ad- the interest subsidy during the 6- lege board show an average tuition in- ministrator of the National Aeronautics and month grace period achieves about $2.7 crease this year of 6 percent, more than Space Administration; double the inflation rate. Average tui- (2) the term ‘‘NASA’’ means the National Aer- billion in savings over that 7-year pe- tion in fees at a 4-year public institu- onautics and Space Administration; and riod. This change would mean an extra tion are $2,860. For a 4-year private in- (3) the term ‘‘institution of higher education’’ $1.89 a month for an undergraduate who stitution, these costs average $12,432. has the meaning given such term in section borrows $5,500 in 1 year. At most, it Mr. President, another 6-percent in- 1201(a) of the Higher Education Act of 1965 (20 U.S.C. 1141(a)). would mean an additional $22.50 a crease in those amounts next year month for a graduate student who has would mean an additional per-student TITLE I—AUTHORIZATION OF APPROPRIATIONS borrowed the $65,000 maximum through cost ranging from $171 to $745, present- his or her college career. ing far more serious problems for stu- SEC. 101. HUMAN SPACE FLIGHT. Capping the direct loan program at 20 There are authorized to be appropriated to the dents and their families than anything percent of loan volume produces about National Aeronautics and Space Administration in this reconciliation package. $1.5 billion in savings. Additional sav- for Human Space Flight the following amounts, Federal student aid is simply not to become available October 1, 1995: ings are achieved through the elimi- going to be able to pick up the slack in nation of fees paid to schools and alter- (1) Space Station, $1,818,800,000. such an environment, nor is that a role (2) Russian Cooperation, $129,200,000. native originators for direct loan ad- for which it was intended. That is what (3) Space Shuttle, $3,031,800,000. ministration. Whatever one may be- I think we need to understand, Mr. (4) Payload and Utilization Operations, lieve about the merits or demerits of President. $293,000,000. direct lending, the fact remains that There is not anything in the rec- SEC. 102. SCIENCE, AERONAUTICS, AND TECH- the way a loan is delivered has abso- onciliation package regarding student NOLOGY. lutely nothing to do with the ability of There are authorized to be appropriated to the loans that I suppose we would be com- National Aeronautics and Space Administration students to borrow or with the fortable with. On the other hand, it is amounts they may borrow. The terms for Science, Aeronautics, and Technology the not the tragedy that is being por- following amounts, to become available October and conditions of direct loans are iden- trayed. I think it is very important 1, 1995: tical to those of guaranteed loans. that students and their families under- (1) Space Science, $1,958,900,000, of which There is no difference to the students stand that. $48,700,000 shall be allocated to the Strato- at that juncture. To suggest that par- No one relishes the task of cutting spheric Observatory for Infrared Astronomy, ing back the direct loan program will back. It is much easier to build upon $15,000,000 shall be allocated to the Space Infra- deprive students of loan funds or make the expensive policies that have red Telescope Facility, and $30,000,000 shall be allocated to the New Millennium initiative. those funds more expensive is plainly brought us to our current budget prob- inaccurate. The one advantage, at this (2) Life and Microgravity Sciences and Appli- lems in the first place. However, one cations, $507,000,000, of which $3,000,000 shall be point, of direct loans and direct lending can prune the branches without killing allocated for the construction of an addition to is that it makes a loan available imme- the tree. It is a disservice to the Amer- the Microgravity Development Laboratory, Mar- diately. ican taxpayers to suggest otherwise. shall Space Flight Center. It does expedite the process of ob- Mr. President, I yield the floor. (3) Mission to Planet Earth, $1,360,100,000, of taining a loan by a student. As far as The PRESIDING OFFICER. Under which $17,000,000 shall be allocated to the con- any difference in the loans being more the previous unanimous consent, the struction of the Earth Systems Science Building, expensive, that is certainly not the Senator from Minnesota is recognized. Goddard Space Flight Center. case. Mrs. KASSEBAUM. I wonder if the (4) Aeronautical Research and Technology, The package also calls upon post- $891,300,000, of which $5,400,000 shall be allo- Senator from Minnesota would yield cated to the modernization of the Unitary Plan secondary education institutions to for a few moments for some unani- Wind Tunnel Complex, Ames Research Center. participate in achieving savings by im- mous-consent requests. (5) Space Access and Technology, $766,600,000, posing a fee equal to 0.85 percent of the Mr. WELLSTONE. I am happy to of which at least $70,000,000 shall be allocated to amount of Federal loans made avail- yield to the Senator. support a shuttle flight for the Shuttle Imaging October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15299 Radar-C, of which $5,000,000 shall be used to es- Experimental Program to Stimulate Competitive priated funds otherwise available to NASA shall tablish a Rural Technology Transfer and Com- Research in accordance with title III of the Na- be transferred to the State of Mississippi to be mercialization Center for the Rocky Mountains tional Aeronautics and Space Administration used in the transition of the facility: Provided and Upper Plains States region, and of which Act, Fiscal Year 1993 (Public Law 102–588; 106 further, That each Federal agency with prior $159,000,000 shall be allocated to the Reusable Stat. 5119). contact to the site shall remain responsible for Launch Vehicle program. SEC. 203. SPECIAL TECHNOLOGY ENHANCEMENT any and all environmental remediation made (6) Mission Communications Services, GRANTS. necessary as a result of its activities on the site: $461,300,000. (a) IN GENERAL.— Provided further, That in consideration of this (7) Academic Programs, $104,700,000, of which (1) GRANTS.—The Administrator shall make conveyance, NASA may require such other terms $3,000,000 shall be allocated to support the es- up to 4 special technology enhancement grants and conditions as the Administrator deems ap- tablishment of an Upper Plains States regional to areas or States that have not participated propriate to protect the interests of the United science education and outreach center and of fully in the Administration’s aeronautical and States: Provided further, That the conveyance which $1,000,000 shall be allocated to establish a space programs in order to enable such areas or of the site and the transfer of the funds to the Rural Teacher Resource Center. States to increase their capabilities in tech- State of Mississippi shall occur not later than 30 SEC. 103. MISSION SUPPORT. nology development, utilization, and transfer in days after the date of enactment of this Act. There are authorized to be appropriated to the aeronautics, space science, and related areas. At SEC. 206. RADAR REMOTE SENSING SATELLITES. National Aeronautics and Space Administration least one such grant shall be made available to (a) FINDINGS.—The Congress finds that— for Mission Support the following amounts, to a consortium of States, each one of which has (1) radar satellites represent one of the most become available October 1, 1995: an average population density of less than 12.3 important developments in remote sensing sat- (1) Safety, Reliability, and Quality Assurance, persons per square mile, based on data for 1993 ellite technology in recent years; $37,600,000. from the Bureau of the Census. (2) the ability of radar satellites to provide (2) Space Communications Services, (2) ACTIVITIES.—Grants made under this sec- high-quality Earth imagery regardless of cloud $219,400,000. tion shall be available for— cover and to provide three-dimensional pictures (3) Research and Program Management, in- (A) assessment of resources and needs; of the Earth’s surface when the satellites are cluding personnel and related costs, travel, and (B) development of infrastructure, including flown in combination dramatically enhance con- research operations support, $2,047,800,000. incubators and prototype demonstration facili- ventional optical remote sensing satellite capa- (4) Construction of Facilities, including land ties; bilities and usefulness; acquisition, $135,000,000, including the follow- (C) collaborations with industry; (3) the National Aeronautics and Space Ad- ing: (D) expansion of capabilities in procurement; ministration has developed a unique back- (A) Restoration of Flight Systems Research (E) development of technology transfer and ground and expertise in developing and operat- Laboratory, Ames Research Center; commercialization support capabilities; ing radar satellites as a result of their activities (B) Restoration of chilled water distribution (F) activities to increase participation in the connected with its radar satellites, Shuttle Im- system, Goddard Space Flight Center; Small Business Innovation Research program aging Radar (SIR)-A, SIR-B, and SIR-C, which (C) Replace chillers, various buildings, Jet and other NASA research, development, and has flown twice on the Space Shuttle; Propulsion Laboratory; technology utilization and transfer programs; (4) other nations currently have operational (D) Rehabilitation of electrical distribution (G) relevant research of interest to NASA; and radar satellite systems, including Japan and system, White Sands Test Facility, Johnson (H) such other activities as the Administrator Western Europe, with other spacefaring nations Space Center; shall deem appropriate. expected to develop such systems in the near fu- (E) Replace main substation switchgear and (3) SPECIAL CONSIDERATION.—In making ture; and circuit breakers, Johnson Space Center; grants under this section, the Administrator (5) the development of an operational radar (F) Replace 15kv load break switches, Ken- shall give special consideration to proposals satellite program at NASA featuring free-flying nedy Space Center; that— satellites and a related ground system is critical (G) Rehabilitation of Central Air Equipment (A) will build upon and expand a developing to maintain United States leadership in remote Building, Lewis Research Center; research and technology base, and sensing satellite technology and is important to (H) Restoration of high pressure air compres- (B) will insure a lasting research and develop- our national security and international competi- sor system, Marshall Space Flight Center; ment and technology development and transfer tiveness. (I) Restoration of Information and Electronic capability. (b) POLICY.—It is the policy of the United Systems Laboratory, Marshall Space Flight (b) ELIGIBLE ENTITIES.—Grants under sub- States that— Center; section (a)(1) may be made to— (1) NASA should develop and operate a radar (J) Restoration of canal lock, Stennis Space (1) State and local governments; satellite program as soon as practicable; Center; (2) institutions of higher education; and (2) NASA should build on the experience and (K) Restoration of primary electrical distribu- (3) organizations with expertise in research knowledge gained from its previous radar en- tion system, Wallops Flight Facility; and development, technology development, and deavors; (L) Repair of facilities at various locations, technology transfer in areas of interest to (3) NASA should work with other Federal not in excess of $1,500,000 per project; NASA. agencies and, as appropriate, with other (M) Rehabilitation and modification of facili- (c) FUNDING OF PROGRAM.—Of the amounts spacefaring nations, in its radar satellite activi- ties at various locations, not in excess of authorized in section 102 for the Space Access ties; and $1,500,000 per project; and Technology account, $15,000,000 are author- (4) NASA should make maximum use of exist- (N) Minor construction of new facilities and ized to be used for grants under subsection (a). ing National remote sensing assets such as the additions to existing facilities at various loca- Landsat system, activities connected with the tions, not in excess of $1,500,000 per project; SEC. 204. CLEAR LAKE DEVELOPMENT FACILITY. Mission to Planet Earth, and the data manage- (O) Facility planning and design, not other- The Administrator is authorized to acquire, ment facilities of the Department of the Interior wise provided for; and for no more than $35,000,000, a certain parcel of in all of its radar satellite activities. (P) Environmental compliance and restora- land, together with existing facilities, located on (c) PROGRAM REQUIREMENTS.—NASA shall tion. the site of the property referred to as the Clear initiate a program to develop and operate a Lake Development Facility, Clear Lake, Texas, SEC. 104. INSPECTOR GENERAL. radar satellite program. The program shall em- comprising approximately 13 acres and includ- There are authorized to be appropriated to the ploy the most advanced radar satellite tech- ing a light manufacturing facility, an avionics National Aeronautics and Space Administration nology currently available. To the maximum ex- development facility, and an assembly and test for Inspector General $17,300,000, to become tent possible, all of the data processing, dissemi- building which shall be modified for use as a available October 1, 1995. nation, and archiving functions shall be per- neutral buoyancy laboratory in support of formed by the Department of the Interior. The SEC. 105. OFFICE OF COMMERCIAL SPACE TRANS- human space flight activities. PORTATION. program should be planned in such a way that There are authorized to be appropriated to the SEC. 205. YELLOW CREEK FACILITY. the data from the radar satellite system are con- Office of Commercial Space Transportation of Notwithstanding any other provision of law or verted into a broad range of informational prod- the Department of Transportation $7,000,000, to regulation, the National Aeronautics and Space ucts with research, commercial, and government become available October 1, 1995. Administration (NASA) is authorized to convey, applications and any other applications that without reimbursement, to the State of Mis- are in the public interest and that such products TITLE II—LIMITATIONS AND GENERAL sissippi, all rights, title, and interest of the are distributed over the widest user community PROVISIONS United States of the United States in the prop- that is practicable, including industry, aca- SEC. 201. SPACE STATION LIMITATION. erty known as the Yellow Creek Facility and demia, research institutions, local and State The aggregate amount authorized to be appro- consisting of approximately 1,200 acres near the governments, and other Federal agencies. The priated for Space Station and related activities city of Iuka, Mississippi, including all improve- program should coordinate with, and make ap- under sections 101, 102, and 103 shall not exceed ments thereon and any personal property owned propriate use of, other remote sensing satellite $2,100,000,000. by NASA that is currently located on-site and programs, such as the Landsat program. SEC. 202. EXPERIMENTAL PROGRAM TO STIMU- which the State of Mississippi requires to facili- (d) PLAN.—Within 90 days after the enactment LATE COMPETITIVE RESEARCH. tate the transfer: Provided, That appropriated of this Act, the Administrator shall submit a de- Of the amounts appropriated under sections funds shall be used to effect this conveyance: tailed plan for implementation of the radar sat- 101 and 102, $6,900,000 are authorized for the Provided further, That $10,000,000 in appro- ellite program to the Committee on Commerce, S 15300 CONGRESSIONAL RECORD — SENATE October 19, 1995 Science, and Transportation of the Senate and tle. The study shall identify, discuss, and, the Administrator may use the amounts author- the Committee on Science of the House of Rep- where possible, present options for resolving, the ized for construction of facilities pursuant to resentatives. The plan should include— major policy and legal issues that must be ad- this Act or previous National Aeronautics and (1) the goals and mission of the program; dressed before the Shuttle is privatized, includ- Space Administration authorization Acts for (2) planned activities for the next 5 years to ing, but not limited to, the following issues— such purposes. The amounts may be used to ac- achieve such goals and mission; (1) whether the government or the Shuttle quire, construct, convert, rehabilitate, or install (3) strategies for maximizing the usefulness of contractor should own the Shuttle orbiters and temporary or permanent public works, including the satellite data to the scientific and academic Shuttle ground facilities; land acquisition, site preparation, appur- communities, the private sector, all levels of gov- (2) whether the federal government should in- tenances, utilities, and equipment. The Adminis- ernment, and the general public; demnify the contractor for any third party li- trator may use such amounts for facility con- (4) concepts for integrating the program with ability arising from Shuttle operations, and, if solidations, closures, and demolition required to other related NASA activities (such as Mission so, under what terms and conditions; downsize the NASA physical plant to improve to Planet Earth), the Landsat program, and (3) whether commercial payloads should be al- operations and reduce costs. other current and emerging remote sensing sat- lowed to be launched on the Shuttle and wheth- (c) LIMITATIONS.— ellite programs and activities in the Federal gov- er any classes of payloads should be made ineli- (1) Amounts appropriated for a construction- ernment and all other public and private sectors gible for launch consideration; of-facilities project— so that the program complements and strength- (4) whether NASA and federal government (A) may be varied upward by 10 percent at the ens such programs and activities and is not du- payloads should have priority over non-federal discretion of the Administrator; or plicative of these efforts; government payloads in the Shuttle launch as- (B) may be varied upward by 25 percent to (5) concepts developed in consultation with signments and what policies should be devel- meet unusual cost variations after the expira- Department of the Interior, for processing, oped to prioritize among payloads generally; tion of 30 days following a report on the cir- archiving, and disseminating the satellite data (5) whether the public interest requires that cumstances of such action by the Administrator using, to the maximum extent possible, existing certain Shuttle functions continue to be per- to the Committee on Commerce, Science, and Federal government programs and assets at the formed by the federal government; and Transportation of the Senate and the Committee Department of the Interior and other Federal (6) whether privatization of the Shuttle would on Science of the House of Representatives. The agencies; produce any significant cost savings and, if so, aggregate amount authorized to be appropriated (6) targets and timetables for undertaking spe- how much cost savings. for construction of facilities shall not be in- (b) Within 60 days of the enactment of this cific activities and actions within the program; creased as a result of actions authorized under Act, NASA shall complete the study and shall (7) a 5-year budget profile for the program; this section. submit a report on that study to the Committee and (2) No amounts may be obligated for a con- (8) a comparison between the program and the on Commerce, Science, and Transportation of struction-of-facilities project until a period of 30 radar satellite programs of other spacefaring na- the Senate and the Committee on Science of the days has passed after the Administrator or the tions, addressing their respective costs, capabili- House of Representatives. Administrator’s designee has transmitted to the (c) As a transitional step towards Shuttle pri- ties, and other relevant features. Committee on Science of the House of Represent- vatization, NASA shall take all necessary and (e) AUTHORIZATION.—Of the funds authorized atives, and to the Committee on Commerce, appropriate actions to consolidate Shuttle con- in section 102 for the Earth Probes account, the Science, and Transportation of the Senate, a tractor activities under one prime contractor Administrator shall allocate at least $15,000,000 written report describing the nature of the ac- and, within 180 days of the enactment of this to the radar satellite program to conduct Phase quisition, construction, conversion, rehabilita- Act, report to the Committee on Commerce, A and Phase B studies. tion, or installation, its cost, and the reasons Science, and Transportation of the Senate and therefor. SEC. 207. STUDY OF THE HYDROLOGY OF THE the Committee on Science of the House of Rep- UPPER MISSOURI RIVER BASIN. (d) TITLE TO FACILITIES.—If funds are used resentatives on those actions. If NASA has pursuant to subsection (a) for grants to institu- The Administrator shall initiate a project to failed to complete such consolidation by the ex- conduct research on the hydrology of the Upper tions of higher education, or to nonprofit orga- piration of the 180-day period, the report shall nizations whose primary purpose is the conduct Missouri River Basin. The project shall be part explain the reasons for that failure and describe of the Mission to Planet Earth program and of scientific research, for purchase or construc- the steps being taken by NASA to finalize the tion of additional research facilities, title to shall employ satellite observations, surface- consolidation as expeditiously as possible. based radar data, and ground-based such facilities shall be vested in the United SEC. 209. USE OF FUNDS FOR CONSTRUCTION. hydrological and other scientific measurements States unless the Administrator determines that (a) AUTHORIZED USES.—The Administrator to develop quantitative models that address the national program of aeronautical and space may use funds appropriate for purposes other complex atmospheric and surface hydrological activities will best be served by vesting title in than those appropriated for— processes. The project shall be incorporated into the grantee institution or organization. Each (1) construction of facilities; such grant shall be made under such conditions NASA’s activities connected with the multi- (2) research and program management, ex- as the Administrator shall determine to be re- agency Global Energy and Water Cycle Experi- cluding research operations support; and quired to ensure that the United States will re- ment to understand the interactions between the (3) Inspector General, atmosphere and land surfaces. In implementing ceive therefrom benefits adequate to justify the for the construction of new facilities and addi- the project, NASA shall coordinate and consult making of that grant. tions to, repair of, rehabilitation of, or modifica- with other appropriate federal agencies, includ- SEC. 211. AVAILABILITY OF APPROPRIATED tion of, existing facilities at any location in sup- ing the Department of Commerce, the Depart- AMOUNTS. port of the purposes for which such funds are ment of the Interior, and the National Science To the extent provided in appropriations Acts, appropriated. Foundation. To the maximum extent possible, appropriations authorized under this Act may (b) LIMITATION.—None of the funds used pur- remain available without fiscal year limitation. NASA shall employ the assistance of univer- suant to subsection (a) may be expended for a sities, local and State governments, industry, project, the estimated cost of which to the Na- SEC. 212. CONSIDERATION BY COMMITTEES. and any other appropriate entities from the tional Aeronautics and Space Administration, Notwithstanding any other provision of this Upper Missouri River Basin region to carry out including collateral equipment, exceeds $750,000, Act— this program and the Administrator is author- until 30 days have passed after the Adminis- (1) no amount appropriated pursuant to this ized to support the project-related work of such trator has notified the Committee on Science of Act may be used for any program deleted by the entities with grants, technical advice, equip- the House of Representatives and the Committee Congress from requests as originally made to ei- ment, in-kind help, and any other type of ap- on Commerce, Science, and Transportation of ther the Committee on Science of the House of propriate assistance. Within 90 days after the the Senate of the nature, location, and esti- Representatives or the Committee on Commerce, enactment of this Act, the Administrator shall mated cost to the National Aeronautics and Science, and Transportation of the Senate; and submit a plan for the implementation of this Space Administration of such project. (2) no amount appropriated pursuant to the project, which shall set forth the goals, project Act may be used for any program in excess of SEC. 210. CONSTRUCTION OF FACILITIES. costs, planned activities, and overall strategies the amount actually authorized for that par- (a) REPROGRAMMING FOR CONSTRUCTION OF for the project, to the Committee on Commerce, ticular program, excluding construction-of-facil- FACILITIES.—If the Administrator determines Science, and Transportation of the Senate and ity projects, that— the Committee on Science of the House of Rep- (1) new developments in the national program unless a period of 30 days has passed after the resentatives. Of the funds authorized in section of aeronautical and space activities have oc- receipt by such Committee of notice given by the 102 for Mission to Planet Earth, at least curred; Administrator or the Administrator’s designee $10,000,000 shall be allocated by the Adminis- (2) such developments require the use of addi- containing a full and complete statement of the trator to the Upper Missouri River Basin tional funds for the purpose of construction, ex- action proposed to be taken and the facts and project. pansion, or modification of facilities at any lo- circumstances relied upon in support of the pro- SEC. 208. SHUTTLE PRIVATIZATION. cation; and posed action. NASA shall keep those Committees (a) The Administrator is hereby directed to (3) deferral of such action until the enactment fully and currently informed with respect to all conduct a study of the feasibility of implement- of the next National Aeronautics and Space Ad- activities and responsibilities within their juris- ing the recommendation of the Independent ministration authorization Act would be incon- diction. Except as otherwise provided by law, Shuttle Management Review Team that NASA sistent with the interest of the Nation in aero- any Federal department, agency, or independ- transition towards the privatization of the Shut- nautical and space sciences; ent establishment shall furnish any information October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15301 requested by either such Committee relating to Earth Observing System Data and Information SEC. 303. AMENDMENT OF SECTION 70102. any activity or responsibility. System in place at the time of the President’s Section 70102 (relating to definitions) is SEC. 213. USE OF FUNDS FOR SCIENTIFIC CON- budget submission for NASA for fiscal year 1996 amended— SULTATIONS OR EXTRAORDINARY unless, 60 days before undertaking such action, (1) by inserting ‘‘from Earth, including a re- EXPENSES. the Administrator has submitted to the Commit- entry vehicle and its payload, if any’’ after Funds appropriated under section 103 may be tee on Commerce, Science, and Transportation ‘‘and any payload’’ in paragraph (3); used for scientific consultations or extraor- of the Senate and the Committee on Science of (2) by striking ‘‘object’’ the first place it ap- dinary expenses upon the authority of the Ad- the House of Representatives a written report pears in paragraph (8) and inserting ‘‘object, in- ministrator, but not to exceed $35,000 . containing— cluding a reentry vehicle and its payload, if SEC. 214. REPORTING REQUIREMENTS. (1) a detailed description of the planned agen- any,’’; (a) REPORTING PERIOD.—Section 206(a) of the cy action; (3) by redesignating paragraphs (9) through National Aeronautics and Space Act of 1958 (42 (2) the reasons and justifications for such ac- (12) as paragraphs (16) through (19), respec- U.S.C. 2476(a)) is amended— tion; tively; (1) by striking ‘‘January’’ and inserting (3) an analysis of the cost impact of such ac- (4) by inserting after paragraph (8) the follow- ‘‘May’’; and tion; ing: (2) by striking ‘‘calendar’’ and inserting ‘‘fis- (4) an analysis of the impact of the action on ‘‘(9) ‘in-space transportation vehicle’ means cal’’. the scientific benefits of the program and the ef- any vehicle designed to operate in space and de- (b) PROTECTION OF COMMERCIALLY VALUABLE fect of the action on the expected applications of signed to transport any payload or object sub- INFORMATION.—Section 303 of the National Aer- the satellite data from the System in such areas stantially intact from one orbit to another orbit. onautics and Space Act of 1958 (42 U.S.C. 2454) as global climate research, land-use planning, ‘‘(10) ‘in-space transportation services’ is amended by adding at the end the following: state and local government management, min- means— ‘‘(c)(1) The Administrator may delay, for a pe- eral exploration, agriculture, forestry, national ‘‘(A) those activities involved in the direct riod not to exceed 5 years, the unrestricted pub- security, and any other areas that the Adminis- transportation or attempted transportation of a lic disclosure of technical data, related to a com- trator deems appropriate; payload or object from one orbit to another; petitively sensitive technology, in the possession (5) an analysis of the impact of the action on ‘‘(B) the procedures, actions, and activities of, or under the control of, the Administration the United States Global Climate Change Re- necessary for conduct of those transportation that has been generated in the performance of search program and international global climate services; and experimental, developmental, or research activi- change research activities; and ‘‘(C) the conduct of transportation services. ties or programs conducted by, or funded in (6) an explanation of what measures, if any, ‘‘(11) ‘in-space transportation control site’ whole or in part by, the Administration, if the are planned by NASA to compensate for any means a location from which an in-space trans- technical data has significant value in main- likely reductions in the scientific value and data portation vehicle is controlled or operated (as taining leadership or competitiveness, in civil collection, processing, and distribution capabili- such terms may be defined in any license the and governmental aeronautical and space ac- ties of the System as a result of the action. Secretary issues or transfers under this chap- tivities by the United States industrial base. TITLE III—COMMERCIAL SPACE LAUNCH ter). ‘‘(2) The Administrator shall publish bian- ACT AMENDMENTS ‘‘(12) ‘reenter’ and ‘reentry’ mean to return nually in the Federal Register a list of all com- purposefully, or attempt to return, a reentry ve- SEC. 301. AMENDMENT OF TITLE 49. petitively sensitive technology areas which it be- hicle and payload, if any, from Earth orbit or Except as otherwise expressly provided, when- lieves have a significant value in maintaining outer space to Earth. ever in this title an amendment or repeal is ex- the United States leadership or competitiveness ‘‘(13) ‘reentry services’ means— pressed in terms of an amendment to, or repeal in civil and governmental aeronautical and ‘‘(A) activities involved in the preparation of of, a section or other provision, the reference space activities. The list shall be generated after a reentry vehicle and its payload, if any, for re- shall be considered to be made to a section or consultation with appropriate Government entry; and other provision of title 49, United States Code. agencies and a diverse cross section of compa- ‘‘(B) the conduct of a reentry. nies— SEC. 302. AMENDMENT OF SECTION 70101. ‘‘(14) ‘reentry site’ means the location on ‘‘(A) that conduct a significant level of re- Section 70101 (relating to findings and pur- Earth to which a reentry vehicle is intended to search, development, engineering, and manufac- poses) is amended— return (as defined in a license the Secretary is- turing in the United States; and (1) by inserting ‘‘microgravity research,’’ after sues or transfers under this chapter). ‘‘(B) the majority ownership or control of ‘‘information services,’’ in subsection (a)(3); ‘‘(15) ‘reentry vehicle’ means any vehicle de- which is held by United States citizens. (2) by inserting ‘‘commercial space transpor- signed to return substantially intact from Earth ‘‘(3) The Administrator shall provide an op- tation services, including in-space transpor- orbit or outer space to Earth.’’; portunity for written objections to the list with- tation activities and’’ after ‘‘providing’’ in sub- (5) by striking ‘‘launch’’ each place it appears in a 60-day period after it is published. After the section (a)(4); in paragraph (18), as redesignated and inserting expiration of that 60-day period, and after con- (3) by striking ‘‘commercial launch vehicles’’ ‘‘launch services, in-space transportation activi- sideration of all written objections received by in subsection (a)(5) and inserting ‘‘commercial ties, or reentry’’. the Administrator during that period, NASA space transportation including commercial SEC. 304. AMENDMENT OF SECTION 70103. shall issue a final list of competitively sensitive launch vehicles, in-space transportation activi- Section 70103(b) (relating to facilitating com- technology areas. ties, reentry vehicles,’’; ‘‘(4) For purposes of this subsection, the term (4) by striking ‘‘launch’’ in subsection (a)(6) mercial launches) is amended— (1) by striking ‘‘LAUNCHES’’ in the caption and ‘technical data’ means any recorded informa- and inserting ‘‘launch, in-space transportation, inserting ‘‘SPACE ACTIVITIES’’; tion, including computer software, that is or and reentry’’; may be directly applicable to the design, engi- (5) by striking ‘‘launches’’ each place it ap- (2) by striking ‘‘commercial space launches’’ neering, development, production, manufacture, pears in subsection (a)(7) and inserting in paragraph (1) and inserting ‘‘commercial or operation of products or processes that may ‘‘launches, in-space transportation activities, space transportation services’’; and (3) by striking ‘‘a space launch’’ in subsection have significant value in maintaining leader- reentries’’ after ; ship or competitiveness in civil and govern- (6) by striking ‘‘sites and complementary fa- (b)(2) and inserting ‘‘space transportation’’. mental aeronautical and space activities by the cilities, the providing of launch’’ in subsection SEC. 305. AMENDMENT OF SECTION 70104. United States industrial base.’’. (a)(8) and inserting ‘‘sites, in-space transpor- Section 70104 (relating to restrictions on SEC. 215. INDEPENDENT RESEARCH AND DEVEL- tation control sites, reentry sites, and com- launches and operations) is amended— OPMENT. plementary facilities, the providing of launch, (1) by striking the section caption and insert- The Congress finds that it is appropriate for in-space transportation, and reentry’’; ing the following: costs contributed by a contractor under a coop- (7) by inserting ‘‘in-space transportation con- ‘‘Restrictions on launches, in-space transportation ac- erative agreement with the National Aero- trol sites, reentry sites,’’ after ‘‘launch sites,’’ in tivities, operations, and reentries’’; nautics and Space Administration to be consid- subsection (a)(9); (2) by striking ‘‘site’’ each place it appears in ered as allowable independent research and de- (8) by striking ‘‘launch vehicles’’ in subsection subsection (a) and inserting ‘‘site, an in-space velopment costs, for purposes of section 31.205– (b)(2) and inserting ‘‘commercial space transpor- transportation operations site, reentry site, or 18 of the Federal Acquisition Regulations if the tation services, including launch vehicles, in- reenter a reentry vehicle,’’; work performed would have been allowable as space transportation activities, reentry vehi- (3) by striking ‘‘launch or operation’’ in sub- contractor independent research and develop- cles,’’; sections (a) (3) and (4) and inserting ‘‘launch, ment costs had there been no cooperative agree- (9) by striking ‘‘launch’’ the first place it ap- in-space transportation activity, or reentry op- ment. The Administration shall seek a revision pears in subsection (b)(3) and inserting eration’’; to that section of the Federal Acquisition Regu- ‘‘launch, in-space transportation vehicle, and (4) by striking subsection (b) and inserting the lations to reflect the intent of the Congress ex- reentry’’; following: pressed in the preceding sentence. (10) by striking ‘‘commercial launch’’ the sec- ‘‘(b) COMPLIANCE WITH PAYLOAD REQUIRE- SEC. 216. RESTRUCTURING OF THE EARTH OB- ond place it appears in subsection (b)(3); and MENTS.—The holder of a license under this SERVING SYSTEM DATA AND INFOR- (11) by inserting ‘‘in-space transportation ve- chapter may launch a payload, operate an in- MATION SYSTEM. hicle control facilities, and development of re- space transportation vehicle, or reenter a pay- The Administrator is prohibited from restruc- entry sites’’ after ‘‘facilities,’’ in subsection load only if the payload or vehicle complies with turing or downscaling the baseline plan for the (b)(4). all requirements of the laws of the United States S 15302 CONGRESSIONAL RECORD — SENATE October 19, 1995 related to launching a payload, operating an in- SEC. 310. AMENDMENT OF SECTION 70110. (3) by striking ‘‘vehicle’’ the second place it space transportation vehicle, or reentering a Section 70110 (relating to administrative hear- appears and inserting ‘‘vehicle, in-space trans- payload.’’; ings and judicial review) is amended— portation vehicle, or reentry vehicle’’. (5) by striking the caption of subsection (c) (1) by striking ‘‘launch’’ in subsection (a)(2) SEC. 315. AMENDMENT OF SECTION 70117. and inserting the following: ‘‘(c) PREVENTING and inserting ‘‘launch, in-space transportation Section 70117 (relating to relationship to other LAUNCHES, IN-SPACE TRANSPORTATION ACTIVI- activity, or reentry’’; and executive agencies, laws, and international obli- TIES, OR REENTRIES.—’’; and (2) by striking ‘‘site’’ in subsection (a)(3)(B) gations) is amended— (6) by striking ‘‘launch’’ each place it appears and inserting ‘‘site, in-space transportation con- (1) by striking ‘‘vehicle or operate a launch in subsection (c) and inserting ‘‘launch, in- trol site, in-space transportation activity, re- site.’’ in subsection (a) and inserting ‘‘vehicle, space transportation activity, or reentry’’. entry site, or reentry of a reentry vehicle,’’. operate a launch site, perform in-space trans- SEC. 306. AMENDMENT OF SECTION 70105. SEC. 311. AMENDMENT OF SECTION 70111. portation activities or operate an in-space trans- Section 70105 (relating to license applications Section 70111 (relating to acquiring United portation control site or reentry site, or reenter and requirements) is amended— States Government property and services) is a reentry vehicle.’’; (1) by striking ‘‘site’’ in subsection (b)(1) and amended— (2) by striking ‘‘launch’’ in subsection (d) and inserting ‘‘site, an in-space transportation con- (1) by inserting ‘‘in-space transportation ac- inserting ‘‘launch, perform an in-space trans- trol site, or a reentry site or the reentry of a re- tivities, or reentry services’’ after ‘‘launch serv- portation activity, or reentry’’; entry vehicle,’’; and ices,’’ in subsection (a)(1)(B); (3) by striking subsections (f) and (g), and in- (2) by striking ‘‘or operation’’ and inserting in (2) by striking ‘‘services’’ in subsection (a)(2) serting the following: lieu thereof ‘‘, in-space transportation activity, and inserting ‘‘services, in-space transportation ‘‘(f) LAUNCH NOT AN EXPORT OR IMPORT.—A operation, or reentry’’ in subsection (b)(2)(A). activities, or reentry services’’; launch vehicle, reentry vehicle, or payload that SEC. 307. AMENDMENT OF SECTION 70106. (3) by inserting ‘‘or reentry’’ after ‘‘launch’’ is launched or reentered is not, because of the Section 70106(a) (relating to monitoring activi- in subsection (a)(2)(A); launch or reentry, an export or import for pur- ties general requirements) is amended— (4) by inserting ‘‘or reentry’’ after ‘‘launch’’ poses of a law controlling exports or imports. (1) by striking ‘‘launch site’’ and inserting the first place it appears in subsection (a)(2)(B); ‘‘(g) NONAPPLICATION.—This chapter does not ‘‘launch site, in-space transportation control (5) by striking ‘‘launch’’ each place it appears apply to— site, or reentry site’’; in subsection (b)(1) and inserting ‘‘launch, in- ‘‘(1) a launch, in-space transportation activ- (2) by inserting ‘‘in-space transportation vehi- space transportation activity, or reentry’’; ity, reentry, operation of a launch vehicle, in- cle, or reentry vehicle,’’ after ‘‘launch vehicle,’’ (6) by striking ‘‘services’’ the first place it ap- space transportation vehicle, or reentry vehicle, and pears in subsection (b)(2)(C) and inserting or of a launch site, in-space transportation con- (3) by striking ‘‘vehicle.’’ and inserting ‘‘vehi- ‘‘services, in-space transportation activities or trol site, or reentry site, or other space activity cle, in-space transportation vehicle, or reentry services, or reentry services’’; and the Government carries out for the Government; (7) by striking subsection (d) and inserting the vehicle.’’. or following: SEC. 308. AMENDMENT OF SECTION 70108. ‘‘(2) planning or policies related to the ‘‘(d) COLLECTION BY OTHER GOVERNMENTAL launch, in-space transportation activity, re- Section 70108 (relating to prohibition, suspen- HEADS.—The head of a department, agency, or sion, and end of launches and operation of entry, or operation.’’. instrumentality of the Government may collect a SEC. 316. REPORT TO CONGRESS. launch sites) is amended— payment for any activity involved in producing (1) by striking the section caption and insert- Chapter 701 is amended by adding at the end a launch vehicle, in-space transportation vehi- thereof the following new section: ing the following: cle, or reentry vehicle or its payload for launch, ‘‘§ 70120. Report to Congress ‘‘Prohibition, suspension, and end of launches, in- in-space transportation activity, or reentry if space transportation activities, reen- the activity was agreed to by the owner or man- ‘‘The Secretary of Transportation shall submit tries, or operation of launch sites, in- ufacturer of the launch vehicle, in-space trans- to Congress an annual report to accompany the space transportation control sites, or re- portation vehicle, reentry vehicle, or payload.’’. President’s budget request that— entry sites’’; ‘‘(1) describes all activities undertaken under SEC. 312. AMENDMENT OF SECTION 70112. and this chapter, including a description of the proc- (2) by striking ‘‘site’’ in subsection (a) and in- Section 70112 (relating to liability insurance and financial responsibility requirements) is ess for the application for and approval of li- serting ‘‘site, in-space transportation control censes under this chapter and recommendations site, in-space transportation activity, or reentry amended— (1) by inserting ‘‘one reentry, or to the oper- for legislation that may further commercial site, or reentry of a reentry vehicle,’’; and ations of each in-space transportation vehicle’’ launches and reentries; and (3) by striking ‘‘launch or operation’’ in sub- ‘‘(2) reviews the performance of the regulatory section (a) and inserting ‘‘launch, in-space after ‘‘launch,’’ in subsection (a)(3); (2) by inserting ‘‘in-space transportation ac- activities and the effectiveness of the Office of transportation activity, operation, or reentry’’. tivities, or reentry services,’’ after ‘‘launch serv- Commercial Space Transportation.’’. SEC. 309. AMENDMENT OF SECTION 70109. ices,’’ each place it appears in subsections (a)(4) SEC. 317. AMENDMENT OF TABLE OF SECTIONS. (a) CAPTION.—The section caption of section and (b)(2); The table of sections for chapter 701 of title 49, 70109 (relating to preemption of scheduled (3) by striking ‘‘services’’ in subsection (b)(1) United States Code, is amended— launches) is amended to read as follows: and the third place it appears in subsection (1) by amending the item relating to section ‘‘Preemption of scheduled launches, in-space trans- (b)(2) and inserting ‘‘services, in-space transpor- 70104 to read as follows: portation activities, or reentries’’. tation activities, or reentry services,’’; ‘‘70104. Restrictions on launches, in-space trans- (b) AMENDMENT OF SUBSECTION (a).—Sub- (4) by inserting ‘‘applicable’’ after ‘‘carried portation activities, operations, section (a) is amended— out under the’’ in subsections (b)(1) and (2); and reentries’’; (1) by inserting ‘‘or reentry’’ after ‘‘ensure (5) by striking ‘‘Science, Space, and Tech- (2) by amending the item relating to section that a launch’’; nology’’ in subsection (d) and inserting 70108 to read as follows: ‘‘Science’’; (2) by striking ‘‘site’’ in the first sentence and ‘‘70108. Prohibition, suspension, and end of (6) by striking ‘‘LAUNCHES’’ in the caption of inserting ‘‘site, reentry site,’’; launches, in-space transportation subsection (e) and inserting ‘‘LAUNCHES, IN- (3) by inserting ‘‘nor shall an in-space trans- activities, reentries, or operation SPACE TRANSPORTATION ACTIVITIES, OR REEN- portation activity or operation be preempted,’’ of launch sites, in-space transpor- TRIES’’; AND after ‘‘launch property,’’ in the first sentence; tation control sites, or reentry (4) by inserting ‘‘or reentry date commitment’’ (7) by striking ‘‘site’’ in subsection (e) and in- serting ‘‘site, in-space transportation control sites’’; after ‘‘launch date commitment’’; (3) by amending the item relating to section (5) by inserting ‘‘or reentry’’ after ‘‘obtained site, or control of an in-space transportation ve- 70109 to read as follows: for a launch’’; hicle or activity, or reentry site or a reentry’’. (6) by striking ‘‘site’’ in the second sentence SEC. 313. AMENDMENT OF SECTION 70113. ‘‘70109. Preemption of scheduled launches, in- and inserting ‘‘site, reentry site,’’; Section 70113 (relating to paying claims ex- space transportation activities, or (7) by striking ‘‘services’’ in the second sen- ceeding liability insurance and financial re- reentries’’; tence and inserting ‘‘services, or services related sponsibility requirements) is amended by strik- and to a reentry,’’; ing ‘‘launch’’ each place it appears in sub- (4) by adding at the end the following new (8) by inserting ‘‘or reentry’’ after ‘‘the sched- sections (a)(1), (d)(1), and (d)(2) and inserting item: uled launch’’; and ‘‘launch, operation of one in-space transpor- ‘‘70120. Report to Congress’’. (9) by adding at the end thereof the following: tation vehicle, or one reentry’’. SEC. 318. REGULATIONS. ‘‘A licensee or transferee preempted from access SEC. 314. AMENDMENT OF SECTION 70115. The Secretary of Transportation shall issue to a reentry site does not have to pay the Gov- Section 70115(b)(1)(D)(i) (relating to enforce- regulations under chapter 701 of title 49, United ernment agency responsible for the preemption ment and penalty general authority) is amend- States Code, that include— any amount for reentry services attributable ed— (1) guidelines for industry to obtain sufficient only to the scheduled reentry prevented by the (1) by inserting ‘‘in-space transportation con- insurance coverage for potential damages to preemption.’’. trol site, or reentry site,’’ after ‘‘launch site,’’; third parties; (c) AMENDMENT OF SUBSECTION (c).—Sub- (2) by inserting ‘‘in-space transportation vehi- (2) procedures for requesting and obtaining li- section (c) is amended by inserting ‘‘or reentry’’ cle, or reentry vehicle’’ after ‘‘launch vehicle,’’; censes to operate a commercial launch vehicle after ‘‘prompt launching’’ in subsection (c). and and reentry vehicle; October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15303 (3) procedures for requesting and obtaining The amendment is as follows: Earth will help researchers understand operator licenses for launch and reentry; and On page 46, line 2, after ‘‘Center’’ insert a and predict the global climate trends (4) procedures for the application of govern- comma and the following: ‘‘and of which that affect our lives. As a Senator rep- ment indemnification. $2,000,000 shall be allocated in fiscal year resenting a State whose economy is de- SEC. 319. SPACE ADVERTISING. 1996, and such sums as are necessary there- pendent upon agriculture, I have a (a) DEFINITION.—Section 70102, as amended by after, for the operation of the Upper Midwest keen interest in this program’s poten- section 303, is amended by redesignating para- Aerospace Consortium (UMAC) of institu- tial to provide detailed data on soil graphs (12) through (19) as (13) through (20), re- tions in the Upper Great Plains Region for spectively, and by inserting after paragraph (11) the purpose of making information derived conditions, topography, crops, and the following new paragraph: from Mission to Planet Earth data available other information critical to the farm- ‘‘(12) ‘obtrusive space advertising’ means ad- to the general public’’. ing and ranching community. I also vertising in outer space that is capable of being On page 57, line 18, strike ‘‘shall’’ and in- take great pride in the selection of the recognized by a human being on the surface of sert ‘‘is authorized to’’. EROS Data Center in Sioux Falls, SD, the earth without the aid of a telescope or other On page 57, line 25, strike ‘‘The’’ and insert as one of the regional data centers that technological device;’’. ‘‘If initiated, the’’. will collect and distribute this satellite (b) PROHIBITION.—Chapter 701 is amended by On page 58, line 15, strike ‘‘Within’’ and in- data. inserting after section 70109 the following new sert ‘‘If this project is initiated, then with- section: in’’. If Mission to Planet Earth is to real- ‘‘§ 70109a. Space advertising Mr. PRESSLER. Mr. President, I am ize its full potential, we must ensure its satellite data are converted to use- ‘‘(a) LICENSING.—Notwithstanding the provi- pleased that today the Senate is con- sions of this chapter or any other provision of sidering S. 1048, the NASA Authoriza- ful information that can be applied to law, the Secretary shall not— tion Act for fiscal year 1996, which I in- real life problems. Reflecting that ‘‘(1) issue or transfer a license under this troduced as chairman of the Senate thinking, our bill authorizes $10 mil- chapter; or lion for an Upper Missouri River Basin ‘‘(2) waive the license requirements of this Committee on Commerce, Science, and Transportation. Let me also take this project to support hydrology studies of chapter; that flood-plagued region. This project opportunity to thank Senator BURNS, for the launch of a payload containing any ma- will enable a consortium of regional in- terial to be used for the purposes of obtrusive who is chairman of our Space Sub- committee, for his fine contributions stitutions led by the South Dakota space advertising. School of Mines and Technology to ‘‘(b) LAUNCHING.—No holder of a license to this bill and his leadership in space under this chapter may launch a payload con- policy matters. apply NASA’s space-age technology to taining any material to be used for purposes of NASA faces two challenges. The first develop better systems for managing obtrusive space advertising on or after the date is maintaining America’s leadership in and investigating floods and other nat- of enactment of the National Aeronautics and aeronautics and space. The second is ural disasters. I am hopeful NASA will Space Administration Authorization Act, Fiscal accomplishing these leadership goals undertake more projects of this type in Year 1996. order to put our country’s wealth of ‘‘(c) COMMERCIAL SPACE ADVERTISING.—Noth- within the confines of a balanced Fed- eral budget. This authorization bill al- scientific knowledge and talent to ing in this section shall apply to nonobtrusive work for the taxpayers’ benefit. commercial space advertising, including adver- lows NASA to meet both of these chal- tising on commercial space transportation vehi- lenges. I am pleased with the current direc- cles, space infrastructure, payloads, space NASA started out this year with a tion of the Mission to Planet Earth launch facilities, and launch support facili- plan to cut $5 billion over 5 years from Program, but, equally significant, so is ties.’’. its budget. Then, the Senate and House the scientific community. In Septem- (c) NEGOTIATION WITH FOREIGN LAUNCHING developed budget plans requiring even ber, the National Academy of Sciences NATIONS.— released its long-awaited report on the (1) The President is requested to negotiate deeper cuts. In keeping with this new with foreign launching nations for the purpose fiscal reality, our bill authorizes a program. The report, which was based of reaching an agreement or agreements that total of $13.8 billion for NASA in Fiscal on a 10-day workshop featuring the Na- prohibit the use of outer space for obtrusive Year 1996, a 3-percent decrease from tion’s finest scientists, strongly en- space advertising purposes. the current funding level of $14.26 bil- dorsed the program’s goals, missions, (2) It is the sense of Congress that the Presi- lion. and activities. In short, the scientific dent should take such action as is appropriate Despite the funding cut, the bill man- community formally declared that and feasible to enforce the terms of any agree- ages to support a diverse and forward- Mission to Planet Earth is indeed good ment to prohibit the use of outer space for ob- science. trusive space advertising purposes. looking space program. It authorizes (3) As used in this subsection, the term ‘‘for- all of NASA’s major current programs It is because this program is on the eign launching nation’’ means a nation— such as Mission to Planet Earth, space right track that I am deeply concerned (A) which launches, or procures the launch- station, space science, and aeronautics about the possibility of NASA taking ing of, a payload into outer space; or and, in almost all cases, at their re- any imprudent and unnecessary efforts (B) from whose territory or facility a payload quested funding levels. At the same to further restructure the program. is launched into outer space. time, it prepares NASA for the future Mission to Planet Earth has just com- (d) CLERICAL AMENDMENT.—The table of sec- pleted a restructuring exercise. In my tions for chapter 701 is amended by inserting the by authorizing a number of new following after the item relating to section 70109: starts—including the new reusable view, further redesigns to the program would only add costs, produce schedule ‘‘70109a. Space advertising’’. launch vehicle technology development program aimed at providing private in- delays, and reduce scientific capabili- AMENDMENT NO. 2939 dustry the technology to eventually ties. To guard against this occurrence, (Purpose: To authorize funds for operation of build a shuttle replacement, and a new the bill specifically prohibits NASA the Upper Midwest Aerospace Consortium, radar satellite program to develop and from changing the data management and to clarify authorization) make use of the latest advances in sat- component of the program, unless, 60 Mrs. KASSEBAUM. Mr. President, I ellite remote sensing technology. days before such action, NASA has re- send an amendment to the desk on be- Mr. President, I would now like to ported to Congress on the nature and half of Senator PRESSLER. make special mention of certain por- overall impact of the planned changes. The PRESIDING OFFICER. The tions of the bill. Mr. President, the bill also provides clerk will report. I believe Mission to Planet Earth the full $2.1 billion requested funding The legislative clerk read as follows: may be NASA’s most important and for space station. However, this au- The Senator from Kansas [Mrs. KASSE- relevant program. The satellite data thorization should not be interpreted BAUM], for Mr. PRESSLER, proposed an from Mission to Planet Earth will de- as a ringing endorsement of that pro- amendment numbered 2939. liver direct benefits to the taxpayer in gram. I am a longstanding supporter of Mrs. KASSEBAUM. Mr. President, I contrast to the speculative spinoffs the program, but, in recent years, I ask unanimous consent reading of the promised by other space activities. For have become concerned that it has be- amendment be dispensed with. this reason, the bill fully funds this ac- come too expensive, too complex, and The PRESIDING OFFICER. Without tivity at $1.36 billion. Using the latest too dependent on the contributions of objection, it is so ordered. satellite technology, Mission to Planet Russia, the latest station partner. S 15304 CONGRESSIONAL RECORD — SENATE October 19, 1995 In a June 1995 report, the General Ac- ica wants to be part of the techno- date the important Commercial Space counting Office [GAO] estimated the logical revolution. More importantly, Launch Act. total cost of the design, launch, and op- it wants to contribute. Mr. President, the administration eration of the space station will be $94 It is in the national interest to does have several concerns about the billion. That is almost seven times the strengthen the scientific talent, re- NASA portions of this bill. The most entire annual budget for NASA. Given sources, and infrastructure in our rural important concerns the bill’s proposed the history of past missions, it is fair States through appropriate research, $200 million reduction in shuttle fund- to assume the $94 billion price tag for education, and outreach activities. The ing. NASA is committed to reducing the program will increase over time. If bill attempts to accomplish this in sev- shuttle costs over time, but the agency that happens, we may wake up to find eral ways. It increases funding for the is concerned that the assumption that the enormous space station budget has Experimental Program to Stimulate $200 million can be cut in 1 year is un- crowded out every other NASA pro- Competitive Research Program realistic. The second is the administra- gram to become NASA’s only mission. [EPSCoR] from its current level of $4.9 tion’s concern about several other cuts Earlier this year, I voted for space sta- to $6.9 million. NASA’s EPSCoR Pro- the bill makes, including funding cuts tion funding, but I may well reconsider gram, as well as similar programs in for the gravity probe-B satellite my support in the future if the pro- six other science agencies, have been project, high-performance computing gram starts to threaten the balance in instrumental in providing Federal in the aeronautical program, and a $100 our space program. funding for quality academic research million reduction in the Tracking and As important as current space pro- in rural States. Our bill also funds a Data Relay Satellite System Replen- grams are, we also have an obligation rural teacher resource center, a rural ishment Program. Third, the adminis- to prepare NASA for the future. To technology transfer and commer- tration also objects to the $123 million that end, the bill supports several new cialization center, and a regional in new, unrequested projects author- initiatives at NASA to extend its vi- science education and outreach center ized by the bill. I believe that these are sion into the next century. The bill au- for the Plains States region. all important issues, and I will discuss thorizes a reusable launch vehicle pro- Mr. President, I believe NASA is up them further with Chairman PRESSLER gram, which will support NASA’s X–33 to the challenge of keeping America and Chairman BURNS as S. 1048 moves and X–34 activities to pave the way for preeminent in aeronautics and space through the legislative process. the later development by the private despite the intense budget pressure and Overall, however, there is much to sector of a replacement for the shuttle despite the increasing competition commend in this bill. I commend in the next decade. from other spacefaring nations. It is Chairman PRESSLER and Chairman Employing 1970’s technologies and my belief this authorization bill pro- BURNS for their dedication to NASA is- costing $400 million per flight, the vides NASA with the support it needs sues and for working with us on this shuttle may have outlived its useful- to meet that challenge. legislation. I support S. 1048 and its ness. However, within today’s budget strong endorsement of our Nation’s I wish to thank my colleagues for constraints, the Government cannot af- space and aeronautical objectives, and their contributions and support and I ford to foot the entire bill for a new I urge our colleagues to join me in vot- urge the Senate to pass S. 1048 as multibillion-dollar spacecraft develop- ing for it. amended. ment program. That is why the reus- Mr. BURNS. Mr. President, today I Mr. ROCKEFELLER. Mr. President, I able launch vehicle program—with its stand in support of bill, S. 1048, the rise today in support of S. 1048, the Na- emphasis on sharing development costs NASA authorization bill for fiscal year tional Aeronautics and Space Adminis- with industry and its goal of moving 1996 which I have enthusiastically co- tration Authorization Act, fiscal year our national space transportation sys- sponsored. The bill authorizes a total 1996. While both the administration tem toward privatization—seems a via- of $13.8 billion for the agency, a 3-per- and I have some concerns with this ble concept worth pursuing. cent decrease from the requested level The bill also authorizes the New Mil- bill, it is in general a ringing endorse- of $14.26 billion. That funding should lennium initiative to develop new ment of the bipartisan space and aero- allow NASA to continue the important microminiature technologies aimed at nautics programs and a strong state- missions already underway such as reducing the cost and development ment in support of our Nation’s future space station, mission to planet Earth, times for satellites, and provides fund- in space. and the aeronautics and space science ing for two infrared astronomy pro- The bill strongly supports the space programs. It should also prepare NASA grams to help us better understand the station and funds NASA’s most impor- for the future by authorizing several vast universe in which we live. tant new satellite initiative, Mission to new missions, such as an effort to de- Mr. President, radar satellites are Planet Earth. It authorizes full funding velop a shuttle replacement and a new one of the most important new tech- for research on reusable launch vehi- radar satellite program. nologies in satellite remote sensing. In cles, and supports the important Mr. President, as you know, we are in recognition of that, S. 1048 authorizes a Cassini and Mars Surveyor projects. It a budget crisis and NASA deserves a new radar satellite program and a third also fully authorizes the President’s re- great deal of credit as one of few Fed- shuttle flight for the shuttle imaging quested funding for aeronautical re- eral agencies to respond to it early and radar ‘‘C’’ satellite. Because radar sat- search and technology, thus continuing responsibly. In 3 years, NASA cut the ellites have the ability to ‘‘see’’ the industry-government partnership space shuttle budget from $4 billion to through cloud cover, they will dramati- that is so vital to the long-term $3.1 billion. It developed a redesign of cally enhance the capability of Ameri- strength of our vital aircraft industry. space station that was $5 billion less ca’s existing optical-based satellite In addition, the bill requires the expensive than the earlier space sta- systems such as Landsat. Japan and NASA Administrator to conduct a tion Freedom concept. Mission to planet Europe already operate radar satellite study of the feasibility of privatizing Earth has been reduced from a $17 bil- systems, and Canada is set to deploy the space shuttle—an important step in lion armada of satellites to a $7 billion one later this year. To maintain our the on-going debate about how to re- focused satellite system. Earlier this scientific leadership as well as protect duce shuttle costs and bureaucracy year, faced with the prospect of deep our national security, the United without jeopardizing safety or Govern- congressional budget cuts across Gov- States must not get left behind in this ment requirements. And I am proud ernment, NASA took the initiative and critical technology. that the bill continues the small but developed a plan to cut $5 billion in 5 In my role as chairman of the Senate very valuable NASA Experimental Pro- years, without reducing program con- Commerce Committee, it has become gram to Stimulate Competitive Re- tent. apparent to me that small city, rural search [EPSCOR]. I also support the But NASA did not stop there. This States like my home State of South bill’s authorization for the Office of year, it conducted a comprehensive Dakota are often forgotten in our vast Commercial Space Transportation at zero-based review of all of its activities $70 billion Federal science and tech- the Transportation Department, and and programs to achieve even greater nology enterprise. That part of Amer- the title III amendments that will up- savings. That review looked at a broad October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15305 range of money-saving measures such higher profile space missions. However, possesses the necessary expertise to manage as workforce reductions, elimination of under Dan Goldin’s leadership, that is CIESIN. Because the context within which redundant activities, consolidation of beginning to change and NASA is giv- SEDAC will operate is data management and integration, NASA is more uniquely quali- functions, and operating more effi- ing aeronautics the backing it de- fied for this role than any other federal agen- ciently. I understand that, within the serves. cy. To me, the aeronautics research is administration, NASA’s efforts are Further, NASA itself, in a letter critical to maintaining U.S. techno- often cited as the model for from the Associate Administrator for reinventing Government. logical leadership and aerospace com- Mission to Planet Earth to the presi- After 3 consecutive years of substan- petitiveness. For instance, the High- dent of CIESIN (July 6, 1995), states: tial budget cuts, NASA is now down to Speed Research Program is developing The contribution CIESIN has made toward the bone. To require additional reduc- precompetitive technologies in support information technology and access to envi- tions would force NASA to cancel im- of supersonic aircraft. It is estimated ronmental data are highly beneficial to portant space programs, close vital fa- that the first country to market such NASA and to society. cilities, or layoff essential skilled per- an aircraft stands to gain $200 billion There are many more examples sonnel. That would decimate the Na- in sales and 140,000 new jobs. Similarly, which I can provide that directly and tion’s science and technology base. the Advanced Subsonic Technology factually challenge the committee re- Equally important, it would decimate Program funds research in support of port’s assertion. We would appreciate the morale of the good men and women subsonic airplanes—a market that gen- the chairman’s clarification of these who have made our space program the erates 1 million jobs and contributes statements. subject of movies like ‘‘Apollo 13’’ and over $25 billion annually to the U.S. Mr. PRESSLER. I appreciate the re- inspired thousands of scientists, engi- trade balance. These programs are marks of the senior Senator from neers, and schoolchildren across our moneymakers and it is in the national Michigan and the information he has country. interest to give them the support they provided. I understand that the NASA It is time to give NASA the support need. Accordingly, our NASA bill au- IG’s final report does not make any it needs to face the challenges of the thorizes aeronautics research at the re- recommendation regarding termi- future. This NASA authorization bill is quested level of $891 million for fiscal nation of CIESIN’s EOS related activi- designed to do just that. year 1996. ties and finds CIESIN’s SEDAC activ- The bill provides the full $2.1 billion As a final point, Mr. President, I note ity well within the goals of the EOS requested level for space station. This that the bill also authorizes a collec- and EOSDIS programs. program is NASA’s most costly, com- tion of activities and initiatives de- Mr. ABRAHAM. Mr. President, I plex, and controversial activity and we signed to extend NASA’s vision to in- would like to touch on a related sub- are all aware of the many criticisms clude our rural States. Our rural ject. During consideration of H.R. 2099, leveled against it. However, space sta- States can make an enormous con- the VA, HUD, and independent agen- tion is precisely the kind of bold vision tribution to the civilian space program cies appropriations bill for fiscal year that NASA was created to pursue. if only given the chance. For example, 1996, I provided to the distinguished Space station will enable the United in May, Prof. Steve Running of the subcommittee chairman, Senator States and the international science University of Montana testified before BOND, a brief summary of the value of community to conduct unique micro- the Science Subcommittee about his CIESIN’s work for NASA. gravity research and expand our efforts to use remote sensing satellite CIESIN is one of NASA’s nine Dis- knowledge about humans’ ability to data in forest and crop management. tributed Active Archive Centers live and work in space. If past missions To embrace our rural States in our [DAAC’s] supporting the Earth Observ- are any indication, the space station space program, the bill contains a $2 ing System Data and Information Sys- will undoubtedly yield breakthroughs million increase for the EPSCoR Pro- tem. CIESIN is the only one that pro- in biomedicine and advanced materials. gram, which funds important research vides integrated socioeconomic data We can probably also expect exciting in our rural States. It also funds an- access for the study of the affect soci- spinoffs just as past space missions other rural teacher resource center to ety has upon the environment. This is have spawned microelectronics, pace- the existing nine centers, as well as an a unique capability and one that NASA makers, advance water filtration sys- additional rural technology transfer officials consider vital to EOS. As the tems, communications, and many and commercialization center, to fill in distinguished manager of the bill may other products and services we now coverage gaps in those two programs. know, the Senate’s version of H.R. 2099 take for granted. Mr. President, I believe that this bill advises NASA to integrate CIESIN into I am a strong station supporter and provides NASA with the support it re- the EOS plan for 1996. the funding provided in the bill will quires to continue and build on its im- Obviously, CIESIN’s SEDAC activity keep the program on track for a first portant work in space and aeronautics is hardly irrelevant to NASA’s mission element launch in 1997. and I urge my colleagues to support and should not be eliminated, as pro- The bill also provides full funding for this legislation. posed in the committee’s report. And, Mission to Planet Earth. Mission to Mr. LEVIN. Mr. President, my col- CIESIN’s valuable skills and expertise Planet Earth is NASA’s $7 billion sat- league from Michigan, Senator ABRA- may be of use to NASA in non-SEDAC ellite program aimed at studying how HAM and I would like to engage the ares or to other Federal agencies. The the oceans, land, and atmosphere work chairman of the Senate Committee on House’s NASA authorization bill ex- as a system in order to understand and Commerce, Science, and Transpor- plicitly provides that CIESIN will not predict global climate change. For tation in a brief colloquy concerning be precluded from receiving contracts those of us representing farm States, the treatment of the Consortium for awarded following a full and open com- weather and water are our lifeblood. International Earth Sciences Informa- petition and that the rights of any par- Mission to Planet Earth promises dra- tion Network [CIESIN] is S. 1048. ties under existing contracts shall not matic improvements in our ability to The committee’s report suggests that be affected. This language would allow predict climate change and manage our funding for CIESIN should be elimi- CIESIN to compete for NASA or any scarce water resources. If those expec- nated since it is, other Federal agency grants or con- tations are met, the program will eas- .. . an activity which was deemed largely ir- tracts. ily pay for itself in lives and property relevant to NASA’s goals and missions and Would the chairman be able to sup- saved and improved water manage- which has been severely criticized in the past port this non-controversial language? ment. by NASA’s Inspector General. Mr. PRESSLER. I understand the Mr. President, in my view, one of the Unfortunately, the committee re- Senator’s point and will certainly work most important areas within NASA is port’s assertion is based on the draft in conference to obtain similar lan- aeronautics—the first ‘‘A’’ in NASA. inspector general’s [IG] report. The guage in the final bill regarding For many years, aeronautics seemed to final version of the IG’s report states: CIESIN’s ability to bid on contracts. be reduced to a small ‘‘a’’ status. It al- By rescoping CIESIN’s mission to include Mr. ABRAHAM. I appreciate the Sen- ways seemed to take a back seat to the only SEDAC-related activities, NASA now ator’s assistance. S 15306 CONGRESSIONAL RECORD — SENATE October 19, 1995 Mr. LEVIN. I would also like to add the Department of the Army, the De- (3) the term ‘‘institution of higher edu- my thanks for the manager’s consider- partment of Energy, and the Environ- cation’’ has the meaning given such term in ation. mental Protection Agency. After much section 1201(a) of the Higher Education Act Mr. GLENN. Mr. President, I rise to discussion between NASA and these of 1965 (20 U.S.C. 1141(a)). express my serious reservations con- parties, none of these agencies indi- TITLE I—AUTHORIZATION OF cerning section 205 of the NASA au- cated that it could make use of this fa- APPROPRIATIONS thorization bill S. 1048. This provision cility. SEC. 101. HUMAN SPACE FLIGHT. authorizes the conveyance of approxi- Mr. GLENN. Would the Senator agree There are authorized to be appropriated to mately 1,200 acres of Federal property, that it is in the best interest of the the National Aeronautics and Space Admin- including all improvements and any United States and the taxpayer that istration for Human Space Flight the follow- ing amounts, to become available October 1, personal property located there to the some form of informal Federal screen- ing by the General Services Adminis- 1995: State of Mississippi. Additionally this (1) Space Station, $1,818,800,000. provision provides $10 million in transi- tration be conducted—in an expedited (2) Russian Cooperation, $129,200,000. tion assistance to the State of Mis- fashion, no more than 30 days—to as- (3) Space Shuttle, $3,031,800,000. sissippi. Would the distinguished chair- sure us that other Federal agencies (4) Payload and Utilization Operations, man of the Committee, Senator PRES- cannot make use of this facility? $293,000,000. SLER, care to discuss this issue with Mr. PRESSLER. I agree that such ac- SEC. 102. SCIENCE, AERONAUTICS, AND TECH- me? tion would be in the best interests of NOLOGY. Mr. PRESSLER. I would be pleased all taxpayers. There are authorized to be appropriated to to discuss this issue with my friend Mr. GLENN. Finally I would ask my the National Aeronautics and Space Admin- from Ohio. colleague whether he has an estimate istration for Science, Aeronautics, and Tech- nology the following amounts, to become Mr. GLENN. I thank my friend. This of the market value of the real and per- sonal property which is covered in this available October 1, 1995: provision concerns me because it skirts (1) Space Science, $1,958,900,000, of which existing law, namely the Federal Prop- section? $48,700,000 shall be allocated to the Strato- erty Act, which governs the process by Mr. PRESSLER. It is my understand- spheric Observatory for Infrared Astronomy, which the Federal Government dis- ing, based on information from NASA $15,000,000 shall be allocated to the Space In- poses of excess property. The Federal that the breakdown of the market frared Telescope Facility, and $30,000,000 Property Act sets up a process designed value of the real and personal property shall be allocated to the New Millennium to ensure that taxpayers—who footed at the site is: Land—$3.8 million based initiative. on a recent appraisal; fixed assets, (2) Life and Microgravity Sciences and Ap- the bill to acquire the property as well plications, $507,000,000, of which $3,000,000 as the buildings and personal property buildings—about $10 million in market value because of their uniqueness to shall be allocated for the construction of an associated with it—get the best return addition to the Microgravity Development on their investment. rocket manufacture, their completion Laboratory, Marshall Space Flight Center. Mr. PRESSLER. I agree with the status, and location; personal prop- (3) Mission to Planet Earth, $1,360,100,000, Senator that the Federal Property Act erty—about $10 to $15 million in mar- of which $17,000,000 shall be allocated to the helps ensure that the taxpayers inter- ket value, some of which is so unique construction of the Earth Systems Science est are protected. to rocket manufacture that it can only Building, Goddard Space Flight Center, and Mr. GLENN. In particular, the Prop- be sold as scrap. of which $2,000,000 shall be allocated in fiscal However because of the limited pur- year 1996, and such sums as are necessary erty Act helps to ensure that we avoid thereafter, for the operation of the Upper the situation of one agency of Govern- poses for which the property can be used, these figures may somewhat Midwest Aerospace Consortium (UMAC) of ment giving property away, while an- institutions in the Upper Great Plains Re- other agency, unbeknownst to the overestimate the real market value of gion for the purpose of making information first, may be trying to acquire similar the property. derived from Mission to Planet Earth data property. Now, Mr. President, I cannot Mr. GLENN. I thank my colleague available to the general public. say that such a situation is happening and look forward to working with him (4) Aeronautical Research and Technology, in this case. We simply cannot say for to address this issue as this bill moves $891,300,000, of which $5,400,000 shall be allo- cated to the modernization of the Unitary sure because no screening has taken into conference with the other body. Mrs. KASSEBAUM. Mr. President, I Plan Wind Tunnel Complex, Ames Research place. However, we have encountered ask unanimous consent that the Center. such situations in the past, and I can amendment be agreed to, the commit- (5) Space Access and Technology, assure my colleagues, that in such cir- $766,600,000, of which at least $70,000,000 shall tee substitute, as amended, be agreed cumstances, the taxpayer ends up on be allocated to support a shuttle flight for to, the bill be deemed to have been read the short end of the stick. the Shuttle Imaging Radar-C, of which One of the main purposes of the Fed- a third time and passed, and the mo- $5,000,000 shall be used to establish a Rural eral Property Act is to ensure that, be- tion to reconsider be laid upon the Technology Transfer and Commercialization fore Federal property is determined to table, and that any statements relating Center for the Rocky Mountains and Upper to the bill be placed in the appropriate Plains States region, and of which be excess, a screening period occur dur- $159,000,000 shall be allocated to the Reusable ing which time other Federal agencies place in the RECORD. The PRESIDING OFFICER. Without Launch Vehicle program. have an opportunity to show that they objection, it is so ordered. (6) Mission Communications Services, have a compelling need for the prop- The amendment (No. 2939) was agreed $461,300,000. (7) Academic Programs, $104,700,000, of erty. The General Services Administra- to. tion, the property management experts which $3,000,000 shall be allocated to support The committee substitute, as amend- the establishment of an Upper Plains States in the Federal Government, coordinate ed, was agreed to. this screening. If no Federal agency regional science education and outreach cen- The bill (S. 1048) was deemed read for ter and of which $1,000,000 shall be allocated speaks up during the screening process, a third time and passed; as follows: to establish a Rural Teacher Resource Cen- then the property is made available to S. 1048 ter. the States and other eligible nonprofit Be it enacted by the Senate and House of Rep- SEC. 103. MISSION SUPPORT. organizations. Can my friend from resentatives of the United States of America in There are authorized to be appropriated to South Dakota tell me whether or not Congress assembled, the National Aeronautics and Space Admin- the Yellow Creek property has under- SECTION 1. SHORT TITLE. istration for Mission Support the following gone my formal, or even informal, This Act may be cited as the ‘‘National amounts, to become available October 1, screening? If so, what have been the re- Aeronautics and Space Administration Au- 1995: sults? thorization Act, Fiscal Year 1996’’. (1) Safety, Reliability, and Quality Assur- Mr. PRESSLER. No formal screening SEC. 2. DEFINITIONS. ance, $37,600,000. has occurred. However, NASA con- For the purposes of this Act— (2) Space Communications Services, (1) the term ‘‘Administrator’’ means the $219,400,000. tacted the following agencies which it Administrator of the National Aeronautics (3) Research and Program Management, in- believed could make use of the Yellow and Space Administration; cluding personnel and related costs, travel, Creek facilities: the Department of the (2) the term ‘‘NASA’’ means the National and research operations support, Air Force, the Department of the Navy, Aeronautics and Space Administration; and $2,047,800,000. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15307

(4) Construction of Facilities, including (2) ACTIVITIES.—Grants made under this occur not later than 30 days after the date of land acquisition, $135,000,000, including the section shall be available for— enactment of this Act. following: (A) assessment of resources and needs; SEC. 206. RADAR REMOTE SENSING SATELLITES. (A) Restoration of Flight Systems Re- (B) development of infrastructure, includ- (a) FINDINGS.—The Congress finds that— search Laboratory, Ames Research Center; ing incubators and prototype demonstration (1) radar satellites represent one of the (B) Restoration of chilled water distribu- facilities; most important developments in remote tion system, Goddard Space Flight Center; (C) collaborations with industry; sensing satellite technology in recent years; (C) Replace chillers, various buildings, Jet (D) expansion of capabilities in procure- (2) the ability of radar satellites to provide Propulsion Laboratory; ment; high-quality Earth imagery regardless of (D) Rehabilitation of electrical distribu- (E) development of technology transfer and cloud cover and to provide three-dimensional tion system, White Sands Test Facility, commercialization support capabilities; pictures of the Earth’s surface when the sat- Johnson Space Center; (F) activities to increase participation in ellites are flown in combination dramati- (E) Replace main substation switchgear the Small Business Innovation Research pro- cally enhance conventional optical remote and circuit breakers, Johnson Space Center; gram and other NASA research, develop- sensing satellite capabilities and usefulness; (F) Replace 15kv load break switches, Ken- ment, and technology utilization and trans- (3) the National Aeronautics and Space Ad- nedy Space Center; fer programs; ministration has developed a unique back- (G) Rehabilitation of Central Air Equip- (G) relevant research of interest to NASA; ground and expertise in developing and oper- ment Building, Lewis Research Center; and ating radar satellites as a result of their ac- (H) Restoration of high pressure air com- (H) such other activities as the Adminis- tivities connected with its radar satellites, pressor system, Marshall Space Flight Cen- trator shall deem appropriate. Shuttle Imaging Radar (SIR)-A, SIR-B, and ter; (3) SPECIAL CONSIDERATION.—In making SIR-C, which has flown twice on the Space (I) Restoration of Information and Elec- grants under this section, the Administrator Shuttle; tronic Systems Laboratory, Marshall Space shall give special consideration to proposals (4) other nations currently have oper- Flight Center; that— ational radar satellite systems, including (J) Restoration of canal lock, Stennis (A) will build upon and expand a develop- Japan and Western Europe, with other Space Center; ing research and technology base, and spacefaring nations expected to develop such (K) Restoration of primary electrical dis- (B) will insure a lasting research and devel- systems in the near future; and tribution system, Wallops Flight Facility; opment and technology development and (5) the development of an operational radar (L) Repair of facilities at various loca- transfer capability. satellite program at NASA featuring free- tions, not in excess of $1,500,000 per project; (b) ELIGIBLE ENTITIES.—Grants under sub- flying satellites and a related ground system (M) Rehabilitation and modification of fa- section (a)(1) may be made to— is critical to maintain United States leader- cilities at various locations, not in excess of (1) State and local governments; ship in remote sensing satellite technology $1,500,000 per project; (2) institutions of higher education; and and is important to our national security (N) Minor construction of new facilities (3) organizations with expertise in research and international competitiveness. and additions to existing facilities at various and development, technology development, (b) POLICY.—It is the policy of the United locations, not in excess of $1,500,000 per and technology transfer in areas of interest States that— project; to NASA. (1) NASA should develop and operate a (O) Facility planning and design, not oth- (c) FUNDING OF PROGRAM.—Of the amounts radar satellite program as soon as prac- erwise provided for; and authorized in section 102 for the Space Ac- ticable; (P) Environmental compliance and restora- cess and Technology account, $15,000,000 are (2) NASA should build on the experience tion. authorized to be used for grants under sub- and knowledge gained from its previous SEC. 104. INSPECTOR GENERAL. section (a). radar endeavors; There are authorized to be appropriated to SEC. 204. CLEAR LAKE DEVELOPMENT FACILITY. (3) NASA should work with other Federal the National Aeronautics and Space Admin- The Administrator is authorized to ac- agencies and, as appropriate, with other istration for Inspector General $17,300,000, to quire, for no more than $35,000,000, a certain spacefaring nations, in its radar satellite ac- become available October 1, 1995. parcel of land, together with existing facili- tivities; and SEC. 105. OFFICE OF COMMERCIAL SPACE TRANS- ties, located on the site of the property re- (4) NASA should make maximum use of ex- PORTATION. ferred to as the Clear Lake Development Fa- isting National remote sensing assets such There are authorized to be appropriated to cility, Clear Lake, Texas, comprising ap- as the Landsat system, activities connected the Office of Commercial Space Transpor- proximately 13 acres and including a light with the Mission to Planet Earth, and the tation of the Department of Transportation manufacturing facility, an avionics develop- data management facilities of the Depart- $7,000,000, to become available October 1, ment facility, and an assembly and test ment of the Interior in all of its radar sat- 1995. building which shall be modified for use as a ellite activities. neutral buoyancy laboratory in support of TITLE II—LIMITATIONS AND GENERAL (c) PROGRAM REQUIREMENTS.—NASA shall human space flight activities. PROVISIONS initiate a program to develop and operate a SEC. 205. YELLOW CREEK FACILITY. radar satellite program. The program shall SEC. 201. SPACE STATION LIMITATION. Notwithstanding any other provision of employ the most advanced radar satellite The aggregate amount authorized to be ap- law or regulation, the National Aeronautics technology currently available. To the maxi- propriated for Space Station and related ac- and Space Administration (NASA) is author- mum extent possible, all of the data process- tivities under sections 101, 102, and 103 shall ized to convey, without reimbursement, to ing, dissemination, and archiving functions not exceed $2,100,000,000. the State of Mississippi, all rights, title, and shall be performed by the Department of the SEC. 202. EXPERIMENTAL PROGRAM TO STIMU- interest of the United States of the United Interior. The program should be planned in LATE COMPETITIVE RESEARCH. States in the property known as the Yellow such a way that the data from the radar sat- Of the amounts appropriated under sec- Creek Facility and consisting of approxi- ellite system are converted into a broad tions 101 and 102, $6,900,000 are authorized for mately 1,200 acres near the city of Iuka, Mis- range of informational products with re- the Experimental Program to Stimulate sissippi, including all improvements thereon search, commercial, and government appli- Competitive Research in accordance with and any personal property owned by NASA cations and any other applications that are title III of the National Aeronautics and that is currently located on-site and which in the public interest and that such products Space Administration Act, Fiscal Year 1993 the State of Mississippi requires to facilitate are distributed over the widest user commu- (Public Law 102–588; 106 Stat. 5119). the transfer: Provided, That appropriated nity that is practicable, including industry, SEC. 203. SPECIAL TECHNOLOGY ENHANCEMENT funds shall be used to effect this conveyance: academia, research institutions, local and GRANTS. Provided further, That $10,000,000 in appro- State governments, and other Federal agen- (a) IN GENERAL.— priated funds otherwise available to NASA cies. The program should coordinate with, (1) GRANTS.—The Administrator shall shall be transferred to the State of Mis- and make appropriate use of, other remote make up to 4 special technology enhance- sissippi to be used in the transition of the fa- sensing satellite programs, such as the ment grants to areas or States that have not cility: Provided further, That each Federal Landsat program. participated fully in the Administration’s agency with prior contact to the site shall (d) PLAN.—Within 90 days after the enact- aeronautical and space programs in order to remain responsible for any and all environ- ment of this Act, the Administrator shall enable such areas or States to increase their mental remediation made necessary as a re- submit a detailed plan for implementation of capabilities in technology development, uti- sult of its activities on the site: Provided fur- the radar satellite program to the Commit- lization, and transfer in aeronautics, space ther, That in consideration of this convey- tee on Commerce, Science, and Transpor- science, and related areas. At least one such ance, NASA may require such other terms tation of the Senate and the Committee on grant shall be made available to a consor- and conditions as the Administrator deems Science of the House of Representatives. The tium of States, each one of which has an av- appropriate to protect the interests of the plan should include— erage population density of less than 12.3 United States: Provided further, That the (1) the goals and mission of the program; persons per square mile, based on data for conveyance of the site and the transfer of (2) planned activities for the next 5 years 1993 from the Bureau of the Census. the funds to the State of Mississippi shall to achieve such goals and mission; S 15308 CONGRESSIONAL RECORD — SENATE October 19, 1995 (3) strategies for maximizing the useful- menting the recommendation of the Inde- (2) such developments require the use of ness of the satellite data to the scientific pendent Shuttle Management Review Team additional funds for the purpose of construc- and academic communities, the private sec- that NASA transition towards the privatiza- tion, expansion, or modification of facilities tor, all levels of government, and the general tion of the Shuttle. The study shall identify, at any location; and public; discuss, and, where possible, present options (3) deferral of such action until the enact- (4) concepts for integrating the program for resolving, the major policy and legal is- ment of the next National Aeronautics and with other related NASA activities (such as sues that must be addressed before the Shut- Space Administration authorization Act Mission to Planet Earth), the Landsat pro- tle is privatized, including, but not limited would be inconsistent with the interest of gram, and other current and emerging re- to, the following issues— the Nation in aeronautical and space mote sensing satellite programs and activi- (1) whether the government or the Shuttle sciences; ties in the Federal government and all other contractor should own the Shuttle orbiters the Administrator may use the amounts au- public and private sectors so that the pro- and Shuttle ground facilities; thorized for construction of facilities pursu- gram complements and strengthens such (2) whether the federal government should ant to this Act or previous National Aero- programs and activities and is not duplica- indemnify the contractor for any third party nautics and Space Administration authoriza- tive of these efforts; liability arising from Shuttle operations, tion Acts for such purposes. The amounts (5) concepts developed in consultation with and, if so, under what terms and conditions; may be used to acquire, construct, convert, Department of the Interior, for processing, (3) whether commercial payloads should be rehabilitate, or install temporary or perma- archiving, and disseminating the satellite allowed to be launched on the Shuttle and nent public works, including land acquisi- data using, to the maximum extent possible, whether any classes of payloads should be tion, site preparation, appurtenances, utili- existing Federal government programs and made ineligible for launch consideration; ties, and equipment. The Administrator may assets at the Department of the Interior and (4) whether NASA and federal government use such amounts for facility consolidations, other Federal agencies; payloads should have priority over non-fed- closures, and demolition required to (6) targets and timetables for undertaking eral government payloads in the Shuttle downsize the NASA physical plant to im- specific activities and actions within the launch assignments and what policies should prove operations and reduce costs. program; be developed to prioritize among payloads (c) LIMITATIONS.— (7) a 5-year budget profile for the program; generally; (1) Amounts appropriated for a construc- and (5) whether the public interest requires tion-of-facilities project— (8) a comparison between the program and that certain Shuttle functions continue to be (A) may be varied upward by 10 percent at the radar satellite programs of other performed by the federal government; and the discretion of the Administrator; or spacefaring nations, addressing their respec- (6) whether privatization of the Shuttle (B) may be varied upward by 25 percent to tive costs, capabilities, and other relevant would produce any significant cost savings meet unusual cost variations after the expi- features. and, if so, how much cost savings. ration of 30 days following a report on the (e) AUTHORIZATION.—Of the funds author- (b) Within 60 days of the enactment of this circumstances of such action by the Admin- ized in section 102 for the Earth Probes ac- Act, NASA shall complete the study and istrator to the Committee on Commerce, count, the Administrator shall allocate at shall submit a report on that study to the Science, and Transportation of the Senate least $15,000,000 to the radar satellite pro- Committee on Commerce, Science, and and the Committee on Science of the House gram to conduct Phase A and Phase B stud- Transportation of the Senate and the Com- of Representatives. The aggregate amount ies. mittee on Science of the House of Represent- authorized to be appropriated for construc- SEC. 207. STUDY OF THE HYDROLOGY OF THE atives. tion of facilities shall not be increased as a UPPER MISSOURI RIVER BASIN. (c) As a transitional step towards Shuttle result of actions authorized under this sec- The Administrator is authorized to initiate privatization, NASA shall take all necessary tion. a project to conduct research on the hydrol- and appropriate actions to consolidate Shut- (2) No amounts may be obligated for a con- ogy of the Upper Missouri River Basin. The tle contractor activities under one prime struction-of-facilities project until a period project shall be part of the Mission to Planet contractor and, within 180 days of the enact- of 30 days has passed after the Administrator Earth program and shall employ satellite ob- ment of this Act, report to the Committee on or the Administrator’s designee has trans- servations, surface-based radar data, and Commerce, Science, and Transportation of mitted to the Committee on Science of the ground-based hydrological and other sci- the Senate and the Committee on Science of House of Representatives, and to the Com- entific measurements to develop quan- the House of Representatives on those ac- mittee on Commerce, Science, and Transpor- titative models that address complex atmos- tions. If NASA has failed to complete such tation of the Senate, a written report de- pheric and surface hydrological processes. If consolidation by the expiration of the 180- scribing the nature of the acquisition, con- initiated, the project shall be incorporated day period, the report shall explain the rea- struction, conversion, rehabilitation, or in- into NASA’s activities connected with the sons for that failure and describe the steps stallation, its cost, and the reasons therefor. multiagency Global Energy and Water Cycle being taken by NASA to finalize the consoli- (d) TITLE TO FACILITIES.—If funds are used Experiment to understand the interactions dation as expeditiously as possible. pursuant to subsection (a) for grants to in- between the atmosphere and land surfaces. SEC. 209. USE OF FUNDS FOR CONSTRUCTION. stitutions of higher education, or to non- In implementing the project, NASA shall co- (a) AUTHORIZED USES.—The Administrator profit organizations whose primary purpose ordinate and consult with other appropriate may use funds appropriate for purposes other is the conduct of scientific research, for pur- federal agencies, including the Department than those appropriated for— chase or construction of additional research of Commerce, the Department of the Inte- (1) construction of facilities; facilities, title to such facilities shall be rior, and the National Science Foundation. (2) research and program management, ex- vested in the United States unless the Ad- To the maximum extent possible, NASA cluding research operations support; and ministrator determines that the national shall employ the assistance of universities, (3) Inspector General, program of aeronautical and space activities local and State governments, industry, and for the construction of new facilities and ad- will best be served by vesting title in the any other appropriate entities from the ditions to, repair of, rehabilitation of, or grantee institution or organization. Each Upper Missouri River Basin region to carry modification of, existing facilities at any lo- such grant shall be made under such condi- out this program and the Administrator is cation in support of the purposes for which tions as the Administrator shall determine authorized to support the project-related such funds are appropriated. to be required to ensure that the United work of such entities with grants, technical (b) LIMITATION.—None of the funds used States will receive therefrom benefits ade- advice, equipment, in-kind help, and any pursuant to subsection (a) may be expended quate to justify the making of that grant. other type of appropriate assistance. If this for a project, the estimated cost of which to SEC. 211. AVAILABILITY OF APPROPRIATED project is initiated, then within 90 days after the National Aeronautics and Space Admin- AMOUNTS. the enactment of this Act, the Adminis- istration, including collateral equipment, ex- To the extent provided in appropriations trator shall submit a plan for the implemen- ceeds $750,000, until 30 days have passed after Acts, appropriations authorized under this tation of this project, which shall set forth the Administrator has notified the Commit- Act may remain available without fiscal the goals, project costs, planned activities, tee on Science of the House of Representa- year limitation. and overall strategies for the project, to the tives and the Committee on Commerce, SEC. 212. CONSIDERATION BY COMMITTEES. Committee on Commerce, Science, and Science, and Transportation of the Senate of Notwithstanding any other provision of Transportation of the Senate and the Com- the nature, location, and estimated cost to this Act— mittee on Science of the House of Represent- the National Aeronautics and Space Admin- (1) no amount appropriated pursuant to atives. Of the funds authorized in section 102 istration of such project. this Act may be used for any program de- for Mission to Planet Earth, at least SEC. 210. CONSTRUCTION OF FACILITIES. leted by the Congress from requests as origi- $10,000,000 shall be allocated by the Adminis- (a) REPROGRAMMING FOR CONSTRUCTION OF nally made to either the Committee on trator to the Upper Missouri River Basin FACILITIES.—If the Administrator determines Science of the House of Representatives or project. that— the Committee on Commerce, Science, and SEC. 208. SHUTTLE PRIVATIZATION. (1) new developments in the national pro- Transportation of the Senate; and (a) The Administrator is hereby directed to gram of aeronautical and space activities (2) no amount appropriated pursuant to the conduct a study of the feasibility of imple- have occurred; Act may be used for any program in excess of October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15309 the amount actually authorized for that par- SEC. 215. INDEPENDENT RESEARCH AND DEVEL- ‘‘launches, in-space transportation activi- ticular program, excluding construction-of- OPMENT. ties, reentries’’ after ; facility projects, The Congress finds that it is appropriate (6) by striking ‘‘sites and complementary for costs contributed by a contractor under a unless a period of 30 days has passed after facilities, the providing of launch’’ in sub- cooperative agreement with the National section (a)(8) and inserting ‘‘sites, in-space the receipt by such Committee of notice Aeronautics and Space Administration to be given by the Administrator or the Adminis- transportation control sites, reentry sites, considered as allowable independent research and complementary facilities, the providing trator’s designee containing a full and com- and development costs, for purposes of sec- plete statement of the action proposed to be of launch, in-space transportation, and re- tion 31.205–18 of the Federal Acquisition Reg- entry’’; taken and the facts and circumstances relied ulations if the work performed would have (7) by inserting ‘‘in-space transportation upon in support of the proposed action. been allowable as contractor independent re- control sites, reentry sites,’’ after ‘‘launch NASA shall keep those Committees fully and search and development costs had there been sites,’’ in subsection (a)(9); currently informed with respect to all activi- no cooperative agreement. The Administra- (8) by striking ‘‘launch vehicles’’ in sub- ties and responsibilities within their juris- tion shall seek a revision to that section of section (b)(2) and inserting ‘‘commercial diction. Except as otherwise provided by law, the Federal Acquisition Regulations to re- any Federal department, agency, or inde- flect the intent of the Congress expressed in space transportation services, including pendent establishment shall furnish any in- the preceding sentence. launch vehicles, in-space transportation ac- tivities, reentry vehicles,’’; formation requested by either such Commit- SEC. 216. RESTRUCTURING OF THE EARTH OB- tee relating to any activity or responsibility. SERVING SYSTEM DATA AND INFOR- (9) by striking ‘‘launch’’ the first place it SEC. 213. USE OF FUNDS FOR SCIENTIFIC CON- MATION SYSTEM. appears in subsection (b)(3) and inserting SULTATIONS OR EXTRAORDINARY The Administrator is prohibited from re- ‘‘launch, in-space transportation vehicle, and EXPENSES. structuring or downscaling the baseline plan reentry’’; Funds appropriated under section 103 may for the Earth Observing System Data and In- (10) by striking ‘‘commercial launch’’ the be used for scientific consultations or ex- formation System in place at the time of the second place it appears in subsection (b)(3); traordinary expenses upon the authority of President’s budget submission for NASA for and the Administrator, but not to exceed $35,000. fiscal year 1996 unless, 60 days before under- (11) by inserting ‘‘in-space transportation taking such action, the Administrator has vehicle control facilities, and development of SEC. 214. REPORTING REQUIREMENTS. submitted to the Committee on Commerce, reentry sites’’ after ‘‘facilities,’’ in sub- (a) REPORTING PERIOD.—Section 206(a) of Science, and Transportation of the Senate section (b)(4). the National Aeronautics and Space Act of and the Committee on Science of the House 1958 (42 U.S.C. 2476(a)) is amended— of Representatives a written report contain- SEC. 303. AMENDMENT OF SECTION 70102. (1) by striking ‘‘January’’ and inserting ing— Section 70102 (relating to definitions) is ‘‘May’’; and (1) a detailed description of the planned amended— (2) by striking ‘‘calendar’’ and inserting agency action; (1) by inserting ‘‘from Earth, including a ‘‘fiscal’’. (2) the reasons and justifications for such reentry vehicle and its payload, if any’’ after (b) PROTECTION OF COMMERCIALLY VALU- action; ‘‘and any payload’’ in paragraph (3); ABLE INFORMATION.—Section 303 of the Na- (3) an analysis of the cost impact of such (2) by striking ‘‘object’’ the first place it tional Aeronautics and Space Act of 1958 (42 action; appears in paragraph (8) and inserting ‘‘ob- U.S.C. 2454) is amended by adding at the end (4) an analysis of the impact of the action ject, including a reentry vehicle and its pay- the following: on the scientific benefits of the program and load, if any,’’; ‘‘(c)(1) The Administrator may delay, for a the effect of the action on the expected ap- (3) by redesignating paragraphs (9) through period not to exceed 5 years, the unrestricted plications of the satellite data from the Sys- (12) as paragraphs (16) through (19), respec- public disclosure of technical data, related tem in such areas as global climate research, tively; to a competitively sensitive technology, in land-use planning, state and local govern- (4) by inserting after paragraph (8) the fol- the possession of, or under the control of, the ment management, mineral exploration, ag- lowing: Administration that has been generated in riculture, forestry, national security, and ‘‘(9) ‘in-space transportation vehicle’ the performance of experimental, devel- any other areas that the Administrator means any vehicle designed to operate in opmental, or research activities or programs deems appropriate; space and designed to transport any payload conducted by, or funded in whole or in part (5) an analysis of the impact of the action or object substantially intact from one orbit by, the Administration, if the technical data on the United States Global Climate Change to another orbit. has significant value in maintaining leader- Research program and international global ‘‘(10) ‘in-space transportation services’ ship or competitiveness, in civil and govern- climate change research activities; and means— mental aeronautical and space activities by (6) an explanation of what measures, if ‘‘(A) those activities involved in the direct the United States industrial base. any, are planned by NASA to compensate for transportation or attempted transportation ‘‘(2) The Administrator shall publish bian- any likely reductions in the scientific value of a payload or object from one orbit to an- nually in the Federal Register a list of all and data collection, processing, and distribu- other; competitively sensitive technology areas tion capabilities of the System as a result of ‘‘(B) the procedures, actions, and activities which it believes have a significant value in the action. necessary for conduct of those transpor- maintaining the United States leadership or TITLE III—COMMERCIAL SPACE LAUNCH tation services; and competitiveness in civil and governmental ACT AMENDMENTS ‘‘(C) the conduct of transportation serv- aeronautical and space activities. The list SEC. 301. AMENDMENT OF TITLE 49. ices. shall be generated after consultation with Except as otherwise expressly provided, ‘‘(11) ‘in-space transportation control site’ appropriate Government agencies and a di- whenever in this title an amendment or re- means a location from which an in-space verse cross section of companies— peal is expressed in terms of an amendment transportation vehicle is controlled or oper- ‘‘(A) that conduct a significant level of re- to, or repeal of, a section or other provision, ated (as such terms may be defined in any li- search, development, engineering, and manu- the reference shall be considered to be made cense the Secretary issues or transfers under facturing in the United States; and to a section or other provision of title 49, this chapter). ‘‘(B) the majority ownership or control of United States Code. ‘‘(12) ‘reenter’ and ‘reentry’ mean to return which is held by United States citizens. SEC. 302. AMENDMENT OF SECTION 70101. purposefully, or attempt to return, a reentry ‘‘(3) The Administrator shall provide an op- Section 70101 (relating to findings and pur- vehicle and payload, if any, from Earth orbit portunity for written objections to the list poses) is amended— or outer space to Earth. within a 60-day period after it is published. (1) by inserting ‘‘microgravity research,’’ ‘‘(13) ‘reentry services’ means— After the expiration of that 60-day period, after ‘‘information services,’’ in subsection ‘‘(A) activities involved in the preparation and after consideration of all written objec- (a)(3); of a reentry vehicle and its payload, if any, tions received by the Administrator during (2) by inserting ‘‘commercial space trans- for reentry; and that period, NASA shall issue a final list of portation services, including in-space trans- ‘‘(B) the conduct of a reentry. competitively sensitive technology areas. portation activities and’’ after ‘‘providing’’ ‘‘(14) ‘reentry site’ means the location on ‘‘(4) For purposes of this subsection, the in subsection (a)(4); Earth to which a reentry vehicle is intended term ‘technical data’ means any recorded in- (3) by striking ‘‘commercial launch vehi- to return (as defined in a license the Sec- formation, including computer software, cles’’ in subsection (a)(5) and inserting ‘‘com- retary issues or transfers under this chap- that is or may be directly applicable to the mercial space transportation including com- ter). design, engineering, development, produc- mercial launch vehicles, in-space transpor- ‘‘(15) ‘reentry vehicle’ means any vehicle tion, manufacture, or operation of products tation activities, reentry vehicles,’’; designed to return substantially intact from or processes that may have significant value (4) by striking ‘‘launch’’ in subsection Earth orbit or outer space to Earth.’’; in maintaining leadership or competitive- (a)(6) and inserting ‘‘launch, in-space trans- (5) by striking ‘‘launch’’ each place it ap- ness in civil and governmental aeronautical portation, and reentry’’; pears in paragraph (18), as redesignated and and space activities by the United States in- (5) by striking ‘‘launches’’ each place it ap- inserting ‘‘launch services, in-space trans- dustrial base.’’. pears in subsection (a)(7) and inserting portation activities, or reentry’’. S 15310 CONGRESSIONAL RECORD — SENATE October 19, 1995 SEC. 304. AMENDMENT OF SECTION 70103. (3) by striking ‘‘launch or operation’’ in agreed to by the owner or manufacturer of Section 70103(b) (relating to facilitating subsection (a) and inserting ‘‘launch, in- the launch vehicle, in-space transportation commercial launches) is amended— space transportation activity, operation, or vehicle, reentry vehicle, or payload.’’. (1) by striking ‘‘LAUNCHES’’ in the caption reentry’’. SEC. 312. AMENDMENT OF SECTION 70112. and inserting ‘‘SPACE ACTIVITIES’’; SEC. 309. AMENDMENT OF SECTION 70109. Section 70112 (relating to liability insur- (2) by striking ‘‘commercial space (a) CAPTION.—The section caption of sec- ance and financial responsibility require- launches’’ in paragraph (1) and inserting tion 70109 (relating to preemption of sched- ments) is amended— ‘‘commercial space transportation services’’; uled launches) is amended to read as follows: (1) by inserting ‘‘one reentry, or to the op- and erations of each in-space transportation ve- ‘‘Preemption of scheduled launches, in-space (3) by striking ‘‘a space launch’’ in sub- hicle’’ after ‘‘launch,’’ in subsection (a)(3); transportation activities, or reentries’’. section (b)(2) and inserting ‘‘space transpor- (2) by inserting ‘‘in-space transportation tation’’. (b) AMENDMENT OF SUBSECTION (a).—Sub- activities, or reentry services,’’ after SEC. 305. AMENDMENT OF SECTION 70104. section (a) is amended— ‘‘launch services,’’ each place it appears in Section 70104 (relating to restrictions on (1) by inserting ‘‘or reentry’’ after ‘‘ensure subsections (a)(4) and (b)(2); launches and operations) is amended— that a launch’’; (3) by striking ‘‘services’’ in subsection (1) by striking the section caption and in- (2) by striking ‘‘site’’ in the first sentence (b)(1) and the third place it appears in sub- serting the following: and inserting ‘‘site, reentry site,’’; section (b)(2) and inserting ‘‘services, in- (3) by inserting ‘‘nor shall an in-space ‘‘Restrictions on launches, in-space transpor- space transportation activities, or reentry transportation activity or operation be pre- tation activities, operations, and reentries’’; services,’’; empted,’’ after ‘‘launch property,’’ in the (2) by striking ‘‘site’’ each place it appears (4) by inserting ‘‘applicable’’ after ‘‘carried first sentence; out under the’’ in subsections (b)(1) and (2); in subsection (a) and inserting ‘‘site, an in- (4) by inserting ‘‘or reentry date commit- space transportation operations site, reentry (5) by striking ‘‘Science, Space, and Tech- ment’’ after ‘‘launch date commitment’’; nology’’ in subsection (d) and inserting site, or reenter a reentry vehicle,’’; (5) by inserting ‘‘or reentry’’ after ‘‘ob- (3) by striking ‘‘launch or operation’’ in ‘‘Science’’; tained for a launch’’; (6) by striking ‘‘LAUNCHES’’ in the caption subsections (a) (3) and (4) and inserting (6) by striking ‘‘site’’ in the second sen- ‘‘launch, in-space transportation activity, or of subsection (e) and inserting ‘‘LAUNCHES, tence and inserting ‘‘site, reentry site,’’; IN-SPACE TRANSPORTATION ACTIVITIES, OR RE- reentry operation’’; (7) by striking ‘‘services’’ in the second (4) by striking subsection (b) and inserting ENTRIES’’; and sentence and inserting ‘‘services, or services (7) by striking ‘‘site’’ in subsection (e) and the following: related to a reentry,’’; ‘‘(b) COMPLIANCE WITH PAYLOAD REQUIRE- inserting ‘‘site, in-space transportation con- (8) by inserting ‘‘or reentry’’ after ‘‘the trol site, or control of an in-space transpor- MENTS.—The holder of a license under this scheduled launch’’; and chapter may launch a payload, operate an in- tation vehicle or activity, or reentry site or (9) by adding at the end thereof the follow- a reentry’’. space transportation vehicle, or reenter a ing: ‘‘A licensee or transferee preempted SEC. 313. AMENDMENT OF SECTION 70113. payload only if the payload or vehicle com- from access to a reentry site does not have Section 70113 (relating to paying claims ex- plies with all requirements of the laws of the to pay the Government agency responsible ceeding liability insurance and financial re- United States related to launching a pay- for the preemption any amount for reentry sponsibility requirements) is amended by load, operating an in-space transportation services attributable only to the scheduled striking ‘‘launch’’ each place it appears in vehicle, or reentering a payload.’’; reentry prevented by the preemption.’’. subsections (a)(1), (d)(1), and (d)(2) and in- (5) by striking the caption of subsection (c) (c) AMENDMENT OF SUBSECTION (c).—Sub- serting ‘‘launch, operation of one in-space and inserting the following: ‘‘(c) PREVENTING section (c) is amended by inserting ‘‘or re- transportation vehicle, or one reentry’’. LAUNCHES, IN-SPACE TRANSPORTATION ACTIVI- entry’’ after ‘‘prompt launching’’ in sub- TIES, OR REENTRIES.—’’; and section (c). SEC. 314. AMENDMENT OF SECTION 70115. (6) by striking ‘‘launch’’ each place it ap- Section 70115(b)(1)(D)(i) (relating to en- SEC. 310. AMENDMENT OF SECTION 70110. pears in subsection (c) and inserting forcement and penalty general authority) is Section 70110 (relating to administrative ‘‘launch, in-space transportation activity, or amended— hearings and judicial review) is amended— reentry’’. (1) by inserting ‘‘in-space transportation (1) by striking ‘‘launch’’ in subsection control site, or reentry site,’’ after ‘‘launch SEC. 306. AMENDMENT OF SECTION 70105. (a)(2) and inserting ‘‘launch, in-space trans- Section 70105 (relating to license applica- site,’’; portation activity, or reentry’’; and tions and requirements) is amended— (2) by inserting ‘‘in-space transportation (2) by striking ‘‘site’’ in subsection (1) by striking ‘‘site’’ in subsection (b)(1) vehicle, or reentry vehicle’’ after ‘‘launch ve- (a)(3)(B) and inserting ‘‘site, in-space trans- and inserting ‘‘site, an in-space transpor- hicle,’’; and portation control site, in-space transpor- tation control site, or a reentry site or the (3) by striking ‘‘vehicle’’ the second place tation activity, reentry site, or reentry of a reentry of a reentry vehicle,’’; and it appears and inserting ‘‘vehicle, in-space reentry vehicle,’’. (2) by striking ‘‘or operation’’ and insert- transportation vehicle, or reentry vehicle’’. ing in lieu thereof ‘‘, in-space transportation SEC. 311. AMENDMENT OF SECTION 70111. SEC. 315. AMENDMENT OF SECTION 70117. activity, operation, or reentry’’ in sub- Section 70111 (relating to acquiring United Section 70117 (relating to relationship to section (b)(2)(A). States Government property and services) is other executive agencies, laws, and inter- amended— SEC. 307. AMENDMENT OF SECTION 70106. national obligations) is amended— Section 70106(a) (relating to monitoring ac- (1) by inserting ‘‘in-space transportation (1) by striking ‘‘vehicle or operate a launch tivities general requirements) is amended— activities, or reentry services’’ after ‘‘launch site.’’ in subsection (a) and inserting ‘‘vehi- (1) by striking ‘‘launch site’’ and inserting services,’’ in subsection (a)(1)(B); cle, operate a launch site, perform in-space ‘‘launch site, in-space transportation control (2) by striking ‘‘services’’ in subsection transportation activities or operate an in- site, or reentry site’’; (a)(2) and inserting ‘‘services, in-space trans- space transportation control site or reentry (2) by inserting ‘‘in-space transportation portation activities, or reentry services’’; site, or reenter a reentry vehicle.’’; vehicle, or reentry vehicle,’’ after ‘‘launch (3) by inserting ‘‘or reentry’’ after (2) by striking ‘‘launch’’ in subsection (d) vehicle,’’ and ‘‘launch’’ in subsection (a)(2)(A); and inserting ‘‘launch, perform an in-space (3) by striking ‘‘vehicle.’’ and inserting (4) by inserting ‘‘or reentry’’ after transportation activity, or reentry’’; ‘‘vehicle, in-space transportation vehicle, or ‘‘launch’’ the first place it appears in sub- (3) by striking subsections (f) and (g), and reentry vehicle.’’. section (a)(2)(B); inserting the following: (5) by striking ‘‘launch’’ each place it ap- ‘‘(f) LAUNCH NOT AN EXPORT OR IMPORT.—A SEC. 308. AMENDMENT OF SECTION 70108. pears in subsection (b)(1) and inserting launch vehicle, reentry vehicle, or payload Section 70108 (relating to prohibition, sus- ‘‘launch, in-space transportation activity, or that is launched or reentered is not, because pension, and end of launches and operation reentry’’; of the launch or reentry, an export or import of launch sites) is amended— (6) by striking ‘‘services’’ the first place it for purposes of a law controlling exports or (1) by striking the section caption and in- appears in subsection (b)(2)(C) and inserting imports. serting the following: ‘‘services, in-space transportation activities ‘‘(g) NONAPPLICATION.—This chapter does ‘‘Prohibition, suspension, and end of or services, or reentry services’’; and not apply to— launches, in-space transportation activities, (7) by striking subsection (d) and inserting ‘‘(1) a launch, in-space transportation ac- reentries, or operation of launch sites, in- the following: tivity, reentry, operation of a launch vehi- space transportation control sites, or re- ‘‘(d) COLLECTION BY OTHER GOVERNMENTAL cle, in-space transportation vehicle, or re- entry sites’’; HEADS.—The head of a department, agency, entry vehicle, or of a launch site, in-space and or instrumentality of the Government may transportation control site, or reentry site, (2) by striking ‘‘site’’ in subsection (a) and collect a payment for any activity involved or other space activity the Government car- inserting ‘‘site, in-space transportation con- in producing a launch vehicle, in-space ries out for the Government; or trol site, in-space transportation activity, or transportation vehicle, or reentry vehicle or ‘‘(2) planning or policies related to the reentry site, or reentry of a reentry vehi- its payload for launch, in-space transpor- launch, in-space transportation activity, re- cle,’’; and tation activity, or reentry if the activity was entry, or operation.’’. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15311 SEC. 316. REPORT TO CONGRESS. containing any material to be used for pur- messages that women receive about Chapter 701 is amended by adding at the poses of obtrusive space advertising on or ways to protect themselves from this end thereof the following new section: after the date of enactment of the National disease. ‘‘§ 70120. Report to Congress Aeronautics and Space Administration Au- But, there is one indisputable fact thorization Act, Fiscal Year 1996. ‘‘The Secretary of Transportation shall that is very clear: early detection by ‘‘(c) COMMERCIAL SPACE ADVERTISING.— submit to Congress an annual report to ac- Nothing in this section shall apply to mammography saves women’s lives. company the President’s budget request nonobtrusive commercial space advertising, Mammograms can detect 90 to 95 per- that— including advertising on commercial space cent of all breast cancers and is the ‘‘(1) describes all activities undertaken transportation vehicles, space infrastruc- under this chapter, including a description of most reliable method of detection. In ture, payloads, space launch facilities, and the process for the application for and ap- addition, and perhaps the most tragic launch support facilities.’’. proval of licenses under this chapter and rec- feature of this disease—9 out of 10 (c) NEGOTIATION WITH FOREIGN LAUNCHING ommendations for legislation that may fur- women could survive breast cancer if NATIONS.— ther commercial launches and reentries; and (1) The President is requested to negotiate detected early and treated properly. ‘‘(2) reviews the performance of the regu- with foreign launching nations for the pur- Mr. President, there is no question latory activities and the effectiveness of the pose of reaching an agreement or agreements that education and awareness are some Office of Commercial Space Transpor- that prohibit the use of outer space for ob- of our best tools for fighting this dis- tation.’’. trusive space advertising purposes. ease; combined with continued re- SEC. 317. AMENDMENT OF TABLE OF SECTIONS. (2) It is the sense of Congress that the search and treatment breakthroughs. The table of sections for chapter 701 of President should take such action as is ap- This day is critical in our efforts to title 49, United States Code, is amended— propriate and feasible to enforce the terms of (1) by amending the item relating to sec- win the battle against breast cancer. any agreement to prohibit the use of outer We owe it to our mothers; our daugh- tion 70104 to read as follows: space for obtrusive space advertising pur- ‘‘70104. Restrictions on launches, in-space poses. ters; our sisters; our neighbors and our transportation activities, oper- (3) As used in this subsection, the term friends to get the word out—early de- ations, and reentries.’’; ‘‘foreign launching nation’’ means a nation— tection can save your life. And we must (2) by amending the item relating to sec- (A) which launches, or procures the not let our efforts diminish; every tion 70108 to read as follows: launching of, a payload into outer space; or month should be Breast Cancer Aware- ‘‘70108. Prohibition, suspension, and end of (B) from whose territory or facility a pay- ness Month. launches, in-space transpor- load is launched into outer space. I would like to thank my colleagues tation activities, reentries, or (d) CLERICAL AMENDMENT.—The table of for expressing their commitment to operation of launch sites, in- sections for chapter 701 is amended by insert- ing the following after the item relating to saving women’s lives, and for paying space transportation control particular attention to raising aware- sites, or reentry sites.’’; section 70109: ‘‘70109a. Space advertising.’’. ness about the importance of mammog- (3) by amending the item relating to sec- raphy. I encourage all of you to sup- tion 70109 to read as follows: f port this resolution, and help us pro- ‘‘70109. Preemption of scheduled launches, in- NATIONAL MAMMOGRAPHY DAY tect women from the tragedy of breast space transportation activities, cancer. or reentries.’’; Mrs. KASSEBAUM. Mr. President, I Mr. BRADLEY. Mr. President, I am and ask unanimous consent that the Sen- very pleased to join my colleagues in (4) by adding at the end the following new ate proceed to the immediate consider- recognizing today, October 19, as Na- item: ation of Senate Resolution 177, re- tional Mammography Day. ‘‘70120. Report to Congress.’’. ported today by the Judiciary Commit- Today, 500 women will be diagnosed SEC. 318. REGULATIONS. tee. with breast cancer. Most likely, each The Secretary of Transportation shall The PRESIDING OFFICER. The will be frightened, uncertain about her issue regulations under chapter 701 of title clerk will report. future, and in search of a treatment 49, United States Code, that include— The legislative clerk read as follows: (1) guidelines for industry to obtain suffi- that, if it cannot cure her, will at least A resolution (S. Res. 177) to designate Oc- cient insurance coverage for potential dam- prolong her life. Each woman’s family tober 19, 1995, National Mammography Day. ages to third parties; and friends, co-workers and caregivers, (2) procedures for requesting and obtaining The PRESIDING OFFICER. Is there will worry deeply about her. licenses to operate a commercial launch ve- objection to the immediate consider- Today, 150 women will die of breast hicle and reentry vehicle; ation of the resolution? cancer. Their lives will be ended pre- (3) procedures for requesting and obtaining There being no objection, the Senate maturely. Their families and friends, operator licenses for launch and reentry; and proceeded to consider the resolution. coworkers and caregivers will be grief- (4) procedures for the application of gov- Mrs. MURRAY. Mr. President, I am ernment indemnification. stricken. proud to join my colleagues in offering SEC. 319. SPACE ADVERTISING. Tragically, today’s numbers are this important resolution to designate (a) DEFINITION.—Section 70102, as amended every day’s numbers in our Nation. by section 303, is amended by redesignating October 19, 1995 as ‘‘National Mammog- Listen to the enormity of this disease: paragraphs (12) through (19) as (13) through raphy Day.’’ I am pleased to support one out of nine women will get breast (20), respectively, and by inserting after this effort to set aside 1 day in the cancer; since 1960 nearly 1 million paragraph (11) the following new paragraph: midst of National Breast Cancer women have died from this disease. ‘‘(12) ‘obtrusive space advertising’ means Awareness Month to increase aware- With their deaths, millions of their advertising in outer space that is capable of ness about the best method of reducing loved ones, including children and being recognized by a human being on the the breast cancer mortality rate—early aging parents dependent on them, have surface of the earth without the aid of a tele- scope or other technological device;’’. detection by mammography. suffered as well. We stagger under (b) PROHIBITION.—Chapter 701 is amended This frightening disease has taken these numbers, as we search for the by inserting after section 70109 the following the lives of far too many women, in- causes and the cure. new section: cluding many of my own friends. It is All women are at risk for breast can- ‘‘§ 70109a. Space advertising one of the leading killers of women— cer, with the incidence increasing ‘‘(a) LICENSING.—Notwithstanding the pro- claiming the lives of more than 46,000 among older women and the mortality visions of this chapter or any other provision women each year. Breast cancer is a rate higher for African-American of law, the Secretary shall not— growing public health problem in this women. While other factors that may ‘‘(1) issue or transfer a license under this Nation, and a great threat to women’s put women at risk are being thor- chapter; or health. oughly investigated, we are still our- ‘‘(2) waive the license requirements of this We can all agree that more must be selves at risk for feeling helpless in the chapter; done to educate us about the risks, pre- face of this killer. for the launch of a payload containing any material to be used for the purposes of obtru- vention and treatment of breast can- However, we do have one sure thing sive space advertising. cer. I also believe we must be vigilant to offer to women and today we bring ‘‘(b) LAUNCHING.—No holder of a license in supporting continued research on that to national attention. With mam- under this chapter may launch a payload breast cancer, and clear up the mixed mography, we offer the possibility of S 15312 CONGRESSIONAL RECORD — SENATE October 19, 1995 early detection. Along with breast self- died of breast cancer when I was only 9 ease. The lives of our mothers, daugh- examination, this is one of the best years old, as well as the fact that 900 ters, sisters and friends may well de- steps women can take for themselves Maine women were diagnosed with pend on our ability to educate them in the fight against breast cancer. And breast cancer last year. about the importance of mammograms. it is the single best service our health This is the most commonly diagnosed This year, I submitted Senate Con- care system can make available to all cancer among Maine women, and this current Resolution 8, expressing the women in this struggle. Offering this represents more than 30 percent of all sense of Congress on the need for accu- service is not enough. We must also as- new cancers among women in Maine. rate guidelines for breast cancer sure the quality of the service, espe- We all know these statistics, we live screening for women ages 40–49. How- cially the equipment used. with them every day of our lives and ever, on this day, National Mammog- Early detection made possible by face them with a growing concern and raphy Day, there are things we can all mammography is wise health care. deepening sorrow, and they are a con- do to ensure there are no more victims With early detection we can reduce the stant reminder of the work that re- of breast cancer, but only survivors. mortality rate by one-third. Further- mains to be done. Talk to the women in your family and more, early discovery of the disease al- But we know that they represent your home States about the impor- lows for less radical and less costly more than just numbers—each number tance of breast cancer screening. Tell treatments. Equally important, with represents the life of a mother, sister, them to arrange for a physical, includ- the provision of mammography, we say grandmother, aunt, daughter, wife, ing a clinical breast exam. Tell them to American women that we under- friend, or co-worker. They are the fab- to schedule a mammogram for them- stand the trauma of this disease and ric of our families, our communities, selves or a loved one. Talk to them. will persist in efforts to triumph over our States and our Nation. Talk to them today. Tell them not to it. As a former co-chair of the Congres- wait. Remembering that these women are sional Caucus for Women’s Issues, I Mrs. KASSEBAUM. Mr. President, I our wives, sisters, mothers, daughters, have joined other members of that cau- ask unanimous consent that the reso- and friends, I am proud to add my voice cus in working diligently to bring the lution be agreed to, the preamble be in recognition of National Mammog- respect and action that is needed to the agreed to, and the motion to reconsider raphy Day. struggle against breast cancer. be laid upon the table, and that any f In past years, we have introduced and statements relating to the resolution passed vital legislation to help us win NATIONAL MAMMOGRAPHY DAY appear in the appropriate place in the this struggle—and that has included RECORD. Ms. SNOWE. Mr. President, today, I the Women’s Health Equity Act, which The PRESIDING OFFICER. Without would like to call attention to a day of in 1993 included the National Breast objection, it is so ordered. critical importance to women across Cancer Strategy Act, which established The resolution (S. Res. 177) was this Nation—National Mammography a National Breast Cancer Commis- agreed to. Day. sion—an interagency office on breast The preamble was agreed to. America’s women are facing a dev- cancer—and authorizes $300 million for astating crisis, and its name is breast The resolution, with its preamble, increased breast cancer research at reads as follows: cancer. NIH. It is a devastating crisis that targets S. RES. 177 The WHEA also contained the Breast women’s lives, their confidence in Whereas, according to the American Can- and Cervical Cancer Mortality Preven- health care, their work, their friends cer Society, one hundred eighty-two thou- tion Act Reauthorization, which pro- and their families. sand women will be diagnosed with breast It is a crisis that results in approxi- vides much-needed grants to States for cancer in 1995, and forty-six thousand women mately 182,000 new cases of breast can- mammograms and pap-smears for low- will die from this disease; cer being diagnosed each year, and income women and was passed by Con- Whereas, in the decade of the 1990’s, it is estimated that about two million women 46,000 deaths. gress and signed into law in late 1993. And we also passed the NIH Revital- will be diagnosed with breast cancer, result- Breast cancer is a crisis that has be- ing in nearly five hundred thousand deaths; come the most common form of cancer ization Act, which authorized increased funding for clinical research on breast, Whereas the risk of breast cancer increases and the second leading cause of cancer with age, with a woman at age seventy hav- deaths among American women—an es- cervical and other reproductive cancers ing twice as much of a chance of developing timated 2.6 million in the United in women. the disease than a woman at age fifty. States are living with breast cancer, 1.6 But these are just the first steps in Whereas 80 percent of the women who get million have been diagnosed, and an es- our crusade to find a cure for breast breast cancer have no family history of the timated 1 million women do not yet cancer and to bring relief and comfort disease; to its victims and their families. Whereas mammograms, when operated know they have breast cancer. professionally at a certified facility, can pro- It is a crisis in which one out of eight Our fight goes on. We need more funding. We need more research. We vide a safe and quick diagnosis; women in our country will come to de- Whereas experts agree that mammography velop breast cancer in their lifetimes— need more education and awareness of is the best method of early detection of a risk that was one out of 14 in 1960. In breast cancer and its causes. We need breast cancer, and early detection is the key fact, this year, a new case of breast more understanding. We need more to saving lives; and cancer will be diagnosed every 3 min- compassion. And we need a cure. Whereas mammograms can reveal the pres- utes, and a woman will die from breast Yet despite these frightening statis- ence of small cancers of up to two years or cancer every 11 minutes. tics, we know that with early detection more before regular clinical breast examina- It is a crisis that has tragically and regular screening, a survival rate tion or breast self-examination (BSE), saving as many as one-third more lives: Now, there- claimed the lives of almost 1 million of over 90 percent can be achieved. Un- fortunately, these statistics reveal fore, be it women of all ages and backgrounds Resolved, That the Senate designate Octo- since 1960. This is more than two times that not enough women are taking ad- ber 19, 1995 as ‘‘National Mammography the number of all Americans who have vantage of preventive measures with Day.’’ The Senate requests that the Presi- died in World War I, World War II, the proven benefits—such as mammo- dent issue a proclamation calling upon the Korean war, the Vietnam war, and the grams. In fact, the Director of the Na- people of the United States to observe such Persian Gulf war, and 48 percent of tional Cancer Institute announced yes- day with appropriate programs and activi- these deaths occurred in the past 10 terday that ‘‘one of the biggest barriers ties. years alone. to reducing breast cancer mortality is f Finally, it is a crisis that has become lack of information.’’ the leading cause of death for women Given that such a promising survival REFERRAL OF AMTRAK aged 40 to 44, and the leading cause of rate is associated with early detection APPROPRIATIONS AUTHORIZATION cancer death in women aged 25 to 54. and treatment, it is essential that we Mrs. KASSEBAUM. Mr. President, I But what really hits home for this be relentless in our efforts to increase ask unanimous consent that Calendar Senator is the fact that my mother public awareness of this terrible dis- 206, S. 1318, the Amtrak and Local Rail October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15313 Revitalization Act of 1995, be referred Code. And the proceeds from these time of tight budgets, in a time when to the Finance Committee solely for modest changes are, in turn, used to we are focusing on deficit reduction, in the consideration of title 10 of the bill, subsidize new and much bigger tax a time when we are cutting into nutri- for not to exceed 15 calendar days; and breaks precisely for those taxpayers in tional programs for children and higher further, that if the bill has not been re- the Nation who least need them. education and health care and environ- ported from the committee after the 15 For example, it relaxes the alter- mental protection, why in the world days, it automatically be discharged native minimum tax that was estab- are not the tax subsidies for the large and placed on the calendar. lished in 1986. What was the idea back pharmaceutical companies and oil The PRESIDING OFFICER. Without then? The idea was that large and prof- companies and tobacco companies and objection, it is so ordered. itable corporations, often multi- insurance companies and you name it, f national corporations, after taking a why are they not on the table? variety of different deductions and Various groups, from all ideological CLOSE TAX BREAK LOOPHOLES credits and exclusions, still are going perspectives, from the National Tax- Mr. WELLSTONE. Mr. President, to have to pay some minimum tax. It is payers Union to the Cato Institute to today I rise before the Senate to com- a part of fairness. Now what we have is the Progressive Policy Institute to ment on some of the provisions of the a provision to scale that back. That Citizens for Tax Justice, have prepared legislation to be reported out of the provision ought to be struck from this a list of tax loopholes and other sub- Senate Finance Committee. piece of legislation. It is truly out- sidies which they believe should be I want to start out by asking a sim- rageous. eliminated. But, despite the logic of ple question: Why are we reducing rev- If you ask people in the country, ‘‘Do their approach, which is a Minnesota enue and investment in Medicare and you believe that tax cuts should be a standard of fairness, my colleagues on medical assistance and higher edu- priority while at the same time we are the other side of the aisle have chosen cation and other programs, which are trying to reduce the deficit?’’ most the path of least political resistance: critical to communities and people in would say—and the polls bear this Slash the programs for the vulnerable Minnesota and all across the country, out—‘‘No.’’ If you ask people, ‘‘Do you elderly, slash the programs for the vul- before going after some of the tax believe that tax breaks for large, prof- nerable poor, slash the earned-income breaks for special interests that have itable corporations ought to be ex- tax credit, slash the programs for child been embedded in the tax code for dec- panded rather than scaled back?’’ vir- care, slash the programs for middle-in- ades? tually every single Minnesotan would come people. But when it comes to If we are serious about deficit reduc- say, ‘‘No.’’ Even so, that is exactly these large, multinational corporate tion, it seems to me that all these loop- what the Finance Committee is about interests who march on Washington holes and deductions and giveaways the business of doing. every day, the big players, the heavy ought to also be on the table. I offered an amendment on the budg- hitters, people who have the lobbyists, Mr. President, what kind of priorities et resolution earlier this year to re- for some reason, we do not ask them to are these that are reflected in this bill? quire that the Senate Finance Commit- tighten their belts at all. tee close $70 billion of tax loopholes They are certainly not the priorities of It is only fair that this be a part of over the next several years. That the people I represent, who understand the agenda. So I want to just outline amendment was defeated. Next week, the value of having funding available very briefly some of the areas on which or the following week when we take up to take care of elderly people, under- I want to focus the attention of my col- the reconciliation bill, I intend to have stand the value of taking care of vul- leagues next week. Let me give but a specific proposals and amendments on nerable people who are in nursing few examples. homes, of boosting kids’ chances to go the floor to close tax loopholes, with I already talked about the minimum to college, of helping struggling fami- up-or-down votes. tax. The effort is to scale that back for lies enter the middle class, of ensuring If we are going to have the deficit re- certain corporations. That’s wrong. Ev- that elderly people can afford health duction, if we are going to pay the in- erybody ought to pay some minimum care, of making sure that children have terest on the debt—all of which we tax. adequate nutrition. It makes no sense agree on—there ought to be a standard at all, Mr. President. of fairness. And rather than focusing so Second, let me talk about expensing After days of closed-door meetings, much on the cuts in Medicare and med- for the oil and gas industry. This has this week Republicans on the commit- ical assistance, rather than focusing on been a special break for this industry. tee announced their proposal for a $245 cuts in benefits for veterans, rather They get to expense their oil and gas billion tax cut. Taken as a whole, this than causing great pain for children exploration costs, instead of depreciat- proposal includes serious reductions and the most vulnerable in our coun- ing them over time. It is an expensive and cuts in Medicare and Medicaid and, try, it seems to me it is not too much tax benefit for this industry. Why in addition, includes some enormous to ask that large corporations, wealthy should the oil and gas industry receive new tax breaks for wealthy corpora- corporations, pay their fair share. That special treatment in the Tax Code tions and others, further worsening our is why we ought to plug some of these which is not generally available to budget crisis. narrowly focused tax breaks and loop- other companies and industries? It is a Mr. President, instead of scaling holes which allow the privileged few to simple question. If we are about the back billions of dollars in tax breaks, it escape paying their fair share, focusing business of deficit reduction, we ought provides billions for firms with high- on other people and forcing other peo- to close this loophole. powered tax lobbyists and almost noth- ple to pay higher taxes to make up the Or take section 936, the Puerto Rico ing for working families. difference. This is a question of fair- tax credit that has been debated in In fact, by slashing the earned in- ness. If you are going to have sacrifice, some detail in recent years. The Fi- come tax credit for working families it ought to be equitable sacrifice. nance Committee has finally acknowl- by over $42 billion, this legislation will Let me make a point here that is edged there ought to be some change. greatly increase the tax burden on mil- often overlooked. We can spend money But what it does is it repeals this over lions of citizens throughout the coun- just as easily through the Tax Code, a fairly long period of time, 7 years or try. through tax breaks, as we can through so, with generous transition benefits In my State of Minnesota, there will the normal appropriations process. for corporations in the interim period. be an increase of taxes for 172,740 Min- Spending is spending, whether it comes If we are going to repeal it, I think nesota taxpayers. Mr. President, these in the form of a Government check or what we have to do is move as quickly are low- and moderate-income families whether it is a tax break for some spe- as possible. It simply makes no sense. that are trying to work their way into cial purpose like a subsidy, a credit, a For those who support a flatter tax or the middle class. deduction, accelerated depreciation— a fairer tax or tax justice and think we At the same time, the bill makes you name it. Some of these tax expend- ought to make the cuts and ought to do only a tiny, token effort to partially itures are justified, they ought to be the belt tightening, this ought to be on scale back a few loopholes in the Tax kept. But it does seem to me that, in a the table. S 15314 CONGRESSIONAL RECORD — SENATE October 19, 1995 Or consider the special exclusion for consumer safety provisions that are U.S. Geological Survey suggest that it foreign-earned income that has been in important to all of the citizens of this is, at best, 4 million to 5 million bar- this code for decades. This little gem country, but at the same time, when it rels. This is equal to 1 year’s worth of will cost taxpayers between $8 and $9 comes to some of this corporate wel- U.S. oil consumption. That is no long- billion over the next 5 years. If you are fare, some of these outrageous breaks term solution to energy dependence, a U.S. citizen living abroad, you get an that go to some of the largest corpora- and dependence on foreign oil. exclusion of taxation for the first tions in America and throughout the Furthermore, there is a mixed mes- $70,000 you make. You get an exclusion world that are just doing fine and can sage. At the same time proponents of of taxation on the first $70,000 you afford to tighten their belts, they are ANWR say that we ought to lessen our make. So, if you make $170,000, you do not asked to be a part of the sacrifice? dependence on foreign oil, they are not pay anything on $70,000 of that. These votes next week will be a lit- pushing to lift the North Slope oil ex- Again, let us talk about a standard of mus test of whether or not Democrats port ban and selling off oil reserves in fairness and let us make some of these and Republicans are serious about defi- the Strategic Petroleum Reserve. cuts, not just based upon the path of cit reduction based upon a standard of I do not see how it is possible to least political resistance, but on the fairness. I look forward to the debate. make the argument for drilling in basis of a path of some fairness. Mr. President, in the absence of any ANWR, at the same time that we are The PRESIDING OFFICER. The colleagues here, I ask unanimous con- exporting some of our oil. It is just in- Chair will advise the Senator from sent that morning business be extended consistent, and it is bad energy policy. Minnesota that his 10 minutes have ex- for an additional 7 minutes. The discussion about ANWR supply- pired. The PRESIDING OFFICER. Is there ing jobs is also way off the mark. If Mr. WELLSTONE. Mr. President, I objection? Without objection, it is so you just look at some statistics from ask unanimous consent that I have 3 ordered. Without objection, morning the American Council for an Energy more minutes to conclude my remarks. business is extended for an additional 7 Efficient Economy, they estimate that The PRESIDING OFFICER. The Sen- minutes. by the year 2010, we could generate 1.1 ator is recognized for 3 additional min- Mr. WELLSTONE. Mr. President, I million jobs, by getting serious about utes. also want to speak on one other matter saved energy and efficient energy use, Mr. WELLSTONE. Mr. President, that I think is very important to the which makes far more sense. there is a provision right now on some country. Now, let me talk about environ- of the corporate-owned life insurance The PRESIDING OFFICER. The mental policy. The Arctic National that has generated some opposition Chair will advise the Senator that his Wildlife Refuge is one of this country’s from the insurance industry and large previously granted time has expired. greatest treasures. The preservation of employers. Frankly, it had been Does the Senator wish additional time? this land and its plants and its animals abused. I refer my colleagues to an ar- Mr. WELLSTONE. Mr. President, I and the way of life they support is ticle by Allan Sloan, ‘‘Companies Find ask unanimous consent for an addi- vital. ANWR contains the Nation’s a Premium Way To Take an Unjusti- tional 7 minutes to speak as in morn- most significant polar bear denning fied Tax Break.’’ He talks about Wal- ing business. habitat on land, supports 300,000 snow Mart taking out this insurance on vir- The PRESIDING OFFICER. The Sen- geese, migratory birds from six con- tually all their employees. The money ator from Minnesota is recognized for tinents, and a concentrated porcupine does not go to their employees as bene- an additional 7 minutes. caribou calving ground. ficiaries, but Wal-Mart gets to take a Mr. WELLSTONE. Mr. President, I Given all that ANWR has to offer, I deduction on whatever money they put also rise today to strongly oppose drill- am appalled that many of my col- into the insurance for every single em- ing in the Arctic National Wildlife Ref- leagues are willing to drill in ANWR ployee. Again, we are talking about uge [ANWR]. This has been an issue without the usual procedure of an En- losing billions of dollars over the years. that I have been involved in from the vironmental Impact Statement as re- I am going to be talking about this at time I first came to the Senate. There quired by current law. I pushed in com- some great length when we finally get was a filibuster over ANWR that I led mittee to have such an environmental down to the debate on this reconcili- when I was here just a short period of impact statement but my amendment ation bill and when we finally get down time and now ANWR is back again. The was defeated. When it was being con- to the point where the rubber meets Energy Committee has voted, over the sidered, my colleagues asked me how it the road. objections of a large bipartisan group would affect scoring. This points to ex- These are about four or five exam- of Senators, to open up ANWR for drill- actly what is going on here: We are ples. I intend to come to the floor with ing and to use the revenue to meet rec- selling important environmental pro- at least some of these specific provi- onciliation instructions. I note a letter tections, and we are mortgaging the sions. What I am going to be saying to from former President Bush to my dis- environment for a momentary short- my colleagues is: Look, eliminate tinguished colleague from Alaska, that run budgetary gain. them. Because what happens is, when is on everybody’s desk, supporting this. Mr. President, finally, let me just these companies or these citizens who I am both aware of and respectful of make a concluding point. For thou- do not need this assistance get these the need to balance the budget. That is sands of years, the Gwich’in people kind of breaks, other citizens end up why I have stood here on the Senate have relied on the porcupine caribou to having to pay more taxes. It is not fair. floor and voted for many spending cuts. provide their food and meet their spir- It is not tax fairness. And, in addition, But there are other ways and meas- itual needs. I have heard them speak it is an expenditure of Government ures that do not balance the budget at very eloquently and directly about money that we can no longer afford. the expense of our natural resources. what oil drilling in ANWR would do to That is what it amounts to. Unfortunately, though, all I see is big their way of life. In fact, many of them If we are going to do the deficit re- industry, oil companies included, win- may have to leave a way of life they duction, we ought to do it on the basis ning big, and our natural resources los- have practiced for thousands of years if of a standard of fairness. I ask the ing big. drilling in ANWR happens. question one more time, by way of con- This is poor energy policy, poor envi- This is a one-sided battle. People like clusion today. How come we are focus- ronmental policy, and it is politics the Gwich’in want to save the environ- ing so much on the elderly? How come that in many ways I think is pro- ment. But they are not the big oil com- we are focusing so much on the chil- foundly wrongheaded and even cynical. panies. They do not have the money. dren? How come we are focusing so First, let me talk about energy pol- They do not have the lobbyists, and much on health care? How come we are icy. The argument is that drilling in they do not have the lawyers here focusing so much on working families, ANWR will lessen our reliance on for- every day. low- and moderate-income families? eign oil, but we do not really know I believe, once again, to open up How come we are stripping away envi- whether there even is oil in ANWR. ANWR to oil drilling through the back ronmental protection? How come we And if there is, we do not know how door of the budgetary process is pro- are stripping away some basic much. The latest numbers from the foundly mistaken. It is not the basis on October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15315 which we should make this decision, additional $75 million funding to pre- serves, but nonetheless it is taking a and I think it would be a huge mistake vent violence against women—an great deal of time. for this Nation. amendment that was unanimously What I would like to do, if my col- Our natural resources are among the adopted. It included support of counsel- league and chairman of the Foreign Re- most important things we can leave to ing and assistance to victims and wit- lations Committee would agree, rather future generations. Those resources are nesses to support them throughout the than having separate debates on in our care. Our children and our prosecution process of offenders, fund- amendments, I will try to confine my grandchildren—we keep talking about ing for safe homes for victims of vio- remarks to both amendments—they our children and our grandchildren— lence, and improving the database that are related, I would say to my col- deserve more than what this bad en- collects nationwide information on league from North Carolina—and then ergy policy, bad environmental policy, stalkers. either have back-to-back votes on and shortsighted politicking would In closing, let me applaud the tireless them or, if he prefers, I could ask unan- leave them. work of Majority Leader DOLE, Sen- imous consent that these two amend- I urge my colleagues to support an ators HATCH, BIDEN, and SNOWE and ments be considered as one amendment amendment to the reconciliation bill many others to bring an end to vio- for the purpose of a single rollcall vote. to strike the provision opening ANWR lence against women in this country. Either way is fine with me, and I will to drilling. It is time to get our prior- Even though there have been some yield to my colleague for any particu- ities right, and if we are serious about tragic setbacks recently, we cannot lar comment he may have on proce- doing well for our children and our give up hope. We need to continue to durally how we handle it. grandchildren, we will make the pro- support these efforts in the Senate and Mr. HELMS. Mr. President, I am per- tection of the environment and the to support women who are victims of fectly willing to have the two amend- protection of ANWR our very highest violence. ments voted en bloc. And I would fur- priority. Mr. President, I yield the floor. ther ask the distinguished Senator Mr. President, I yield the floor. f from Connecticut if he would be willing f to enter into a time agreement? CONCLUSION OF MORNING Mr. DODD. I am happy to, if he SUPPORTING DAY OF CONFRONTING VIOLENCE BUSINESSAGAINST WOMEN wants. I know some of our colleagues e will make the protection of the environment and theThe protection PRESIDING of ANWR our OFFICER. very highest priority.Morning have—there is one other amendment Mr. COVERDELL. Mr. President, I business is now closed. pending, the Simon amendment. rise in support of observing a Day of Mr. HELMS. Yes. f Confronting Violence Against Women Mr. DODD. I believe he needs 20 min- and this week as a Week Without Vio- CUBAN LIBERTY AND DEMOCRATIC utes. lence. SOLIDARITY [LIBERTAD] ACT OF Mr. HELMS. There is a time agree- Widely publicized media reports, es- 1995 ment. pecially those most recent, have lit- Mr. DODD. Of 20 minutes. I would say The PRESIDING OFFICER. Under erally seized the attention of the 40 minutes, and it may not even be that the previous order, the Senate will now American public and brought to the amount of time necessarily. resume consideration of H.R. 927, which forefront alarming instances of vio- Mr. HELMS. Forty minutes equally? the clerk will report. Mr. DODD. Yes. lence against women. When I learn The legislative clerk read as follows: that three out of four women will be Mr. HELMS. I ask unanimous con- victims of violence at some time in A bill (H.R. 927) to seek international sanc- sent that the time agreement be 40 tions against the Castro government in minutes equally divided—on the two their life, it makes me angry, as it Cuba, to plan for support of a transition gov- should every Member of the U.S. Sen- amendments? ernment leading to a democratically elected Mr. DODD. That is fine. ate. government in Cuba, and for other purposes. This issue should strike each of us at Pending: Mr. HELMS. Very well. the heart of our homes and families. Dole amendment No. 2898, in the nature of The PRESIDING OFFICER. Without Why? Because we are not just talking a substitute. objection, it is so ordered. about numbers and statistics here, we Helms amendment No. 2936 (to amendment Mr. HELMS. I thank the Chair. I are talking about our mothers, our sis- No. 2898), to strengthen international sanc- thank the Senator. tions against the Castro government and to The PRESIDING OFFICER. Without ters, and our daughters. We may even support for a free and independent Cuba. objection, the amendments will be con- be talking about some of our col- Simon modified amendment No. 2934 (to sidered en bloc. leagues. When you consider that every Amendment No. 2936), to protect the con- Mr. DODD. Fine. Mr. President, I will 15 seconds a women is battered in stitutional right of Americans to travel to wait to ask for the yeas and nays. America, four women have been cruelly Cuba. AMENDMENTS NOS. 2906 AND 2908 TO AMENDMENT beaten since I began my statement The Senate resumed consideration of NO. 2936 only a minute ago. When every 5 min- the bill. Mr. DODD. Mr. President, the amend- utes a women is sexually attacked, Mr. HELMS addressed the Chair. ments are at the desk. They are num- sadly enough, one woman’s life is for- The PRESIDING OFFICER. The Sen- bered 2906 and 2908. I ask for their im- ever destroyed by the time I conclude ator from North Carolina. mediate consideration. Mr. HELMS. Mr. President, I suggest my remarks. The PRESIDING OFFICER. The In our country, one in every four re- the absence of a quorum. clerk will report the amendments. lationships involve physical abuse. In The PRESIDING OFFICER. The The legislative clerk read as follows: my home State, I am sad to say, 250,000 clerk will call the roll. women are abused each year. This is The legislative clerk proceeded to The Senator from Connecticut [Mr. DODD] proposes amendments numbered 2906 and 2908 why violence against women is an issue call the roll. to amendment No. 2936: very important to me. One of my first Mr. DODD. Mr. President, I ask unan- The amendments are as follows: imous consent that the order for the acts as Senator was to sign onto Sen- AMENDMENT NO. 2906 OLE quorum call be rescinded. ator D ’s Violence Against Women On page 23 of the pending amendment be- Act. Last year two antistalking The PRESIDING OFFICER (Mr. ginning with line 18, strike all through line amendments I offered were adopted by CAMPBELL). Without objection, it is so 21 on page 24. the Senate. They provided for training ordered. of criminal justice officials and vic- Mr. DODD. Mr. President, I have a AMENDMENT NO. 2908 tims’ service providers as well as fund- couple of amendments that I would On page 28 of the pending amendment be- ing for further research. like to offer to the pending legislation. ginning with line 42, strike all through line Most recently, I am proud to have I point out we have already spent, I 32 on page 32. been a cosponsor of an amendment to guess, 4 or 5 days on this bill, and I Mr. DODD. Mr. President, let me ex- the fiscal year 1996 Commerce, State, think people might suggest probably plain, both of these amendments are Justice appropriations bill to target an more time than the legislation de- related to title II of this bill. S 15316 CONGRESSIONAL RECORD — SENATE October 19, 1995 Let me explain both of these amend- ple and to be impartial toward any individ- what we mean about that in this coun- ments. I should begin by thanking my ual or entity in the selection by the Cuban try. But I am not going to quibble colleague from North Carolina that we people of their future government. about the individual wording in it, Mr. have gotten to this point and that we That is exactly the position we ought President. I think there is value in are considering the bill, having dropped to have. In fact, if it ended right there each one of these statements. title III of the bill. I would be standing up here urging all But my point is, if we applied these I should, before discussing these two my colleagues to support this. But un- standards to the New Independent amendments, make clear, having read fortunately, Mr. President, if you read States that emerged after the collapse the comments of the distinguished ma- further on in here, we seem to then of the Soviet Union, we still would not jority leader and others, that title III contradict the very statement that I be providing any assistance to them, of the bill will come back in the bill, I have just read to you. And I suspect and we would not be allowed to under guess, or at least there are threats of that many of my colleagues—most this, if adopted. We need to provide that when the House and the Senate go would endorse the first statement. Presidents and Congresses in the future to their conference on this legislation. However, key provisions of title II with the flexibility to respond to a On the assumption that the bill is belie that statement. transition in Cuba. And to sit down and passed out of the Senate, I would just I would urge my colleagues to take a have a four-page minutia detail by de- notify my colleagues that if that is the look, if they would, at sections 205, 206, tail by detail, steps that they have to case and it comes back, we will be back and 207 of title II which set forth a go through before we can help them, I in the same position we were in earlier laundry list of conditions and require- think just is wrong, wrong headed. this week where I strongly objected to ments that either must or should be Again, this has nothing to do with title III of the bill and would take ap- met before the President, our Presi- Fidel Castro. This title II works on the propriate actions if that is the case. dent, the President of the United presumption he is gone, he is out of I certainly understand and respect States, can provide even very limited the right of the conferees to have and there. Now, we are talking about a new assistance to help the Cuban people government. decide what they are going to decide, make the very difficult transition from but I would have to also put my col- Mr. President, I just think it is a dictatorship to democracy. mistake to be passing legislation that leagues on notice that I would use These conditions, Mr. President, go whatever procedural vehicles are avail- micromanages and goes into such de- on for four pages here, laying out, in tail. It is not just this President. able to me as a Member of this body to some cases, ‘‘shall,’’ and what we stop consideration of the legislation if Maybe people are talking about this ‘‘must’’ do. administration somehow. No one can that were to occur. Section 205: Mr. President, these two amend- say with certainty when the transition ments, as I mentioned a moment ago, (a) A determination . . . that a transition is going to occur in Cuba. We all hope government in Cuba is in power shall not be it occurs peacefully and occurs soon. strike portions of title II of the bill made unless that government has taken the that I think unduly hamper the ability following actions—(1) legalized all political But it may very well not be for a year of our country to provide assistance— activity; (2) released all political prisoners or 2 or 3 or 4 for 5. Who can say? and let me emphasize this—to a post- ... We have listened to nine Presidents Castro government. Title II does not Most of the list I do not have any since Dwight Eisenhower talk about talk about Fidel Castro’s government problem with whatsoever except that it the change coming in Cuba. It has not in Cuba today. Title II exclusively gets to micromanagement in a sense happened yet. Now, again, all of us talks about the government that comes and lays out in great specificity ex- here, I presume, would like to see it after Fidel Castro. actly what we are going to require be- happen quickly. But if it does not hap- So my colleagues who are worried fore we provide any assistance to the pen during this administration but here that they may in some way, if people of that new government. some future administration, including they were to adopt these amendments I Again, I go back, Mr. President, to the administration of some of our col- am proposing, do something to support read, if you will, the statement I read leagues who are in this Chamber today, Fidel Castro, they have nothing to do a moment ago when we started talking they could face four pages we adopt with Fidel Castro. The language spe- about it. ‘‘The policy of the United into law setting out in detail what that cifically refers to the post-Castro gov- States to support the self-determina- government must look like before we ernment. And I want to emphasize that tion of the Cuban people and to be im- can provide assistance to them, despite point because I think it sets new partial toward any individual or en- the fact that we said earlier in the bill ground, that is, the language in the tity.’’ Again, we are talking about a that it is the policy of our Government bill, that I think is dangerous, in my post-Castro government here. Presum- to support the self-determination of view, and precedent setting. ably, they are getting rid of the dicta- the Cuban people and to be impartial, The restrictions, of course, I men- torship and moving in the right direc- impartial toward any individual or en- tioned are not restrictions on how we tion. tity in the election by the Cuban peo- relate to the existing government. Now, I am not suggesting we ought to ple of their future government. Rather, they are restrictions on a rela- say we are going to provide help to Again, I would not suggest in any tionship with a future Cuban Govern- anybody that becomes a transition way whatsoever, Mr. President, that ment, a government in transition from government or becomes the new gov- we ought to write a bill that would say dictatorship to democracy. And, Mr. ernment after Castro. I would oppose no matter what happens, no matter President, this does not make any just as strongly any suggestion in leg- who follows Fidel Castro, we ought to sense at all to me. Title II of this legis- islation that we automatically ought provide aid to them. lation relates in large measure to what to be providing assistance. But I also Imagine if I wrote a bill that said the United States’ policy should be to- think it gets rather ridiculous if we lay that, that whoever comes after Fidel ward a post-Castro government. Castro automatically qualifies for U.S. It states, among other things—I am out four pages, Mr. President, of condi- assistance. I would be laughed off the quoting here: tionality here that a government must floor of the Senate if I suggested a bill It is the policy of the United States to sup- meet absolutely in many ways if we are port the self-determination of the Cuban peo- going to provide any assistance at all. that proposed that idea. And yet, what ple and to be impartial toward any individ- I am talking about humanitarian as- we are doing here today, in a sense, is ual or entity in the selection by the Cuban sistance to people in transition. just like that. We are saying in effect people of their future government. And, in fact, these standards that we that ‘‘no matter who comes after Fidel That is a beautiful statement. I en- have here, as much as I think they Castro, unless you meet these detailed dorse it 1000 percent. It is exactly the have value, and although I think some standards, we cannot provide any help position we ought to have. Let me re- of the language is a little less than pre- to you at all.’’ peat it again. cise, I do not—‘‘legalizing all political I thought the idea was to encourage a It is the policy of the United States to sup- activity’’—I do not know what ‘‘all po- transition, to move to democracy, and port the self-determination of the Cuban peo- litical activity’’ means. I do not know to then provide the kind of nurturing October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15317 support to see that that transition oc- that even among our allies around the The PRESIDING OFFICER. The Sen- curs. Now, it may not occur exactly as globe, seems to me to be going too far. ator from North Carolina [Mr. HELMS], we like. It just goes too far. is recognized for 20 minutes. One of the provisions says you must Again, I realize with everything else ORDER OF PROCEDURE have free elections within 2 years. I going on around here that the atten- Mr. HELMS. Mr. President, the dis- wish it was 6 months. I wish it were the tion on something like this may not tinguished President of Estonia waits next day. What happens if it is 21⁄2 seem like much to people. I just think without in the Vice President’s Office. years and not 2 years, or 2 years, 2 it is bad policy, Mr. President, to have I desire to present him to the Senate, months? It is that kind of detail that is this kind of detailed step-by-step re- and I shall do so, and I shall go and in- in this bill, Mr. President. That is not quirement that you have to meet and vite him to come in. In the meantime, smart. That is not wise. That is not then absolutely hamstring not just this I suggest the absence of a quorum, the prudent. I do not know of any other administration, but future administra- time to be charged to neither side. place where we provided this kind of tions, from being able to move intel- The PRESIDING OFFICER. The language. ligently and rapidly to try to shore up clerk will call the roll. Imagine the Philippines if we tried a government that will follow Fidel The bill clerk proceeded to call the that. Imagine if we tried it, as I said, in Castro. roll. all of these New Independent Republics Again, I emphasize to my colleagues, Mr. HELMS. Mr. President, I ask that have emerged. Our ability to none of these provisions has anything unanimous consent that the order for weigh in and create that kind of transi- to do with the present government in the quorum call be dispensed with. tion would have been severely ham- Cuba—not one thing to do with it. It is The PRESIDING OFFICER. Without pered had we been required to meet the all about the government that comes objection, it is so ordered. standards we are going to be adopting afterward. It seems to me we ought to f in this legislation if my amendment is be trying to figure out a way how we VISIT TO THE SENATE BY THE not approved. can play the most creative role in that PRESIDENT OF ESTONIA, Now, I do not know, again, how this transition, to try to move that process LENNART MERI will come out politically. But I hope toward a democratically elected gov- my colleagues would look and just read ernment as quickly as we can—as Mr. HELMS. Mr. President, I am hon- the sections 205, 206, and 207. They go quickly as we can. And yet, before we ored to present to the Senate the Presi- on for some pages. Some require can do that, we now have to go through dent of Estonia, the distinguished ‘‘shall,’’ others ‘‘should,’’ in the transi- a series of hoops that will make it Lennart Meri. tion. very, very difficult for us to respond f Last, and it gets into this same area, creatively and imaginatively to a situ- RECESS the settlement of outstanding U.S. ation that has gone on far too long. claims. And here the language, Mr. So, Mr. President, I will not dwell on Mr. HELMS. Mr. President, I ask President, is pretty emphatic in the this any longer. I made the point, I unanimous consent that the Senate bill. hope, and I urge my colleagues to look stand in recess for 5 minutes, so that No assistance may be provided under the at these sections of the bill. Some, as I Senators and staff can greet our distin- authority of this act to a transition govern- said, are more advisory. Others abso- guished guest. ment in Cuba. lutely demand certain things occur. There being no objection, the Senate, And then it goes on for a page or two They can go through and read which is at 11:06 a.m., recessed until 11:13 a.m.; here talking about how we resolve which. It seems to me we ought to whereupon, the Senate reassembled these outstanding claims. stick with the paragraph I read earlier when called to order by the Presiding Mr. President, I hope that happens. I on in my statement, and that is that Officer (Mr. CAMPBELL). do not think any U.S. citizen who has we provide the kind of flexibility in al- f property confiscated anywhere in the lowing the Cuban people to determine CUBAN LIBERTY AND DEMOCRATIC world ought not to be compensated. for themselves what it is that they But we have now 38 countries in the SOLIDARITY [LIBERTAD] ACT OF would like to have as that new govern- 1995 world, including Cuba, where United ment. States citizens’ property has been ex- We may not decide to support it. It The Senate continued with the con- propriated, and we are in the process of may not meet our standards and we sideration of the bill. trying to get those individuals com- Mr. HELMS addressed the Chair. will act accordingly, but the best pol- The PRESIDING OFFICER. The Sen- pensated for that property. icy is the one that is included as a pre- Some of the countries where that oc- ator from North Carolina is recognized. amble to this section, and the preamble Mr. HELMS. As I understand it, I curs are very strong allies of ours. Ger- to this section is one that every single many is one, I point out. We now have have 20 minutes. person in this country, let alone in this The PRESIDING OFFICER. The Sen- diplomatic relations with Vietnam. body, can support, and that is the pol- ator is correct. The list is lengthy, 38 countries. icy of the United States to support the Mr. HELMS. On the two amend- We never said before we cannot pro- self-determination of the Cuban people ments. vide any assistance to those countries and be impartial to any selection of the The PRESIDING OFFICER. The Sen- until those claims and matters are all Cuban people as to their government. ator is correct. settled, and yet that is what we do It is their choice. If they want to make Mr. HELMS. Mr. President, I will not with this legislation. We are saying we a bad choice, that is their right. We do use all that time. I will reserve some. cannot provide under this—the lan- not have to support it, but that is their When the Senator from Connecticut is guage very specifically in section 207, right if they so desire. willing, we will yield back what re- ‘‘Settlement of Outstanding U.S. The idea, then, that we are going to mains of our time. Claims to Confiscated Property in detail in painful minutiae every step Mr. President, Senator DODD’s Cuba,’’ section (A), paragraph 1: that must be met, I think is a mistake. amendment proposes to delete from the No assistance may be provided— Again, I am not quarreling myself with pending bill any guidance and rec- The assumption is that you are going any provisions here necessarily. There ommendations to the President from to set up a mechanism to resolve these are things I support and I believe make the Congress of the United States as to claims, again no matter how meritori- sense. But to spell out as a roadmap what constitutes a transition or demo- ous they may be, and have that control what they have to follow in great de- cratic government in Cuba. I am a lit- our foreign policy interests, which tail before we can provide any kind of tle surprised at the thrust of the would be, I presume, to support the help down there is a mistake, and I amendment. But I respect the Senator, transition to get aid to people to try to urge the adoption of the amendment. although I disagree with him. establish a presence there and assist Mr. President, I withhold the remain- The administration has maintained that process. To have it totally linked der of my time. that the President should retain flexi- to claims issues, where we do not do Mr. HELMS addressed the Chair. bility to deal with the situation in S 15318 CONGRESSIONAL RECORD — SENATE October 19, 1995 Cuba once a transition begins. So the section? It doesn’t appear to be the in- EXPLANATION OF CHANGE OF VOTE ON CLOTURE beginning trouble with this amend- terests of the property claimants. Mr. HEFLIN. Mr. President, when ment is that it is in conflict not only It is clearly within Congress’ power the Senate first voted October 12 on with the bill itself but with the admin- to set out conditions on providing aid the cloture petition relative to H.R. istration itself. to other nations—we do it all the time. 927, the Dole-Helms Cuba sanctions As the Libertad bill was drafted, we However, the Libertad bill acknowl- bill, I voted no. Like most of my Demo- took the administration’s concerns edges that the President will need cratic colleagues and some Repub- into account, and we agreed that any flexibility in responding to Cuba’s po- licans, I strongly opposed title III of parameters not be ‘‘overly rigid,’’ to litical evolution. The language in the the bill as written because of its det- quote from an administration state- Libertad bill represents a balance be- rimental effect on U.S. Federal courts. ment on the House bill. But we also tween these interests and should be re- Indeed most of our debate over the last agreed that Congress should speak as tained, and that is why I will move to few days on the bill has focused on title to what constitutes sufficient change table the Senator’s amendment. III’s provisions allowing suits to be in Cuba to merit any support or aid Mr. President, I reserve the remain- filed against companies that acquired from the United States. der of my time, pending Senator property confiscated by the Castro re- So the result is that the pending bill DODD’s discussion of his other amend- gime after it took power in 1959. This provision of the measure flouted gives the President of the United ment. international law, threatened already States, whomever he may be, a great I am advised, Mr. President, that severely overburdened courts with deal of latitude in making the deter- Senator DODD has no further comment costly new litigation, and jeopardized mination required before—before—any on his amendments. Is it fair for me to our relations with major trading part- United States aid can begin to flow to assume that he yields back the remain- ners who do business with Cuba. If a new Cuban Government. der of his time? If staff would please in- quire of Senator DODD. adopted, this provision would have I am not aware that the administra- Mr. President, while we are waiting, exponentially expanded the pool of per- tion has any problems with the way the on occasions like this, when important sons in the United States seeking com- pending legislation is drafted. But let legislation is being considered, I won- pensation from the Cuban Government me be clear about what is in the der what the reaction of those who for their claims. There could be tens or Libertad bill. The only specific require- come to visit the Senate is with re- even hundreds of thousands of persons ment, Mr. President, that a transition spect to so few Senators being on the who would be eligible to file such law- government must meet before United floor. The answer to that is that Sen- suits. States aid is released is that the Gov- ators are tied up in committee meet- While no one knows for certain how ernment has legalized political activ- ings all over this complex. I, myself, many lawsuits could have been filed ity, released all political prisoners and had to get away from a committee under title III, if even a fraction of allowed for access to Cuban prisons by meeting to be here to manage this bill those newly eligible did so, it would international human rights organiza- and to discuss Senator DODD’s amend- prove costly to the Federal courts and tions. It also stipulates that the Cuban ment. greatly complicate the tasks of resolv- Government must have dissolved the So I say to our guests that not only ing claims and assisting Cuba’s eco- state security and secret police appara- do we welcome them, but we beg their nomic recovery once the Castro regime tus, and agreed to hold elections within understanding that Senators are work- is gone. 2 years of taking power and has pub- ing; they are just not working here at After that first cloture vote, I dis- licly committed, and is taking steps, to the moment. cussed these issues during private con- resolve American property claims. Mr. President, I suggest the absence versations with several of my col- The pending bill contains several ad- of a quorum, the time not being leagues who supported the measure, in- ditional factors that the President is charged to either side. cluding Senator HELMS, and by the asked—not required, but asked—to The PRESIDING OFFICER. The time of the second vote on October 17, take into account when determining clerk will call the roll. I had obtained assurances that title III whether a transition or democratic The assistant legislative clerk pro- would be substantially modified or government is in power in Cuba. ceeded to call the roll. eliminated entirely. Therefore, I was Mr. President, Congress offers this Mr. HELMS. Mr. President, I ask able to support cloture when the sec- type of guidance to the President all unanimous consent that the order for ond vote occurred. the time on various matters. This is the quorum call be rescinded. I am happy that we were able to not out of the ordinary, nor is it some The PRESIDING OFFICER. Without reach a compromise on this legislation legislative straitjacket. So that is why objection, it is so ordered. which allowed the third cloture vote to I have a little bit of difficulty under- Mr. HELMS. Mr. President, I have succeed on a solid bipartisan vote of 98 standing how anybody could oppose been advised—Senator DODD has con- to 0 after the announcement that title asking, before we give away the United veyed to me his desire that his remain- III would be stricken from the bill. Mr. PELL. Mr. President, I believe States taxpayers’ dollars, that a Cuban ing time be yielded back if I yield mine all my colleagues agree on the goals of Government allow political activity, back. I so do. United States policy toward Cuba—pro- free political prisoners, dissolve the se- The PRESIDING OFFICER. All time moting a peaceful transition to democ- cret police, and agree to take care of is yielded back. racy, economic liberalization, and American citizens’ property claims. I Mr. HELMS. Mr. President, I want greater respect for human rights while must ask, what is wrong with that? the Chair to correct me if I am wrong, but there will be one vote on the two controlling immigration from Cuba. As for the property requirements, the Dodd amendments; is that correct? Where some of us clearly differ, how- President can waive them if he deter- The PRESIDING OFFICER. The Sen- ever, is on how we get there. Despite mines that it is in the vital national ator is correct. the changes that have been made to interest of the United States to do so. Mr. HELMS. I ask unanimous con- the pending legislation, I believe that This is consistent with existing restric- sent that it be in order for me to ask it continues to take us further away tions on aid to Cuba in section 620(a) of for the yeas and nays en bloc. from achieving these goals. I believe, the Foreign Assistance Act. The PRESIDING OFFICER. Is there a therefore, that this legislation is con- Now, I find it ironic that Senators sufficient second? trary to U.S. national interests. would come to the floor, expressing There is a sufficient second. We should undertake policy measures concerns about the Libertad bill, osten- The yeas and nays were ordered. to enhance contact with the Cuban sibly in the name of certified property Mr. HELMS. Now, Mr. President, people, because that will serve United claimants, and then turn around and that leaves Senator SIMON’s amend- States national interests; namely, the want to strike a provision that reaf- ment on which a time agreement is al- fostering of the peaceful transition to firms the need for Cuba to remedy past ready in place. democracy on that island. wrongs. Whose interest is really being The PRESIDING OFFICER. The Sen- In my view, greater contact with the protected by removing this Libertad ator is correct. Cuban people will plant the seeds of October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15319 change and advance the cause of de- my colleagues of some promises which Unfortunately, we are now using the mocracy just as greater exchange with were made to voters last November. term ‘‘corporate welfare’’ to describe the West helped hasten the fall of com- You may ask why I should be ad- instances where we have simply chosen munism in Eastern Europe. dressing this issue when we have so not to levy a tax. In other words, a tax I think it is naive to think that the much work that remains to be done on we have not voted on. The corporations measure before us today is going to the budget, but I do so because I am of this country are now being called succeed in forcing Castro to step aside, surprised that we have forgotten some corporate welfare simply because we where all other pressures have not. fundamental principles about economic have not levied the tax. However, the measures proposed in this growth which we so clearly articulated Have we been here in Washington so bill do have the serious potential of last year. long that we have forgotten the dif- further worsening the living conditions Those who embrace these basic ference between a subsidy and a tax? It of the Cuban people and once again truths are now in the majority. The is not a subsidy to allow a corporation making a mass exodus for Miami an at- consequence of abandoning that mes- to keep more of the money it has tractive option. Taken to its most ex- sage of hope and opportunity could be earned so that it can reinvest that treme, this bill could even provoke se- profound for the American people. money, which creates jobs, pays divi- rious violence on the island. Many of our colleagues are hard at dends to all shareholders, including This legislation is even more prob- work trying to balance the Federal large institutional investors respon- lematic than earlier efforts to tighten budget. This is a necessary and a dif- sible for protecting the pension funds the screws on Castro. I say this because ficult job. The American people rightly of America. its implications go well beyond United expect us to balance the budget and we The Federal Government does not States-Cuban relations. It alienates must not disappoint them. own the American people’s money. It our allies and tie the administration’s In our zeal to put our financial house does not own their land, their homes or foreign policy hands. in order we must not forget why we are their income. Failure to tax is not cor- Contact and dialog between Havana doing this in the first place. porate welfare. and Washington will bring about de- I offer this reminder: We are bal- For us to say we are doing the Amer- mocracy on the island of Cuba, not iso- ancing the budget because deficits are ican people some sort of favor by not lation and impoverishment. Perhaps if a tax on the American people. Today’s taxing some aspect of their livelihood we took that approach, our allies debt is a tax levied not only on tax- is the very height of political and gov- would be more likely to support our payers, but it is levied on future gen- ernmental arrogance. We should not policy with respect to Cuba. Today we erations. hide behind Washington doublespeak are virtually alone. We do not usually speak of budget and call it corporate welfare. The Helms-Burton bill has gone deficits as taxes, but they are. That is It we decide to raise the tax, let us through a number of changes since it very simply what they are. Deficits are call it what it is—a plain and simple was first introduced. In fact, Senator taxes. tax increase. Let us not say that we are HELMS’ substitute amendment differs Who among us would support impos- ending corporate welfare when we are, in a number of areas from the House- ing taxes on our children and grand- in fact, raising the taxes on the cor- passed bill. However, no version to date children? Yet every time we vote for porations of America. resolves the fundamental problem I deficit spending, we do very simply I find nothing noble in raising taxes. have with the direction it takes U.S. that. It misses the point of what we are try- policy. For these reasons I will vote If the deficit is a tax, then the solu- ing to do in the first place. against this bill and urge my col- tion is not an additional tax. The prob- I campaigned on spending cuts and leagues to do so as well. lem is that we are spending money that tax cuts. Closing certain corporate tax Mr. HELMS. Mr. President, I suggest we do not have on programs we do not breaks certainly increases taxes. The the absence of a quorum. need. time to address these tax breaks is The PRESIDING OFFICER. The The answer is simple. That is, to stop when we are engaged in comprehensive clerk will call the roll. The assistant the spending. tax reform such as a flat tax. Now is legislative clerk proceeded to call the Who among us is really convinced not the time to rewrite the corporate roll. that we need to raise taxes to balance Tax Code. Now is not the time to im- Mr. HELMS. Mr. President, I ask a budget? None of us. President Clinton pose an arbitrary retroactive tax in- unanimous consent that the order for supported the largest tax increase in crease on companies and, more impor- the quorum call be rescinded. American history and he now admits tantly, on their employees who partici- The PRESIDING OFFICER. Without that it was wrong. pate in a corporate-owned life insur- objection, it is so ordered. Yet our national debt continues to ance policy purchased after 1987. Mr. HELMS. Mr. President, in order grow out of control. While President The only reason some are discussing to save a little time, my distinguished Clinton has been focused on new ways tax increases now is because we failed colleague from North Carolina desires to take hard-earned money away from to make serious cuts in Government to address the Senate, and he under- the American taxpayers, I believe that spending and in corporate subsidies. We stands that Senator SIMON is on his we in Congress should focus on ways to failed to downsize, eliminate, or pri- way to discuss his pending amendment. drastically decrease spending and allow vatize boondoggles such as the Export- I ask that the Senator from North taxpayers to keep more of their money. Import Bank, the International Trade Carolina [Mr. FAIRCLOTH] be recognized The answer is to cut spending. Administration, and the Overseas Pri- for the purpose of addressing the Sen- I regret that I have begun to hear vate Investment Corporation. ate. some of my colleagues in both bodies The CATO Institute has identified The PRESIDING OFFICER. Without and on both sides of the aisle talk more than 125 corporate welfare sub- objection, it is so ordered. about raising taxes. I regret even more sidy programs which cost taxpayers The Senator from North Carolina the manner in which they talk about over $85 billion in subsidies this year [Mr. FAIRCLOTH] is recognized. raising them. Just as the deficit is a alone. This is true corporate welfare. Mr. FAIRCLOTH. Mr. President, I tax which we do not dare call a tax, a These are subsidies which we should be ask unanimous consent to speak in new term, a new euphemism has been attacking. We need to make clear and morning business for 15 minutes. invented to hide a new tax increase. distinct the difference between a sub- The PRESIDING OFFICER. Without The new tax is hiding behind the call sidy and a tax increase. We should not objection, it is so ordered. to end corporate welfare, a term whose be talking about tax increases until we f meaning has been distorted. have eliminated indefensible corporate When the Government levies a tax cash subsidies. PROMISES TO VOTERS and then uses that revenue to subsidize As you know, I strongly support dra- Mr. FAIRCLOTH. Mr. President, in certain industries or such activities, it matic reform in our Social Security so- the closing months of the first session is accurately described as corporate cial welfare programs. The worst of of this 104th Congress, I rise to remind welfare. these programs simply uses tax dollars S 15320 CONGRESSIONAL RECORD — SENATE October 19, 1995 to subsidize and promote self-destruc- CUBAN LIBERTY AND DEMOCRATIC It is interesting that every other tive behavior. SOLIDARITY [LIBERTAD] ACT OF country in the world, so far as I know, In the same way, I oppose corporate 1995 permits its citizens to travel to Cuba. welfare which uses tax dollars to sub- The Senate continued with the con- Only the United States of America does sidize companies in a manner incon- sideration of the bill. not. Listen to what President Eisenhower sistent with free market principles. AMENDMENT NO. 2934 said: ‘‘Any limitation on the right to Taking money away from individual Mr. SIMON. Mr. President, I see my travel can only be tolerated in terms of taxpayers and giving it to businesses is distinguished colleague and friend, overriding requirements of our na- simply wrong, and I support my col- Senator HELMS, on the floor. I think we tional security.’’ leagues on both sides of the aisle who each have 10 minutes to speak for our call for an end to that practice. President Eisenhower was right. The sides, in terms of the travel to Cuba de- reality is Americans can travel to As we continue our effort to balance bate. If the Parliamentarian gives us Cuba, but you have to go to Canada or the budget, I would hope that we not his OK, I will be pleased to move ahead Mexico or some other country to do it. forget the following: and take part of my 10 minutes at this We do not have the freedom the citi- The deficit is a tax on the American point. zens of every other country in the The PRESIDING OFFICER. The people and on future generations. world have, to travel to Cuba. It just clerk will report. does not make sense. To end this tax, we must balance the The assistant legislative clerk read I will add, the American Association budget. as follows: for the Advancement of Science testi- Our problem is that we have been The Senator from Illinois [Mr. SIMON] pro- spending money that we do not have on fied before the Senate Judiciary Com- poses an amendment numbered 2934 to mittee on this question and pointed programs we do not need. amendment No. 2936. out that there have been scientific We need not and should not raise Mr. SIMON. Mr. President, I ask meetings, international scientific taxes to balance the budget. Raising unanimous consent that reading of the meetings held in Cuba, where our sci- taxes will not balance the budget. It amendment be dispensed with. entists have not been able to attend. It never has. It only leads to increased The PRESIDING OFFICER. Without just does not make sense. spending. objection, it is so ordered. In one case they were able to attend, I will not vote for a tax increase, no (The text of the amendment is print- but listen to this. In order to attend a matter what it is ultimately called. ed in the RECORD of October 18, 1995.) meeting of the World Federation of En- Mr. SIMON addressed the Chair. gineering Organizations, in Havana, be- In ending deficit spending, we are Mr. HELMS. Will the distinguished ginning on October 17, 1993, they were doing the right thing—the honest Senator yield about 30 seconds for a lit- first denied licenses, and then, ‘‘Fi- thing. Let us not stray back into hid- tle housekeeping item? nally, members were granted licenses den taxes and double-talk about Medi- Mr. SIMON. I will always yield to my but not without long delays and the ne- care before we reach our goal of a bal- colleague from North Carolina. anced budget. Let us not give in to the cessity of submitting themselves to a UNANIMOUS-CONSENT AGREEMENT detailed screening process by Treasury defenders of the status quo whose polit- Mr. HELMS. Mr. President, I ask ical bankruptcy has led them to fright- Department officials.’’ All kinds of unanimous consent that when the Sen- needless paperwork. And not an Amer- en our youth and senior citizens with ate resumes consideration of the Simon false and negative rhetoric. I implore ican citizen who has gone to Canada or amendment, which it has just done, No. Mexico and traveled to Cuba has been my colleagues to abandon the rhetoric 2934, under the previous 20-minute time of tax increases and embrace spending prosecuted, sentenced to prison, or limitation, that following the expira- fined. It is just ridiculous, and we look cuts and tax cuts—to embrace smaller tion of that debate, the Senate then Government and greater individual ridiculous in the eyes of the rest of the proceeded to a vote on or in relation to world. freedom. As this Congress changes the the Simon amendment, No. 2934; and, size and cost of the Federal Govern- This limitation on Americans to further, immediately following that travel to Cuba does not do one thing in ment, it is only right that taxpayers vote, there be 4 minutes of debate, share in the dividends. That is why terms of pulling down the Castro re- equally divided in the usual form, on gime. There is not a Member of the spending cuts, deficit reduction and tax the Dodd amendments 2906 and 2908, en cuts must go hand in hand. United States Senate who believes that bloc; and following that debate, the Castro is doing what he should be doing I am a proud cosponsor of legislation Senate vote on or in relation to the for the people of Cuba. We do not like to provide tax relief to America’s fami- Dodd amendments, 2906 and 2908, en his human rights record. But I do not lies in the form of a $500 per child cred- bloc; and, further, that following that want to impose human rights restric- it. I am also a sponsor of a bipartisan vote, there be 10 minutes of debate tions on American citizens because he bill to provide a capital gains tax cut equally divided in the usual form, to be does it in Cuba. So my amendment which we all know is essential and nec- immediately followed by a vote on the simply would give American citizens essary for economic growth and new substitute amendment, to be followed the clear right to travel to Cuba. job creation. by a vote on passage of H.R. 927, as Mr. DODD. Mr. President, will my Tax cuts and spending cuts are two amended, all without any other inter- colleague yield? ways of putting more money into the vening debate or action. Mr. SIMON. I yield 2 minutes to the hands of America’s taxpayers who will The PRESIDING OFFICER. Without Senator. invest that money in our children and objection, it is so ordered. Mr. DODD. Just to engage my col- in our economy and in our country as Mr. HELMS. I thank the Senator league, I want to commend him for his a whole. Both investments contribute from Illinois. amendment. What is underlying in this to long-term fiscal responsibility. This Mr. SIMON addressed the Chair. amendment is the notion here that we is the path to real and sustained deficit The PRESIDING OFFICER. The Sen- have to start to get back to the con- reduction. It is what the voters expect ator is recognized for 10 minutes. duct of foreign policy. We are dealing and deserve. And, it is what we in Con- AMENDMENT NO. 2934 with Cuba as if this were a domestic gress owe them. Mr. SIMON. Mr. President, this issue and not a foreign policy issue. If I yield the remainder of my time. amendment says simply that Ameri- someone can explain to me why it is cans can use what I think is a constitu- that we allow unlimited travel to the The PRESIDING OFFICER. Who tional right to travel. We should not People’s Republic of China, and we yields time? restrict travel to any country unless allow unlimited travel to Vietnam— Mr. SIMON addressed the Chair. security is threatened, so that Amer- even in the case of North Korea, the The PRESIDING OFFICER. The Sen- ican citizens are not subject to simply North Koreans impose restrictions, but ator from Illinois [Mr. SIMON] is recog- propaganda from one side or from our we do not impose restrictions. Yet here nized. Government. for the island nation of Cuba, as much October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15321 as all of us find the Government there kind of involvement, that kind of con- of isolating Fidel Castro, including re- reprehensible, I think most of us be- tact, that kind of interchange is prob- strictions on travel to Cuba. Obviously, lieve that access and contact between ably something Fidel Castro worries the Simon amendment would enthu- peoples, particularly free people with more about than the adoption of this siastically do away with that restric- the people who are living under a dicta- kind of language. I suspect he may sup- tion. torship, has a tremendous impact, or port the language in this bill because it I mentioned yesterday, and I guess I can have a tremendous impact, to say is that kind of contact which he would shall reiterate today, that there are that no one in this country to the one most worry about jeopardizing the good intentions behind anything that place throughout the entire globe could foundations of his dictatorship. PAUL SIMON does. He is a gentleman. I travel makes no sense at all. So, again, I applaud my colleague regret the fact on a personal basis that Again, this is not as if we are talking from Illinois for his proposal. I suspect he has announced that he will not seek about any other country. Imagine if we we may not win in these amendments, reelection next year. But having said offered an amendment here that in- regretfully, because this is about do- that, I just cannot support his amend- cluded the People’s Republic of China, mestic policy. It is not about foreign ment. And I cannot fail to urge Sen- just add that one Communist country policy. ators to vote against it because the re- that engages in human rights viola- Mr. SIMON. I will simply add that we sult of the Simon amendment will not tions—I would argue probably far more should make policy based on the na- be the free exchange of ideas that they egregious than what occurs in Cuba, as tional interest, not national passion. talk about. The result will be to give bad as that may be—if I would offer With what we are doing, our present Fidel Castro access to new and des- that amendment to this, it would be re- policy is the opposite. perately needed hard currency. On this, soundingly defeated if we stopped peo- I reserve the remainder of my time. the State Department and I absolutely ple going to the People’s Republic of Mr. HELMS. Mr. President, I suggest agree. China today. And people would argue the absence of a quorum, and I suggest What Castro has to offer is Cuban not just in terms of our own financial that the time be charged equally. beaches. That is it. And allowing The PRESIDING OFFICER. The interests, but I think most realize Americans to sit on Cuban beach does clerk will call the roll. there is probably a greater likelihood not do anything for the Cuban people The assistant legislative clerk pro- of achieving change there because who are oppressed and from whom we ceeded to call the roll. there are those contacts. Others will hear daily pleas to enact the Libertad Mr. HELMS. Mr. President, I ask argue with that. But here we are sin- bill. The Cuban people inside of Cuba— unanimous consent that the order for gling out one country 90 miles off our and also the Cuban people in exile in the quorum call be rescinded. shore where an influx of Americans the United States and elsewhere— The PRESIDING OFFICER. Without down there might have a very positive unanimously, as far as I know, favor objection, it is so ordered. impact on encouraging people to en- the pending bill. Tourism, of course, is gage in the legitimate, political kind of ORDER FOR RECESS one of Fidel Castro’s most important activity that would create the kind of Mr. HELMS. Mr. President, I ask sources of hard currency, and for years change we would like to see there. unanimous consent that the Senate and years Castro has lured foreigners What my colleague is offering here stand in recess at 12 noon today until 4 to Cuba. This has not resulted in any makes eminently good sense. It is the p.m. and that at 4 p.m. the Senate pro- liberalizing of his regime. It has in- direction we ought to be going in. It is ceed to the votes under the previous stead resulted in less freedom and the most effective way to change the order. worse living circumstances for the Government there. I commend him for The PRESIDING OFFICER. Is there Cuban people. Old Fidel, he is ugly, and this amendment, and I ask him wheth- objection? he is blunt, and he is rough, and he is er or not he would agree with me, if he Without objection, it is so ordered. cruel, but he is not dumb. He knows knows of any other case anywhere else Mr. HELMS. Mr. President, I again the value of tourism for his regime. As in the world where we apply this. suggest the absence of a quorum on the a matter of fact, if he does not get hard Mr. SIMON. Absolutely not. It is in- same basis as the first request was cash from tourism and other aspects of teresting that it is the same debate made. operations, down he goes. And that is that we went through when we had the The PRESIDING OFFICER. The the point. We want him to go down. We Soviet Union. Should we let Americans clerk will call the roll. want to be rid of him. We want the travel there? We finally made the deci- The assistant legislative clerk pro- Cuban people to be rid of him so that sion that it might open up the Soviet ceeded to call the roll. they can establish a democratic gov- Union if we would let people travel. Mr. HELMS. Mr. President, I ask ernment there that they have not had And that was the right decision, and unanimous consent that the order for in a long, long time. that is what we are asking for here. Let the quorum call be rescinded. us make the right decision on Cuba. The PRESIDING OFFICER. Without Now, back in June, Castro began im- Mr. DODD. I point out as well that it objection, it is so ordered. posing a 100 percent tariff on all new is not just that. But Cuban-Americans Mr. HELMS. Mr. President, would articles brought into Cuba with a value themselves—first of all, I have said this the Chair state the time situation? between $100 and $1,000. And that before, Mr. President. This notion that The PRESIDING OFFICER. The Sen- means, Mr. President, if Castro offi- we are dealing with a monolithic com- ator from North Carolina has 8 min- cials, his cronies, determine that an munity here is insulting to many utes, and the Senator from Illinois has item being brought into Cuba by a Cuban-Americans. They do not like 2 minutes. tourist is new, or if it is something having people stand up here and sug- Mr. HELMS. I thank the Chair. that will be left behind when the tour- gest that every American of Cuban de- Mr. President, what I am about to ist departs, then Cuba can charge 100 scent or heritage is of totally like mind say may indicate the widest legislative percent of the cost of that item. The on these issues. Many feel that they wing span in history, but the State De- tax on tourists benefits nobody but would like to be able to go back and partment and JESSE HELMS agree on Fidel Castro and his cronies. start meeting with their families, something. Both the State Department Critics of the travel restrictions working with their families. To go and JESSE HELMS oppose the Simon argue that we should remove them through the charade of traveling to amendment. I do so respectfully—and since they are not fully enforced. I rec- Canada, going to Mexico, engaging in PAUL SIMON is my friend. We do not ognize that the Treasury Department all kinds of subterfuge in order to agree on everything, but that does not has encountered some problems in en- make contact with their families and matter. He operates in good faith, and forcing travel regulations. They prob- support them is not healthy. I try to. ably encounter some problems in en- I would suggest that if we could Let me say very briefly that during forcing a lot of regulations. The reason make it possible for Cuban-Americans the tenure or parts thereof of eight for any problem they have in this re- to go back and be with their old neigh- American Presidents, the United gard is that currently only criminal bors, friends, and family members, that States has pursued a bipartisan policy penalties can be imposed for violations. S 15322 CONGRESSIONAL RECORD — SENATE October 19, 1995 The administration supports the enact- tation conference report; legislative derstand how he can blame us for that. ment of civil penalties as the best branch appropriations, a new bill, but It was the biggest tax increase in means of enforcing existing restric- it is identical to the one vetoed by the American history. In fact, I think the tions, and that is exactly what we do in President. That will be available early Senator from New York [Mr. MOY- the Libertad bill. So there goes that to midweek; energy and water con- NIHAN] said, no, it was the biggest tax wide wingspread again from left to ference report. That conference is increase in world history, and it prob- right. going to convene next Tuesday at 9 ably was. Mr. President, I am going to reserve o’clock. We hope to finish that day and So I would ask the President today, the remainder of my time because I then take that up. We are trying to get now that he is feeling in a mood to say have one or two other points that I more and more of the appropriations he has made mistakes—and we all may want to make, but I want there to bills to the President. We hope that he make mistakes from time to time—we be enough time for Senator SIMON to would indicate he will sign the bills. would be happy to have him join us in make whatever rebuttal he wishes to f this budget debate in balancing the make. budget by the year 2002 and protecting, Mr. SIMON. Mr. President, I think if BALANCING THE BUDGET preserving, strengthening Medicare and we can, before we vote—I understand Mr. DOLE. Mr. President, before we overhauling welfare and providing tax we are going to vote at 4 o’clock. recess, I would like to take a moment cuts for families with children, the Mr. HELMS. Yes. to discuss President Clinton’s appear- very thing that the President proposed, Mr. SIMON. If each of us can have 2 ance before reporters at the White I might add. minutes, if that is satisfactory to the House this morning. About 70 percent of our total tax Senator from North Carolina, that is Republicans have been willing to credit goes to families. They are not satisfactory to me. work with the President in our efforts rich. On the Senate side we have Mr. HELMS. Mr. President, that is to finally balance the budget. Regret- capped what your total income could certainly a fair and reasonable request. tably, the President’s veto threat be if you are going to be eligible for the I ask unanimous consent that 4 min- today makes us wonder whether he is tax credit for your children. utes equally divided be provided at 4 serious about working with the con- So, Mr. President, we agree you o’clock on the Simon amendment. gressional majority to fulfill the man- raised taxes too much. We agree it hurt The PRESIDING OFFICER. Without the economy. We agree it probably cost objection, it is so ordered. date the American people gave us. If anyone needs to think again, in my a lot of jobs in America. We agree it Mr. SIMON. I would yield back the cost a lot of dislocation, a lot of pain, remainder of my time. view it is President Clinton. Rather than continuing his cynical reelection a lot of suffering. But now that you Mr. HELMS. And I yield back the re- have confessed to making that mis- campaign designed to scare the Amer- mainder of my time. I see the distin- take, let us not make another mistake. ican people, particularly senior citi- guished majority leader. I am glad to Let us work together. Let us try to bal- zens, he should show some leadership yield to the majority leader. ance the budget, Mr. President. Let us and work with us to balance the budg- Mr. DOLE addressed the Chair. try to save Medicare, Mr. President, The PRESIDING OFFICER. The ma- et, cut taxes for American families, and try to have a good tax cut for fami- jority leader is recognized. protect Medicare from bankruptcy, and lies with children and stimulate the Mr. DOLE. I understand the chair- overhaul welfare. economy with the capital gains rate re- man has gotten the consent that we If any plan puts America’s elderly at duction, and then reform welfare, stand in recess at noon until 4 p.m. risk, it is the President’s plan, which which the President indicates he sup- I might explain to my colleagues, the fails to offer any long-term reforms, purpose of this is so that the Finance ports. any choices for seniors, and any real We are prepared. I know the Speaker Committee can complete action on the solutions, just sort of a Band-Aid to is prepared. I hope that we might have tax cut package. They agreed yester- get us beyond the next election in 1996. some cooperation. day to have 7 hours and then they I think it is interesting that the I yield the floor. And I think it is 12 would vote. They started at 9 o’clock President confessed this week he raised o’clock. this morning. We cannot get consent taxes too much in 1993. I think a $265 f for the Finance Committee to meet billion tax increase is a bit too much. while the Senate is in session, so we It affected senior citizens, people who RECESS UNTIL 4 P.M. have no recourse but to let the Finance drive automobiles, subchapter S cor- The PRESIDING OFFICER. The hour Committee meet all afternoon. But porations, a lot of Americans who did of 12 o’clock having arrived, the Senate right now they are moving along at a not consider themselves rich until the stands in recess until 4 p.m. pretty rapid pace, and they would like President announced that only the rich Thereupon, at 12 noon, the Senate re- to complete action. Hopefully, at 4 pay taxes. But he has learned since 1993 cessed until 4 p.m.; whereupon, the o’clock, they could finish and the Sen- that other people pay these increased Senate reassembled when called to ate could come in and, as I understand, taxes, too, who are not rich, when he order by the Presiding Officer (Mr. there will be three votes and then final increased taxes on Social Security, THOMPSON). passage. when he increased taxes on gasoline, f Then after that we will hopefully when he increased taxes on subchapter take up the Labor, HHS appropriations S corporations, and a number of other CUBAN LIBERTY AND DEMOCRATIC bill or, if there has been any progress, people who were not rich. SOLIDARITY [LIBERTAD] ACT OF State Department reorganization. I un- So I think now that he has confessed 1995 derstand there is another meeting, the he made a mistake on raising taxes, he The Senate continued with consider- chairman has another meeting this ought to confess he has made a mis- ation of the bill. afternoon at 2 o’clock. So hopefully we take on not wanting to adopt a bal- AMENDMENT NO. 2934 can finish action this afternoon on the anced budget. He fought us in an effort The PRESIDING OFFICER. The tax cut package. Chairman ROTH and to pass a constitutional amendment to pending business is the Simon amend- the ranking member, Senator MOY- balance the budget. He convinced six ment numbered 2934. There are 4 min- NIHAN, are trying to get that done by 4 Democrats who voted for a balanced utes of debate equally divided. o’clock. That would go to the Budget budget last year to vote no this year. Mr. HELMS. Mr. President, I suggest Committee. It is our hope that next We lost by one vote. We had 66. We the absence of a quorum. Wednesday we will take up the rec- needed 67. The PRESIDING OFFICER. The onciliation package on the Senate So it seems to me the President is clerk will call the roll. floor, Wednesday and Thursday. In the now saying, well, I raised taxes too The legislative clerk proceeded to meantime, we have a number of items much but it was not my fault; Repub- call the roll. on which we hope to complete action. licans are responsible. Not a single Re- Mr. SIMON. Mr. President, I ask I would also indicate that we will publican in the House or the Senate unanimous consent that the order for have, hopefully, next week a Transpor- voted for the tax increase. I do not un- the quorum call be rescinded. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15323 The PRESIDING OFFICER. Without tion to who will fall within those three Roth Smith Thompson objection, it is so ordered. categories and will receive authoriza- Santorum Snowe Thurmond Sarbanes Specter Warner Mr. SIMON. Mr. President, our par- tion to travel to Cuba. Shelby Stevens liamentary situation now I believe is The basic prohibition on general Simpson Thomas that I have 2 minutes to speak on be- travel is a cornerstone of the United NAYS—25 half of my amendment and my col- States’ effort to isolate the dictator- Akaka Harkin Moseley-Braun league from North Carolina has 2 min- ship in Cuba while we were attempting Baucus Hatfield Moynihan utes to speak in opposition. to reach out to the people of Cuba with Bingaman Inouye Murray The PRESIDING OFFICER. The Sen- a hand of friendship. If we were to Boxer Jeffords Pell Bumpers Johnston Pryor ator is correct. eliminate this prohibition on travel, we Dodd Kennedy Mr. SIMON. Mr. President, this is a Simon would be pouring dollars into Castro’s Dorgan Kerrey Wellstone fairly clear and simple issue: Do we fol- thin coffers, dollars which would allow Feingold Leahy low the advice of people like President him to continue to operate the most Feinstein Levin Eisenhower who said, ‘‘Any limitation repressive state security apparatus left NOT VOTING—1 on the right to travel can only be toler- in the world, one which has set new Biden ated in terms of overriding require- standards for human rights abuses. We So the motion to lay on the table the ments of our national security.’’ would also prop up his regime against amendment (No. 2934) was agreed to. Americans can travel to North Korea the inexorable forces which are leading Mr. HELMS. Mr. President, I move to and China. Name the dictatorship any- toward its downfall. reconsider the vote. where, we can travel there. The one Mr. President, I urge the defeat of Mr. BYRD. I move to lay that motion country we cannot: Cuba. Citizens of this amendment by adopting the mo- on the table. every other country in the world can tion that I will offer to table the Simon The motion to lay on the table was travel to Cuba, but Americans cannot amendment. agreed to. do it legally. The PRESIDING OFFICER. Does the AMENDMENTS NOS. 2906 AND 2908 Now, we can go by way of Mexico or Senator from Illinois wish to use his The PRESIDING OFFICER. Under Canada and violate the law and do it, remaining 25 seconds? but that should not be the way we do the previous order, the question now Mr. SIMON. Mr. President, the as- occurs on the en bloc consideration of things around here. sistance to Castro in terms of economic It is very interesting that in the So- amendments numbered 2906 and 2908 of- terms is almost nil. What this amend- fered by the Senator from Connecticut viet Union we had this same question: ment does is give Americans the free- Should we cut them off and isolate [Mr. DODD]. Debate is limited to 4 min- dom that citizens in every other coun- utes equally divided in the usual form. them, or should we have American visi- try in the world have: To travel to tors who go there and help to amelio- Mr. DODD addressed the Chair. Cuba. I think that ought to be a basic The PRESIDING OFFICER. The Sen- rate their policy? We, fortunately, right of Americans—to travel to any made the right decision that Ameri- ator from Connecticut. country where there is not a security Mr. DODD. Mr. President, very brief- cans could travel there. That should be threat. what we do today. ly, the amendments we are about to The PRESIDING OFFICER. The Sen- vote on, or two amendments which Americans ought to have the right to ator from Florida. travel anywhere where there is not a were combined en bloc, deal with the Mr. GRAHAM. Mr. President, I move issue of title II of this bill. security risk for Americans. That to table the Simon amendment and ask ought to be part of the freedom that Regardless of how anyone feels about for the yeas and nays. the present government in Cuba, title every American has. The PRESIDING OFFICER. Is there a Mr. President, I know there will be a II of this bill does not deal with the sufficient second? motion to table. I hope, despite that Castro government in Cuba. It deals There is a sufficient second. motion, the amendment will be agreed with the next government in Cuba. It The yeas and nays were ordered. to. says that the next government in Cuba Mr. HELMS. Mr. President, I said The PRESIDING OFFICER. The must meet a set of four pages of cri- earlier this morning when Senator question is on agreeing to the motion teria before we can provide even transi- to table the SIMON amendment. SIMON and I were on the floor together tional assistance to the next govern- that this amendment has prompted the The yeas and nays have been ordered. ment in Cuba. widest political legislative extremes in The clerk will call the roll. Mr. President, I do not know what history: The State Department and The legislative clerk called the roll. the next government in Cuba is going JESSE HELMS agree it is a very bad Mr. FORD. I announce that the Sen- to look like. Hopefully, it will be a amendment. ator from Delaware [Mr. BIDEN] is nec- democratic government. But it seems I believe the distinguished Senator essarily absent. to me that we ought not to be condi- from Florida [Mr. GRAHAM] will move The PRESIDING OFFICER. Are there tioning our assistance on some future to table. any other Senators in the Chamber de- government in Cuba in this piece of This amendment undercuts the em- siring to vote? legislation. bargo that has been in effect for eight The result was announced—yeas 73, Whatever else we may want to do to Presidents. It does not help the Cuban nays 25, as follows: the Castro government, why would we people. Tourism will not change Cas- [Rollcall Vote No. 492 Leg.] want to tie the hands of this adminis- tro. In fact, it will merely contribute YEAS—73 tration or future administrations when to Castro’s economic status a little bit. Abraham DeWine Kassebaum you have a change in Cuba? If we ap- I hope that the Senate will vote to Ashcroft Dole Kempthorne plied the same rules and the same cri- table the amendment. I say that with Bennett Domenici Kerry teria that are located in title II of this Bond Exon Kohl all due respect to my friend and neigh- Bradley Faircloth Kyl bill, we would not be able to provide bor, PAUL SIMON. Breaux Ford Lautenberg the transitional assistance to many of I yield back the balance of my time. Brown Frist Lieberman the New Independent States that have Mr. GRAHAM. If I could use the re- Bryan Glenn Lott emerged after the collapse of the So- Burns Gorton Lugar maining time of Senator HELMS for the Byrd Graham Mack viet Union. purpose of a couple of points. First, the Campbell Gramm McCain I urge my colleagues in the next few current Cuban Democracy Act provides Chafee Grams McConnell minutes to just read sections 205 Coats Grassley Mikulski for limited travel under controlled cir- Cochran Gregg Murkowski through 208 of this bill. They are four cumstances to Cuba by three groups of Cohen Hatch Nickles pages of criteria. Whatever else you Americans: those who are traveling for Conrad Heflin Nunn may feel about Fidel Castro, however educational, religious, or humanitarian Coverdell Helms Pressler you want to change the government in Craig Hollings Reid purposes. The President, within the D’Amato Hutchison Robb Cuba, do not make it impossible for last 2 weeks, has given greater defini- Daschle Inhofe Rockefeller this administration or the next one to S 15324 CONGRESSIONAL RECORD — SENATE October 19, 1995 deal effectively with that new govern- Mr. DODD. I yield back my time. The PRESIDING OFFICER. There ment. This amendment strikes those The PRESIDING OFFICER. The time are 10 minutes of debate on the Helms sections of the bill, and I urge adoption has been yielded back. amendment. of the amendment. The question now occurs on agreeing Mr. DOLE. Mr. President, we are Mr. HELMS addressed the Chair. to the motion to table the amendments about to conclude action on the Cuban The PRESIDING OFFICER. The Sen- numbered 2906 and 2908, en bloc. The Liberty and Democratic Solidarity ator from North Carolina. yeas and nays have been ordered. The Act. The Senate has spent a week on Mr. HELMS. I yield 30 seconds to the clerk will call the roll. this bill. We had three cloture votes. A distinguished Senator from New Jer- The legislative clerk called the roll. sustained lobbying campaign by the sey. Mr. FORD. I announce that the Sen- White House forced Chairman HELMS to The PRESIDING OFFICER. The Sen- ate from Delaware [Mr. BIDEN] is nec- delete a significant section of the bill. ator from New Jersey. essarily absent. The Senate will pass the bill today, and Mr. BRADLEY. Mr. President, I rise The PRESIDING OFFICER. Are there the conference will certainly address in opposition to the amendment by the any other Senators in the Chamber de- the issue of stolen property. Senator from Connecticut. Title II is siring to vote? I am confident that the House-Senate authored by the only Cuban-American The result was announced—yeas 64, conference will be able to find a way to Democrat in the Congress, BOB nays 34, as follows: prevent Fidel Castro from using foreign MENENDEZ of New Jersey. For once, we [Rollcall Vote No. 493 Leg.] investment to prolong his tyranny. should be ready when the commander YEAS—64 That is the issue—do we want to allow of a Communist dictatorship falls. All Abraham Ford McCain the hemisphere’s last dictator to re- this says is when the dictatorship falls, Ashcroft Frist McConnell place his lost aid from the Soviet em- we should have in place emergency re- Bennett Gorton Murkowski pire with western investment? The Bond Graham Nickles Senate will have another chance to ad- lief measures and assistance that will Bradley Gramm Pressler effect the transition from a command Breaux Grams Reid dress this issue when the conference re- economy to a market economy, from a Brown Grassley Robb port comes back. Bryan Gregg Rockefeller We should be clear on what is still in totalitarian state to a democracy. It Burns Hatch Roth says for once let us be ready when a Campbell Helms this bill. Title I strengthens the inter- Santorum Communist dictator falls. Coats Hollings national embargo on Cuba. It requires Cochran Hutchison Shelby Mr. HELMS addressed the Chair. Simpson the United States to oppose Cuban Cohen Inhofe membership in international financial The PRESIDING OFFICER. The Sen- Conrad Kassebaum Smith ator from North Carolina. Coverdell Kempthorne Snowe institutions. It conditions aid to Rus- Mr. HELMS. In that connection, let Craig Kerry Specter sia on an end to support for Cuba. It me read one paragraph from a letter D’Amato Kyl Stevens tightens the restrictions against the DeWine Lautenberg Thomas dated today by Congressman MENENDEZ Dole Lieberman Thompson importation of Cuban sugar. And it au- to the distinguished minority leader, Domenici Lott Thurmond thorizes assistance to the real victims Mr. DASCHLE: Dorgan Lugar Warner of Castro’s repression—the Cuban peo- Faircloth Mack Dear Mr. DASCHLE. As the author of title II ple. of the Helms-Burton Libertad legislation and NAYS—34 In the debate, some of the advocates the only Cuban American Democrat in the Akaka Glenn Mikulski of lifting the embargo have said this Congress, I am writing to urge you to vote Baucus Harkin Moseley-Braun bill looks backward, that this bill does against the Dodd amendments which seek to Bingaman Hatfield Moynihan not respond to current conditions. gut title II of the legislation. Boxer Heflin Murray Bumpers Inouye Nothing could be further from the I yield the remainder of my time to Nunn Byrd Jeffords Pell truth. Title II of the bill requires the the distinguished Senator from Flor- Chafee Johnston Pryor President to look ahead—to look at the ida. Daschle Kennedy Sarbanes inevitable post-Castro period. Title II Dodd Kerrey Mr. GRAHAM addressed the Chair. Simon Exon Kohl provides for support for a free and inde- Wellstone The PRESIDING OFFICER (Mr. Feingold Leahy pendent Cuba and authorizes suspen- BURNS). The Senator from Florida. Feinstein Levin sion for the embargo and other restric- Mr. GRAHAM. Mr. President, I, too, NOT VOTING—1 tions once a transitional government is rise in opposition to the amendments Biden in place. Title II also provides incen- offered by our colleague from Connecti- tives for a truly democratic govern- So the motion to lay on the table the cut. This proposal lays out a rational ment in Cuba. amendments (Nos. 2906 and 2908) was transition from the current authoritar- So I think the President, the Senate ian Communist regime to what we hope agreed to. is going to speak loudly today—in sup- Mr. HELMS. Mr. President, I move to will soon be a democratic and market- port of the Cuban people and in opposi- place political and economic system in reconsider the vote. Mr. DOLE. I move to lay that motion tion to Fidel Castro. He should know Cuba. It is consistent with the provi- on the table. that as he prepares to come to New sions that were contained in the Cuban The motion to lay on the table was York for whatever he is going to do at Democracy Act which was passed by agreed to. the United Nations. The White House this body by an overwhelming vote in Mr. DOLE. Mr. President, what is the has made its views known. By allowing 1993, but it continues the dual track of pending business? Fidel Castro to enter the United the United States providing pressure The PRESIDING OFFICER. Pending States, and by vigorously lobbying against the regime in Cuba while it is the Helms amendment. against this bill, there is no doubt opens up to the people of Cuba, includ- Mr. DOLE. I ask that the yeas and where they stand. Today, the Senate ing opening up with a clear statement nays be vitiated. can make its views known, and I urge of how we will assist the transition to The PRESIDING OFFICER. Without my colleagues to support the bill. democracy. objection, it is so ordered. I thank Senator HELMS for his out- Mr. President, I move to table the Mr. DOLE. Have the yeas and nays standing work on this issue. amendments of the Senator from Con- been ordered on final passage? Mr. DODD. Mr. President, I said at necticut. The PRESIDING OFFICER. They the very outset of this debate that I ask for the yeas and nays. have not. when we consider legislation aimed at The PRESIDING OFFICER. Is there a Mr. DOLE. I ask for the yeas and a foreign country, we ought to ask our- sufficient second? nays on final passage. selves two basic questions. Is what is There is a sufficient second. The PRESIDING OFFICER. Is there a being proposed in the best interest of The yeas and nays were ordered. sufficient second? our Nation, and is it likely to achieve The PRESIDING OFFICER. The time There is a sufficient second. the desired results in the country in has expired under the control of the The yeas and nays were ordered. question—in this case, Cuba? Senator from North Carolina. The Sen- Mr. DOLE. How much time is left on I have had grave concerns, Mr. Presi- ator from Connecticut has 21 seconds. the Helms amendment? dent, about title III of this bill. That October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15325 section has been taken out. I thank my Castro. Once again, we have managed The amendment (No. 2898), as amend- colleagues for supporting us in that ef- to make him larger than life. Once ed, was agreed to. fort. Notwithstanding, however, Mr. again, we have given him excuses on The PRESIDING OFFICER. The President, this changed. The two basic why his government has failed and why question is on the engrossment of the questions I raised at the outset of these the Cuban economy is in a shambles. amendments and third reading of the remarks remain. In my view, the an- Once again, we will force our allies to bill. swer to both of those questions, if one come to his defense because they pro- The amendments were ordered to be reads this bill carefully, is ‘‘no.’’ foundly disagree with our tactics. None engrossed and the bill to be read a It is not in our interest to complicate of this, Mr. President, makes any sense third time. our relations with the governments of whatsoever. We all know that to be the The bill was read a third time. Russia or other New Independent State case, but frankly, to state it bluntly, The PRESIDING OFFICER. The bill countries. Yet, provisions of this bill because of domestic political consider- having been read the third time, the would do just that by linking our as- ations, we continue to take actions question is, Shall the bill pass? sistance to these countries, to their counterproductive to our own self-in- The yeas and nays have been ordered, policies toward Cuba. We provide, Mr. terest. I urge defeat of this amend- and the clerk will call the roll. President, assistance to Russia, and ment. The legislative clerk called the roll. other of the New Independent States, I yield the floor. Mr. FORD. I announce that the Sen- because we want to see them carry out The PRESIDING OFFICER. Who ator from Delaware [Mr. BIDEN] is nec- the kinds of programs that we are yields time? essarily absent. funding, because we want to continue Mr. HELMS. What is the time situa- The PRESIDING OFFICER. Are there to strengthen their still fragile demo- tion, Mr. President? any other Senators in the Chamber de- cratic institutions. Conditioning, Mr. The PRESIDING OFFICER. The Sen- siring to vote? President, that assistance on what is ator from North Carolina has 3 minutes The result was announced—yeas 74, going on in Cuba, I think, is counter- 34 seconds. The Senator from Connecti- nays 24, as follows: productive. cut has a minute 26 seconds. [Rollcall Vote No. 494 Leg.] Provisions of this bill ultimately Mr. HELMS. Mr. President, passage YEAS—74 hinge on our arms control treaties with of the Libertad bill will send a message Abraham Faircloth Lugar Russia, specifically, on Russian ver- that Congress wants a tightening of Ashcroft Ford Mack Baucus Frist McCain ification of United States compliance. the screws on Fidel Castro. Bennett Glenn McConnell While it is certainly legitimate for the Castro knows that this bill will expe- Bond Gorton Mikulski United States to discuss the types of dite his departure from power. Why on Bradley Graham Murkowski Earth would Castro have launched such Breaux Gramm Nickles activities that appropriately fall with- Brown Grams in the scope of verification of arms a huge campaign against this bill if it Pressler Bryan Grassley Reid control treaties, that should be done wasn’t harmful to his rule? He knows Burns Gregg Robb Campbell Hatch bilaterally with the Government of that the Libertad Act will help set the Rockefeller Chafee Heflin Roth Russia, not unilaterally imposed by the Cuban people free—free from oppres- Coats Helms Santorum Congress in the context of a debate sion, free from communism, free from Cochran Hollings Cohen Hutchison Sarbanes about Cuba. Castro’s dictatorship. Shelby Other provisions of this bill bar As several principal cosponsors of Conrad Inhofe Coverdell Kassebaum Simpson Cuban participation in international fi- this bill have already stated on this Craig Kempthorne Smith nancial institutions until after democ- floor, including Senators DOLE and D’Amato Kerrey Snowe Specter racy has been established in that coun- GRAMM, we are going to fight hard— Daschle Kerry DeWine Kohl Stevens try. We all know, Mr. President, the and I mean very hard—to keep the Dole Kyl Thomas critical roles played by the World Bank pressure on Castro—and on this admin- Domenici Lautenberg Thompson and International Monetary Fund in istration to work for Castro’s removal. Dorgan Lieberman Thurmond the early days of Russia’s transition to Mr. President, let me say this: Fidel Exon Lott Warner democracy. It is foolhardy, Mr. Presi- Castro is going to come to New York NAYS—24 dent, to prohibit the IMF and the City this weekend to address the Unit- Akaka Harkin Moseley-Braun World Bank from offering their assist- ed Nations. Since the State Depart- Bingaman Hatfield Moynihan ment has just given Mr. Castro a visa Boxer Inouye Murray ance and expertise to a post-Castro Bumpers Jeffords Nunn government as it grapples with the to enter this country, I want to give Byrd Johnston Pell complicated task of dismantling a Mr. Castro an early Christmas gift to Dodd Kennedy Pryor command economy. be delivered to the people of Cuba—a Feingold Leahy Simon Mr. President, I have already men- gift called the Libertad Act, on which Feinstein Levin Wellstone tioned those provisions of the bill we will vote final passage in a moment. NOT VOTING—1 which my amendment would have I yield the remainder of my time. Biden sought to strike, provisions that se- Mr. DODD. Mr. President, I point out So the bill (H.R. 927), as amended, verely limit the flexibility of the Unit- that Richard Nixon also gave Fidel was passed. ed States to respond to the change in Castro a visa to come to this country. [The text of the bill will appear in a Cuba when it comes. This bill could That kind of political rhetoric does not future edition of the RECORD.] also have the United States spend more advance our cause. He is going to be Mr. HELMS. Mr. President, I move to money on TV Marti, this time convert- larger than life when he comes to the reconsider the vote by which the ing from VHF to UHF broadcasting. We United Nations. What we do here today amendment was agreed to. all know that TV Marti has been a is going to make him a hero when he Mr. COCHRAN. I move to lay that complete failure. GAO report after comes to the United Nations. I regret motion on the table. GAO report after GAO report has found that. I yield back my time. The motion to lay on the table was that it is totally ineffective, that vir- The PRESIDING OFFICER. Under agreed to. tually nobody watches it, and that it is the previous order, the question is on (At the request of Mr. FORD, the fol- a total waste of taxpayer money. agreeing to amendment No. 2936 by the lowing statement was ordered to be More than just the individual provi- Senator from North Carolina [Mr. printed in the RECORD.) sions of the bill, Mr. President, the en- HELMS]. ∑ Mr. BIDEN. Mr. President, a serious tire thrust of this legislation makes no The amendment (No. 2936) was agreed family emergency in Pennsylvania has sense whatsoever. Calling Castro to. required me to leave this afternoon on names does not get Cuba any closer to The PRESIDING OFFICER. The the spur of the moment. Had I been democracy. We have spent a week de- question is on agreeing to the sub- present, I would have voted against the bating this. It is too long. stitute amendment No. 2898, as amend- amendments offered by Senator SIMON Perhaps the only individual who will ed, offered by the Senator from Kansas and Senator DODD, and in favor of final truly benefit from this debate is Fidel [Mr. DOLE]. passage of the bill.∑ S 15326 CONGRESSIONAL RECORD — SENATE October 19, 1995 Mr. KERRY. Mr. President, I do not that changes entitlement programs as culation—‘‘the CBO would project an want my vote for final passage of H.R. well as the appropriated bills that have on-budget deficit of $98 billion in the 927, the Cuban Liberty and Democratic passed the Congress which is about to year 2002.’’ Solidarity Act to be misunderstood. I take place. I hope that we will have an Now, I have an 8-year-old son who, was strongly opposed to the center- opportunity as we approach that period when we last went to Toys ’R Us, was piece of the legislation—title III. This to talk about some of the changes that fascinated by vanishing ink. We passed title would have altered 45 years of we foresee and the resulting influence this little thing. They sell vanishing international and domestic law and that it is going to have for good on the ink. He said, ‘‘Daddy, how do they do practice with respect to the resolution fiscal policies of the country, as well as that?’’ I said of claims resulting from the expropria- the effect on interest rates, the effect I do not really know. I know it is simple. tion of U.S. property abroad. I sup- on the general overall economic envi- It does not cost very much. We could buy it ported efforts to ensure that that title ronment for job creation and business and take it home. But I do not know how was deleted from the bill. activity, which will be positive and they do vanishing ink. I will oppose any conference report continue to move us in the right direc- I could tell my son that we do not that restores this title or adds draco- tion in terms of economic growth and have to stop at Toys ’R Us. We have nian provisions. I will join with my col- economic well-being as a nation. folks who have Ph.D.’s that know how leagues in utilizing all parliamentary But I congratulate the distinguished to deal with vanishing ink. procedures to ensure that a conference chairman of the Budget Committee, Here we have an October 18 letter report containing what was title III is Senator DOMENICI, for his good work that says: ‘‘You Republicans have not enacted into law. and his strong leadership in bringing us asked me, an appointee of the Repub- f to this point. We look forward to the licans, how has our plan fared in your debate on the resolution. eyes?’’ And you said, ‘‘Well, we think MORNING BUSINESS Several Senators addressed the you are doing real good. In fact, you Chair. Mr. COCHRAN. Mr. President, I ask, have produced a surplus.’’ at the request of the Republican leader, The PRESIDING OFFICER. The Sen- We sent a letter to the same person unanimous consent that there now be a ator from North Dakota. who said: period for the transaction of routine f morning business during which Sen- But if you do this the right way, if you cal- ators may speak for up to 10 minutes RECONCILIATION LEGISLATION culate this the right way and do not take the Mr. DORGAN. Thank you, Mr. Presi- Social Security trust funds, because you can- each. not misuse those, those are Social Security The PRESIDING OFFICER. Without dent. It is a timely opportunity to take trust funds, do not bring them over here in objection, it is so ordered. the floor to follow my friend from Mis- the operating budget, that that is the way f sissippi. you do it, that is the way the law requires My friend from Mississippi was that you do it. THE BUDGET RECONCILIATION quoting from a letter dated October 18 Then what happens is the same per- Mr. COCHRAN. Mr. President, I was from the CBO signed by Director June son 1 day later says, ‘‘By the way, in just looking at a letter that was given O’Neill. It is a letter that says that the year 2002 there is not a balanced to me by the chairman of the Budget based on those estimates—referring to budget. There is a $98 billion deficit.’’ estimates in the letter—using the eco- Committee, the Honorable Senator Mr. BUMPERS. Will the Senator nomic and technical assumptions un- from New Mexico [Mr. DOMENICI], ad- yield for a question? vising that the Congressional Budget derlying the budget resolution and as- Mr. DORGAN. I would be happy to Office has had an opportunity to review suming—this is the way economists yield. the budget reconciliation package that talk—the level of discretionary spend- Mr. BUMPERS. The thing even more has been assembled and will be pre- ing specified in that resolution, the perplexing on the point which the Sen- sented to the Senate, we assume during CBO projects that enactment of the ator from North Dakota raises is this. next week. The good news is that the reconciliation legislation submitted to This is the conference report of the Congressional Budget Office’s analysis the Budget Committee would produce a budget bill. Let me read it. It says: of the bill as assembled at this point, small budget surplus in the year 2002. assuming that the tax bill being re- The Senator is quite correct about Section 205 of the conference agreement re- ported in the Finance Committee is what this letter said. That is dated yes- quires the chairman of the Budget Commit- tee to submit the committee’s responses to within the budget reconciliation tar- terday. Let me, however, read a letter dated the first reconciliation instruction to the gets, not only will achieve a balanced Congressional Budget Office. budget by the year 2002 but will actu- today signed by the same person, the So the committee has to send all of ally result in a small surplus. Director of the Congressional Budget The letter from the Director of the Office, June O’Neill. This is in response these things to the Congressional Congressional Budget Office goes into to a letter that Senator CONRAD and I Budget Office. more detail with the analysis that she wrote to her yesterday saying: Next sentence, if the Congressional and her staff have made of this rec- This is a curious letter you have sent to Budget Office ‘‘certifies’’—this is the onciliation package. But I hope that Congress, saying it is going to produce a sur- operative word—if the Congressional between now and next week, when the plus. Would you please tell us what the im- Budget Office certifies that these legis- Senate will have an opportunity to pact of the reconciliation bill will be on this lative recommendations will reduce country’s fiscal policy? In other words, what take up and debate the reconciliation spending by an amount that will lead kind of surplus or deficit will we have if you to a balanced budget by the year 2002, bill, Senators will review these docu- follow the law that exists in this country, in ments and the analysis that has been fact, the law written by the Senator from the second reconciliation instruction is done, because this is the centerpiece of South Carolina, Senator Hollings, that says triggered. the effort to achieve the balanced you cannot use Social Security trust funds If you read the letter from the Con- budget by the target that was set in as revenues to balance the budget? gressional Budget Office, she does not the budget resolution that has passed So we sent the letter to Director certify anything; she projects a bal- both Houses and is reflected in the con- O’Neill of the Congressional Budget Of- anced budget. ference report that earlier passed the fice, and here is the letter we received Mr. DORGAN. Only yesterday. Congress. today from the Congressional Budget Today, there is a deficit. This is the centerpiece, this is the Office, this afternoon. The letter says Mr. BUMPERS. But the point is, cer- heart and soul of the effort to achieve in the first paragraph—the same kind tification is a certification. You look a balanced budget. And we are about to of language from economists—‘‘Exclud- in the dictionary. It says: ‘‘certifies: to embark upon a very historic debate for ing an estimated off-budget surplus of be accurate.’’ I could project a bal- the first time in anybody’s memory on $108 billion’’—translated, it means by anced budget. But certification and a plan to actually achieve an annual and large excluding the Social Security projection are two entirely different operating budget that is in balance, trust fund surplus in 2001 from the cal- words. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15327 I wrote her a letter, and I think the Well, of course, they do not have a and the response given to their inquiry Senator from North Dakota, my col- balanced budget. They do not have a by the Director of the Congressional league, and several others of us sent a balanced budget by the law of the Unit- Budget Office. letter to her saying: ed States. They do not have a balanced While my distinguished colleague When you send this letter over, you should budget that any accountant would any- from Mississippi congratulated the be very careful to make sure that you are ab- where certify to in America. chairman of the Budget Committee, I solutely certain that all of this is going to I say to my colleague, is it not inter- was sorry that I could not join in those lead to a balanced budget, because you have esting the difference a day makes, from congratulations, and I wish to explain been instructed not to project but to certify. a surplus to a massive deficit in the in a very dignified way just exactly Mr. DORGAN. I wonder if the Sen- year 2002 under the Republican plan? why. ator might let me reclaim my time. There is no balanced budget here, just On July 10, 1990, we voted in the Mr. BUMPERS. I would be happy to. a big fraud. Budget Committee by a vote of 20 to 1 Mr. DORGAN. That is a great point. Mr. HOLLINGS addressed the Chair. to put the Social Security trust fund I want to say Harry Truman—you Mr. DORGAN. Mr. President, let me off budget—20 yeas, 1 nay. The one nay know, a fine-spoken guy from Inde- just make one additional comment and was the distinguished Senator from pendence, MO, could not always follow yield the floor. Texas, Mr. GRAMM, but the distin- all of the logic, or at least the pre- Mr. HOLLINGS. I am sorry. guished present chairman of the Budg- Mr. DORGAN. We will talk a little sumed logic, by the Congress. He fi- et Committee, Senator DOMENICI, voted nally says in exasperation bit more about this next week. The for my Social Security preservation only reason we bothered to do this is For God’s sake, give me a one-armed econ- amendment. omist. I am so tired of hearing economists because some of us yesterday found it I ask unanimous consent to include saying ‘‘on the one hand’’ and ‘‘on the other not believable, those who held up with the committee rollcall in the RECORD. hand.’’ Give me a one-armed economist. great pride this missive from the CBO. There being no objection, the vote Here it is. If Harry Truman were We felt if you are going to misuse the was ordered to be printed in the here, he would say, This is, on the one Social Security trust funds to the tune RECORD, as follows: of $100 billion in the year 2002, there is hand, yesterday. This plan produces a JULY 10, 1990—HOLLINGS MOTION TO REPORT surplus. But, on the other hand, today, a law on the books—and the law was THE SOCIAL SECURITY PRESERVATION ACT written, incidentally, by the Senator when asked by Senator CONRAD and The Committee agreed to the Hollings mo- myself, if you really do it right, the who will speak now, the Senator who is tion to report the Social Security Preserva- way the law requires, then how does it now standing—which says you cannot tion Act by a vote of 20 yeas to 1 nay: add up? use the Social Security trust fund. Why would we do that? Because So- Yeas Nays Well, on the other hand, this pro- cial Security trust funds come out of duces a $98 billion deficit in the year Mr. Sasser Mr. Gramm people’s paychecks and they are dedi- 2002. Mr. Hollings cated to go into a trust fund to be used My son tonight is going to be real ex- Mr. Johnston only for one purpose and no other pur- cited to hear that you can get this Mr. Riegle pose, Social Security. We are creating Mr. Exon right in the Senate without paying for a surplus because we need it for the fu- Mr. Lautenberg it—vanishing ink, 24 hours, a new let- ture. It is one of the few responsible Mr. Simon ter, a new projection. This is not a bal- things we have done in the last 15 Mr. Sanford anced budget. It is a $100 billion deficit Mr. Wirth years. That surplus under today’s budg- Mr. Fowler in the year 2002. et scheme is now being used as revenue Mr. CONRAD. Will the Senator yield Mr. Conrad in the operating budget, and that is the Mr. Dodd for a question? basis on which yesterday’s letter was Mr. DORGAN. I will be happy to Mr. Robb issued improperly. Today we say issue Mr. Domenici yield. it properly and then tell us what the Mr. Boschwitz Mr. CONRAD. Is it not amazing what impact is. Mr. Symms a day makes? Mr. President, I yield the floor. Mr. Grassley Yesterday, the American people were The PRESIDING OFFICER. The time Mr. Kasten told, you enact the Republican plan, of the Senator from North Dakota has Mr. Nickles Mr. Bond you have a balanced budget. You even expired. have a little bit of a surplus. But when The Senator from South Carolina. Mr. HOLLINGS. I thank the Chair. we asked the question, yes, but what if Mr. HOLLINGS. I thank the Chair. On October 18, 1990, I toiled alongside you obey the law of the United States, f the distinguished Senator from Penn- which says you cannot count Social Se- sylvania, our late, wonderful Senator curity surpluses—and, of course, the NO BALANCED BUDGET and friend, John Heinz. He had been reason you cannot count Social Secu- Mr. HOLLINGS. Mr. President, let working diligently on this issue as rity surpluses is because no accountant me first congratulate the distinguished well. He was not on the Budget Com- anywhere would allow you to take the Senator from North Dakota, Senator mittee, but I said to John, if you can reserve funds, the retirement funds of DORGAN, and the distinguished Senator get the votes on the Republican side, I your people, and throw those into the from North Dakota, Senator CONRAD. think we can really finally fix this pot and call it a balanced budget. That These two gentlemen have been per- problem. It needed fixing because ev- is why we have a law that says you sistent on this issue, and this particu- eryone had been playing games. cannot count the Social Security sur- lar Senator from South Carolina is The truth of the matter is, Mr. Presi- plus. And when you ask the question, most grateful because for a long time I dent, that beyond using the surpluses what do you do if you obey the law? have felt a little like a Johnny One in the Social Security trust fund, an- then the head of the Budget Office Note. I took the floor 2 days ago and other $12 billion comes from other comes back and says, including an esti- now again today to reiterate what Sen- trust funds. They use the highway mated off-budget surplus of $180 billion, ator DORGAN just said—namely, that trust fund. They use the airport and which is the Social Security surpluses, the Republican budget is not balanced. airways trust fund, the civil service re- CBO would project an on-budget deficit A couple weeks ago, when we were tirement, the military retirement trust of $98 billion in 2002—$98 billion. In passing the State, Justice, Commerce fund. You can go right on down the fact, the Republican plan, in order to Appropriations bill I said that if there list. Back in 1990, you could not get balance, takes every penny of Social were a way to balance the budget with- anybody’s attention talking about Security surpluses over the next 7 out increasing revenues as well as hold- these other trust funds, but I said on years—$650 billion. It takes all those ing the line on spending, I would jump Social Security I think we have got Social Security surpluses, throws those off the Capitol dome. them. into the pot and says, hallelujah, we Let me turn, Mr. President, to the Mr. President, the vote on October have a balanced budget. subject raised by these two gentlemen 18, 1990, was 98 to 2. S 15328 CONGRESSIONAL RECORD — SENATE October 19, 1995 I ask unanimous consent to have Subtitle C—Social Security communications bill. Half of our as- printed in the RECORD the Senate vote SEC. 13301. OFF-BUDGET STATUS OF OASDI signed savings in the Commerce Com- on the Hollings-Heinz amendment put- TRUST FUNDS. mittee is absolutely false. The same ting Social Security off budget. (a) EXCLUSION OF SOCIAL SECURITY FROM may be true in other committees as ALL BUDGETS.—Notwithstanding any other There being no objection, the vote provision of law, the receipts and disburse- well. was ordered to be printed in the ments of the Federal Old-Age and Survivors It is like Cato’s famous couplet, ‘‘The RECORD, as follows: Insurance Trust Fund and the Federal Dis- politician makes his own little laws Subject.—Hollings-Heinz, et al., amend- ability Insurance Trust Fund shall not be and sits attentive to his own ap- ment which excludes the Social Security counted as new budget authority, outlays, plause.’’ Why, heavens above, you will Trust Funds from the budget deficit calcula- receipt, or deficit or surplus for purposes of— probably be able to say something else tion, BEGINNING in FY 1991. (1) the budget of the United States Govern- tomorrow. ment as submitted by the President, YEAS (98) (2) the congressional budget, or What we are trying to do is to level Democrats (55 or 100%)—Adams, Akaka, (3) the Balanced Budget and Emergency with the American people. What we are Baucus, Bentsen, Biden, Bingaman, Boren, Deficit Control Act of 1985. trying to do is cut spending, freeze Bradley, Breaux, Bryan, Bumpers, Burdick, (b) EXCLUSION OF SOCIAL SECURITY FROM spending, close loopholes. But you can- CONGRESSIONAL BUDGET.—Section 301(a) of Byrd, Conrad, Cranston, Daschle, DeConcini, not balance the budget, Mr. President, Dixon, Dodd, Exon, Ford, Fowler, Glenn, the Congressional Budget Act of 1974 is amended by adding at the end the following: you cannot do it without also increas- Gore, Graham, Harkin, Heflin, Hollings, ing revenues. Nobody around here Inouye, Johnston, Kennedy, Kerrey, Kerry, ‘‘The concurrent resolution shall not include Kohl, Lautenberg, Leahy, Levin, Lieberman, the outlays and revenue totals of the old age, wants to say that, but that is the Metzenbaum, Mikulski, Mitchell, Moynihan, survivors, and disability insurance program truth. Nunn, Pell, Pryor, Reid, Riegle, Robb, established under title II of the Social Secu- I was put to the metal when the dis- Rockefeller, Sanford, Sarbanes, Sasser, Shel- rity Act or the related provisions of the In- tinguished chairman of the Budget by, Simon, Wirth. ternal Revenue Code of 1986 in the surplus or deficit totals required by this subsection or Committee, and others, appeared on Republicans (43 or 96%)—Bond, Boschwitz, in any other surplus or deficit totals re- December 18. Mr. KASICH, Senator DO- Burns, Chafee, Coats, Cochran, Cohen, quired by this title.’’. MENICI, and others, said, ‘‘We are going D’Amato, Danforth, Dole, Domenici, Duren- Mr. HOLLINGS. I thank the distin- to have three budgets. We don’t care berger, Garn, Gorton, Gramm, Grassley, Hatch, Hatfield, Heinz, Helms, Humphrey, guished Chair. what the President has got. We are Jeffords, Kassebaum, Kasten, Lott, Lugar, Mr. President, my friends on the going to balance the budget without Mack, McCain, McClure, McConnell, Mur- other side are well rehearsed in repeat- taxes.’’ I went to the budget staff and kowski, Nickles, Packwood, Pressler, Roth, ing their little drumbeat—balanced said, ‘‘I’m missing something.’’ Rudman, Simpson, Specter, Stevens, Symms, budget, balanced budget, balanced I had worked with Senator Baker on Thurmond, Warner, Wilson. budget, balanced budget. But like they a freeze and back in 1981. Then I got to- NAYS (2) say back home: no matter how many gether with Senator GRAMM and Sen- Democrats (0 or 0%). times you say it, it doesn’t make it so. ator Rudman, and we had a freeze and Republicans (2 or 4%)—Armstrong, Wallop. Chairman KASICH filed a conference cuts across the board. In 1986 we closed report on June 26, 1995, and on page 3 the loopholes with tax reform. Then in NOT VOTING (0) you will see the word ‘‘deficit’’—not 1989 and in 1990 we appeared before the Democrats (0). ‘‘balance’’—for fiscal 2002, $108.4 bil- Finance Committee and in the Budget Republicans (0). lion. Committee proposing a value-added Mr. HOLLINGS. I thank the distin- We need to open our eyes. When we tax. guished Chair. started the budget process at the be- We got eight votes in the Budget And then on November 5, Mr. Presi- ginning of the year, the distinguished Committee on that proposal. We got dent, George Bush, President George chairman of the committee said that Senator Danforth, Senator Boschwitz Bush, signed into law, Public Law 101– we were going to provide the American and others to work as part of a biparti- 508, saying here: people with a down payment. We were san group with truth-in-budgeting. not going to balance the budget. Section 301(a) of the Congressional Budget As we marked up the budget, the dis- But now we have a big act going on Act of 1974 is amended by adding at the end now. Pressure is being exerted by the the following: The concurrent resolution tinguished chairman of the Budget Committee said, ‘‘Now, we require that House leadership over there, pressuring shall not include the outlays and revenue to- my friend, the distinguished chairman tals of the old age, survivors and disability the reconciliation bill be passed into of the Budget Committee. He should insurance program established under title II law before we do any tax cut.’’ of the Social Security Act or the related pro- That has been changed, Mr. Presi- know better than anybody else that visions of the Internal Revenue Code of 1986 dent. Now we have a different process this budget we are talking about has in the surplus or deficit totals required by where we give CBO certain assump- no idea of being balanced by the year this subsection or in any other surplus or tions. We send them over one day and 2002. deficit totals required by this title. they say we have a $10 billion surplus. Mr. President, I ask unanimous con- I ask unanimous consent to include We come back the next day and they sent to have printed in the RECORD a in the RECORD at this particular point say you have a $100 billion deficit. budget table compiled by my staff section 13301 of Public Law 101–508 of In the Commerce Committee, where I using CBO figures at this particular the United States. am the ranking member, we are point. There being no objection, the mate- charged with saving $15 billion. Mr. There being no objection, the table rial was ordered to be printed in the President, $8 billion of our allotment was ordered to be printed in the RECORD, as follows: has already been spent on the tele- RECORD, as follows: BUDGET TABLES [Outlays in billions]

Government Unified Grosss fed- Gross Year budget Turst funds deficit Real deficit eral debt interest

1968 ...... 178.1 3.1 ¥25.2 ¥28.3 368.7 14.6 1969 ...... 183.6 ¥0.3 +3.2 +2.9 365.8 16.6 1970 ...... 195.6 12.3 ¥2.8 ¥15.1 380.9 19.3 1971 ...... 210.2 4.3 ¥23.0 ¥27.3 408.2 21.0 1972 ...... 230.7 4.3 ¥23.4 ¥27.7 435.9 21.8 1973 ...... 245.7 15.5 ¥14.9 ¥30.4 466.3 24.2 1974 ...... 269.4 11.5 ¥6.1 ¥17.6 483.9 29.3 1975 ...... 332.3 4.8 ¥53.2 ¥58.0 541.9 32.7 1976 ...... 371.8 13.4 ¥73.7 ¥87.1 629.0 37.1 1977 ...... 409.2 23.7 ¥53.7 ¥77.4 706.4 41.9 1978 ...... 458.7 11.0 ¥59.2 ¥70.2 776.6 48.7 1979 ...... 504.0 12.2 ¥40.7 ¥52.9 829.5 59.9 1980 ...... 590.9 5.8 ¥73.8 ¥79.6 909.1 74.8 October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15329 BUDGET TABLES—Continued [Outlays in billions]

Government Unified Grosss fed- Gross Year budget Turst funds deficit Real deficit eral debt interest

1981 ...... 678.2 6.7 ¥79.0 ¥85.7 994.8 95.5 1982 ...... 745.8 14.5 ¥128.0 ¥142.5 1,137.3 117.2 1983 ...... 808.4 26.6 ¥207.8 ¥234.4 1,371.7 128.7 1984 ...... 851.8 7.6 ¥185.4 ¥193.0 1,564.7 153.9 1985 ...... 946.4 40.6 ¥212.3 ¥252.9 1,817.6 178.9 1986 ...... 990.3 81.8 ¥221.2 ¥303.0 2,120.6 190.3 1987 ...... 1,003.0 75.7 ¥149.8 ¥225.5 2,346.1 195.3 1988 ...... 1.064.1 100.0 ¥155.2 ¥255.2 2,601.3 214.1 1989 ...... 1,143.2 114.2 ¥152.5 ¥266.7 2,868.0 240.9 1990 ...... 1,252.7 117.2 ¥221.4 ¥338.6 3,206.6 264.7 1991 ...... 1,323.8 122.7 ¥269.2 ¥391.9 3,598.5 285.5 1992 ...... 1,380.9 113.2 ¥290.4 ¥403.6 4,002.1 292.3 1993 ...... 1,408.2 94.2 ¥255.1 ¥349.3 4,351.4 292.5 1994 ...... 1,460.6 89.1 ¥203.2 ¥292.3 4,643.7 296.3 1995 ...... 1,518.0 121.9 ¥161.4 ¥283.3 4,927.0 336.0 1996 estimated ...... 1,583.0 121.8 ¥189.3 ¥311.1 5,238.0 348.0 Source: CBO’s 1995 Economic and Budget Outlook: An Update, August 1995.

Year 2002 (billion) This goes back a long, long time. I One was a gentleman who came in from 1996 Budget: Kasich Conf. Report, can remember, Mr. President, U.S. Sen- one of the former Soviet Republics. I p. 3 (deficit) ...... ¥$108 ator Carl Curtis from Nebraska. I saw cannot recall the name of which one it 1996 Budget Outlays (CBO est.) .... 1,583 1995 Budget Outlays ...... 1,518 the Senator from Nebraska a moment was at this time. But they just re- ago. I was hoping he would still be here cently found their freedoms in that Increase spending ...... +65 when I talked about his home State. He country. came up with an idea way back in 1972. He asked me a question in front of a CBO Baseline Assuming Budget Carl Curtis said the only way we are group. This is during a national prayer Resolution: ever going to get a balanced budget breakfast discussion. He said, ‘‘Senator Outlays ...... $1,874 amendment to the Constitution is to Inhofe, in your country, how much can Revenues ...... 1,884 get something ratified in advance from you keep?’’ the States to show that there is enough I said, ‘‘No. I don’t understand what This Assumes: grassroots support to pass it. (1) Discretionary Freeze Plus you are saying.’’ And so he devised this plan. He said, Additional Cuts (in 2002) ...... ¥121 He said, ‘‘How much money can you (2) Other Spending Cuts (in we are going to have the State senates keep?’’ and State legislatures throughout 2002) ...... ¥226 Then after a little while I figured out America pass and preratify an amend- (3) Using SS Trust Fund (in what he was talking about. 2002) ...... ¥109 ment to the Constitution so that will What he was really saying is how give us the power that is necessary and much do you have to give the Govern- Total reductions (in 2002) ... ¥456 influence necessary to get this thing ment in America? He was very proud to passed. He came to Oklahoma. I was in announce to us that under their new Mr. HOLLINGS. Since my time is the State senate at that time. limited here, let me just point out one I remember back in 1972 the total na- democracy, under their new freedom, thing. The interest costs are growing tional debt was something like $200 bil- that they are able to keep 20 percent. faster than the cuts. The interest costs lion. And I remember a TV ad that In other words, in that particular coun- on the gross debt are scheduled to total they had to try to impress upon people try, they turned around and had to give $348 billion for this fiscal year. That is to quantify how much money this real- the government 80 percent of every- almost $1 billion a day. In addition, ly was. They had $100 bills that they thing they earned on a periodic basis over the 7-year period you know how stacked up and then finally it was up like every month or every 2 months. I much we use of Social Security, $636 to the height of the Empire State do not remember the exact timeframe. billion. It is not a balanced budget, Mr. Building, which was a tall building at And I thought, my goodness, he is so President, and it’s high time we recog- that time. That was $200 billion. That proud of this freedom. Then we looked nize this fact. was 1972. Well, anyway, I passed a reso- at a study that no one has refuted, and The PRESIDING OFFICER. The Sen- lution in the State senate of the State no one in this Chamber today will re- ator from South Carolina’s time has of Oklahoma to preratify it even fute it, that if we do not do something expired. though technically we know that to change the course that we are on, Mr. HOLLINGS. I thank the Chair. would not work. And so he came in and that by the time someone who is born Mr. INHOFE addressed the Chair. we talked about it. That is how long we today, like my three grandchildren, The PRESIDING OFFICER. The Sen- have been working on this. during the course of their lifetimes, ator from Oklahoma. Now since that time in my own per- they will have to pay, not 80 percent, f sonal life we have had four children. but 82 percent of their lifetime income Now they are all grown. Now we have just to support the Federal Govern- BALANCING THE BUDGET grandchildren. ment. Mr. INHOFE. I hope that everyone is We talked on the floor of this Senate Now, that is what we are looking at watching what is going on right now. I as to the significance of the discussion right now. That is why this is signifi- cannot tell you how long many of us that has taken place right now of the cant. That is why we are at a point we have been working on the problem of fact that we really have an opportunity cannot say that we are just going to be the deficits in this country. And we are to make a vote, to take a step that the business as usual. The elections of 1994 finally to a point where we can do CBO and everybody else says is going were very specific. They had mandates something about it. to balance the budget, is going to in those elections. All of the post- It is hard for Americans to under- eliminate the deficit by the year 2002. election surveys have indicated there stand the obstacles that we are facing. Many of us would like to do it earlier are about four areas that people want There are those of us who really want than that. But we are satisfied in in this country. First, they want less to do something, really want to bal- knowing that we cannot continue on Government involvement in their lives; ance the budget, with the obstacles we the course that we are on. second, a stronger national defense; face, and not just the things that are During the national prayer breakfast third, punishing criminals; and fourth, said that are not true, but the fact that that took place in February of this which actually came out first, they I cannot help but believe there are year I had the honor of participating in want to do something about eliminat- some people who really do not care that and of talking to many groups ing the deficit, about starting to cut that much about balancing the budget. that came in from foreign countries. into reducing the debt. S 15330 CONGRESSIONAL RECORD — SENATE October 19, 1995 Now, obviously you cannot do that in Social Security, raising it from 50 to A TAX INCREASE FOR 50 PERCENT until you stop increasing the deficits. 80 percent. This is something the OF AMERICAN PEOPLE We have a program now, that will ac- American people did not want. Mr. BUMPERS. Mr. President, I complish that by the year 2002. So I suggest to you, Mr. President, never will forget in 1981 how the wind I yesterday took to the floor and that if there is anyone out there, in- swept through this Senate and accept- talked about some of the new allies cluding Democrats or Republicans, who ed Ronald Reagan’s promise that if we that those of us who really want to do opposed that tax increase, they should just pass this massive tax cut, it would something constructive about elimi- be for tax relief now. Essentially all we generate so much economic activity nating the deficit have, some new al- are trying to do is repeal the damage and so many taxes that we would bal- lies that are coming along. We are see- that was done to the American people ance the budget in 3 years, no more ing right now responsible but liberal back in 1993. than 4 years. That was $4 trillion ago. editorial boards throughout America ‘‘Medagogues’’ is the name of the edi- I am happy to report I was 1 of 11 torial: are now saying, ‘‘Look. We have heard Senators that did not buy that for one enough of this lie that is being per- What the Democrats have instead is a lot instant. And, Mr. President, we are of expostulation, TV ads and scare talk. petrated by the leadership of the getting the same snake oil with this Democrats in both the House and the They go on and on. bill. Senate, trying to draw a connection be- But there isn’t any evidence that they I applaud a lot of people on both sides tween tax relief and balancing the would ‘‘lose their Medicare’’ or lose their of the aisle who have committed them- choice of doctor under the Republican plan. budget.’’ selves to dealing with the problem the And I suggest to you that the choice This is something that is very criti- American people have said is No. 1. But is not taking that amount of money cal, because this is an important part there is a time to pass tax cuts, and that is going to be coming out in tax of the bill that will be considered. the time to do it is after we balance Ten days later, they came out again, relief and putting it toward the deficit the budget, not before. and I think this is the first time prob- because we know if we are going to be But having said that, Mr. President, ably in the history of the Washington honest with ourselves all that would do let me add that I would not vote for Post that they came out twice on the is go to more social programs which this tax bill if we had a $300 billion sur- same subject taking the conservative this administration wants. They do not plus this year. I would not vote for this side of an issue. The last two sentences want cuts. They do not want freezes. tax bill if you held a gun to my head, of this editorial are: They do not want to control growth. because it betrays every value I hold They want to increase the social pro- The Democrats have fabricated the Medi- care-tax cut connection because it is useful dear about this Nation. The budget res- grams. They want business as usual. politically. It allows them to attack and to olution that we passed in June said Mr. President, the times are changed duck responsibility, both at the same time. CBO will certify, not project, certify a now. This is not the way it would have We think it’s wrong. balanced budget by the year 2002. And been 2 years ago or 4 years ago or 6 I want to conclude, because my time that once they certify it, then the Fi- years ago. is almost up. I have to be very critical nance Committee can report out a $245 Mr. FORD. Mr. President, will the of the Democratic Senatorial Cam- billion tax cut. The problem with that distinguished Senator yield? paign Committee. They are flooding is not only has CBO not certified, they Mr. INHOFE. I will not yield yet. We the airwaves throughout America with have only projected, but once this tax are on a timeframe. There are a couple propaganda such as this one that says: bill passes—and it is going to pass, Mr. things I want to cover first. The Sen- ‘‘Inhofe Feasts on Tax Cut for the Priv- President, make no mistake about ator will have an opportunity to have ileged While Children Go to Bed Hun- that—but once it passes, the money his 10 minutes. gry.’’ will be gone and unavailable to help Mr. FORD. I just want to ask a ques- Just the other day this was sent out meet unexpected obligations like reces- tion. to every newspaper in Oklahoma char- sions, wars, trade wars, earthquakes, Mr. INHOFE. With this timeframe we acterizing me as some kind of monster hurricanes, or floods. are looking at now, it is so critical abusing the children, abusing the elder- A flood 3 years ago cost somewhere that we ignore the demagogs and those ly. All we are trying to do is protect between $10 and $20 billion. We are still who are trying to ignore this problem. America for the next generation, my paying for Hurricane Hugo, which also I suggest, as I did yesterday, that one grandchildren, which, if we do not do cost billions. of these newspapers which has always it, will have to spend 82 percent of But here is the reason I would not been pro-Democrat, as opposed to Re- their lifetime income just to support vote for the tax bill. Look what it does. publican, which has been liberal in this monstrous Government. It has a capital gains provision: 76.3 their editorial policy, the Washington So, Mr. President, this is what con- percent—think of that, 76.3 percent of Post, had an editorial just the other servatives are going up against. This is the capital gains tax cut which costs day, September 15. This editorial is the ridicule we have been subjected to. almost $50 billion goes to people who called ‘‘Medagogues.’’ In this editorial, These are the slings and arrows that make over $100,000 or more. That is they talk about how the Democrats are are happening to us. about 7 percent of the American peo- trying to draw a relationship between I can tell you right now, the Amer- ple, including every single Member of tax relief and balancing the budget. ican people understand the same as the U.S. Congress. I suggest that anyone—and it has they understood they did not want our You think I am going to vote for a been suggested in some of these health care delivery system turned bill that gives 6.4 percent to people who editorials, not this particular one, over to Government, they understand make less than $30,000 a year; 4.6 per- that if anyone was opposed to the tax this is the last opportunity we are cent if you make $30,000 to $50,000; 6.1 increase of the Clinton administration going to have in America to actually percent if you make $75,000 to $100,000; of 1993—this is back when the Demo- bring this budget under control and, in and 76 percent to people who make over crats controlled the House and the Sen- this case, to eliminate the deficit by $100,000? I would not vote for that ate and this was characterized as the the year 2002. under any circumstances. Those people largest single tax increase in the his- I will conclude by quoting one of my do not need a tax cut. tory of public finance in America or favorite people, Churchill, who said: I might also say, my friends in the anyplace in the world, and that was not ‘‘Truth is incontrovertible. Panic may business community in my State say, JIM INHOFE, a conservative Republican rescind it, ignorance may deride it, ‘‘Senator, we don’t need a tax cut, we talking, that happened to be a Demo- malice may destroy it, but there it is.’’ need to get the deficit under control. crat on the floor of the Senate talking, And the truth is going to come Balance the budget and then talk that that was the largest single tax in- through. We are going to succeed in about taxes.’’ crease in 1993. this effort. Thank you, Mr. President. What is even worse—talk about be- What did they do? It was a tax in- Mr. BUMPERS addressed the Chair. traying our values—CBO said this bill crease on, among other people, the sen- The PRESIDING OFFICER (Mr. BEN- represents a tax increase on 51 percent ior citizens, a 50-percent tax increase NETT). The Senator from Arkansas. of the American people. That is how October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15331 many people in America make less Let me go back to the earned income Mr. President, I listened to my col- than $30,000 a year—51 percent. They tax credit for a moment. The EITC league on the other side, and I have get a tax increase out of this when you helps reduce the poverty rate. Look at heard that speech for 25 years. For 25 consider the cuts in the EITC, student this chart. In 1993, 15.1 percent of the years, we have not balanced the budget loans, and all the others. At the same people lived in poverty. By 1994, the in this place. Every year we have the time, the richest 1 percent of the peo- poverty rate had dropped to 14.5 per- same litany of reasons why we cannot ple in the country get $20,000 in tax cent. And if you consider the actual do that. For the first time in that pe- cuts. Think of that, 50 percent of the number of persons living in poverty, it riod of time, we have a dedication to people on the lowest rung of the ladder was down almost one million people. doing it. For the first time, we have a get a tax increase, and people making So what are we going to do? Cut the pattern to do that. We can balance the $200,000 a year or more get $20,000. earned-income tax credit, even as the budget. What has happened to the country? program is working. There is the proof. The real question is, is it reasonable, Why do we do things like that? It be- The other day at this Million Man is it morally and fiscally responsible to trays everything I believe in. During March, the point was made over and go for 25 years without balancing the the Depression when I was growing up over again that fewer and fewer black amount of money you take in with the in a family poor as Job’s turkey, we people are enrolling in college. So what amount of money you take out? How looked to the Government to help us, are we going to do? We are going to cut long could you do that in your family not hurt us. It was the Government we education funds by 30 percent—the or in your business? We are beginning turned to for sewer systems and water most massive cut in the history of the to have the same repercussions that systems and paved streets and rural country in education. It is going to you would have there—the repercus- electrification. Today, we are saying, make it much more difficult to get a sion being that we have a $5 trillion let them eat cake. loan, and then more difficult to pay it debt, and we will have to vote on that this month, or early next month; that Who wants the tax cut? Seventy per- off. the interest on that debt will now cent of the people in this country, in a We are torpedoing all the programs amount to probably the largest single- USA Today poll, said reduce the defi- that are working. Mind you, there are line item in the budget. So we hear, cit. One-third as many, 24 percent, said some programs that we need to tor- year after year, the same litany of rea- give me a tax cut. There is no clamor pedo, but the EITC and educational sons why we cannot do this, basically, for it. loans are not among them. I stood on this floor and I fought the B–2 bomber, frankly, from the same people who On the earned income tax credit, have been here for 25 years. I do not President Reagan, Majority Leader I fought the space station, and I fought the super collider. I fought so many mean to be critical. It is a tough deci- DOLE, Senator DOMENICI, and many fights trying to save money to get sion. But people sent us here, this year others on the Republican side of the particularly, to deal with that issue. It aisle have said that is a wonderful pro- spending under control here, and I lost most of them. Do you know why? Be- is time to do that. We hear the talk gram. So what are we going to do? We about the Reagan years, when we re- are going to cut it. cause the companies who make those big-ticket items dominate. We are not duced taxes and the promise that it Mr. President, it is not just the tax going to solve our spending problems would increase the economy. It did in bill that is so horrendous about this until we reform campaign financing. fact increase the economy markedly. thing. There are all kinds of things in The space station is made in 36 States, The problem was, we did not reduce or there. We continue to give away west- and that guarantees that it will con- hold down spending. The constitutional ern lands to the biggest corporations in tinue. It is the most horrendous, out- responsibility for doing that lies right America, the mining corporations. And rageous waste of money in the history here in this Congress. Right here. It is there is $18 million, over a 7-year pe- of man, and you cannot stop it. But our responsibility to do that. riod, in here against the mining compa- you can sure stop payments to old peo- We hear about capital gains tax cuts. nies. They get off scot-free—essentially ple, who depend on Medicare for their These are tax cuts that provide an op- scot-free. health care. portunity for investment to create And then there is ANWR. Open up You think of it. A $270 billion cut in jobs, that give us a prosperous econ- ANWR up on the north slope. That is Medicare. A $182 billion cut in Medic- omy and give us a chance for people to going to be a tough one, Mr. President. aid, health care for the poorest of the work and take care of their families. That is going to be debated heavily poor. I ask for 1 additional minute. That is what that is about. The earned here, because that is the same thing as Mr. THOMAS. Mr. President, I ob- income tax credit. That will continue an asset sale. When you sell an asset— ject. We were set up for 10 minutes. to grow. It has been the fastest growing as any businessman will tell you—that The PRESIDING OFFICER. Objec- program in the entire budget. It start- is a one-time bonanza for you. If you tion has been heard. The Senator has ed out, I believe, at about $1.5 billion. put that one-time bonanza into your spoken for 10 minutes. It has gone to $25 billion in less than 10 operating budget, you will be in big Mr. BUMPERS. I yield the floor. years and is scheduled to go to $32 bil- trouble the next year. Mr. THOMAS addressed the Chair. lion. That is a cut? Give me a break. It Mr. President, we are selling our pe- The PRESIDING OFFICER. The Sen- is not a cut. It is also one of the pro- troleum reserve in Elk Hills, our naval ator from Wyoming is recognized. grams that has been most filled with petroleum reserves. We are selling 40 f inconsistencies, and indeed fraud in million barrels of oil out of our strate- many cases, payments going to people gic petroleum reserve. We are selling BALANCING THE BUDGET that did not qualify for them. everything in the world we can lay our Mr. THOMAS. Mr. President, when So, Mr. President, it is really time hands on, with no thought of what you we have an arrangement to speak for 10 that we take a little look at what we do for an encore, once you sell those minutes, it seems to me that is what are doing here. If we do not balance the assets. Until a few months ago, Con- we should do. budget, what happens? If we do not do gress could not count the sale of an I want to talk a little bit about the something about Medicare, what hap- asset as a revenue raiser. Why? Be- opportunity and the time that we now pens? Medicare in the trust fund, in cause counting the revenue from an have to come to a decision. We have part A, goes broke in 2002. That is the asset sale fails to show the loss of been talking this whole year about way it is. So we have to do something value of the asset. It was only this year budgets, about balanced budgets. We about it. A child born today owes that Congress changed the budget law started out in the beginning of the year $187,000 in interest on the Federal debt. to allow asset scoring and count it to- with a vote on balanced budgets, which That is where we are. That is why we ward balancing the budget. Now that lost by one vote. We have worked the have to do something about it. By the we have changed the scoring process, whole year long, and now we are down year 2015, all of our spending will be on we are selling everything we can get to the place where it begins to count. entitlements and the national debt in- our hands on and counting that against We are down to where we are going to terest. All of our tax revenues will be the deficit. make a decision as to what we do. taken for that reason. S 15332 CONGRESSIONAL RECORD — SENATE October 19, 1995 So what do we need to do? Obviously, spending every dime to balance this est barrier between the American peo- we need to balance the budget. We need budget over the next 7 years. But what ple and their Government. to preserve, protect and strengthen they fail to tell you is that they have Every segment of society has a rea- Medicare. We need to reform welfare. endorsed this same practice for years. son to complain about the Tax Code. And we need to—to the extent that we In fact, this year alone, the budget For individuals and families, the cost can do it after the budget is balanced— that the President of the United States of complying with the Tax Code too reduce the taxes on American families that they passed in 1993 spent every often becomes the difference between so they can spend more of their own dime of the surplus out of the Social making it in America, and just making money. Security trust fund, which, by the way, do. In this proposition, the tax cutting under law, can only be invested in U.S. I have spoken several times on the comes after the balanced budget is cer- securities, backed by the Federal Gov- Senate floor about a young Minnesota tified. That is the system. That is the ernment. So that money goes to the family, the Wolstads, who represent plan that we have here. The benefits Treasury, and it has been spent by the the very frustrations felt by millions of include lower interest rates for busi- Congress ahead of us, by the Demo- Americans when it comes to the topic nesses, for families, and less expensive cratic majority. It has been spent of taxes. homes, cars, and student loans. The away. So when they talk about the Re- Natalie Wolstad wrote to me about Senator talked about education. Stu- publicans using every dime from the the enormous tax burden her family is dent loans will be at a lower interest Social Security trust fund, they should forced to bear, a burden she and her rate. There will be a higher standard of look at their votes in 1993, as their husband did not fully appreciate until living. Some estimate there will be as President tried to mask the deficit in they met 1 day with their realtor, and many as 6 million more jobs. So we the budget by using those trust fund learned they simply could not afford to have to do this. dollars. purchase a new home on their own. The best opportunity that we have In fact, the deficit touted today by had will be before us in the next 2 Countless other Minnesota families this President of $170 billion actually is weeks. That is what the voters said to have sent me letters sharing similar using $68 billion of Social Security us last November. That is their expec- stories of their own. trust fund money from this year. Oth- tation. That is our expectation—those They were trying to decide, ‘‘Where of us, particularly, who have just come erwise, he would have to report a defi- are we spending our money foolishly?’’ this year. We came with the commit- cit of about $240 billion. This Congress When they finally looked at their pay ment to fundamentally change the di- has inherited the troubles created over stubs, they were seeing how much rection in which we are going. We came the last 30 years. It would have been a money was being taken from them in with a commitment to change the lot easier, especially politically, if we taxes. things the Senator was talking about— could have just continued this huge Yes, the Tax Code is tough on fami- deficits for 25 years. The administra- giveaway. But it would have been at lies, and it is equally hard on Ameri- tion does not have a budget that will the expense of the next generation. It ca’s job providers—small businesses give us a balanced budget. The first was time to stand up and look this and large. budget was defeated 99–0. The second problem in the face and make some of When nearly 2,000 entrepreneurs was not voted on. By CBO’s own esti- those tough decisions. gathered in Washington this summer mates, at the end of 10 years, it will The Democrats talked about the for the third White House Conference still have a $200 billion deficit. drastic cuts. Just a few moments ago, on Small Business, they came with So we can talk about the same things my good friend from Arkansas talked hundreds of ideas on how to make Gov- we have talked about forever. We can about fewer dollars for education. Well, ernment more responsive to the people talk about all the reasons why this these are the first signs of the prob- who create the jobs on Main Street. cannot be done. We can make excuses. lems we are facing today because of the Although their suggestions covered But the real question is, is it fiscally last 30 years and the spending spree an enormous range of concerns, one and morally responsible to move to- that this Congress has been on. point generated near-universal agree- ward a balanced budget in 7 years? If The Democrats have pre-spent those ment: something must be done about the answer is yes, then the opportunity dollars that could be used today for the complex and costly Federal tax arises before us in this next 2-week pe- education, and if we do not get this system. riod. budget under control today, next year If Congress is truly serious about an- Mr. President, I hope that my col- those problems are even going to be swering the calls of help from the leagues will take advantage of this op- worse, and we are going to be talking American people and reforming the tax portunity and that, for the first time about other programs that are not system, there are three distinct prob- in a very long time, we will have going to have the dollars because they lems which must be addressed. changed the course of irresponsible are going to pay interest and other ex- First, taxes are too high. That is spending and moved into a time of a re- penses. something President Clinton acknowl- sponsible balanced budget. So we do have to make some very se- edged this week, when he admitted I yield the floor. rious decisions, Mr. President. Other- Mr. GRAMS addressed the Chair. that the recordbreaking tax increase The PRESIDING OFFICER. The Sen- wise, our next generation, and the gen- he pushed through Congress in 1993 was ator from Minnesota. eration after, are going to have to pay too much for the American people. for the mistakes we have made, and we Under the headline in the paper ‘‘Tax f should not leave them, financially or Rise,’’ ‘‘too much,’’ President Clinton WHY AMERICANS NEED TAX morally, that way. It is wrong to do concedes. But he did take time to REFORM that. This is the first good attempt to blame the Republicans for it. That is at Mr. GRAMS. Mr. President, I have put a balanced budget in place that is a time when the Democrats controlled been sitting here listening earlier to- going to make sure that we do not every branch of Government—the night to some of my colleagues on the leave our children with our debts. House, the Senate, and the White other side of the aisle talking about Mr. President, as we begin debating House. I welcome the President’s real- the numbers and problems associated the tax policy, including a $245 billion ization, but I wish it had come before with trying to balance this budget over tax cut, I believe that the time has he signed the $255 billion tax hike into the next 7 years, and while they have come to also begin some serious discus- law. been laughing and telling jokes, not sions about how best to reform our The first step toward building a bet- just tonight, but for the last 30 years, badly outdated Tax Code itself. ter Tax Code is to look at the role of they have buried the American tax- Since 1913, when Congress first the Federal Government and let the payer $5 trillion in debt. It would be gained the power to impose taxes on in- people start keeping more of their own funny, maybe, if it were not so serious. come, the Tax Code has been manipu- money, which they work for. They talk about the Social Security lated and expanded so many times by After all, it does not belong to the trust fund and that Republicans are Congress that it has become the great- Government in the first place. And who October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15333 is in a better position to make a fami- ten to some Senators say that we have Mr. KYL addressed the Chair. ly’s spending decisions and set their fi- to increase taxes more. The PRESIDING OFFICER. The Sen- nancial priorities—Washington, or the In fact, families with children are ator from Arizona. family itself? now the lowest income group in Amer- f Clearly, that responsibility belongs ica—below elderly households, below with the family. single persons, below couples without BUDGET FANTASY VERSUS We have the opportunity to take that children. REALITY first step in the next few weeks, by In 1950, the average American family Mr. KYL. Mr. President, I would like passing a $245 billion tax cut which in- sent $1 out of every $50 it earned to to continue discussing the same sub- cludes the $500 per child tax credit I au- Washington—today, the average family ject that the Senator from Wyoming thored and have fought for over the sends $1 out of every $4 to feed the Fed- and the Senator from Minnesota have last 3 years. eral Government. been discussing, and to do so by, first I welcome President Clinton’s sup- The marriage penalty targets fami- of all, focusing on some of the myths port for tax relief, and urge him to join lies by taxing them at a higher rate that have been created by the Presi- our efforts. By letting taxpayers keep than it does single filers. dent and by some of his supporters here what is rightfully theirs. we send a And if the dependent exemption had in the Senate. I am talking about the strong message that our efforts to bal- kept up with inflation, it would be difference between the budget fantasy ance the budget will always make tax- more than $8,000 today instead of just and the reality that faces us here payers the first priority—not the last. over $2,000. today. It is almost an ‘‘Alice in Won- The second area we must address The message we’re sending through derland’’ exercise where words take on when discussing reform of the Tax Code our tax policy is that families are just meanings that are only in the eye of is simplification—and simplification not as important today as they were in the beholder and have no relationship must be at the heart of any plan Con- 1950. to actual reality. gress considers. That message must change. Frankly, they are the last desperate We have the opportunity and respon- There is nothing simple about our attempts by proponents of big Govern- sibility in this Congress to repair the tax system anymore. ment to cling to the status quo, which fractured relationship between the The IRS manages a library of 437 sep- means more spending, higher taxes, Government and its owners—the tax- arate tax forms and mails out 8 billion and greater regulation. That is really pages of tax instructions every year. payers. It is time we started to talk seriously what this exercise in opposition to a The distinguished House majority about cutting taxes, simplifying the balanced budget and tax cuts is all leader, Representative ARMEY of Texas, system, and making it more equitable. about. points out that American workers and A recent Forbes magazine cover Many of the Democrats cannot be- businesses spent 5.4 billion hours in story called tax reform a ‘‘broad politi- lieve, let alone accept, that the Amer- 1990 just preparing their taxes—more cal movement, gaining in popularity ican people overwhelmingly rejected time than it takes to build every car, the way a hurricane gathers force as it their approach to governing in that truck and van manufactured in the heads for land.’’ way in last fall’s election. Rather than United States each year. The questions we should be asking attempting to fulfill the mandate This Congress has made shrinkage ourselves are not will we ever break which the American people gave us, and simplification its primary goals, form the past and will we ever have a they are now cynically pandering to and there is nothing that needs it more Tax Code that treats all Americans eq- the mandates while doing everything than our current tax system. uitably, but rather when. they can to undermine it. Today’s Tax Code may be good busi- Mr. President, the answer to that In this topsy-turvy ‘‘Alice in Wonder- ness for tax lawyers and accountants, question is now, and the Senate Fi- land’’ change, the meaning-of-words but it is not good policy for the aver- nance Committee has taken an enor- situation they have created, spending age American taxpayer. mous step toward reaching that goal cuts are increases; spending increases Tax reform must include tax sim- with its $245 billion tax cut package. are cuts. For example, claiming that a plification. By cutting taxes for families and job- Medicare spending increase of $2,000 per The final consideration in building a providers, simplifying the way those person over the next 7 years is actually better Tax Code is making it fairer and taxes are collected, and ensuring a a cut when, in fact, it is a $2,000 in- more equitable for the taxpayers. Far process that’s fair, reforming the tax crease. too often, the current system is not. system will go a long way toward mak- Tax cuts, they say, are spending in- The Government continually manip- ing government more accountable to creases. Tax relief for families become ulates the Tax Code—not just to fund the people. tax cuts for the rich. A volunteer in Government objectives, but to Washington needs to be reminded AmeriCorps is actually paid by the tax- micromanage the economy and the ac- that the money it collects is not theirs payers $20,000, $30,000, or $40,000 a year. tivities of the taxpayers. by right—it is collected for use at the Tax payments, the President says, are If the Government wants to encour- will of the taxpayers. And Congress contributions. Preserving Medicare is age a particular behavior, it offers a needs to be reminded daily that it rep- slashing Medicare. And, of course, tax benefit. resents the taxpayers. bankrupting Medicare is saving it. If it wants to discourage a particular The success of our efforts to reform President Clinton is even now so bold behavior, it sets a tax penalty. the tax system won’t be measured sole- as to blame Republicans, not a single The social engineers have had a field ly by how much of their own dollars one of whom supported his budget in day with the Tax Code. Fairness seems Congress allows families and job pro- 1993, for forcing him to raise taxes. It is to have been left by the wayside, and viders to keep. It will also be measured like ‘‘the old devil made me do it’’ skit families are paying the price. by how equitable the system is, and that we used to see on TV. He says he Look how they have been manipu- how the taxpayers fare under it. wishes he had not increased the taxes. lated through the tax system. If we can successfully accomplish all I, too, wish he had not increased taxes. Families, who in 1947 paid just 22 per- of that, then we will have heard the But at least our attempt to reduce cent of their personal income in the message of last November and deliv- taxes by $245 billion is a beginning, a form of taxes, today send nearly 50 ered on the solemn promises we made partial rollback of this tax increase cents of every dollar they earn to Fed- to the American people. which he now wishes he had not im- eral, State, or local government. Mr. President, it is time that we get posed upon the American people. As someone who ran for Congress be- behind this effort. It is time that we Here are some examples of increases cause of high taxes and what they are balance the budget and stop passing that the Democrats claim are cuts. doing to this Nation, I am incensed our deficits on to our children and The Republican Party has said all that middle-class American families grandchildren. year that we would not balance the are being asked to bear the brunt of Thank you very much. I yield the budget at the expense of Social Secu- our enormous tax burden, and then lis- floor. rity. The budget reconciliation bill will S 15334 CONGRESSIONAL RECORD — SENATE October 19, 1995 not touch Social Security retirement are subsidized. That means they get money The Democrats have fabricated the Medi- benefits or cost-of-living adjustments, that the tax man extracted from the tax- care tax connection because it’s useful po- COLA’s. Social Security will increase payers. litically. It allows them to attack and duck 43 percent, from $336 billion this year ‘‘Next word: deduction. That’s when responsibility, both at the same time. We think it’s wrong. to $482 billion 7 years from now. you were allowed to count some of Medicare—we are going to increase your income as off limits to the tax The editorial, by the way, was enti- Medicare spending, not cut it. Medi- man. You can take a deduction for tled, ‘‘Medagogues, Cont’d.’’ care will grow from $178 billion in 1995 mortgage interest. A portion of your It is no wonder, Mr. President, that to $274 billion in 2002, a 54-percent in- own money stays in the bank.’’ the American people are frustrated and crease. Spending per beneficiary will Democrats claim the tax relief for angry. We need to keep the promise we rise from an average of $4,800 today to families is a tax cut for the rich. The made to the American people to bal- more than $6,700 in the year 2002, al- fact is over 70 percent of the tax cuts ance the budget by the year 2002. most a $2,000 increase, as I said before. included in the Finance Committee bill The Congressional Budget Office has Student loans—we have heard a lot go to families with incomes of less certified that our budget will do just about that. Student loan volume will than $75,000 a year. that. We have abided by the Congres- grow from $24 billion in 1995 to $36 bil- Let us talk about the AmeriCorps for sional Budget Office, the agency that lion in the year 2002, a 50-percent in- a moment. The GAO estimated that the President praised for its accuracy crease. The maximum Pell grant will the program cost nearly $27,000 for in budget forecasting in 1993. But while be raised to $2,440 next year, the high- each ‘‘volunteer,’’ and I put quotation we have abided by the CBO’s est level it has ever been. marks around that word ‘‘volunteer’’ scorekeeping, the same entity the By the way, we could send a whole since they are paid that salary. In fact, President praised 2 years ago, the lot more needy kids to school with Pell that salary is more than the average President himself has changed the grants, eight or nine for every single American earns in a year. Paying peo- numbers to make his alternative budg- AmeriCorps volunteer that we pay a ple makes them employees, in my et balance by the year 2005. He has used salary to. view, not volunteers. the numbers from his own office rather Here are some examples of cuts that For the average of $20,000 to $30,000 than the Congressional Budget Office. the Democrats claim are actually in- cost per year for each student in As former CBO Director Robert creases. AmeriCorps, as I said, eight needy stu- Reischauer put it, ‘‘He lowered the bar Defense spending declines from $270 dents could get Pell grants at $2,400 and then gracefully jumped over it.’’ billion in 1995 to $264 billion in 1996. apiece. The fact is Americans aged 18 Let me close by saying that it is un- That is $6 billion less. Defense spending and up volunteer 19.5 billion hours of fortunate that the President would is not going up. It is going down. their time, which is a 50-percent in- change the numbers in order to get his Here is an example of spending in- crease in the number of hours since budget balanced rather than face the creases that many of the Democrats 1981. We do not need to pay people to be tough realities we have had to face in not only call cuts but claim are tax in- volunteers under AmeriCorps. putting together a budget which we creases as well. Only in Washington Another one of these Alice in Won- know will balance by the year 2002. I can such distorted logic have any sem- derland meaning changes is calling think we owe it to our children and blance of credibility. taxes contributions. Referring to tax grandchildren to do that, not to hand Talking first about the earned in- increases he would be proposing, Presi- them the debt that we have accumu- come tax credit, we will spend more on dent Clinton, in an address to the pub- lated over the years we have been here. the EITC program every year between lic from the Oval Office on February 15, We have a historic opportunity this now and the year 2002. Spending will 1993, said: year. Not since 1969 has Congress had a rise from $19.8 billion in 1995 to $22.8 We just have to face the fact that to make chance to vote on a balanced budget. billion in the year 2002. The maximum the changes our country needs more Ameri- And I do not think we can miss this op- credit for families with one child will cans must contribute today so that all portunity. It is not just because of the rise from $2,094 in 1995 to $2,615 in the Americans can do better tomorrow. politics of it. It is because of the chil- year 2002. For families with two chil- I have an idea, Mr. President. Let us dren and grandchildren who are going dren, it rises from $3,100 next year to just call these contributions voluntary to follow us and who do not deserve to $3,888 in the near 2002, and the exam- and we will see how much in the way of have to pay off the debts that we have ples go on. contributions are received. There is accumulated. The Democrats not only call that a nothing voluntary about the income So I am very hopeful that we can cut, but a tax increase on low-income tax. support the budget that will be pre- families. If you are eligible, you get a On Medicare, President Clinton says, sented, the reconciliation bill that will check from the Government to offset ‘‘The Republican plan would dismantle be before us next week. I think if we do any income tax liability you might Medicare as we know it’’—the Washing- that the American people will say have under that program, plus any ex- ton Post, September 16, 1995—despite thank you for keeping the commitment cess to which you are entitled. Eighty- the fact that six Medicare Board of that you made to us in 1994. four percent of the program costs are Trustees, five of whom are Clinton ad- Mr. COCHRAN addressed the Chair. cash grants. The program is run ministration appointees, issued a re- The PRESIDING OFFICER. The Sen- through the Tax Code because it is port in April, with which we are all fa- ator from Mississippi. more efficient. It requires less bureauc- miliar, which stated that ‘‘The Medi- f racy. But it is just not possible that care Program is clearly unsustainable COMMENDATION OF SENATORS you can be hit by a tax increase if you in its present form and will become in- get back all of your tax payments plus solvent within the next 6 to 11 years.’’ Mr. COCHRAN. Mr. President, let me more. It cannot be a tax increase. Mr. President, the reality is clear. commend the distinguished Senator Here are some examples of tax cuts Medicare benefits will be cut off com- from Arizona for his excellent state- that they claim are spending increases. pletely unless we act now. If Medicare ment and the other Senators who have They claim that allowing individuals goes bankrupt, which could happen as spoken on our side of the aisle tonight and businesses to keep more of what early as the year 2002, according to the on the subject of the balanced budget they earn is a subsidy that is equiva- trustees, by law no payments could be process, the reconciliation bill which lent to direct spending. But as made to Medicare beneficiaries for hos- will be coming before the Senate next Llewellyn Rockwell, Jr., pointed out in pital care, doctor services, or any other week, and the effort that has been a column in the Washington Times on covered benefit. made to put together a plan to achieve September 18 of this year, I am Even the Washington Post has con- a balanced budget by the year 2002. quoting: demned the duplicity of those who This is a plan that is workable. It is de- A subsidy means the Government is giving would oppose solving this Medicare fensible in every respect. It shows a money to you that originally belonged to problem. In a lead editorial on Septem- new awareness and sense of responsibil- somebody else. Dairy farmers, for example, ber 25, 1995, the Post wrote: ity for managing the fiscal policy of October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15335 this country in a more commonsense sequently, emphasis on the unique more emphasis on training business school fashion, getting us to a point where on skills associated with nonprofit man- students and managers of nonprofit groups. an annual basis we can operate the agement is becoming increasingly im- ‘‘I became fascinated by nonprofits,’’ Mr. Whitehead said. ‘‘Their reach is much bigger Federal Government within a budget portant. than I realized. One out of every 10 workers that is in balance; that we do not over- John Whitehead, former U.S. Deputy in the United States works for a nonprofit. spend; that our projections are sound Secretary of State, renowned entre- And if you add in the volunteer time, it’s and based on reality and facts, not fic- preneur, philanthropist, and expert in even greater.’’ tion. the world of nonprofit management, is ‘‘But I came to realize that while people So I think the statements that have paving the way for scholars to study who run nonprofits are fully committed, been made this evening are very per- the art of managing nonprofit organi- they are not very good managers, and non- suasive as we approach this point when zations. Mr. Whitehead is founder of profits are not very well run,’’ Mr. White- head said. we will be taking up the reconciliation the John C. Whitehead Fund for Not- Sometimes they are not on the up-and-up bill. We have already considered a for-Profit Management at Harvard either, as Mr. Whitehead has learned the number of appropriations bills that Business School. He is dedicated to hard way. Earlier this year, after he had have reduced spending from last year’s teaching students about the important planned his gift to Harvard, he and other levels in accordance with the direc- role not-for-profit organizations play prominent businessmen were embarrassed to tions of the budget resolution. So we in a traditionally for-profit business learn that they had foolishly lent their are well on our way to achieving suc- world. names to the New Era for Philanthropy, a cess in this very ambitious undertak- A recent article appeared in the New charity based near Philadelphia that was es- sentially a giant Ponzi scheme. New Era for ing and very important undertaking. York Times describing Mr. Whitehead’s Philanthropy filed for bankruptcy protection I thank the Senators who have par- achievements and his devotion to in May, and it and its president, John G. ticipated in this special order and am teaching nonprofit management. This Bennett Jr., have been charged with fraud. convinced that the American people article details Mr. Whitehead’s recent But the more common problem, one he has are going to support our efforts, not contributions to the Harvard Business seen much of since he became involved in the just because of the speeches made here School and offers a fascinating account nonprofit world during his years at Goldman but because we are doing the right of his entrepreneurial ventures. I ask Sachs, is a lack of management expertise. thing. unanimous consent that the text of the That is something he can offer, although he is quick to add: ‘‘Just to show that I don’t f article be printed in the RECORD at the know everything. I went on the board of a re- conclusion of my remarks. THE BAD DEBT BOXSCORE gional theater that went out of business.’’ He The PRESIDING OFFICER. Without declines to name the theater. Mr. HELMS. Mr. President, more objection, it is so ordered. He describes himself as a sucker for get- than 3 years ago I began these daily re- (See exhibit 1.) ting involved in nonprofit groups, and said ports to the Senate to make a matter Mr. PRESSLER. Mr. President, John he has a particular affinity for the ones that of record the exact Federal debt as of Whitehead is a skilled businessman and need help, ‘‘not just the big prestigious ones, close of business the previous day. a generous philanthropist. His con- but some of the little, weak ones.’’ The list, As of the close of business yesterday, tributions to the study of nonprofit he says in an embarrassed tone, is too long to enumerate, because someone might think Wednesday, October 18, the Federal management will help those currently he does not have time for so much. debt stood at exactly running nonprofit organizations and But he is disciplined in his approach, $4,970,326,555,499.77. On a per capita future managers maximize efficiency spending the first hour of each day in his basis, every man, woman, and child in and attain group goals. Not-for-profit Park Avenue office working on business for America owes $18,867.44 as his or her management strategies deserve greater AEA Investors Inc., a private investment share of the Federal debt. attention both in the academic and company of which he is chairman. The rest It is important to recall, Mr. Presi- business world. I applaud Mr. White- of the day, sometimes starting with a 7:30 dent, that the Senate this year missed breakfast meeting and going through a late head for his dedication to the mission dinner, is devoted to his menagerie of non- an opportunity to implement a bal- of nonprofit groups and wish him well profit institutions. anced budget amendment to the U.S. as he continues to promote better, ‘‘He does so many things, but the remark- Constitution. Regrettably, the Senate more-effectively managed nonprofit or- able thing is that he does it all so effec- failed by one vote in that first attempt ganizations. tively,’’ said William Boardman Jr., director to bring the Federal debt under con- EXHIBIT 1 of university capital giving at Harvard. ‘‘His very special capacity is to focus and not to trol. HOW TO SUCCEED IN NONPROFITS BY REALLY waste time, and he’s very insightful.’’ There will be another opportunity in TRYING—HARVARD IS GIVEN $10 MILLION TO Mr. Whitehead has given one other $10 mil- TEACH MANAGEMENT SKILLS the months ahead to approve such a lion gift, to Haverford College, ‘‘my other constitutional amendment. (By Karen W. Arenson) first love,’’ where he was an undergraduate f When John Whitehead was co-chairman of and other nonprofit groups say he has been Goldman Sachs from 1976 to 1984, it was held generous. THE ART OF MANAGEMENT IN A up as the epitome of the well-managed Wall He described his own philosophy that good NONPROFIT WORLD Street firm. It made money and it ran citizens need to be generous in both time and Mr. PRESSLER. Mr. President, the smoothly. money. Having had the ‘‘good fortune to Now Mr. Whitehead is trying to bring some global marketplace changes constantly make all this money,’’ he said, ‘‘I say some- of those same management skills to the non- what facetiously that by giving it back, it as the economy and consumer pref- profit world. In what he calls the third stage will come out even at the end.’’ erences fluctuate. To be competitive, of his life, after Goldman Sachs and service When he started discussions with John H. businesses must keep pace with mar- as Deputy Secretary of State, he has pre- McArthur, dean of the Harvard Business ketplace trends. As a result, pres- sided as chairman or president over several School, a couple of years ago, he discovered tigious business schools across the Na- venerable institutions, from Harvard-Univer- that several faculty members there had been tion continuously develop and update sity’s Board of Overseers and the Brookings talking about doing more on nonprofit man- new curricula in response to our chang- Institution, to the Trustees Council of the agement. Mr. Whitehead held out the pros- National Gallery of Art and the Greater New pect of a large gift if they could develop a ing world. York Councils/Boy Scouts of America. productive plan. Management practices, in particular, But he is not content simply to bring his The group did more than plan. Research are beginning to depart from tradi- own management counsel to the boardrooms has begun to build. Courses have been added tional business school teachings. After of a Rolodex of nonprofit organizations. He (elective courses on Social Entrepreneurship years of educating future business lead- has a broader aim: to improve the whole art and on Field Studies in Social Enterprise). ers about the art of managing busi- of managing nonprofit organizations. To Case studies are being written. An eight-day nesses to maximize profits, profes- that end, he is giving $10 million to the Har- advanced management program for execu- sional schools are beginning to direct vard Business School to endow the John C. tives who run nonproit programs attracted 50 Whitehead Fund for Not-for-Profit Manage- participants last spring (at a subsidized price attention toward the management of ment. of $3,000), and another session will be held not-for-profit organizations. Nonprofit His goal is to encourage several develop- next year. groups are growing rapidly, becoming ments: research in nonprofit management Satisfied that the commitment was there, larger and more influential. Con- techniques, teaching of these techniques, and Mr. Whitehead told the school he was ready S 15336 CONGRESSIONAL RECORD — SENATE October 19, 1995 to make the gift. Even though Mr. McArthur cipline that offers the depth and breadth of MESSAGES FROM THE PRESIDENT is stepping down today, to be succeeded as business management. They talk of the over- dean by Kim Clark, Mr. McArthur has prom- lap between the two fields—and the dif- Messages from the President of the ised the nonprofit initiative would remain a ferences. And they talk about building new United States were communicated to priority, and that he will stay involved with intellectual capital. the Senate by Mr. Thomas, one of his it. V. Kasturi Rangan, a business school pro- secretaries. Despite the new attention, it is unlikely fessor who is one of the leaders of the social f that nonprofit management will ever be a enterprise initiative, talked about the cross- main theme for the school. The M.B.A. class over in his own field of marketing: EXECUTIVE MESSAGES REFERRED of 1996, for example, has only 40 students out ‘‘Nonprofit management offers its own As in executive session the Presiding of 807 who came out of government, edu- challenges, but the trick is to bring the core cation or nonprofit jobs. Even though 10 per- disciplines into these challenges,’’ he said. Officer laid before the Senate messages cent of the class of 1995 cited working with a ‘‘We don’t have Marketing 1 for toothpaste, from the President of the United nonprofit group as their career goal after and marketing 2 for computers. marketing is States submitting a nomination which graduation, the school sent only 11 students marketing.’’ was referred to the Committee on into those fields. ‘‘The financial pressures He added, however, that nonprofit groups Armed Services. are very high,’’ Mr. Whitehead said. face a dual customer problem that is unique (The nominations received today are But Mr. Whitehead said he did not worry to them, because they need to concern them- printed at the end of the Senate pro- that nonprofit management would be a step- selves both with the clients who receive ceedings.) child at the business school. He said the new their services, and with the donors who pay course on social entrepreneurship was over- for the services with their charitable con- f subscribed last spring, when more than 10 tributions. The usual marketing discipline, percent of the second year class signed up for coming out of consumers’ choices that weigh REPORT OF DEFERRALS OF BUDG- it, instead of the 60 that had originally been benefits against costs, doesn’t apply when ETARY RESOURCES—MESSAGE set as the limit. consumers and payers are separate, he said. FROM THE PRESIDENT—PM 88 ‘‘Usually elective courses start small and So a nonprofit group needs to develop special build their reputations,’’ Mr. Whitehead said, The PRESIDING OFFICER laid be- internal measures to know whether its prod- fore the Senate the following message ‘‘But this was very successful. I was just de- ucts are appropriate. lighted.’’ It is analysis like this that excites Mr. from the President of the United He spoke of the growing interest among Whitehead and makes him feel that his States, together with an accompanying business students, who know they are likely money will be well spent. report; which was referred jointly, pur- to serve as directors of nonprofit groups, as ‘‘This is fun,’’ Mr. Whitehead said. ‘‘This is suant to the order of January 30, 1975, he and so many other business executives do what keeps me going.’’ as modified by the order of April 11, now; and the growing recognition that they should know more when they do. 1986, to the Committee on Appropria- JOHN C. WHITEHEAD ‘‘I believe more of this kind of program, tions, to the Committee on the Budget, and more scholarship, will help,’’ he said. Born April 2, 1922, Evanston, Illinois. to the Committee on Foreign Rela- That is not to say that Mr. Whitehead sees Education: tions, to the Committee on Labor and such programs as curing all ills. He does not Haverford College, 1943. Human Resources, and to the Commit- think that better education would have M.B.A. with distinction, Harvard Business tee on Finance. stopped the scandal involving the Founda- School, 1947. To the Congress of the United States: tion for New Era Philanthropy. Professional life: In accordance with the Congressional New Era persuaded sophisticated execu- Goldman, Sachs & Co., 1947–1984. Securities tives like Mr. Whitehead to funnel money Industry Association, chairman, 1972–1973. Budget and Impoundment Control Act they wanted to contribute to other charities New York Stock Exchange, director, 1982– of 1974, I herewith report three defer- through New Era, saying that it would be 1984. Deputy Secretary of State, 1985–1989, rals of budgetary resources, totaling matched after six months. The participation Harvard University, President of the Board $122.8 million. of top business leaders like Mr. Whitehead of Overseers, 1989–1991. These deferrals affect the Inter- helped attract other donors. Current leadership in these organizations: national Security Assistance program, ‘‘New Era was a real tragedy,’’ said Mr. AEA Investors Inc. International Rescue and the Departments of Health and Whitehead, who stands to lose up to $1 mil- Committee. United Nations Association of Human Services and State. lion in the bankruptcy. ‘‘I doubt that a pro- the U.S.A. Andrew W. Mellon Foundation. gram like this would have lessened the prob- International House, Youth for Understand- WILLIAM J. CLINTON. lem. If you have a dishonest guy, there is not ing, The Brookings Institution, and Asia So- THE WHITE HOUSE, October 19, 1995. much you can do. I hope we will all be able ciety. Greater New York Councils/Boy f to put it behind us.’’ Scouts of America. J. Paul Getty Trust, Although the management of nonprofit in- Rockefeller University, Lincoln Center The- MESSAGES FROM THE HOUSE stitutions is a relatively new academic spe- ater, and Outward Bound. At 10:59 a.m., a message from the cialty, Harvard is by no means the first uni- versity to turn its attention to the subject. f House of Representatives, delivered by Ms. Goetz, one of its reading clerks, an- There are now more than three dozen centers TRIBUTE TO SUSAN HOFFMANN for the study of nonprofit enterprises at uni- nounced that the House has agreed to versities around the country, from Yale and Mr. DOLE. Mr. President, I would the following the concurrent resolu- Duke to the New School for Social Research like to take a moment to recognize a tion, in which it requests the concur- and the University of San Francisco, and at staffer who has recently left my To- rence of the Senate: least a dozen offer some focus on manage- peka, KS office, Susan Hoffmann. Susie H. Con. Res. 108. Concurrent resolution to ment. correct technical errors in the enrollment of In addition, there is already one other was a dedicated member of my staff for the bill H.R. 1594. school at Harvard, the John F. Kennedy almost 8 years and has recently moved School of Government, that focuses on non- on to pursue her career with the Com- The message also announced that the profit enterprise, and sends about a third of munity Bankers Association in To- House disagrees to the amendment of its graduates into jobs in nonprofit institu- peka. the Senate to the bill (H.R. 2076) mak- tions. It even offers the only course on non- Susie is a graduate of my alma ing appropriations for the Departments profit management at Harvard. mater, Washburn University, and has of Commerce, Justice, and the judici- While the two schools talked about the worked for several years helping the ary, and related agencies for the fiscal possibility of a joint program, Mr. Whitehead’s money was ultimately directed Young Republicans in the State. She year ending September 30, 1996, and for to the business school. was committed to assisting constitu- other purposes, and agrees to the con- ‘‘They both have a role to play,’’ he said, ents with their concerns about govern- ference asked by the Senate on the dis- ‘‘My interest is in teaching managers busi- ment and they knew Susie was always agreeing votes of the two Houses there- ness skills. The Kennedy School teaches there to lend a helping hand to a Kan- on; and appoints Mr. ROGERS, Mr. them about the policy issues. There is a dif- san in need. She made a difference in KOLBE, Mr. TAYLOR of North Carolina, ferent kind of emphasis, and there is room hundreds of people’s lives, because she Mr. REGULA, Mr. FORBES, Mr. LIVING- for both.’’ Those connected with the business school cared. STON, Mr. MOLLOHAN, Mr. SKAGGS, Mr. program, the Initiative on Social Enterprise, Mr. President, I know my staff joins DIXON, and Mr. OBEY as managers of which was established in 1993, concede that me in wishing Susan Hoffmann the best the conference on the part of the there is much to learn before there is a dis- of luck in her future endeavors. House. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15337 The message further announced that EC–1521. A communication from the Direc- EC–1534. A communication from the Sec- the House disagrees to the amendment tor of Communications and Legislative Af- retary of Veterans Affairs, transmitting, a of the Senate to the bill (H.R. 2126) fairs, U.S. Equal Employment Opportunity draft of proposed legislation to amend title making appropriations for the Depart- Commission, transmitting, pursuant to law, 38, United States Code, to modify disburse- the annual report for fiscal year 1993; to the ment agreement authority to include resi- ment of Defense for the fiscal year end- Committee on Labor and Human Resources. dents and interns serving in any Department ing September 30, 1996, and for other EC–1522. A communication from the Direc- facility providing hospital care or medical purposes, and asks a further conference tor of Communications and Legislative Af- services’’; to the Committee on Veterans’ Af- with the Senate on the disagreeing fairs, U.S. Equal Employment Opportunity fairs. votes of the two Houses thereon; and Commission, transmitting, pursuant to law, EC–1535. A communication from the Sec- the federal sector report on complaints and appoints Mr. YOUNG of Florida, Mr. retary of Veterans Affairs, transmitting, a appeals, and the annual report on the em- draft of proposed legislation to amend title MCDADE, Mr. LIVINGSTON, Mr. LEWIS of ployment of minorities, women, and people 38, United States Code, to revise the proce- California, Mr. SKEEN, Mr. HOBSON, Mr. with disabilities for fiscal year 1993; to the dures for providing claimants and their rep- BONILLA, Mr. NETHERCUTT, Mr. ISTOOK, Committee on Labor and Human Resources. resentatives with copies of Board of Veter- Mr. MURTHA, Mr. DICKS, Mr. WILSON, EC–1523. A communication from the Sec- ans’ Appeals (Board) decisions and to protect Mr. HEFNER, Mr. SABO, and Mr. OBEY as retary of the Department of Health and the right of claimants to appoint veterans managers of the conference on the part Human Services, transmitting, pursuant to service organizations as their representative of the House. law, the report on out-of-wedlock childbear- in claims before the Department of Veterans ing; to the Committee on Labor and Human Affairs; to the Committee on Veterans’ Af- Resources. fairs. At 4:13 p.m., a message from the EC–1524. A communication from the Sec- House of Representatives, delivered by retary of Labor, transmitting, pursuant to f Mr. Hays, one of its reading clerks, an- law, the report on the Employment Retire- nounced that the House has passed the ment Income Security Act (ERISA) during REPORTS OF COMMITTEES following bill, without amendment: calendar year 1993; to the Committee on The following reports of committees S. 1254. An act to disapprove of amend- Labor and Human Resources. were submitted: EC–1525. A communication from the Sec- ments to the Federal Sentencing Guidelines By Mr. PRESSLER, from the Committee retary of Labor, transmitting, pursuant to relating to lowering of crack sentences and on Commerce, Science, and Transportation, law, the annual report on the Office of Work- sentences for money laundering and trans- without amendment: ers’ Compensation Programs for fiscal year actions in property derived from unlawful S. 187. A bill to provide for the safety of 1994; to the Committee on Labor and Human activity. journeymen boxers, and for other purposes Resources. (Rept. No. 104–159). The message also announced that the EC–1526. A communication from the Direc- By Mr. PRESSLER, from the Committee tor of the Office of Management and Budget, House has passed the following bill, in on Commerce, Science, and Transportation, the Executive Office of the President, trans- which it requests the concurrence of with an amendment in the nature of a sub- mitting, pursuant to law, the report on ap- the Senate: stitute: propriations legislation within five days of S. 1004. A bill to authorize appropriations H.R. 39. An act to amend the Magnuson enactment; to the Committee on the Budget. Fishery Conservation and Management Act EC–1527. A communication from the Sec- for the United States Coast Guard, and for to improve fisheries management. retary of Transportation, transmitting, pur- other purposes (Rept. No. 104–160). By Mrs. KASSEBAUM, from the Commit- suant to law, the annual report entitled, f tee on Labor and Human Resources, with an ‘‘Relative Cost of Shipbuilding’’ for 1994; to amendment in the nature of a substitute: ENROLLED BILLS the Committee on Commerce, Science, and S. 673. A bill to establish a youth develop- Transportation. At 6:46 p.m., a message from the EC–1528. A communication from the Sec- ment grant program, and for other purposes House of Representatives, delivered by retary of Energy, transmitting, a draft of (Rept. No. 104–161). Ms. Goetz, one of its reading clerks, an- proposed legislation to amend the Energy By Mr. MURKOWSKI, from the Committee nounced that the Speaker has signed Policy and Conservation Act to manage the on Energy and Natural Resources, without Stretegic Petroleum Reserve more effec- amendment: the following enrolled bills: S. 1012. A bill to extend the time for con- tively and for other purposes; to the Com- S. 227. An Act to amend title 17, United struction of certain FERC licensed hydro States Code, to provide an exclusive right to mittee on Energy and Natural Resources. EC–1529. A communication from the Assist- projects (Rept. No. 104–162). perform sound recordings publicly by means H.R. 1266. A bill to provide for the ex- of digital transmissions and for other pur- ant Secretary of State for Legislative Af- fairs, transmitting, pursuant to law, notice change of lands within Admiralty Island Na- poses. tional Monument, and for other purposes S. 268. An Act to authorize the collection of a Presidential determination relative to Military Financing Funds to the Economic (Rept. No. 104–163). of fees for expenses for triploid grass carp By Mr. HATCH, from the Committee on Support Fund for El Salvador; to the Com- certification inspections, and for other pur- the Judiciary, without amendment and with poses. mittee on Foreign Relations. EC–1530. A communication from the Assist- a preamble: f ant Legal Adviser for Treaty Affairs, Depart- S. Res. 177. A resolution to designate Octo- ment of State, transmitting, pursuant to ber 19, 1995, as ‘‘National Mammography MEASURES REFERRED law, the report of the texts of international Day.’’ Pursuant to the order of October 19, agreements, other than treaties, and back- f ground statements; to the Committee on 1995, the following bill was referred to INTRODUCTION OF BILLS AND the Committee on Finance: Foreign Relations. EC–1531. A communication from the Chair- JOINT RESOLUTIONS S. 1318. A bill to reform the statutes relat- person of the U.S. Commission on Civil ing to Amtrak, to authorize appropriations The following bills and joint resolu- Rights, transmitting, puruant to law, the re- tions were introduced, read the first for Amtrak, and for other purposes. port entitled, ‘‘Racial and Ethnic Tensions The following bill was read the first in American Communities: Poverty, Inequal- and second time by unanimous con- and second times by unanimous con- ity, and Discrimination’’; to the Committee sent, and referred as indicated: sent and referred as indicated: on the Judiciary. By Mr. MCCONNELL (for himself, Mr. EC–1532. A communication from the Chair- BENNETT, and Mr. DORGAN): H.R. 39. An act to amend the Magnuson man of the Federal Elections Commission, S. 1335. A bill to provide for the protection Fishery Conservation and Management Act transmitting, pursuant to law, communica- of the flag of the United States and free to improve fisheries management; to the tions disclaimer requirements; to the Com- speech, and for other purposes; to the Com- Committee on Commerce, Science, and mittee on Rules and Administration. mittee on the Judiciary. Transportation. EC–1533. A communication from the Sec- By Mr. LUGAR: f retary of Veterans Affairs, transmitting, a S. 1336. A bill to enable processors of pop- draft of proposed legislation to amend title corn to develop, finance, and carry out a na- EXECUTIVE AND OTHER 38, sections 810(2) and 8109(h)(3)(B), United tionally coordinated program for popcorn COMMUNICATIONS States Code, to delete the references therein promotion, research, consumer information, The following communications were to ‘‘working drawings’’ and substitute there- and industry information, and for other pur- for the words ‘‘construction documents,’’ and poses; to the Committee on Agriculture, Nu- laid before the Senate, together with to further delete the references therein to trition, and Forestry. accompanying papers, reports, and doc- ‘‘preliminary plans’’ and to substitute there- By Mr. BROWN: uments, which were referred as indi- for the words ‘‘design development’’; to the S. 1337. A bill to amend the Legal Services cated: Committee on Veterans’ Affairs. Corporation Act to limit frivolous lawsuits, S 15338 CONGRESSIONAL RECORD — SENATE October 19, 1995 and for other purposes; to the Committee on and free speech, and for other purposes; said that we should turn America into a Labor and Human Resources. to the Committee on the Judiciary. ‘‘city shining on a hill, a light to all na- S. 1338. A bill to improve the United States tions.’’ Don’t be afraid of freedom, it is the THE FLAG PROTECTION AND FREE SPEECH ACT Marshals Service, and for other purposes; to best weapon wee have. OF 1995 the Committee on the Judiciary. ∑ Mr. MCCONNELL. Mr. President, on I hope my colleagues will study this By Mrs. FEINSTEIN: bill and consider it, as we approach the S. 1339. A bill to amend title 18, United behalf of myself, Senator BENNETT and States Code, to restrict the mail-order sale Senator DORGAN, I am introducing a significant debate on a Constitutional of body armor; to the Committee on the Ju- bill to outlaw the desecration of the amendment to ban flag desecration. diciary. American flag. Mr. President, I ask unanimous con- By Mr. DASCHLE (for himself, Mr. Flag burning is a despicable act. And sent that the text of the bill be printed HARKIN, Mr. BAUCUS, Mr. WELLSTONE, we should have zero tolerance for those in the RECORD. Mr. KERREY, Mr. CONRAD, Mr. GRASS- who deface our flag. Make no mistake There being no objection, the bill was LEY, Mr. CRAIG, Mr. LEAHY, Mr. DOR- about it—I am disgusted by those who ordered to be printed in the RECORD, as GAN, Mr. BOND, Mr. PRESSLER, Mrs. follows: MURRAY, Mr. FEINGOLD, Mr. KOHL, desecrate our symbol of freedom, under Mr. BURNS, and Mr. EXON): which so many men and women, in- S. 1335 S. 1340. A bill to require the President to cluding my father, have gone into bat- Be it enacted by the Senate and House of Rep- appoint a Commission on Concentration in tle in order to preserve our way of life. resentatives of the United States of America in the Livestock Industry; to the Committee on Many patriotic Americans believe Congress assembled, the Judiciary. that we need a Constitutional amend- SECTION 1. SHORT TITLE. By Mr. MCCAIN (for himself and Mr. ment to ban flag burning. The Supreme This Act may be cited as the ‘‘Flag Protec- KYL): Court has rejected laws which have at- tion and Free Speech Act of 1995’’. S. 1341. A bill to provide for the transfer of SEC. 2. FINDINGS AND PURPOSE. certain lands to the Salt River Pima-Mari- tempted to ban flag burning, finding such laws to be in conflict with the (a) FINDINGS.—The Congress finds that— copa Indian Community and the city of (1) the Flag of the United States is a Scottsdale, Arizona, and for other purposes; first amendment’s protection of free unique symbol of national unity and rep- to the Committee on Indian Affairs. speech. So, the supporters of the Con- resents the values of liberty, justice, and By Mr. AKAKA (for himself, Mr. stitutional amendment argue that the equality that make this Nation an example ROCKEFELLER, Mr. INOUYE, Mr. only way to get it done right is to of freedom unmatched throughout the world; WELLSTONE, and Mr. SIMON): change the Constitution. (2) the Bill of Rights is a guarantee of S. 1342. A bill to amend title 38, United Flag burners must be punished for those freedoms and should not be amended in States Code, to authorize the Secretary of their vile behavior. But the precedent a manner that could be interpreted to re- Veterans Affairs to make loans to refinance strict freedom, a course that is regularly re- loans made to veterans under the Native of amending the Bill of Rights is a dan- gerous one. I fear that if we amend the sorted to by authoritarian governments American Veterans Direct Loan Program; to which fear freedom and not by free and the Committee on Veterans’ Affairs. first amendment this year, soon the democratic nations; By Mr. HELMS: fifth amendment’s protection of pri- (3) abuse of the flag of the United States S. 1343. A bill to amend title XVIII of the vate property rights or the second causes more than pain and distress to the Social Security Act to provide that eligible amendment’s protection of the right to overwhelming majority of the American peo- organizations assure out-of-network access; bear arms, will be under assault. ple and may amount to fighting words or a to the Committee on Finance. So, I have been searching for an al- direct threat to the physical and emotional By Mr. HEFLIN: well-being of individuals at whom the threat S. 1344. A bill to repeal the requirement re- ternative which will result in the swift and certain punishment for those who is targeted; and lating to specific statutory authorization for (4) destruction of the flag of the United increases in judicial salaries, to provide for commit the contemptible act of defac- States can be intended to incite a violent re- automatic annual increases for judicial sala- ing the flag, but leave the first amend- sponse rather than make a political state- ries, and for other purposes; to the Commit- ment untouched. ment and such conduct is outside the protec- tee on the Judiciary. This bill achieves those purposes. tions afforded by the first amendment to the By Mr. SIMPSON (by request): The deviants who burn the flag do so to Unites States Constitution. S. 1345. A bill to amend title 38, United provoked or incite patriotic Ameri- (b) PURPOSE.—It is the purpose of this Act States Code, and various other statutes, to cans. And, it is well established that to provide the maximum protection against reform eligibility for Department of Veter- fighting words or speech which incites the use of the flag of the United States to ans Affairs health-care benefits, improve the promote violence while respecting the lib- operation of the Department, and improve lawlessness is not protected by the erties that it symbolizes. first amendment. My bill provides for the processes and procedures the Department SEC. 3. PROTECTION OF THE FLAG OF THE UNIT- uses to administer various benefit programs imprisoning and fining those who dam- ED STATES AGAINST USE FOR PRO- for veterans; and for other purposes; to the age a flag intending to incite a breach MOTING VIOLENCE. Committee on Veterans’ Affairs. of the peace. It also punishes anyone (a) IN GENERAL.—Section 700 of title 18, f who steals a flag belonging to the Fed- United States Code, is amended to read as eral Government or a flag displayed on follows: SUBMISSION OF CONCURRENT AND Federal property. ‘‘§ 700. Incitement; damage or destruction of SENATE RESOLUTIONS This bill will get the job done with- property involving the flag of the United The following concurrent resolutions out tampering with the first amend- States and Senate resolutions were read, and ment. There have been well-respected ‘‘(a) ACTIONS PROMOTING VIOLENCE.—Any referred (or acted upon), as indicated: conservative voices who have cau- person who destroys or damages a flag of the United States with the primary purpose and By Mr. FAIRCLOTH: tioned against amending the first intent to incite or produce imminent vio- S. Res. 185. A resolution to express the amendment to ban flag burning, in- lence or a breach of the peace, and in cir- sense of the Senate regarding repayment of cluding George Will, Charles cumstances where the person knows it is rea- loans to Mexico; to the Committee on For- Krauthammer, Cal Thomas, Bruce sonably likely to produce imminent violence eign Relations. Fein. But perhaps the most compelling or a breach of the peace, shall be fined not By Mr. DOLE (for himself and Mr. words have come from Jim Warner, a more than $100,000 or imprisoned not more DASCHLE): patriot and hero who fought in Viet- than 1 year, or both. S. Res. 186. A resolution to authorize testi- ‘‘(b) DAMAGING A FLAG BELONGING TO THE nam and survived more than 5 years of mony by Senate employees and representa- UNITED STATES.—Any person who steals or tion by Senate Legal Counsel; considered and torture and brutality as a prisoner or knowingly converts to his or her use, or to agreed to. war: the use of another, a flag of the United f We don’t need to amend the Constitution States belonging to the United States and in order to punish those who burn our flag. intentionally destroys or damages that flag STATEMENTS ON INTRODUCED They burn the flag because they hate Amer- shall be fined not more than $250,000 or im- BILLS AND JOINT RESOLUTIONS ica and they are afraid of freedom. What bet- prisoned not more than 2 years, or both. ter way to hurt them than with the subver- ‘‘(c) DAMAGING A FLAG OF ANOTHER ON FED- C By Mr. M CONNELL (for himself, sive idea of freedom? Spread freedom. [When ERAL LAND.—Any person who, within any Mr. BENNETT, and Mr. DORGAN): a] flag in Dallas was burned to protest the lands reserved for the use of the United S. 1335. A bill to provide for the pro- nomination of Ronald Reagan, . . . he told us States, or under the exclusive or concurrent tection of the flag of the United States how to spread the idea of freedom when he jurisdiction of the United States, steals or October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15339 knowingly converts to his or her use, or to The entire popcorn industry would (C) authorizes and funds programs that re- the use of another, a flag of the United benefit from a popcorn promotion pro- sult in government speech promoting gov- States belonging to another person, and in- gram. These programs have been ex- ernment objectives; and tentionally destroys or damages that flag tremely successful for other commod- (2) establish a nationally coordinated pro- shall be fined not more than $250,000 or im- gram for popcorn promotion, research, prisoned not more than 2 years, or both. ities. Furthermore, they operate at no consumer information, and industry infor- ‘‘(d) CONSTRUCTION.—Nothing in this sec- cost to the Federal Government, be- mation. tion shall be construed to indicate an intent cause all Government expenses are re- (d) STATUTORY CONSTRUCTION.—This Act on the part of Congress to deprive any State, imbursed from the programs funds. I treats processors equitably. Nothing in this territory or possession of the United States, urge my colleagues to support this self- Act— or the Commonwealth of Puerto Rico of ju- help agricultural initiative. (1) provides for the imposition of a trade barrier to the entry into the United States of risdiction over any offense over which it Mr. President, I ask unanimous con- would have jurisdiction in the absence of imported popcorn for the domestic market; this section. sent that a copy of the bill be printed or ‘‘(e) DEFINITION.—As used in this section, in the RECORD. (2) provides for the control of production or the term ‘flag of the United States’ means There being no objection, the bill was otherwise limits the right of any individual any flag of the United States, or any part ordered to be printed in the RECORD, as processor to produce popcorn. thereof, made of any substance, in any size, follows: SEC. 3. DEFINITIONS. In this Act (except as otherwise specifi- in a form that is commonly displayed as a S. 1336 flag and would be taken to be a flag by the cally provided): reasonable observer.’’. Be it enacted by the Senate and House of Rep- (1) BOARD.—The term ‘‘Board’’ means the (b) CLERICAL AMENDMENT.—The table of resentatives of the United States of America in Popcorn Board established under section sections for chapter 33 of title 18, United Congress assembled, 5(b). States Code, is amended by striking the item SECTION 1. SHORT TITLE. (2) COMMERCE.—The term ‘‘commerce’’ relating to section 700 and inserting the fol- This Act may be cited as the ‘‘Popcorn means interstate, foreign, or intrastate com- lowing new item: Promotion, Research, and Consumer Infor- merce. ‘‘700. Incitement; damage or destruction of mation Act’’. (3) CONSUMER INFORMATION.—The term ‘‘consumer information’’ means information property involving the flag of SEC. 2. FINDINGS AND DECLARATION OF POLICY. and programs that will assist consumers and the United States.’’.∑ (a) FINDINGS.—Congress finds that— other persons in making evaluations and de- (1) popcorn is an important food that is a By Mr. LUGAR: cisions regarding the purchase, preparation, valuable part of the human diet; and use of popcorn. S. 1336. A bill to enable processors of (2) the production and processing of pop- (4) DEPARTMENT.—The term ‘‘Department’’ popcorn to develop, finance, and carry corn plays a significant role in the economy means the Department of Agriculture. out a nationally coordinated program of the United States in that popcorn is proc- (5) INDUSTRY INFORMATION.—The term ‘‘in- for popcorn promotion, research, essed by several popcorn processors, distrib- dustry information’’ means information and consumer information, and industry in- uted through wholesale and retail outlets, programs that will lead to the development and consumed by millions of people through- formation, and for other purposes. of— out the United States and foreign countries; (A) new markets, new marketing strate- THE POPCORN PROMOTION, RESEARCH, AND (3) popcorn must be of high quality, readily gies, or increased efficiency for the popcorn CONSUMER INFORMATION ACT available, handled properly, and marketed industry; or ∑ Mr. LUGAR. Mr. President, today I efficiently to ensure that the benefits of pop- (B) activities to enhance the image of the am introducing the Popcorn Research, corn are available to the people of the United popcorn industry. Promotion and Consumer Information States; (6) MARKETING.—The term ‘‘marketing’’ Act which will allow the U.S. Depart- (4) the maintenance and expansion of exist- means the sale or other disposition of ment of Agriculture to issue an order ing markets and uses and the development of unpopped popcorn for human consumption in new markets and uses for popcorn are vital establishing a popcorn promotion pro- a channel of commerce, but does not include to the welfare of processors and persons con- a sale or disposition to or between proc- gram. This will be similar to other ag- cerned with marketing, using, and producing essors. ricultural promotion programs for popcorn for the market, as well as to the ag- (7) ORDER.—The term ‘‘order’’ means an dairy, beef, pork, eggs, and potatoes, to ricultural economy of the United States; order issued under section 4. name a few. (5) the cooperative development, financing, (8) PERSON.—The term ‘‘person’’ means an Americans consume 17.3 billion and implementation of a coordinated pro- individual, group of individuals, partnership, quarts of popped popcorn annually, or gram of popcorn promotion, research, corporation, association, or cooperative, or 68 quarts per person. It is one of the consumer information, and industry infor- any other legal entity. mation is necessary to maintain and expand most wholesome and economical foods (9) POPCORN.—The term ‘‘popcorn’’ means markets for popcorn; and unpopped popcorn (Zea Mays L), commer- available to the consumer. My home (6) popcorn moves in interstate and foreign cially grown in the United States, processed State of Indiana leads all States in commerce, and popcorn that does not move by shelling, cleaning, or drying and intro- popcorn production, with more than in those channels of commerce directly bur- duced into a channel of commerce. 77,000 acres harvested last year. Fol- dens or affects interstate commerce in pop- (10) PROCESS.—The term ‘‘process’’ means lowing Indiana, major popcorn produc- corn. to shell, clean, dry, and prepare popcorn for ing States are Illinois, Nebraska, Ohio, (b) POLICY.—It is the policy of Congress the market, but does not include packaging Kansas, Iowa, Missouri, Kentucky, and that it is in the public interest to authorize popcorn for the market without also engag- the establishment, through the exercise of ing in another activity described in this Michigan. the powers provided in this Act, of an or- paragraph. In the past, the popcorn industry has derly procedure for developing, financing (11) PROCESSOR.—The term ‘‘processor’’ united to promote and market its prod- (through adequate assessments on unpopped means a person engaged in the preparation of uct. Total popcorn sales, as a result of popcorn processed domestically), and carry- unpopped popcorn for the market who owns these efforts, have grown throughout ing out an effective, continuous, and coordi- or shares the ownership and risk of loss of the past several years, but great poten- nated program of promotion, research, the popcorn and who processes and distrib- tial exists to accelerate this trend with consumer information, and industry infor- utes over 4,000,000 pounds of popcorn in the a larger, industry-wide, cooperative ef- mation designed to— market per year. (1) strengthen the position of the popcorn ROMOTION fort. (12) P .—The term ‘‘promotion’’ industry in the marketplace; and means an action, including paid advertising, Under a popcorn promotion program, (2) maintain and expand domestic and for- to enhance the image or desirability of pop- popcorn processors would pay a small eign markets and uses for popcorn. corn. assessment on each pound of popcorn (c) PURPOSES.—The purposes of this Act (13) RESEARCH.—The term ‘‘research’’ marketed. The Secretary of Agri- are to— means any type of study to advance the culture would then select a Popcorn (1) maintain and expand the markets for image, desirability, marketability, produc- Board, made up of representatives from all popcorn products in a manner that— tion, product development, quality, or nutri- the industry to administer the pro- (A) is not designed to maintain or expand tional value of popcorn. gram, with oversight by USDA. The any individual share of a producer or proc- (14) SECRETARY.—The term ‘‘Secretary’’ essor of the market; means the Secretary of Agriculture. funds collected would be used for re- (B) does not compete with or replace indi- (15) STATE.—The term ‘‘State’’ means each search, promotion and consumer infor- vidual advertising or promotion efforts de- of the 50 States and the District of Columbia. mation projects with the goal of in- signed to promote individual brand name or (16) UNITED STATES.—The term ‘‘United creasing consumption of popcorn. trade name popcorn products; and States’’ means all of the States. S 15340 CONGRESSIONAL RECORD — SENATE October 19, 1995 SEC. 4. ISSUANCE OF ORDERS. motion, research, consumer information, and lished by the Board but not more than $.08 (a) IN GENERAL.—To effectuate the policy industry information, and to contract with per hundredweight of popcorn. described in section 2(b), the Secretary, sub- appropriate persons to implement the plans (B) ADJUSTMENT OF RATE.—The order shall ject to subsection (b), shall issue 1 or more or projects; provide that the Board, with the approval of orders applicable to processors. An order (5) to accept and receive voluntary con- the Secretary, may raise or lower the rate of shall be applicable to all popcorn production tributions, gifts, and market promotion or assessment annually up to a maximum of and marketing areas in the United States. similar funds; $.08 per hundredweight of popcorn. Not more than 1 order shall be in effect (6) to invest, pending disbursement under a (4) USE OF ASSESSMENTS.— under this Act at any 1 time. plan or project, funds collected through as- (A) IN GENERAL.—Subject to subparagraph (b) PROCEDURE.— sessments authorized under subsection (f), (B), the order shall provide that the assess- (1) PROPOSAL OR REQUEST FOR ISSUANCE.— only in— ments collected shall be used by the Board— The Secretary may propose the issuance of (A) obligations of the United States or an (i) to pay the expenses incurred in imple- an order, or an association of processors or agency of the United States; menting and administering the order, with any other person that would be affected by (B) general obligations of a State or a po- provision for a reasonable reserve; and an order may request the issuance of, and litical subdivision of a State; (ii) to cover such administrative costs as submit a proposal for, an order. (C) an interest-bearing account or certifi- are incurred by the Secretary except that (2) NOTICE AND COMMENT CONCERNING PRO- cate of deposit of a bank that is a member of the costs incurred by the Secretary that may POSED ORDER.—Not later than 30 days after the Federal Reserve System; or be reimbursed by the Board may not exceed the receipt of a request and proposal for an (D) obligations fully guaranteed as to prin- 5 percent of the projected annual revenues of order under paragraph (1), or at such time as cipal and interest by the United States; the Board. the Secretary determines to propose an (7) to receive, investigate, and report to (B) EXPENDITURES BASED ON SOURCE OF AS- order, the Secretary shall publish a proposed the Secretary complaints of violations of the SESSMENTS.—In implementing plans and order and give due notice and opportunity order; and projects of promotion, research, consumer for public comment on the proposed order. (8) to recommend to the Secretary amend- information, and industry information, the (3) ISSUANCE OF ORDER.—After notice and ments to the order. Board shall expend funds on— (i) plans and projects for domestic popcorn opportunity for public comment under para- (d) PLANS AND BUDGETS.— (including Canadian popcorn) in proportion graph (2), the Secretary shall issue an order, (1) IN GENERAL.—The order shall provide taking into consideration the comments re- that the Board shall submit to the Secretary to the amount of assessments collected on ceived and including in the order such provi- for approval any plan or project of pro- popcorn marketed domestically (including Canada); and sions as are necessary to ensure that the motion, research, consumer information, or (ii) plans and projects for exported popcorn order conforms to this Act. The order shall industry information. in proportion to the amount of assessments be issued and become effective not later than (2) BUDGETS.—The order shall require the collected on exported popcorn. 150 days after the date of publication of the Board to submit to the Secretary for ap- (g) PROHIBITION ON USE OF FUNDS.—The proposed order. proval budgets on a fiscal year basis of the order shall prohibit any funds collected by (c) AMENDMENTS.—The Secretary, as appro- anticipated expenses and disbursements of the Board under the order from being used to priate, may amend an order. The provisions the Board in the implementation of the influence government action or policy, other of this Act applicable to an order shall be ap- order, including projected costs of plans and than the use of funds by the Board for the de- plicable to any amendment to an order, ex- projects of promotion, research, consumer velopment and recommendation to the Sec- cept that an amendment to an order may not information, and industry information. retary of amendments to the order. require a referendum to become effective. (e) CONTRACTS AND AGREEMENTS.— (h) BOOKS AND RECORDS OF THE BOARD.— SEC. 5. REQUIRED TERMS IN ORDERS. (1) IN GENERAL.—The order shall provide The order shall require the Board to— (a) IN GENERAL.—An order shall contain that the Board may enter into contracts or (1) maintain such books and records (which the terms and conditions specified in this agreements for the implementation and car- shall be available to the Secretary for in- section. rying out of plans or projects of promotion, spection and audit) as the Secretary may (b) ESTABLISHMENT AND MEMBERSHIP OF research, consumer information, or industry prescribe; POPCORN BOARD.— information, including contracts with a (2) prepare and submit to the Secretary, (1) IN GENERAL.—The order shall provide processor organization, and for the payment from time to time, such reports as the Sec- for the establishment of, and appointment of of the cost of the plans or projects with retary may prescribe; and members to, a Popcorn Board that shall con- funds collected by the Board under the order. (3) account for the receipt and disburse- sist of not fewer than 4 members and not (2) REQUIREMENTS.—A contract or agree- ment of all funds entrusted to the Board. more than 9 members. ment under paragraph (1) shall provide (i) BOOKS AND RECORDS OF PROCESSORS.— (2) NOMINATIONS.—The members of the that— (1) MAINTENANCE AND REPORTING OF INFOR- Board shall be processors appointed by the (A) the contracting party shall develop and MATION.—The order shall require that each Secretary from nominations submitted by submit to the Board a plan or project, to- processor of popcorn for the market shall— processors in a manner authorized by the gether with a budget that shows the esti- (A) maintain, and make available for in- Secretary, subject to paragraph (3). Not mated costs to be incurred for the plan or spection, such books and records as are re- more than 1 member may be appointed to project; quired by the order; and the Board from nominations submitted by (B) the plan or project shall become effec- (B) file reports at such time, in such man- any 1 processor. tive on the approval of the Secretary; and ner, and having such content as is prescribed (3) GEOGRAPHICAL DIVERSITY.—In making (C) the contracting party shall keep accu- in the order. appointments, the Secretary shall take into rate records of each transaction of the party, (2) USE OF INFORMATION.—The Secretary account, to the extent practicable, the geo- account for funds received and expended, shall authorize the use of information re- graphical distribution of popcorn production make periodic reports to the Board of activi- garding processors that may be accumulated throughout the United States. ties conducted, and make such other reports under a law or regulation other than this Act (4) TERMS.—The term of appointment of as the Board or the Secretary may require. or a regulation issued under this Act. The in- each member of the Board shall be 3 years, (3) PROCESSOR ORGANIZATIONS.—The order formation shall be made available to the except that the members appointed to the shall provide that the Board may contract Secretary as appropriate for the administra- initial Board shall serve, proportionately, for with processor organizations for any other tion or enforcement of this Act, the order, or terms of 2, 3, and 4 years, as determined by services. The contract shall include provi- any regulation issued under this Act. the Secretary. sions comparable to the provisions required (3) CONFIDENTIALITY.— (5) COMPENSATION AND EXPENSES.—A mem- by paragraph (2). (A) IN GENERAL.—Subject to subparagraphs ber of the Board shall serve without com- (f) ASSESSMENTS.— (B), (C), and (D), all information obtained by pensation, but shall be reimbursed for the (1) PROCESSORS.—The order shall provide the Secretary under paragraphs (1) and (2) expenses of the member incurred in the per- that each processor marketing popcorn in shall be kept confidential by all officers, em- formance of duties for the Board. the United States or for export shall, in the ployees, and agents of the Board and the De- (c) POWERS AND DUTIES OF BOARD.—The manner prescribed in the order, pay assess- partment. order shall define the powers and duties of ments and remit the assessments to the (B) DISCLOSURE BY SECRETARY.—Informa- the Board, which shall include the power and Board. tion referred to in subparagraph (A) may be duty— (2) DIRECT MARKETERS.—A processor that disclosed if— (1) to administer the order in accordance markets popcorn produced by the processor (i) the Secretary considers the information with the terms and provisions of the order; directly to consumers shall pay and remit relevant; (2) to make regulations to effectuate the the assessments on the popcorn directly to (ii) the information is revealed in a suit or terms and provisions of the order; the Board in the manner prescribed in the administrative hearing brought at the re- (3) to appoint members of the Board to order. quest of the Secretary, or to which the Sec- serve on an executive committee; (3) RATE.— retary or any officer of the United States is (4) to propose, receive, evaluate, and ap- (A) IN GENERAL.—The rate of assessment a party; and prove budgets, plans, and projects of pro- prescribed in the order shall be a rate estab- (iii) the information relates to the order. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15341

(C) DISCLOSURE TO OTHER AGENCY OF FED- lected by the Board for any expenses in- tion specifically to enforce, and to prevent ERAL GOVERNMENT.— curred by the Secretary in connection with and restrain any person from violating, an (i) IN GENERAL.—No information obtained the conduct of any referendum under this order or regulation issued under this Act. under the authority of this Act may be made section, except for the salaries of Govern- (c) REFERRAL TO ATTORNEY GENERAL.—A available to another agency or officer of the ment employees associated with conducting civil action authorized to be brought under Federal Government for any purpose other a referendum. this section shall be referred to the Attorney than the implementation of this Act and any (d) METHOD OF CONDUCTING REFERENDUM.— General for appropriate action. investigatory or enforcement activity nec- Subject to this section, a referendum con- SEC. 9. INVESTIGATIONS AND POWER TO SUB- essary for the implementation of this Act. ducted under this section shall be conducted POENA. (ii) PENALTY.—A person who violates this in such manner as is determined by the Sec- (a) INVESTIGATIONS.—The Secretary may subparagraph shall, on conviction, be subject retary. make such investigations as the Secretary to a fine of not more than $1,000 or to impris- (e) CONFIDENTIALITY OF BALLOTS AND considers necessary— onment for not more than 1 year, or both, OTHER INFORMATION.— (1) for the effective administration of this and if an officer, employee, or agent of the (1) IN GENERAL.—The ballots and other in- Act; and Board or the Department, shall be removed formation or reports that reveal or tend to (2) to determine whether any person sub- from office or terminated from employment, reveal the vote of any processor, or any busi- ject to this Act has engaged, or is about to as applicable. ness operation of a processor, shall be con- engage, in an act that constitutes or will (D) GENERAL STATEMENTS.—Nothing in this sidered to be strictly confidential and shall constitute a violation of this Act or of an paragraph prohibits— not be disclosed. order or regulation issued under this Act. (b) OATHS, AFFIRMATIONS, AND SUBPOE- (i) the issuance of general statements, (2) PENALTY FOR VIOLATIONS.—An officer or NAS.—For the purpose of an investigation based on the reports, of the number of per- employee of the Department who violates under subsection (a), the Secretary may ad- sons subject to the order or statistical data paragraph (1) shall be subject to the pen- minister oaths and affirmations, subpoena collected from the reports, if the statements alties described in section 5(i)(3)(C)(ii). witnesses, compel the attendance of wit- do not identify the information provided by SEC. 7. PETITION AND REVIEW. nesses, take evidence, and require the pro- any person; or (a) PETITION.— duction of any records that are relevant to (ii) the publication, by direction of the (1) IN GENERAL.—A person subject to an the inquiry. The attendance of witnesses and Secretary, of the name of a person violating order may file with the Secretary a peti- the production of records may be required the order, together with a statement of the tion— from any place in the United States. particular provisions of the order violated by (A) stating that the order, a provision of (c) AID OF COURTS.— the person. the order, or an obligation imposed in con- (1) REQUEST.—In the case of contumacy by, (j) OTHER TERMS AND CONDITIONS.—The nection with the order is not established in or refusal to obey a subpoena issued to, any order shall contain such terms and condi- accordance with law; and person, the Secretary may request the aid of tions, consistent with this Act, as are nec- (B) requesting a modification of the order any court of the United States within the ju- essary to effectuate this Act, including regu- or obligation or an exemption from the order risdiction of which the investigation or pro- lations relating to the assessment of late or obligation. ceeding is carried on, or where the person re- payment charges. (2) HEARINGS.—The petitioner shall be sides or carries on business, in requiring the SEC. 6. REFERENDA. given the opportunity for a hearing on a pe- attendance and testimony of the person and (a) INITIAL REFERENDUM.— tition filed under paragraph (1), in accord- the production of records. (1) IN GENERAL.—Within the 60-day period ance with regulations issued by the Sec- (2) ENFORCEMENT ORDER OF THE COURT.— immediately preceding the effective date of retary. The court may issue an enforcement order an order, as provided in section 4(b)(3), the (3) RULING.—After a hearing under para- requiring the person to appear before the Secretary shall conduct a referendum among graph (2), the Secretary shall issue a ruling Secretary to produce records or to give testi- processors who, during a representative pe- on the petition that is the subject of the mony concerning the matter under inves- riod as determined by the Secretary, have hearing, which shall be final if the ruling is tigation. been engaged in processing, for the purpose in accordance with applicable law. (3) CONTEMPT.—A failure to obey an en- of ascertaining whether the order shall go (b) REVIEW.— forcement order of the court under para- into effect. (1) COMMENCEMENT OF ACTION.—The district graph (2) may be punished by the court as a (2) APPROVAL OF ORDER.—The order shall court of the United States for any district in contempt of the court. become effective, as provided in section 4(b), which a person who is a petitioner under sub- (4) PROCESS.—Process in a case under this only if the Secretary determines that the section (a) resides or carries on business subsection may be served in the judicial dis- order has been approved by not less than a shall have jurisdiction to review a ruling on trict in which the person resides or conducts majority of the processors voting in the ref- the petition, if the person files a complaint business or wherever the person may be erendum and if the majority processed more not later than 20 days after the date of issu- found. ance of the ruling under subsection (a)(3). than 50 percent of the popcorn certified as SEC. 10. RELATION TO OTHER PROGRAMS. having been processed, during the represent- (2) PROCESS.—Service of process in a pro- Nothing in this Act preempts or supersedes ative period, by the processors voting. ceeding under paragraph (1) may be made on any other program relating to popcorn pro- (b) ADDITIONAL REFERENDA.— the Secretary by delivering a copy of the motion organized and operated under the (1) IN GENERAL.—Not earlier than 3 years complaint to the Secretary. laws of the United States or any State. (3) REMANDS.—If the court determines, after the effective date of an order approved SEC. 11. REGULATIONS. under paragraph (1), that a ruling issued under subsection (a), on the request of the The Secretary may issue such regulations under subsection (a)(3) is not in accordance Board or a representative group of proc- as are necessary to carry out this Act. with applicable law, the court shall remand essors, as described in paragraph (2), the Sec- SEC. 12. AUTHORIZATION OF APPROPRIATIONS. the matter to the Secretary with direc- retary may conduct an additional referen- There are authorized to be appropriated tions— dum to determine whether processors favor such sums as are necessary to carry out this (A) to make such ruling as the court shall the termination or suspension of the order. Act. Amounts made available under this sec- determine to be in accordance with law; or (2) REPRESENTATIVE GROUP OF PROC- tion may not be used to pay any expense of (B) to take such further proceedings as, in ESSORS.—An additional referendum on an the Board in administering any provision of the opinion of the court, the law requires. order shall be conducted if the referendum is an order.∑ requested by 40 percent or more of the num- (c) ENFORCEMENT.—The pendency of pro- ber of processors who, during a representa- ceedings instituted under subsection (a) may By Mr. BROWN: tive period as determined by the Secretary, not impede, hinder, or delay the Secretary or S. 1337. A bill to amend the Legal the Attorney General from taking action have been engaged in processing. Services Corporation Act to limit friv- (3) DISAPPROVAL OF ORDER.—If the Sec- under section 8. olous lawsuits, and for other purposes; retary determines, in a referendum con- SEC. 8. ENFORCEMENT. ducted under paragraph (1), that suspension (a) IN GENERAL.—The Secretary may issue to the Committee on Labor and Human or termination of the order is favored by at an enforcement order to restrain or prevent Resources. least 2⁄3 of the processors voting in the ref- any person from violating an order or regula- THE LEGAL SERVICES CORPORATION ACT erendum, the Secretary shall— tion issued under this Act and may assess a AMENDMENT ACT OF 1995 (A) suspend or terminate, as appropriate, civil penalty of not more than $1,000 for each ∑ Mr. BROWN. Mr. President, I intro- collection of assessments under the order not violation of the enforcement order, after an duce a bill to bring the Legal Services later than 180 days after the date of deter- opportunity for an administrative hearing, if Corporation in line with the obliga- mination; and the Secretary determines that the adminis- tions of every other attorney in Amer- (B) suspend or terminate the order, as ap- tration and enforcement of the order and propriate, in an orderly manner as soon as this Act would be adequately served by such ica; that is, to allow the Legal Services practicable after the date of determination. a procedure. Corporation to be sanctioned when its (c) COSTS OF REFERENDUM.—The Secretary (b) JURISDICTION.—The district courts of attorneys bring frivolous or meritless shall be reimbursed from assessments col- the United States are vested with jurisdic- cases. S 15342 CONGRESSIONAL RECORD — SENATE October 19, 1995 The Legal Services Corporation was in a society where litigation too complex merit based promotion system created to provide for the everyday often takes the place of negotiation, to evaluate, select and promote the legal needs of the poor. Unfortunately, where the cost of a defense determines most qualified individuals for positions the LSC has digressed from its original the outcome of a case, and where one in every level of service. This bill function. Rather than taking care of lawsuit can bankrupt a law-abiding cit- would extend that type of merit based the day to day needs of American fami- izen, it is imperative that all parties selection to the office of the U.S. Mar- lies, the LSC has used its resources to play on the same legal field, including shal, so that the most qualified and ex- challenge Federal programs, lobby gov- the Legal Services Corporation.∑ perienced personnel are in a position to ernment, and pursue costly class ac- contribute to the U.S. Marshals Serv- tion lawsuits. By Mr. BROWN: ice rather than hinder its operations. In 1974, President Nixon cited three S. 1338. A bill to improve the U.S. Removing the political appointment major objectives when he signed legis- Marshals Service, and for other pur- process from the Marshals Service is lation to create the Legal Services Cor- poses; to the Committee on the Judici- not a new idea. The reform debate first poration. One was ‘‘that the lawyers in ary. began in 1955 when the Commission on the program have full freedom to pro- UNITED STATES MARSHALS SERVICE Organization of the Executive Branch tect the best interests of their clients LEGISLATION of the Government recommended an in keeping with the Canon of Ethics ∑ Mr. BROWN. Mr. President, I intro- end to the political appointment of and the high standards of the legal pro- duce a bill to improve the U.S. Mar- U.S. Marshals. During the 104th Con- fessions.’’ Achieving that goal is pre- shals Service by eliminating the politi- gress, the idea took hold in the House cisely what this bill intends to do. cal appointment of U.S. Marshals. of Representatives. Both the House Since 1789, U.S. Marshals have been The high standards of the legal pro- Balanced Budget Task Force and the appointed by the President and con- fessions include adhering to the Fed- Budget Committee recommended end- firmed by the Senate. For nearly 150 eral Rules of Civil Procedure. Rule 11, ing the political appointments. Vice years this political appointment proc- which applies to all attorneys, allows President GORE’s National Perform- ess served as the only control Washing- for sanctions against an attorney for ance Review also recommended select- ton had over its primary law enforcers. any action designed to cause unneces- ing Marshals by merit and estimated a The distance between the bureaucracy sary delay or needlessly increase the savings of over $36 million. of Washington and the ever expanding cost of litigation, or when the plain- With such broad based support why Territories of the United States gave tiff’s action is frivolous or without are we waiting? The answer lies in the U.S. Marshals such as Wyatt Earp and legal foundation. If the LSC is provid- Senate. For the past 150 years the Ex- Lloyd Garrison, nearly autonomous ing legal services with Federal funds, ecutive branch has allowed the Sen- control in their jurisdictions. one would assume it would be subject ators affiliated with the President’s But the days of the gun-slinging Fed- to these basic rules. party to select the U.S. Marshals for eral Marshal are long past. Today the the judicial districts within their Under current law, however, the executive office of the Marshals Serv- Legal Services Corporation is pro- States. Each time the idea of appoint- ice in Washington calls the shots, ing Marshals based on merit was tected from the rule 11 standard. The trains, and promotes the deputies, and LSC can only be sanctioned if it is raised, it was quashed in the Senate by operates under the watchful eye of the those unwilling to relinquish the power proven that an action was brought Department of Justice and Congress. solely to harass another party, or that of appointment. The one area in which the Service does Mr. President, if we really are for a it maliciously abused the legal system. not have control is over the appoint- leaner, less intrusive, and more effec- This standard is virtually impossible to ment of U.S. Marshals. tive government, we must begin by prove and therefore lacks any deter- Under the current system, U.S. Mar- promoting the most qualified personnel rent effect. Furthermore, only actions shals are appointed to 4-year terms by to the most important positions. Let are sanctionable—the LSC is com- the President. Appointees need not us take a real step to improve the way pletely protected from sanctions for have served in the U.S. Marshals Serv- government works—let us end the po- baseless motions, pleadings, or other ice or even have had previous profes- litical appointment process for the U.S. documents. sional law enforcement experience. In Marshals.∑ If the Legal Services Corporation is fact, of the 94 U.S. Marshals, only 30 going to provide federally funded legal have previously served in the Marshals By Mrs. FEINSTEIN: services, it should live under the same Service. S. 1339. A bill to amend title 18, Unit- laws as every other attorney in the According to a 1994 U.S. Marshals ed States Code, to restrict the mail- United States. When an attorney en- Service Reinvention Proposal reported order sale of body armor; to the Com- ters any courtroom in the Nation, ad- by the Department of Justice, the ap- mittee on the Judiciary. vocating a case without merit, he can pointment process has become a burden THE JAMES GUELFF BODY ARMOR ACT OF 1995 be sanctioned by the court. It should upon the operations of the Marshals ∑ Mrs. FEINSTEIN. Mr. President, I in- not be any different for the Legal Serv- Service. The proposal states that: troduce the James Guelff Body Armor ices Corporation. Disagreement between Marshals and head- Act which would ban the mail order The language of this bill would alter quarters often put career deputies and staff sale of bullet-proof vests to all individ- the Legal Services Corporation Act so in conflicting situations. The Marshals con- uals except law enforcement or public that it parallels the Federal Rules of trolled day-to-day assignments while head- safety officers including paramedics. Civil Procedure. Specifically, it would quarters controlled the deputies’ career ad- This legislation would require that the vancement and duty stations. The tradi- allow courts to sanction the LSC ac- sale, transfer, and receipt of bullet- cording to the standards set forth in tional independence of the Marshals clashed with the growing central control of head- proof vests to anyone other than a law rule 11. Under the bill, sanctions would quarters. Headquarters began bypassing the enforcement or public safety officers be be allowed for any action, motion, Marshals by establishing program units in conducted in person. This Act will pleading or other document that: First, the field to oversee witness security, fugitive make it more difficult for criminals to is brought for improper purpose, such investigations, asset forfeiture programs, obtain this body armor which hinders as to harass, cause unnecessary delay, and high level judicial protection activities. law enforcement’s ability to disarm or needlessly increase the cost of liti- Mr. President, my bill would elimi- and capture them. gation; or second, is frivolous or not nate some of these problems by putting For those who may not have heard warranted by existing law. experienced law enforcement personnel the story of Officer James Guelff, I This new standard is not designed to into the office of U.S. Marshal. The bill would like to provide just a few details preclude or replace rule 11 sanctions would require the Attorney General to about this tragic story. against attorneys. Rather, it would select U.S. Marshals from the ranks of On November 13, 1994, Officer James provide an additional source of funds to the Marshals Service rather than from Guelff, a 10-year veteran of the San compensate those parties forced to de- a political party. The U.S. Marshals Francisco Police Department, was shot fend against baseless legal actions. Service already has an extensive and to death in a fire-fight by a heavily October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15343 armed gunman wearing a bullet-proof armor during the commission of a ‘‘(d) Whoever knowingly violates this sec- vest on a major street corner in the crime. And, in Baltimore, MD, the city tion shall be fined under this title or impris- middle of San Francisco. council reacted quickly and severely to oned not more than two years, or both.’’.∑ Captain Richard Cairns was the com- a billboard advertising the sale of bul- By Mr. DASCHLE (for himself, manding officer on the scene. Earlier let-proof vests as ‘‘Life Insurance for Mr. HARKIN, Mr. BAUCUS, Mr. this year, Captain Cairns participated the 90’s’’ with a 1–800 number printed WELLSTONE, Mr. KERREY, Mr. in a roundtable discussion with me at the bottom by introducing a city or- CONRAD, Mr. GRASSLEY, Mr. about the violence of assault weapons. dinance which bans the sale of bullet- CRAIG, Mr. LEAHY, Mr. DORGAN, This is how Captain Cairns described proof vests to anyone unless they have Mr. BOND, Mr. PRESSLER, Mrs. the scene: the permission of the police commis- MURRAY, Mr. FEINGOLD, Mr. (The assailant) was firing as fast as you sioner. KOHL, Mr. BURNS, and Mr. could pull the trigger. He had semi-auto- Not only have States and localities matic assault weapons. He had an AK 223 EXON): begun to control the sale of body S. 1340. A bill to require the Presi- rifle, with 30 round clips. He had a Steyr armor, at least three Nation-wide AUG which is a sophisticated weapon, that dent to appoint a Commission on Con- he didn’t get to. The officers managed to stores have already pulled bullet-proof centration in the Livestock Industry; keep him away from that. He had an uzi that vests from their shelves. Those stores to the Committee on the Judiciary. jammed, and he had two other semi-auto- that responded to the requests of law THE LIVESTOCK MARKET REPORT ACT OF 1995 matic pistols, and he had thousands of enforcement officials to cease the sale rounds of ammunition that were in maga- of body armor are The Sharper Image, Mr. DASCHLE. Mr. President, today zines. And they were all in 30-round maga- Wall-mart and Sam’s Club. several colleagues and I will introduce zines already. He didn’t have to stop and There were over 200 rounds of ammu- the Livestock Concentration Report load magazines. We ended up having 104 offi- nition fired by the gunman that killed Act of 1995. This legislation addresses cers at the scene and he probably had more the deep concern of cattle, hog and ammunition than all 104 officers put to- Officer James Guelff before other po- lice officers were able to injure the as- sheep producers from across the nation gether. And our officers did run out of am- that the livestock industry does not munition and they got more ammunition sailant. I cannot say that Officer Guelff from other responding units to try and keep would still be alive if this criminal had operate in a free and open market. The him down. He was finally killed by the not been wearing a bullet-proof vest. I bipartisan support from colleagues SWAT teams that got there, who got above imagine, however, that law enforce- from Vermont to Washington is indic- him . . . ment would have more easily shot and ative of the importance of this issue. Captain Cairns continued: disabled this gunman if he had not Livestock producers, especially cat- He had a bullet proof vest, he had a Kevlar been protected by body armor. I at- tle producers, are receiving the lowest Helmet on and he was hit by our officers tended Officer Guelff’s funeral. Maybe, prices in recent memory. Producers twice in the helmet and six times in the vest. if these bullet-proof vests were not so can barely make ends meet, let alone He was finally killed by a shot that came accessible, Officer Guelff would be en- make a profit. The farmer’s share of through his shoulder and into his chest and the retail beef dollar has also plunged killed him. Officer Guelff was hit several tering his 15th year of service. At this time, I wish to acknowledge from 63 percent in 1980 to only 40 per- times and then killed with a bullet through cent today. Producers face economic the left eye out of the assault rifle. Officer the leadership of Representatives ruin at a time when the four largest Guelff fired off six of his rounds and when he STUPAK and PELOSI who have intro- went to re-load—the suspect fired on him duced similar legislation, H.R. 2192, in meat packers in the country control 87 and killed him. the House of Representatives. I also percent of the cattle slaughtered and That story, simply put, is the reason ask that following my remarks, my enjoy record profits. Our legislation calls for a thorough this legislation is being put forward legislation be printed in the RECORD . today. There being no objection, the bill was examination of the livestock markets to ensure they operate in a free and California is not the only State to ex- ordered to be printed in the RECORD, as perience assailants—including heavily- follows: competitive manner. We ask the Presi- armed gang members—who are wearing dent to establish a Commission on Con- Be it enacted by the Senate and House of Rep- centration in the Livestock Industry. bullet proof vests and other body resentatives of the United States of America in armor. Congress assembled, This body will consist of six producers, In Colorado, a man entered a grocery SECTION 1. SHORT TITLE. two antitrust experts, two economists, store where his wife worked, killed her, This Act may be cited as the ‘‘James two corporate financial officers, and the store’s manager, shot a bystander Guelff Body Armor Act of 1995’’. two corporate procurement experts. and then fatally shot a sheriff’s ser- SEC. 2. UNLAWFUL MAIL-ORDER SALE OF BODY The members will be appointed by the geant before being physically tackled ARMOR. President, and the Commission will be from behind and brought to the ground. Title 18, United States Code, is amended by chaired by the Secretary of Agri- Gunfire from law enforcement was to adding at the end the following new chapter: culture. no avail because of his body armor. ‘‘CHAPTER 44A—BODY ARMOR The Commission will review the on- In Long Island, NY, an armed high ‘‘Sec. going USDA Study on Concentration in school student after being pushed out ‘‘941. Unlawful act. the Red Meat Packing Industry to en- of his girlfriend’s house by her father, ‘‘S. 941. Unlawful acts sure the results are representative of shot 12 rounds into the house before a ‘‘(a) Except as provided in subsection (b) of current market conditions. Producers sheriff’s investigator shot the young this section, it shall be unlawful for a person are concerned that the data in the man in the shoulder, just avoiding his to sell or deliver body armor unless the study is out-of-date and will not pro- bullet-proof vest, killing him. The transferee meets in person with the trans- vide insight into today’s market. Addi- sheriff who shot the gunman com- feror to accomplish the sale, delivery, and tionally, the Commission will review mented after the incident that the bul- receipt of the matter. the adequacy of price discovery in the ‘‘(b) Subsection (a) does not apply to body livestock markets to ensure forward let-proof vest the young man was wear- armor used by law enforcement officers. ing was ‘‘ * * * better than anything ‘‘(c) As used in this section— contracting and formula pricing prac- we’ve got now, other than what’s in the ‘‘(1) the term ‘body armor’ means any tices do not unduly bias livestock mar- SWAT locker.’’ product sold or offered for sale as personal kets. The causes of the wide farm-to- How are law enforcement officers to protective body covering whether the prod- retail price spread will also be exam- protect the public when the criminals uct is to be worn alone or is sold as a com- ined. The Commission will report its have better body armor than do the po- plement to other products or garments; and findings within 90 days of the release of lice? ‘‘(2) the term ‘law enforcement officer’ the USDA study. States and localities have already means any officer, agent, or employee of the I am very appreciative of Secretary United States, a State, or a political subdivi- begun the effort to control the sale of sion of a State, authorized by law or by a Glickman’s support throughout this body armor. The State of Michigan, for government agency to engage in or supervise process. USDA is currently pursuing a instance, has a law which increases the the prevention, detection, investigation, or case against IBP, Inc., the largest meat sentence of a criminal who wears body prosecution of any violation of criminal law. packer for alleged anti-competitive S 15344 CONGRESSIONAL RECORD — SENATE October 19, 1995 procurement practices. The Secretary applicable, with respect to concentration and izes a 5-year pilot program to provide has made this issue a top priority, and vertical integration in the procurement and direct home loans to native American I look forward to working with him on pricing of slaughter cattle and of slaughter veterans who live on U.S. trust lands. I hogs by meat packers, the implementation of this Commis- am pleased that Senators ROCKE- (3) make recommendations regarding sion. whether the laws relating to the operation of FELLER, INOUYE, WELLSTONE, and SIMON This action is crucial for our Na- the meat packing industry should be modi- are cosponsors of this measure. tion’s livestock producers. Free and fied regarding the concentration, vertical in- My bill would allow the Department open markets are one of the founda- tegration, and vertical coordination in such of Veterans Affairs [VA] to refinance tions of our Nation and our economy. industry, direct loans made under this unique We as consumers all suffer if markets, (4) review the farm-to-retail price spread initiative, known as the Native Amer- especially food markets, do not operate for livestock during the period beginning on ican Direct Home Loan Program. January 1, 1993, and ending on the date the Under my bill, credit standards for un- freely. I hope this commission can get report is submitted under section 4, to the bottom of the problems that (5) review the adequacy of price data ob- derwriting direct loans to Native exist in the livestock market and pro- tained by the Department of Agriculture American veterans would be the same vide answers for us in Congress about under section 203 of the Agricultural Market- as those for VA guaranteed loans. The the steps we can take to ensure a fair ing Act of 1946 (7 U.S.C. 1622), underwriting would be performed by shake for hard-working livestock pro- (6) make recommendations regarding the the VA and would allow qualified vet- ducers and the Nation’s consumers. adequacy of price discovery in the livestock erans to refinance existing loans. Mr. President, I ask unanimous con- industry for animals held for market, and The Native American Direct Loan (7) review the lamb industry study com- Program was established to ensure sent that the text of the bill be printed pleted by the Department of Justice in 1993. in the RECORD. (b) SOLICITATION OF INFORMATION.—For pur- that veterans who reside on reserva- There being no objection, the bill was poses of complying with the requirements of tions or other trust lands would have ordered to be printed in the RECORD, as paragraphs (2), (3), and (4) of subsection (a), the same access to VA loan benefits en- follows: the Commission on Concentration in the joyed by other veterans. Under the 5- Livestock Industry shall solicit information S. 1340 year pilot program, VA is authorized to from all parts of the livestock industry, in- Be it enacted by the Senate and House of provide direct loans of up to $80,000 for cluding livestock producers, livestock mar- most areas of the United States, al- Representatives of the United States of America keters, meat packers, meat processors, and in Congress assembled, retailers. though higher limits were established SECTION 1. SHORT TITLE. for certain high-cost regions. SEC. 4. REPORT. Until the program was adopted 3 This Act may be cited as the ‘‘Livestock (a) SUBMISSION OF REPORT TO THE PRESI- Concentration Report Act of 1995’’. DENT.—Not later than 90 days after the study years ago, Native American veterans SEC. 2. APPOINTMENT OF COMMISSION. of concentration in the red meat packing in- who lived on trust lands were denied Not later than 30 days after the date of the dustry is submitted to the Congress, the access to traditional VA guaranteed enactment of this Act, the President shall Commission on Concentration in the Live- loans. The inability to take title to appoint a Commission on Concentration in stock Industry shall submit to the President trust lands in the event of default, cul- the Livestock Industry which shall be com- a report summarizing the results of the du- tural misunderstandings, and the gen- posed of the Secretary of Agriculture, who ties carried out under section 3. Not later erally poor economic conditions that shall be the chairperson of the Commission, than 30 days after the President receives exist on reservations, dissuaded poten- and 2 members appointed from among indi- such report, the President shall terminate viduals in each of the following categories: the Commission. tial lenders from approving mortgages (1) Cattle producers. (b) TRANSMISSION OF REPORT TO THE CON- for housing on such lands. (2) Hog producers. GRESS.—The President shall promptly trans- During the guaranty program’s half- (3) Lamb producers. mit, to the Speaker of the House of Rep- century of existence, not a single Na- (4) Experts in antitrust laws. resentatives and the President pro tempore tive American veteran was able to uti- (5) Economists. of the Senate, a copy of the report the Presi- lize his or her home loan entitlement (6) Corporate chief financial officers. dent receives under subsection (a). for housing on trust lands. In contrast, (7) Corporate procurement experts. SEC. 5. DEFINITIONS. over 13 million other veterans received SEC. 3. DUTIES OF COMMISSION. For purposes of this Act— more than $350 billion in VA guaranties (a) DUTIES.—The Commission on Con- (1) the term ‘‘antitrust laws’’ has the meaning given it in subsection (a) of the first during that period. It was to redress centration in the Livestock Industry shall— this inequity that Congress enacted (1) determine whether the study of con- section of the Clayton Act (15 U.S.C. 12(a)), centration in the red meat packing industry except that such term includes section 5 of Public Law 102–547. adequately— the Federal Trade Commission Act (15 U.S.C. Despite the complexities of creating (A) examined and identified regional pro- 45) to the extent such section applies to un- a program that must address the needs curement markets for slaughter cattle in the fair methods of competition, and of hundreds of different tribal entities, continental United States, (2) the term ‘‘study of concentration in the each with its own cultural, political, (B) analyzed the effects that slaughter cat- red meat packing industry’’ means the study and legal systems, VA has successfully tle procurement practices, and concentra- of concentration in the red meat packing in- entered into agreements to provide di- dustry proposed by the Department of Agri- tion in the procurement of slaughter cattle, rect VA loans to members of 30 tribes have on the purchasing and pricing of culture in the Federal Register on January 9, slaughter cattle by beef packers, 1992 (57 Fed. Reg. 875), and for which funds and Pacific Island groups, and negotia- (C) examined the use of captive cattle sup- were appropriated by Public Law 102–142. tions are ongoing with approximately ply arrangements by beef packers and the ef- 20 more tribes. To date, approximately fects of such arrangements on slaughter cat- By Mr. AKAKA (for himself, Mr. 45 loans have been closed, 3 of them tle markets, ROCKEFELLER, Mr. INOUYE, Mr. with American Indians, the balance (D) examined the economics of vertical in- WELLSTONE, and Mr. SIMON): with Hawaiian Natives and Pacific Is- tegration and of coordination arrangements S. 1342. A bill to amend title 38, Unit- landers. In addition, the VA has a com- in the hog slaughtering and processing in- ed States Code, to authorize the Sec- mitment to close 36 more loans, includ- dustry, retary of Veterans Affairs to make (E) examined the pricing and procurement ing American Indians residing on allot- by hog slaughtering plants operating in the loans to refinance loans made to veter- ted lands. eastern corn belt, ans under the Native American Veter- Although the VA has made signifi- (F) reviewed the pertinent research lit- ans Direct Loan Program; to the Com- cant progress in implementing the pro- erature on issues relating to the structure mittee on Veterans’ Affairs. gram, a serious, unanticipated short- and operation of the meat packing industry, THE NATIVE AMERICAN VETERANS DIRECT LOAN coming has come to light. According to and PROGRAM the VA, the Department has no statu- (G) represents, for the matters described in ∑ Mr. AKAKA. Mr. President, today I tory authority to offer refinancing to subparagraphs (A) through (F), the current am introducing legislation to amend veterans receiving loans under the pro- situation in the livestock industry compared to the situation of such industry reflected in section 3762 of title 38, United States gram. Thus, native Americans who re- the data on which such study is based, Code. Section 3762 was established ceive loans under the program cannot (2) review the application of the antitrust under the Veterans Home Loan Pro- take advantage of interest rate reduc- laws, and the operation of other Federal laws gram Amendments of 1992 and author- tions to ease their financial burden. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15345 This is in stark contrast to other vet- treatment. In reforming Medicare, knows and trusts? My bill will enable erans who use the regular guaranty Congress must make sure that senior women being treated for breast cancer program. In the period between Octo- citizens can choose their doctors and to rest assured that they can continue ber 1993 and August 1995, for example, other medical providers. to see the specialists familiar with the VA refinanced over 25,000 interest One of the many reasons for my hav- them and their conditions. For this reduction loans with a face value of ing opposed the Clinton health plan reason, more than a hundred patient more than $2 billion. was the well founded fear that the advocacy groups have voiced their sup- Mr. President, this situation runs American people would have been de- port for this bill. contrary to the intent of Congress in nied their right to chose their medical We must provide a safety valve to enacting the Native American Direct care. The enormous bureaucracy of the protect seniors who find themselves in Home Loan Program three years ago. Clinton plan made that apprehension a that position. A point of service option In creating the program, Congress in- certainty—which is why the American would enable patients to see physicians tended to ensure that, to the maximum people rejected it. and specialists inside and outside the extent possible, Native American vet- Now, Mr. President, the Senate is managed care network. If senior citi- erans would have the same opportunity considering major reforms to save Med- zens are satisfied with the care they re- as other veterans to achieve the Amer- icare, and prevent its being pushed ceive within the network, they will feel ican dream of home ownership. Insofar over the cliff. Medicare must be re- no need to choose outside doctors and as refinancing is an important element formed before it goes bankrupt—other- specialists. Without such options, how- of other VA home loan programs, it is wise the Medicare trust fund will be ever, these senior citizens will be just and reasonable that veterans who flat broke when the 21st century rolls locked into a rigid system which may receive benefits under the direct loan around a few years hence. or may not give them the health care program be accorded an opportunity to Americas’s senior citizens depend on they need from people they most trust refinance. the health care coverage provided by to provide it. Mr. President, the legislation I am the Medicare system, and those of us in Mr. President, we heard from the offering today would correct this over- Congress have a duty to make sure CBO last February that a built-in point sight by providing VA with specific re- they will not be forced to give up their of service feature would not increase financing authority under the direct right to choose their doctors. the cost of Medicare. In testimony be- loan program. My bill also includes a It is vital to their future security fore the Senate Budget Committee, provision for a special fee that would that our senior citizens retain this CBO stated that ‘‘the point of service cover all refinancing costs thus making right to choose. The power to choose option would permit Medicare enroll- the bill revenue neutral. will place citizens firmly in control of ees to go to providers outside the Mr. President, I believe this legisla- their health care. Their right to choose HMO’s panel when they wanted to, and tion will significantly enhance VA’s will encourage efficiency and cut costs yet it need not increase the benefit ability to provide native American vet- without sacrificing quality care and cost to HMO’s or to * * * ’’ The fastest growing health insurance erans with equal access to services and treatment. product is a managed care plan that in- benefits available to other veterans. It Mr. President, all of us know full cludes the point of service feature. The would reduce the costs of home owner- well that reform of the present Medi- marketplace has responded to patient’s ship for those presently receiving bene- care System is imperative. The provi- demand. Requiring HMO’s to include fits under the program, possibly reduc- sions of the legislation allowing senior point of service is not intrusive, but ing the risk of default and the costs as- citizens to join health maintenance or- rather advances a developing trend. In sociated with foreclosure. Perhaps ganizations, and other types of man- fact, in 1993, 61 percent of all HMO’s of- most importantly, it would encourage aged care plans, will surely lower the costs of operating the vast Medicare fered a point of service option. eligible Native American to come for- Building a point of service option System. And citizens who belong to a ward to take advantage of the pro- into all health plans under Medicare Medicare-supported HMO may gain gram’s benefits. will not interfere with the plan’s abil- Thank you, Mr. President. I hope coverage for prescription drugs, eye- ity to contain cost, nor will it limit that the measure I am offering today glasses and hearing aids—coverages not their efforts to encourage providers will be supported by colleagues from presently provided by Medicare. and patients to use their health care Without some moderating legisla- both sides of the aisle.∑ resources wisely. It simply will ensure tion, however, senior citizens could that health plans put the patient’s in- By Mr. HELMS: very well find themselves locked into S. 1343. A bill to amend title XVIII of terest first. coverage that limits them to services Moreover, the actuarial firm of the Social Security Act to provide that provided by HMO-affiliated doctors, Milliman and Robertson concluded eligible organizations assure out-of- other professionals and hospitals. No that depending on the terms of the network access; to the Committee on longer would senior citizens have the plan and a reasonable cost sharing Finance. freedom to choose their own doctor. schedule, there would be no increase in OUT-OF-NETWORK ACCESS LEGISLATION So, Mr. President, these are the rea- cost to the HMO. In fact, there could Mr. HELMS. Mr. President, three sons why I am today introducing the actually be a savings. summers ago I had a close but fortu- Senior Citizens’ Health Freedom Act to Mr. President, according to polls I nate encounter with some remarkable guarantee all Medicare-eligible Ameri- have seen, patients are willing to pay a medical doctors in my home town of cans who choose to enroll in an HMO little more for the ability to go out of Raleigh. My heart surgery and the very the same freedom to choose their doc- network to be assured of seeing the effective subsequent rehabilitation tors that every member of Congress en- doctors of their choice. As many as 70 made it clear that I had been cared for joys. percent of Americans over 50 years old by some of the most capable people in As much as I support the Republican declared in one poll that they would be the medical profession. Medicare plan now under discussion, I unwilling to join a Medicare managed I was free to choose the surgeon who cannot dismiss my reservations about plan that denied them the freedom to performed the operation. Senior citi- the absence of doctor choice in the plan choose their own physicians. zens enrolled in Medicare should have as it presently stands. So the best incentive to get senior the same choice, and the bill I’m intro- Mr. President, consider if you will citizens to join HMO’s is to make sure ducing today will enable senior citizens the predicament of a patient who re- they can choose their own doctors. who join HMO’s to preserve their right quires heart surgery, and whose HMO As we prepare to enact this historic to choose their doctor. will not approve the cardiologist with revision of the Medicare Program, let Mr. President most Americans, whom the senior has built up a long- us not overlook the steps that are nec- whether their health is insured by pri- standing relationship. Should the pa- essary to protect the security of our vate firms or by Medicare, enjoy their tient be required to wait for a year’s senior citizens. Let us never deny them freedom to decide which medical pro- time to change to a plan that will the right to take an active part in fessional will provide their care and cover the cardiologist that the patient their health care and treatment. S 15346 CONGRESSIONAL RECORD — SENATE October 19, 1995 We can save Medicare. We can extend American Thoracic Society. Let me share with my colleagues its benefits while lowering the tower- American Urological Association. some of the history relating to Section ing costs that beset us today. And with Amputee Coalition of America. 140, and the reasons why I think it Arthritis Foundation. the legislation I introduce today, we Arthroscopy Association of North Amer- should be repealed. The Federal Salary can also preserve a basic American ica. Act of 1967 established a commission on freedom to choose. Association of Subspecialty Professors. executive, legislative and judicial sala- Mr. President, I ask unanimous con- Asthma & Allergy Foundation of America. ries, which was popularly referred to as sent that the list of patient advocacy California Access to Specialty Care Coali- the ‘‘Quadrennial Commission.’’ The groups supporting this bill be printed tion. purpose of this commission was to re- California Congress of Dermatological So- in the RECORD. cieties. view executive schedule positions (fed- There being no objection, the list was Congress of Neurological Surgeons. eral judges, Members of congress, and ordered to be printed in the RECORD, as Cooley’s Anemia Foundation. high ranking officials in all branches) follows: Cystic Fibrosis Foundation. and to make recommendations on how ORGANIZATIONS SUPPORTING PATIENT ACCESS Eye Bank Association of America. salaries should be adjusted. TO SPECIALIZED MEDICAL SERVICES UNDER Federated Ambulatory Surgery Associa- In 1975 Congress enacted the Execu- HEALTH CARE REFORM tion. Joint Council of Allergy and Immunology. tive Salary Cost-of-Living Adjustment Allergy and Asthma Network Mothers of Lupus Foundation of America, Inc. Act, which provided, for the first time, Asthmatics, Inc. National Association for the Advancement for annual cost-of-living adjustments American Academy of Allergy and Immu- of Orthotics and Prosthetics. for executive schedule officials. This nology. National Association of Epilepsy Centers. American Academy of Child and Adoles- statute was designed to give Federal National Association of Medical Directors judges, Members of Congress, and other cent Pyschiatry. of Respiratory Care. American Academy of Dermatology. National Foundation for Ectodermal high ranking officials the same annual American Academy of Facial Plastic and Dysplasias. adjustment that was given to other Reconstructive Surgery. National Hemophilia Foundation. Federal employees. In October 1975, American Academy of Neurology. National Kidney Foundation. these executive schedule officials re- American Academy of Ophthalmology. National Multiple Sclerosis Society. American Academy of Orthopaedic Sur- ceived a cost-of-living adjustment; National Osteoporosis Foundation. however, from 1977–1981, Congress with- geons. National Psoriasis Foundation. American Academy of Otolaryngology- Orthopaedic Trauma Association. held cost-of-living adjustments for Head and Neck Surgery. Pediatric Orthopedic Society of North these officials. In the case of United American Academy of Pain Medicine. America. States v. Will, 449 US 200 (1980), the Su- American Academy of Physical Medicine & Pediatrix Medical Group? Neonatology and preme Court issued a ruling which re- Rehabilitation. Pediatric Intensive Care Specialists. American Association for Hand Surgery sulted in an increase in the salaries for Renal Physicians Association. Federal judges. American Association for the Study of Scoliosis Research Society. Headache Society for Vascular Surgery. Two years later, Congress adopted an American Association of Clinical Society of Cardiovascular & Interventional appropriation for Fiscal Year 1982, Endocrinologist. Radiology. which provided in Section 140 that American Association of Clinical Urolo- Society of Gynecologic Oncologists. judges would not automatically receive gists. Society of Nuclear Medicine. an increase under the Executive Salary American Association of Hip and Knee Sur- Society of Thoracic Surgeons. geons. Cost-of-Living Adjustment Act, ‘‘ex- The Alexander Graham Bell Association cept as specifically authorized by act American Association of Neurological Sur- for the Deaf, Inc. geons. The American Society of Derma- of Congress.’’ The Ethics Reform Act of American College of Cardiology. tophathology. 1989 restored cost-of-living adjustments American College of Foot and Ankle Sur- The Endocrine Society. and amended the Adjustment Act, to geons. The Paget Foundation For Paget’s Disease provide for a method of computing an- American College of Gastroenterology. of Bone and Related Disorders. American College of Nuclear Physicians. nual pay adjustments for Federal The TMJ Association, Ltd. American College of Obstetricians & Gyne- judges and other executive schedule National Committee to Preserve Social Se- cologists. employees. curity and Medicare. American College of Osteopathic Surgeons. Cost-of-living adjustments were pro- American College of Radiation Oncology. vided for Federal judges in calendar American College of Radiology. By Mr. HEFLIN: American College of Rheumatology. S. 1344. A bill to repeal the require- years 1990, 1991, 1992, and 1993. There American Diabetes Association. ment relating to specific statutory au- have been no cost-of-living adjust- American EEG Society. thorization for increases in judicial ments for Federal judges in 1994, 1995, American Gastroenterological Association. salaries, to provide for automatic an- nor it would appear in 1996. With re- American Lung Association. nual increases for judicial salaries, and gard to 1996, it appears that the Treas- American Orthopedic Society for Sports ury, Postal Service and General Gov- Medicine. for other purposes; to the Committee American Pain Society. on the Judiciary. ernment Appropriations bill will again American Pediatric Medical Association. JUDICIAL COST-OF-LIVING INCREASES deny a cost-of-living adjustment for American Psychiatric Association. LEGISLATION Federal judges since we are proposing American Sleep Disorders Association. Mr. HEFLIN. Mr. President, I am to deny ourselves such an adjustment American Society for Dermatologic Sur- today introducing legislation to ad- and under current law, adjustments for gery. dress the need of providing annual, Federal judges are linked to adjust- American Society for Gastrointestinal En- ments for Members of Congress. doscopy. automatic cost-of-living increases for American Society for Surgery of the Hand. the Federal Judiciary. This legislation Having reviewed this history, it is American Society for Anesthesiologists. would achieve two goals. First, it my belief that Congress should take ac- American Society for Cataract and Refrac- would repeal Section 140 of Public Law tion to not only repeal Section 140, tive Surgery. 97–42 (28 U.S.C. Sec. 461 note) a provi- which currently bars cost-of-living ad- American Society for Clinical Patholo- sion which was enacted in a continuing justments in pay for Federal judges, gists. American Society for Dermatology. appropriation resolution in 1981. Sec- except as specifically authorized by American Society for Echocardiography. ond, it would delink Federal judges Congress, but to also delink such ad- American Society for General Surgeons. from Members of Congress and execu- justments from those of Members of American Society for Hematology. tive schedule employees of the execu- Congress and other executive schedule American Society for Nephrology. tive branch with respect to receiving employees of the executive branch. American Society for Pediatric Nephrol- cost of living adjustments and would Delinkage will remove Federal judges ogy. American Society for Plastic and Recon- guarantee that Federal judges would from the highly charged political at- structive Surgeons, Inc. automatically receive such annual ad- mosphere surrounding cost-of-living American Society for Transplant Physi- justments, assuming economic condi- adjustments. This legislation does not cians. tions so justified. seek to raise judicial pay, but is in an October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15347 attempt to avoid a diminution in judi- (b) AUTOMATIC ANNUAL INCREASES.—Sec- TITLE I—VETERANS HEALTH-CARE cial compensation by allowing salaries tion 461(a) of title 28, United States Code, is PROGRAMS to keep pace with increases in the cost amended to read as follows: PART A—REFORM OF THE HEALTH-CARE of living. ‘‘(a) Effective on the first day of the first ELIGIBILITY SYSTEM applicable pay period beginning on or after Remember, judges are not like Mem- Sec. 101. Definitions. January 1 of each calendar year, each salary Sec. 102. Eligibility for health care. bers of Congress or high ranking execu- rate which is subject to adjustment under tive schedule employees of the execu- Sec. 103. Exposure related treatment au- this section shall be adjusted by an amount, thorities. tive branch of the Federal Government. rounded to the nearest multiple of $100 (or if Sec. 104. Mental health services and bereave- Members of Congress come and go, and midway between multiples of $100, to the ment counseling for family likewise, executive schedule employees next higher multiple of $100) equal to the members. are high ranking political employees percentage of such salary rate which cor- Sec. 105. Consolidation of special authorities such as Cabinet secretaries, deputy sec- responds to the most recent percentage pertaining to prosthetic de- change in the Employment Cost Index, as de- retaries, assistant secretaries, and dep- vices, and aids for the blind and termined under section 704(a)(1) of the Ethics aids for the hearing impaired. uty assistant secretaries, etc. They, Reform Act of 1989.’’. too, being short-term employees, come Sec. 106. Dental care. Sec. 107. Home improvements and structural and go from the private sector to the By Mr. SIMPSON (by request): alterations. public sector. S. 1345. A bill to amend title 38, Unit- Sec. 108. Furnishing medications prescribed Federal judges are different in this ed States Code, and various other stat- by non-VA physicians. regard. They make a lifetime commit- ues, to reform eligibility for Depart- Sec. 109. Furnishing care in community ment to public service as Federal ment of Veterans Affairs health care nursing homes. judges. They should be able to plan benefits, improve the operation of the Sec. 110. Furnishing residential care. their financial futures based on the Department, and improve the processes Sec. 111. Expansion of authority to share reasonable expectation that their com- health-care resources. and procedures the Department uses to Sec. 112. Authorization of Appropriations. pensation will at least keep even with administer various benefits programs Sec. 113. Conforming amendments. annual cost-of-living increases. for veterans; and for other purposes; to PART B—ADMINISTRATION OF HEALTH-CARE I think it is imperative to remove the the Committee on Veterans’ Affairs. BENEFITS judicial pay process from the political THE DEPARTMENT OF VETERANS AFFAIRS Sec. 120. Means test reform. arena. In the middle of the 1980’s, this IMPROVEMENT AND REINVENTION ACT OF 1995 Sec. 121. VA retention of funds collected issue was widely discussed on tele- ∑ Mr. SIMPSON. Mr. President, as from third parties. vision talk shows and various news chairman of the Veterans’ Affairs Com- TITLE II—BENEFIT PROGRAMS programs, and it was very damaging to mittee, I have today introduced, at the PART A—LOAN GUARANTY PROGRAM attracting top quality individuals to request of the Secretary of Veterans Sec. 201. Termination of the manufactured serve as Federal judges. We also know Affairs, S. 1345, a bill to reform eligi- housing loan program. that there were a number of resigna- bility for Department of Veterans Af- Sec. 202. Loan fees. tions in the Federal judiciary in the fairs health care benefits, improve the Sec. 203. Contracting for portfolio loan serv- 1980’s, because it was becoming very operation of the Department, and im- ices. difficult to attract top individuals to prove the processes and procedures the PART B—EDUCATION PROGRAMS serve on the Federal bench. Department uses to administer various Sec. 210. Electronic signatures on documents I believe that we must continue to benefit programs for veterans; and for concerning education benefits attract and retain judges from all other purposes. The Secretary of Veter- for veterans. walks of life who have demonstrated ans Affairs submitted this legislation Sec. 211. Electronic funds transfer for edu- cation benefits payments. superior legal skills whether they have to the President of the Senate by letter served as State judges, private practi- SEC. 2. REFERENCES TO TITLE 38, UNITED dated September 12, 1995. STATES CODE. tioners, academicians, prosecutors, or My introduction of this measure is in public defenders. If we fail to deal with Except as otherwise expressly provided, keeping with the policy which I have whenever in this Act an amendment is ex- this matter, we will soon attract only adopted of generally introducing—so pressed in terms of an amendment to a sec- those judges who are independently that there will be specific bills to tion or other provision, the reference shall wealthy and do not have to worry which my colleagues and others may be considered to be made to a section or about providing for their families on a direct their attention and comments— other provision of title 38, United States Federal judiciary salary. all administration-proposed draft legis- Code. I think this is unwise, and I hope lation referred to the Veterans’ Affairs TITLE I—VETERANS HEALTH-CARE that Congress will have the courage to Committee. Thus, I reserve the right to PROGRAMS repeal section 140 of Public Law 97–92 support or oppose the provisions of, as PART A—REFORM OF THE HEALTH CARE and further delink their cost-of-living well as any amendment to, this legisla- ELIGIBILITY SYSTEM adjustments from Members of Congress tion. SEC. 101. DEFINITIONS. and executive schedule employees, Mr. President, I ask unanimous con- Section 1701 is amended by striking out thereby removing this matter from the paragraphs numbered (5), (6), (7), (8), and (9) sent that the text of the bill be printed and inserting in lieu thereof the following: political process once and for all. in the RECORD at this point, together Mr. President, I ask unanimous con- ‘‘(5) Then term ‘health care’ means the with the transmittal letter and the en- most appropriate care and treatment for the sent that the text of the bill be printed closed section-by-section analysis of patient furnished in the most appropriate in the RECORD. the draft legislation. setting, as determined by the Secretary, in- There being no objection, the bill was There being no objection, the mate- cluding the provision of such pharma- ordered to be printed in the RECORD, as rial was ordered to be printed in the ceuticals, supplies, equipment, devices, ap- pliances and other materials as the Sec- follows: RECORD, as follows: retary determines to be necessary, and in- S. 1344 S. 1345 cluding hospital care, nursing home care, Be it enacted by the Senate and House of Rep- Be it enacted by the Senate and House of Rep- domiciliary care, outpatient care, rehabilita- resentatives of the United States of America in resentatives of the United States of America in tive care, home care, respite care, preventive Congress assembled, Congress assembled, care, and dental care. SECTION 1. JUDICIAL COST-OF-LIVING IN- ‘‘(6) The term ‘hospital care’ means care SECTION 1. SHORT TITLE; TABLE OF CONTENTS. CREASES. and treatment for a disability furnished to (a) SHORT TITLE.—This Act may be cited as (a) REPEAL OF STATUTORY REQUIREMENT an individual who has been admitted to a the ‘‘Department of Veterans Affairs Im- RELATING TO JUDICIAL SALARIES.—Section 140 hospital as a patient. provement and Reinvention Act of 1995’’. of the resolution entitled ‘‘A Joint Resolu- ‘‘(7) The term ‘nursing home care’ means tion making further continuing appropria- (b) TABLE OF CONTENTS.—The table of con- care and treatment for a disability furnished tions for the fiscal year 1982, and for other tents of this Act is as follows: to an individual who has been admitted to a purposes.’’, approved December 15, 1981 (Pub- Sec. 1. Short title; table of contents. nursing home as a resident. lic Law 97–92; 95 Stat. 1200; 28 U.S.C. 461 note) Sec. 2. References to title 38, United States ‘‘(8) The term ‘domiciliary care’ means the is repealed. Code. furnishing of shelter and food, and includes S 15348 CONGRESSIONAL RECORD — SENATE October 19, 1995 necessary care and treatment for a disability would be entitled to disability compensa- who is admitted for nursing home care under furnished to a veteran with no adequate tion, but only to the extent that the veter- this section after being furnished, during the means of support, who has been admitted as ans’ continuing eligibility for such care is preceding 365-day period, hospital care for a resident to a domiciliary facility under the provided for in the judgment or settlement which the veteran has paid the amount of direct jurisdiction of the Secretary. described in section 1151. the inpatient Medicare deductible under this ‘‘(9) The term ‘outpatient care’ means care ‘‘(B) Veterans receiving care under sec- subsection and who has not been furnished 90 and treatment for a disability, and preven- tions 1712, 1712A, 1719, and 1720B. days of hospital care in connection with such tive health services, furnished to an individ- ‘‘(C) Veterans with noncompensable serv- payment, the veteran shall not incur any li- ual other than hospital, nursing home, or ice-connected disabilities, veterans of the ability under paragraph (2)(B)(i) of this sub- domiciliary care. Mexican Border period or World War I, and section with respect to such nursing home ‘‘(10) The term ‘rehabilitative care’ means veterans receiving increased pension or addi- care until— such professional, counseling, and guidance tional compensation or allowances based on ‘‘(I) the veteran has been furnished, begin- services and treatment programs (other than the need of regular aid and attendance or by ning with the first day of such hospital care those types of vocational rehabilitation serv- reason of being permanently housebound. furnished in connection with such payment, ices provides under chapter 31 of this title) ‘‘(D) Veterans with attributable income a total of 90 days of hospital care and nurs- as are necessary to restore, to the maximum less than the threshold amount specified in ing home care; or extent possible, the physical, mental, and section 1722 which is applicable to those vet- ‘‘(II) the end of the 365-day period applica- psychological functioning of an ill or dis- erans, provided they sign a declaration that ble to the hospital care for which payment abled person. their net worth, together with that of their was made, ‘‘(11) The term ‘home care’ means out- spouse and dependent children, if any, does patient care, rehabilitative care, and preven- not exceed $50,000, and veterans receiving whichever occurs first. tive health services furnished to an individ- care under section 1751. ‘‘(ii) In the case of a veteran who is admit- ual in the individual’s home or other place of ‘‘(E) Veterans with attributable income ted for nursing home care under this section residence but may not include care or serv- greater than the threshold amount specified after being furnished, during any 365-day pe- ices that any other person or entity has a in section 1722 which is applicable to those riod, hospital care for which the veteran has contractual or legal obligation to provide. veterans and veterans who do not sign the paid an amount under subparagraph (A)(ii) of ‘‘(12) The term ‘residential care’ means the declaration described in clause (D). this paragraph and who has not been fur- provision of room and board and such limited ‘‘(2) The Secretary may, by regulation, es- nished 90 days of hospital care in connection personal care for and supervision of residents tablish additional priorities within each pri- with such payment, the amount of the liabil- as the Secretary determines, in accordance ority group established in paragraph (1) of ity of the veteran under paragraph (2)(B)(i) with regulations, are necessary for the this subsection, as the Secretary determines of this subsection with respect to the num- health, safety, and welfare of residents, and necessary. ber of days of such nursing home care which, the term ‘community residential-care’ ‘‘(d) Nothing in this section requires the when added to the number of days of such means the provision of residential-care in a Secretary to furnish care to a veteran to hospital care, is 90 or less, is the difference non-VA facility. whom another agency of Federal, State, or between the inpatient Medicare deductible ‘‘(13) The term ‘respite care’ means care local government has a duty under law to and the amount paid under such subpara- furnished on an intermittent basis in a de- provide care in an institution of such govern- graph until— partment facility for a limited period to a ment. ‘‘(I) the veteran has been furnished, begin- veteran suffering from a chronic illness, who ‘‘(e)(1) The Secretary may furnish health ning with the first day of such hospital care resides primarily in a private residence when care under subsections (a) and (b) of this sec- furnished in connection with such payment, such care will help the veteran to continue tion to any veteran described in subsection a total of 90 days of hospital care and nurs- residing in such private residence. (c)(1)(E) who has attributable income greater ing home care; or ‘‘(14) The term ‘preventive health services’ than the amount specified in section 1722(a) ‘‘(II) the end of the 365-day period applica- remans care and treatment furnished to pre- which is applicable to that veteran, only if ble to the hospital care for which payment vent disease or illness including periodic ex- the veteran agrees to pay the United States was made, aminations, immunization, patient health the applicable amount determined under whichever occurs first. paragraph (2) of this subsection. education, and such other services as the ‘‘(D) In the case of a veteran who is admit- ‘‘(2) A veteran who is required under para- Secretary determines are necessary to pro- ted for hospital care under this section after graph (1) of this subsection to agree to pay vide effective and economical preventive having been furnished, during the preceding an amount to the United States in order to health care.’’. 365-day period, nursing home care for which be furnished such care shall be liable to the SEC. 102. ELIGIBILITY FOR HEALTH CARE. the veteran has paid the amount of the inpa- United States for an amount equal to— Section 1710 is amended to read as follows: tient Medicare deductible under this sub- ‘‘(A) for hospital care— ‘‘§1710. Eligibility for health care ‘‘(i) the lesser of the cost of furnishing section and who has not been furnished 90 ‘‘(a)(1) The Secretary shall, to the extent such care, as determined by the Secretary, days of nursing home care in connection and in the amount provided in advance in ap- or the amount determined under paragraph with such payment, the veteran shall not propriations acts for these purposes, furnish (3) of this subsection; and incure any liability under paragraph (2) of health care which the Secretary determines ‘‘(ii) $10 for every day the veteran receives this subsection with respect to such hospital is needed to any veteran described in clauses hospital care. care until— (A), (C), and (D) of subsection (c)(1), subject ‘‘(B) for nursing home care— ‘‘(i) the veteran has been furnished, begin- to the priorities set forth in subsection (c) ‘‘(i) the lesser of the cost of furnishing ning with the first day of such nursing home and to section 1715 and excluding care de- such care, as determined by the Secretary, care furnished in connection with such pay- scribed in subsection (b). or the amount determined under paragraph ment, a total of 90 days of nursing home care ‘‘(2) The Secretary may furnish health care (3) of this subsection; and and hospital care; or which the Secretary determines is needed to ‘‘(ii) $5 for every day the veteran receives ‘‘(ii) the end of the 365-day period applica- any veteran not described in clauses (A) nursing home care; and ble to the nursing home care for which pay- through (D) of subsection (c)(1). ‘‘(C) for outpatient care, an amount equal ment was made. ‘‘(b) Subject to the priorities set forth in to 20 percent of the estimated cost of care, as whichever occurs first. subsection (c), the Secretary may furnish determined by the Secretary. ‘‘(E) A veteran may not be required to nursing home care, respite care, home care, ‘‘(3)(A) In the case of hospital care fur- make a payment under paragraph (2)(A)(i) or and domiciliary care which the Secretary de- nished during any 365-day period, the paragraph (2)(B)(i) of this subsection for any termines is needed to any veteran. amount referred to in paragraph (2)(A)(i) of days of care in excess of 360 days of care dur- ‘‘(c)(1) To the extent and in the amount this subsection is— ing any 365-calendar-day period. provided in advance in appropriations acts ‘‘(i) the amount of the inpatient Medicare ‘‘(4) Amounts collected or received on be- for these purposes, the Secretary shall fur- deductible, plus nish health care under subsections (a) and (b) ‘‘(ii) one-half of such amount for each 90 half of the United States under this sub- and sections 1712, 1712A, 1712B, 1714, 1717, days of care (or fraction thereof) after the section shall be deposited in the Treasury as 1718, 1719, 1720B, and 1751, in accordance with first 90 days of such care during such 365-day miscellaneous receipts. the following order of priority: period. ‘‘(5) For the purposes of this subsection, ‘‘(A) Veterans (i) who have compensable ‘‘(B) In the case of nursing home care fur- the term ‘inpatient Medicare deductible’ service-connected disabilities, (ii) who are nished during any 365-day period, the means the amount of the inpatient hospital former prisoners of war, (iii) whose discharge amount referred to in paragraph (2)(B)(i) of deductible in effect under section 1813(b) of or release from the active military, naval or this subsection is the amount of the inpa- the Social Security Act (42 U.S.C. 1395(b)) on air service was for a disability incurred or tient Medicare deductible for each 90 days of the first day of the 365-day period applicable aggravated in line of duty, and (iv) who are such care (or fraction thereof) during such under paragraph (3) of this subsection.’’. in receipt of, or who, but for a suspension 365-day period. SEC. 103. EXPOSURE-RELATED TREATMENT AU- pursuant to section 1151 (or both such a sus- ‘‘(C)(i) Except as provided in clause (ii) of THORITIES. pension and the receipt of retired pay), this subparagraph, in the case of a veteran Section 1712 is amended to read as follows: October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15349 ‘‘§ 1712. Treatment for veterans exposed to patient receiving hospital care for any dis- ‘‘(A) which is service-connected and com- certain toxic substances or hazards ability, or receiving outpatient care for a pensable in degree; ‘‘(a) Subject to subsections (b) and (c), and service-connected mental health condition; ‘‘(B) which is service-connected, but not to the extent and in the amount provided in ‘‘(3) mental health services, consultation, compensable in degree, but only if— advance in appropriations acts for these pur- professional counseling, and training as nec- ‘‘(i) the dental condition or disability is poses, the Secretary shall furnish hospital essary in connection with the treatment of a shown to have been in existence at the time care and may furnish other health care to— patient receiving outpatient care for a of the veteran’s discharge or release from ac- ‘‘(1) a veteran— nonservice-connected mental health condi- tive military, naval, or air service; ‘‘(A) who served on active duty in the Re- tion, but only if the patient’s treatment for ‘‘(ii) the veteran had served on active duty public of Vietnam during the Vietnam era, the mental health condition was begun dur- for a period of not less than 180 days or, in and ing a period of hospitalization and the serv- the case of a veteran who served on active ‘‘(B) who the Secretary finds may have ices to the family member, guardian, or duty during the Persian Gulf War, 90 days been exposed during such service to dioxin or other person were commenced prior to the immediately before such discharge or re- was exposed during such service to a toxic patient’s discharge from such period of hos- lease; substance found in a herbicide or defoliant pital care. ‘‘(iii) application for treatment is made used in connection with military purposes ‘‘(c) The Secretary may furnish counseling within 90 days after such discharge or re- during such era, services for a limited period to any individ- lease, except that (I) in the case of a veteran who reentered active military, naval, or air for any disability, notwithstanding that ual who was a recipient of services under service within 90 days after the date of such there is insufficient medical evidence to con- subsection (a) of this section at the time of— veteran’s prior discharge or release from clude that such disability may be associated ‘‘(1) the unexpected death of the veteran; such service, application may be made with- with such exposure; or in 90 days from the date of such veteran’s ‘‘(2) a veteran who the Secretary finds was ‘‘(2) the death of the veteran while the vet- subsequent discharge or release from such exposed while serving on active duty to ion- eran was participating in a hospice program service, and (II) if a disqualifying discharge izing radiation from the detonation of a nu- (or a similar program) conducted by the Sec- or release has been corrected by competent clear device in connection with such veter- retary, authority, application may be made within an’s participation in the test of such a device if the Secretary determines that furnishing 90 days after the date of correction; and or with the American occupation of Hiro- such services would be reasonable and nec- ‘‘(iv) the veteran’s certificate of discharge shima and Nagasaki, Japan, during the pe- essary to assist such individual with the or release from active duty does not bear a riod beginning on September 11, 1945, and emotional and psychological stress accom- certification that the veteran was provided, ending on July 1, 1946, for any disability, panying the veteran’s death.’’. within the 90-day period immediately before notwithstanding that there is insufficient SEC. 105. CONSOLIDATION OF SPECIAL AUTHORI- the date of such discharge or release, a com- medical evidence to conclude that such dis- TIES PERTAINING TO PROSTHETIC plete dental examination (including dental ability may be associated with such expo- DEVICES, AIDS FOR THE BLIND, AND X-rays) and all appropriate dental services sure; and AIDS FOR THE HEARING IMPAIRED. and treatment indicated by the examination ‘‘(3) a veteran who the Secretary finds may Section 1714 is amended— to be needed. have been exposed while serving on active (1) by amending the heading to read as fol- ‘‘(C) which is a service-connected dental duty in the Southwest Asia theater of oper- lows: condition or disability due to combat wounds ations during the Persian Gulf War to a toxic ‘‘§ 1714. Prosthetic devices and aids for the or other service trauma, or of a former pris- substance or environmental hazard for any blind and hearing impaired’’; oner of war; disability, notwithstanding that there is in- (2) by designating subsection (b) as sub- ‘‘(D) which is associated with and is aggra- sufficient medical evidence to conclude that section (d) and inserting after subsection (a) vating a disability resulting from some other such disability may be associated with such the following new subsections (b) and (c): disease or injury which was incurred in or exposure. ‘‘(b) The Secretary may procure medical aggravated by active military, naval, or air ‘‘(b) Hospital and health care may not be equipment, prosthetic devices and similar service; provided under subsection (a) with respect to appliances furnished under section 1710 or ‘‘(E) which is a nonservice-connected con- a disability that is found, in accordance with subsections (d) and (e) of this section by pur- dition or disability of a veteran for which guidelines issued by the Under Secretary for chase or by manufacture, whichever the Sec- treatment was begun while such veteran was Health, to have resulted from a cause other retary determines may be advantageous and receiving hospital care under this chapter than an exposure described in paragraph (1), reasonably necessary. and such services and treatment are reason- (2), or (3) of subsection (a) in the case of a ‘‘(c) The Secretary may repair or replace ably necessary to complete such treatment; veteran described in the applicable para- any prosthetic or orthotic device or similar ‘‘(F) from which a veteran who is a former graph. appliance (not including dental appliances) prisoner of war and who was detained or in- ‘‘(c) Hospital and health care may not be reasonably necessary to a veteran and be- terned for a period of not less than 90 days is provided— longing to such veteran which was damaged suffering; ‘‘(1) after December 31, 1996, in the case of or destroyed by a fall or other accident ‘‘(G) from which a veteran who has a serv- a veteran described in paragraph (1) of sub- caused by a service-connected disability for ice-connected disability rated as total is suf- section (a); and which such veteran is in receipt of, or but for fering; or ‘‘(2) after September 30, 1997, in the case of the receipt of retirement pay would be enti- ‘‘(H) the treatment of which is medically a veteran described in paragraph (3) of sub- tled to, disability compensation.’’; and necessary (i) in preparation for hospital ad- section (a).’’. (3) by adding at the end the following new mission, or (ii) for a veteran otherwise re- SEC. 104. MENTAL HEALTH SERVICES AND BE- subsection (e): ceiving care or services under this chapter. REAVEMENT COUNSELING FOR FAM- ‘‘(2) The Secretary concerned shall at the ILY MEMBERS. ‘‘(e) The Secretary may furnish devices for assisting in overcoming the handicap of deaf- time a member of the Armed Forces is dis- Chapter 17 is amended by adding the fol- charged or released from a period of active lowing new section: ness (including telecaptioning television de- coders) to any veteran who is profoundly military, naval, or air service of not less ‘‘§ 1712C. Mental health services and bereave- deaf and is entitled to compensation on ac- than 180 days or, in the case of a veteran who ment counseling for family members count of hearing impairment.’’. served on active duty during the Persian ‘‘(a) If necessary for the effective treat- SEC. 106. DENTAL CARE. Gulf War, 90 days provide to such member a written explanation of the provisions of ment and rehabilitation of a patient who is Section 1715 is amended to read as follows: either a veteran or a dependent or survivor clause (B) of paragraph (1) of this section and receiving care under the last sentence of sec- ‘‘§ 1715. Dental care enter in the service records of the member a tion 1713(b), the Secretary may furnish the ‘‘(a) The Secretary may, within the limits statement signed by the member acknowl- services described in subsection (b) to mem- of Department facilities, furnish a veteran edging receipt of such explanation (or, if the bers of the immediate family of the patient, receiving hospital, nursing home, or domi- member refuses to sign such statement, a the patient’s legal guardian, or the individ- ciliary care in a Department facility with— certification from an officer designated for ual in whose household such patient certifies ‘‘(1) any dental services and treatment, and such purpose by the Secretary concerned an intention to live. related dental appliances necessary for con- that the member was provided such expla- ‘‘(b) The services referred to in subsection tinued safe and effective treatment of other nation). (a) are— disabilities for which the veteran is receiv- ‘‘(3) The total amount which the Secretary ‘‘(1) consultation, professional counseling, ing care in the VA facility; and may expend for furnishing, during any and training as necessary in connection with ‘‘(2) any dental services and treatment for twelve-month period, outpatient dental serv- the treatment of any disability of a patient which the veteran is eligible under sub- ices, treatment, or related dental appliances receiving outpatient care for a physical con- section (b) of this section. to a veteran under this section through pri- dition; ‘‘(b)(1) The Secretary may furnish out- vate facilities for which the Secretary has ‘‘(2) mental health services, consultation, patient dental services and treatment, and contracted under clause (1), (2), or (5) of sec- professional counseling, and training as nec- related dental appliances under this chapter tion 1703(a) of this title may not exceed essary in connection with the treatment of a only for a dental condition or disability— $1,000 unless the Secretary determines, prior S 15350 CONGRESSIONAL RECORD — SENATE October 19, 1995 to the furnishing of such services, treatment, good professional standards, in which event under this chapter in any Department health or appliances and based on an examination of such additional services may be afforded as care facility. Any such immunization shall the veteran by a dentist employed by the De- are required to complete professionally ac- be made using vaccine furnished by the Sec- partment (or, in an area where no such den- ceptable treatment. retary of Health and Human Services at no tist is available, by a dentist conducting ‘‘(d) Dental appliances, to be furnished by cost to the Department. For such purpose, such examination under a contract or fee ar- the Secretary under this section may be pro- notwithstanding any other provision of law, rangement), that the furnishing of such serv- cured by the Secretary either by purchase or the Secretary of Health and Human Services ices, treatment, or appliances at such cost is by manufacture, whichever the Secretary de- may provide such vaccine to the Department reasonably necessary. termines may be advantageous and reason- at no cost. Section 7316 of this title shall ‘‘(4)(A) Except as provided in subparagraph ably necessary.’’. apply to claims alleging negligence or mal- (B) of this subsection, in any year in which SEC. 107. HOME IMPROVEMENTS AND STRUC- practice on the part of Department personnel the President’s Budget for the fiscal year be- TURAL ALTERATIONS. granted immunity under such section.’’. ginning October 1 of such year includes an Section 1717 is amended to read as follows: SEC. 109. FURNISHING CARE IN COMMUNITY amount for expenditures for contract dental NURSING HOMES. care under the provisions of section 1710(a) of ‘‘§ 1717. Home improvements and structural alterations Section 1720 is amended— this title (other than care for a veteran of (1) in the heading by striking out the semi- ‘‘(a) The Secretary may furnish improve- the Mexican border period or of World War I, colon and all that follows; ments and structural alterations to the and a veteran who is in receipt of increased (2) in subsection (a)(1)(A)(i), by striking home of a veteran if necessary for the effec- pension or additional compensation or allow- out ‘‘hospital care, nursing home care, or tive and economical treatment of a disabil- ances based on the need of regular aid and domiciliary’’ and inserting in lieu thereof ity of the veteran, but only if the improve- attendance or by reason of being perma- ‘‘health’’; nently housebound (or who, but for the re- ments or alterations are necessary to assure (3) by striking out subsection (a) and redes- ceipt of retired pay, would be in receipt of the continuation of treatment or to provide ignating subsection (e) as subsection (d); and such pension, compensation or allowance)) the veteran access to the home or to essen- (4) by striking out subsection (f). and section 1703 of this title during such fis- tial lavatory and sanitary facilities. SEC. 110. FURNISHING RESIDENTIAL CARE. cal year in excess of the level of expenditures ‘‘(b) The cost of improvements and struc- Section 1730 is amended— made for such purpose during fiscal year tural alterations (or the amount of reim- (1) by redesignating subsections (a), (b), 1978, the Secretary shall, not later than Feb- bursement therefor) furnished under sub- (c), (d), and (e) as subsections (b), (c), (d), (e), ruary 15 of such year, submit a report to the section (a) may not exceed— and (f), respectively; appropriate committees of the Congress jus- ‘‘(1) $4,100 if needed— (2) by inserting the following new sub- tifying the requested level of expenditures ‘‘(A) for treatment of a service-connected section (a): for contract dental care and explaining why disability (including a disability that was in- ‘‘(a)(1) The Secretary may furnish residen- the application of the criteria prescribed in curred or aggravated in line of duty and for tial care to a veteran in receipt of hospital section 1703 of this title for contracting with which the veteran was discharged or released care in a VA facility when such care would private facilities and in section 1715(a) of from the active military, naval, or air serv- be an alternative to continued hospital care. this title for furnishing incidental dental ice); ‘‘(2) The Secretary may only furnish care care to hospitalized veterans will not pre- ‘‘(B) for any disability of a veteran who has under paragraph (1) of this subsection clude the need for expenditures for contract a service-connected disability rated at 50 through contracts with community residen- dental care in excess of the fiscal year 1978 percent or more; and tial-care facilities— level of expenditures for such purpose. In any ‘‘(C) to any veteran for a disability for ‘‘(A) when the veteran has no resources to case in which the amount included in the which the veteran is in receipt of compensa- pay for the care, as determined by the Sec- President’s Budget for any fiscal year for ex- tion under section 1151 of this title or for retary in regulations; and penditures for contract dental care under which the veteran would be entitled to com- ‘‘(B) for a period not to exceed 90 days dur- such provisions is not in excess of the level pensation under that section but for a sus- pension pursuant to that section (but in the ing any 12-month period.’’. of expenditures made for such purpose during (3) by amending subsection (b), as so redes- case of such a suspension, such medical serv- fiscal year 1978 and the Secretary determines ignated, to read as follows: ices may be furnished only to the extent that after the date of submission of such budget ‘‘(b) Subject to this section and regulations such person’s continuing eligibility for medi- and before the end of such fiscal year that to be prescribed by the Secretary under this cal services is provided for in the judgment the level of expenditures for such contract section, the Secretary may assist a veteran or settlement described in that section); and dental care during such fiscal year will ex- who does not meet the requirement set forth ‘‘(2) $1,200 in all other cases.’’. ceed the fiscal year 1978 level of expendi- in subsection (a)(2)(A) of this section by re- tures, the Secretary shall submit a report to SEC. 108. FURNISHING MEDICATIONS PRE- ferring the veteran for placement in, and aid- SCRIBED BY NON-VA PHYSICIANS. the appropriate committees of the Congress ing the veteran in obtaining placement in, a containing both a justification (with respect Section 1719 is amended to read as follows: community residential-care facility if— to the projected level of expenditures for ‘‘§ 1719. Medications prescribed by non-VA ‘‘(1) at the time of initiating the assist- such fiscal year) and an explanation as re- physicians; immunization programs ance, the Secretary— quired in the preceding sentence in the case ‘‘(a) The Secretary shall, to the extent and ‘‘(A) is furnishing the veteran hospital, of a report submitted pursuant to such sen- in the amount provided in advance in appro- domiciliary, nursing home, or outpatient tence. Any report submitted pursuant to this priation acts for these purposes, furnish to care; or paragraph shall include a comment by the each veteran who is receiving additional ‘‘(B) has furnished the veteran such care or Secretary on the effect of the application of compensation or allowance under chapter 11 services within the preceding 12 months; and the criteria prescribed in section 1715(a) of of this title, or increased pension as a vet- ‘‘(2) placement of the veteran in a commu- this title for furnishing incidental dental eran of a period of war, by reason of being nity residential-care facility is appro- care to hospitalized veterans. priate.’’. ‘‘(B) A report under subparagraph (A) of permanently housebound or in need of regu- (4) in subsection (c), as so redesignated, by this paragraph with respect to a fiscal year lar aid and attendance, such drugs and medi- striking out ‘‘subsection (a) of’’ in paragraph is not required if, in the documents submit- cines as may be ordered on prescription of a (1), and by inserting ‘‘community residen- ted by the Secretary to the Congress in jus- duly licensed physician as specific therapy in tial-care’’ before ‘‘facility’’ the first time it tification for the amounts included for De- the treatment of any illness or injury suf- appears in paragraph (2); partment programs in the President’s Budg- fered by such veteran: provided, that the (5) in subsection (d), as so redesignated, by et, the Secretary specifies with respect to Secretary shall continue to furnish such striking out ‘‘(b)’’ and inserting in lieu contract dental care described in such sub- drugs and medicines so ordered to any such thereof ‘‘(c)’’; paragraph— veteran in need of regular aid and attend- ‘‘(i) the actual level of expenditures for ance whose pension payments have been dis- (6) in subsection (e), as so redesignated, by such care in the fiscal year preceding the fis- continued solely because such veteran’s an- striking out ‘‘(b)’’ and inserting in lieu cal year in which such Budget is submitted; nual income is greater than the applicable thereof ‘‘(c)’’; ‘‘(ii) a current estimate of the level of ex- maximum annual income limitation, but (7) in subsection (f), as so redesignated, by penditures for such care in the fiscal year in only so long as such veteran’s annual income striking out ‘‘(b)(2) or (c)(1)’’ and ‘‘(d)’’ and which such Budget is submitted; and does not exceed such maximum annual in- inserting in lieu thereof ‘‘(c)(2) or (d)(1)’’ and ‘‘(iii) the amount included in such Budget come limitation by more than $1,000. ‘‘(e)’’; for such care. ‘‘(b) In order to assist the Secretary of (8) by striking subsection (g) ‘‘(c) Dental services and related appliances Health and Human Services in carrying out SEC. 111. EXPANSION OF AUTHORITY TO SHARE for a dental condition or disability described national immunization programs under HEALTH-CARE RESOURCES. in paragraph (1)(B) of subsection (b) of this other provisions of law, the Secretary may (a) The text of section 8151 is amended to section shall be furnished on a one-time authorize the administration of immuniza- read as follows: completion basis, unless the services ren- tions to eligible veterans who voluntarily re- ‘‘It is the purpose of this subchapter to im- dered on a one-time completion basis are quest such immunizations in connection prove the quality of health care provided found unacceptable within the limitations of with the provision of care for a disability veterans under this title, by authorizing the Secretary to enter into agreements with October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15351 health-care providers in order to share care, when reasonably necessary to complete (n) The table of sections for subchapters I, health-care resources with, and receive treatment incident to such care for a period II, and III and IV at the beginning of chapter health-care resources from those health care up to 12 months after discharge from such 17 is amended to read as follows: providers, provided there is no diminution of care unless the Secretary authorizes a longer ‘‘Subchapter I—General services to veterans. Among other things, it period of care after finding that a longer pe- ‘‘Sec. is intended by these means to strengthen the riod is required by reason of the disability ‘‘1701. Definitions. medical programs at Department facilities being treated; or ‘‘1702. Presumption relating to psychosis. located in small cities or rural areas that are ‘‘(C) a veteran of the Mexican border period ‘‘1703. Contracts for hospital and outpatient remote from major medical centers.’’ or World War I, or a veteran who is in receipt care. (b) Section 8152 is amended— of increased pension or additional compensa- ‘‘Subchapter II—Hospital, Nursing Home, or (1) by striking out paragraphs (1) and (2) tion or allowances based on the need of regu- Domiciliary Care and Medical Treatment and redesignating paragraphs (3) and (4) as lar aid and attendance or by reason of being paragraphs (1) and (2), respectively; and permanently housebound (or who, but for the ‘‘1710. Eligibility for health care. (2) by amending paragraph (1), as so redes- receipt of retired pay, would be in receipt of ‘‘1711. Care during examinations and in ignated, to read as follows: such pension, compensation, or allowance) if emergencies. ‘‘(1) The term ‘health-care resource’ in- the Secretary has determined, based on an ‘‘1712. Treatment for veterans exposed to cludes health care as that term is defined in examination by a physician employed by the certain toxic substances or hazards. paragraph (5) of section 1701, any other Department (or, in areas where no such phy- ‘‘1712A. Eligibility for readjustment coun- health-care service, and any health-care sup- sician is available, by a physician carrying seling and related mental health serv- port or administrative resource.’’. out such function under a contract or fee ar- ices. (3) by adding at the end the following new rangement), that the medical condition of ‘‘1712B. Counseling for former prisoners of paragraph (3): such veteran precludes appropriate treat- war. ‘‘(3) The term ‘health-care providers’ in- ment in Department facilities.’’; and ‘‘1712C. Mental health services and be- cludes health-care plans, insurers, organiza- (5) by amending paragraph (5) of subsection reavement counseling for family mem- tions, institutions, or any other entity or in- (a) to read as follows: bers. dividual who furnishes any health-care re- ‘‘(5) Hospital care, or outpatient care for ‘‘1713. Medical care for survivors and de- source.’’. veterans in a State (other than the Common- pendents of certain veterans. (c) Section 8153 is amended— wealth of Puerto Rico) not contiguous to the ‘‘1714. Prosthetic devices and aids for the (1) by amending the heading to read as fol- contiguous States.’’. blind and hearing impaired. lows: (6) in paragraph (6) of subsection (a), by ‘‘1715. Dental care. ‘‘1716. Hospital care by other agencies of ‘‘§ 8153. Health-care resource sharing’’; striking out ‘‘to obviate the need for hos- the United States. (2) by amending paragraph (1) of subsection pital admission’’; and (7) in paragraph (7) of subsection (a), by ‘‘1717. Home improvements and structural (a) to read as follows: alterations. ‘‘(a)(1) The Secretary may, when the Sec- striking out ‘‘1712(b)(1)(F)’’ and inserting in lieu thereof ‘‘1715(b)(1)(F)’’. ‘‘1718. Therapeutic and rehabilitative ac- retary determines it to be necessary in order tivities. to secure health-care resources which other- (b) Section 1704 is repealed. (c) Section 1711 is amended by striking ‘‘1719. Medications prescribed by non-VA wise might not be feasibly available, or to ef- physicians; immunization programs. fectively utilize health-care resources, make ‘‘medical services’’ wherever it appears and inserting in lieu thereof ‘‘outpatient care’’. ‘‘1720. Transfers for nursing home care. arrangements, by contract or other form of ‘‘1720A. Treatment and rehabilitation for agreement, without regard to any law or reg- (d) Section 1712A is amended— (1) in subsection (b)(1), by striking alcohol or drug dependence or abuse ulation pertaining to competitive proce- ‘‘1712(a)(5)(B)’’ and inserting in lieu thereof disabilities. dures, for the mutual use, or exchange of ‘‘1710’’; ‘‘1720B. Counseling and treatment for sex- use, of health-care resources between De- (2) in subsection (b)(2), by striking ual trauma. partment health-care facilities and non-De- ‘‘1701(6)(B)’’ and inserting in lieu thereof ‘‘1720C. Noninstitutional alternatives to partment health-care providers.’’; ‘‘1712C’’; and nursing home care: pilot program. (3) in subsection (c), by striking out ‘‘hos- (3) in subsection (e)(1), by striking ‘‘sec- ‘‘1720D. Authorization of Appropriations. pital care and medical services’’ and ‘‘hos- tions 1712(a)(1)(B) and’’ and inserting in lieu ‘‘Subchapter III—Miscellaneous Provisions pital care or medical services’’ and inserting thereof ‘‘section’’; Relating to Hospital and Nursing Home in lieu thereof ‘‘health care’’ in both places; (e) Section 1713 is amended by striking out Care and Medical Treatment of Veterans and ‘‘medical care’’ each place it appears and in- (4) in subsection (d), by striking out ‘‘hos- ‘‘1721. Power to make rules and regula- serting in lieu thereof ‘‘health care’’. pital care and health services’’ and inserting tions. (f) Section 1718 is amended in subsection in lieu thereof ‘‘health care’’. ‘‘1722. Income thresholds. (e), by striking out ‘‘1712(i) of this title’’ and (5) by striking out subsection (e). ‘‘1722A. Copayment for medications. inserting ‘‘1710(c)’’ in lieu thereof. (d) The table of sections at the beginning ‘‘1723. Furnishing of clothing. (g) Section 1720A is amended— of chapter 81 is amended by striking out the ‘‘1724. Hospital care, medical services, and (1) by striking out ‘‘hospital, nursing item relating to section 8153 and inserting in nursing home care abroad. home, and domiciliary care and medical re- lieu thereof the following: ‘‘1726. Reimbursement for loss of personal habilitative services’’ and inserting in lieu ‘‘8153. Health care resource sharing’’. effects by natural disaster. thereof ‘‘health care’’; and SEC. 112. AUTHORIZATION OF APPROPRIATIONS. ‘‘1727. Persons eligible under prior law. (2) by striking out ‘‘1995’’ and inserting in ‘‘1728. Reimbursement of certain medical Subchapter II of chapter 17 is amended by lieu thereof ‘‘1997’’. adding at the end the following new section: expenses. (h) Section 1720B is repealed. ‘‘1729. Recovery by the United States of the (i) Section 1720D is redesignated as section ‘‘§ 1720D. Authorization of appropriations cost of certain care and services. 1720B. There are authorized to be appropriated ‘‘1730. Community residential care. such sums as are necessary to carry out this (j) Section 1724 is amended— ‘‘Subchapter IV—Hospital Care and Medical subchapter. (1) by amending the heading to read as fol- lows: Treatment for Veterans in the Republic of SEC. 113. CONFORMING AMENDMENTS. the Philippines (a) Section 1703 is amended— ‘‘§ 1724. Health care abroad’’; ‘‘1731. Assistance to the Republic of the (1) by amending the section heading to and Philippines. read as follows: (2) by striking out ‘‘medical services’’ ‘‘1732. Contracts and grants to provide for wherever it appears and inserting in lieu ‘‘§ 1703. Contracts for hospital and outpatient the care and treatment of United thereof ‘‘outpatient care’’. care’’; States veterans by the Veterans Memo- (k) Section 1727 is amended by striking out (2) by striking out the words ‘‘medical rial Medical Center. ‘‘medical services’’ and inserting in lieu services’’ wherever they appear and inserting ‘‘1733. Supervision of program by the Presi- thereof ‘‘outpatient care’’. in lieu thereof ‘‘outpatient care’’; (l) Section 1728 is amended by striking out dent. (3) in the first sentence of subsection (a), ‘‘medical services’’ and inserting in lieu ‘‘1734. Health care in the United States. by striking out ‘‘or services’’ and ‘‘or 1712’’; thereof ‘‘outpatient care’’. ‘‘1735. Definitions.’’. (4) by amending paragraph (2) of subsection (m) Section 1734 is amended— PART B—GENERAL PROGRAM ADMINISTRATION (a) to read as follows: (1) by amending the heading to read as fol- IMPROVEMENTS ‘‘(2) Outpatient care for the treatment of lows: any disability of— SEC. 120. MEANS TEST REFORM. ‘‘(A) a veteran with a service-connected ‘‘§ 1734. Health care in the United States’’; (a) Section 1722 is amended to read as fol- disability rated at 50 percent or more; and lows: ‘‘(B) a veteran who has been furnished hos- (2) by striking ‘‘hospital and nursing home § 1722. Income thresholds pital care, nursing home care, or domiciliary care and medical services’’ and inserting in ‘‘(a)(1) For purposes of section 1710(c)(1)(D), lieu thereof ‘‘health care’’. section 1710(c)(1)(E) and section 1710(e), the S 15352 CONGRESSIONAL RECORD — SENATE October 19, 1995 income threshold for the calendar year be- ‘‘(m)(1) Except as provided in paragraph (2) mat as the Secretary may prescribe, includ- ginning on January 1, 1995, is— of this subsection, no loan closed after Sep- ing a requirement for the use of a digital sig- ‘‘(A) $20,469 in case of a veteran with no de- tember 30, 1995, may be guaranteed under nature or other individually identified elec- pendents; and this section. tronic designation of the reporting or cer- ‘‘(B) $24,585 in the case of a veteran with ‘‘(2) Paragraph (1) of this subsection shall tifying party on the electronic reports and one dependent; plus $1,368 for each additional not apply to a loan described in subsection certifications submitted. Such a digital sig- dependent. (a)(1)(F) of this section.’’. nature or other electronic designation will ‘‘(2) Effective on January 1, of each year SEC. 202. LOAN FEES. be deemed to be the original signature of the after 1995, the amounts specified in para- (a) Section 3729(a)(2) is amended— reporting or certifying party.’’. graph (1) shall be increased by the percent- (1) by striking out in subparagraph (A) ‘‘or (c) Section 3684 is amended by adding at age by which the maximum rates of pension for any purpose specified in section 3712 the end the following new subsection: were increased under section 5312(a) during (other than section 3712(a)(1)(F)) of this ‘‘(d) For purposes of this section, the Sec- the preceding calendar year. title’’; retary may require that any report or cer- ‘‘(b) For purposes of this chapter, the term (2) by striking out in subparagraphs (B) tification required by this section is to be ‘attributable income of a veteran’ means the and (C) ‘‘(except for a purchase referred to in submitted to the Department electronically income of a veteran for the previous year de- section 3712(a) of this title)’’ each place it ap- by such means and in such format as the termined in the same manner as the manner pears; Secretary may prescribe, including a re- in which a determination is made of the (3) by inserting ‘‘or’’ at the end of clause (i) quirement for the use of a digital signature total amount of income by which the rate of of subparagraph (D); or other individually identified electronic pension for such veteran under section 1521 (4) by striking out clause (ii) of subpara- designation of the reporting or certifying of this title would be reduced if such veteran graph (D); party on the electronic reports and certifi- were eligible for pension under that section. (5) by striking out in clause (iii) of sub- cations submitted. Such a digital signature ‘‘(c) If a veteran has attributable income paragraph (D) ‘‘(other than a purchase re- or other electronic designation will be greater than the applicable amount specified ferred to in section 3712 of this title)’’; and deemed to be the original signature of the re- in subsection (a), but projections of the vet- (6) by redesignating clause (iii) of subpara- porting or certifying party.’’. eran’s income for the current year are that graph (D) as clause (ii). (d) Section 5101 (a) is amended— it will be substantially below that amount, (b) The amendments made by this section (1) by inserting ‘‘(1)’’ after the ‘‘(a)’’ at the then to avoid a hardship to the veteran, the shall take effect October 1, 1995. beginning; and Secretary may deem the veteran to have an (2) by adding at the end the following new SEC. 203. CONTRACTING FOR PORTFOLIO LOAN paragraph: attributable income less than the applicable SERVICES. ‘‘(2) The secretary is authorized to provide amount specified in subsection (a). (a) Subchapter III of chapter 37 is amended that a claim for education benefits under ‘‘(d) For the purposes of section 1724(c) of by inserting after section 3735 the following laws administered by the Department may this title, the fact that a veteran is— new section: ‘‘(1) eligible to receive medical assistance be submitted to the Department electroni- under a State plan approved under title XIX ‘‘§ 3736. Portfolio loan servicing cally through an electronic terminal, tele- of the Social Security Act (42 U.S.C. 1396 et ‘‘(a) Notwithstanding the provisions of any phone, computer or other electronic means seq.); other law, the Secretary is authorized to in such manner as the Secretary may pre- ‘‘(2) a veteran with a service-connected dis- contract with a private entity for the servic- scribe, including a requirement for the use of ability; or ing of loans made or acquired by the Sec- a digital signature or other individually ‘‘(3) in receipt of pension under any law ad- retary under this chapter. The contract may identified electronic designation of the ministered by the Secretary, provide for the contractor to retain, as com- claimant on the electronic claim submitted ‘‘shall be accepted as sufficient evidence of pensation for the work performed under such by the claimant. Such a digital signature or such veteran’s inability to defray necessary contract, a portion of the interest collected other electronic designation will be deemed expenses.’’. on such loans. A contract under this sub- to be the individual claimant’s original sig- (b) Section 1722A(a)(3)(B) is amended by in- section may be for a term not in excess of 15 nature.’’. serting ‘‘attributable’’ before ‘‘income’’. years. (e) Chapter 53 is amended— SEC. 121. VA RETENTION OF FUNDS COLLECTED ‘‘(b) For purposes of the Federal Credit Re- (1) by adding at the end the following new FROM THIRD PARTIES. form Act of 1990, the deduction from interest section: (a) Section 1729(g) is amended— retained by a contractor as authorized by ‘‘§ 5320. Verification of education benefits in- (1) in paragraph (3)(A) by striking ‘‘1710(f) subsection (a) of this section shall be deemed formation of this title for hospital care or nursing to be a cost of a direct loan or the cost of a ‘‘(a) The Department may utilize data elec- home care, under section 1712(f) of this title loan guarantee, and not an administrative tronically provided to the Department by for medical services’’ and inserting in lieu expense.’’. any individual in initially establishing or thereof ‘‘1710(e) of this title for health care’’. (b) The table of sections at the beginning verifying eligibility or continued eligibility (2) by amending paragraph (4) to read as of such chapter is amended by inserting of an individual for education benefits under follows: below the item relating to section 3735 the laws administered by the Department. The ‘‘(4) Not later than January 1 if each year, following new item: data will be in the form prescribed by the there shall be deposited into the Treasury as ‘‘3736. Portfolio loan servicing.’’. Secretary. miscellaneous receipts an amount equal to PART B—EDUCATION PROGRAMS ‘‘(b) Notwithstanding section 552a(o) and the amount of the unobligated balance re- (p) of title 5, the Secretary may suspend, ter- SEC. 210. ELECTRONIC SIGNATURES ON DOCU- maining in the Fund at the close of business minate, or reduce payments based on the on September 30, the preceding year— MENTS CONCERNING EDUCATION BENEFITS FOR VETERANS. data described in subsection (a) once the ‘‘(A) minus any part of such balance that (a) Section 3674(a)(3) is amended by insert- Secretary (1) informs the individual of the the Secretary determines is necessary in ing ‘‘(A)’’ before ‘‘Each’’ and by adding at data provided electronically, (2) gives the in- order to enable the Secretary to defray, dur- the end the following new subparagraph (B): dividual an explanation of the procedures to ing the fiscal year in which the deposit is ‘‘(B) The Secretary may require that any contest such data, and (3) gives notice of the made, the expenses, payments, and costs de- report or certification required by this sub- individual’s right to appeal the decision in scribed in paragraph (3); and the same manner as applies to other infor- ‘‘(B) minus twenty-five percent of that section be submitted to the Department electronically by such means and in such for- mation and findings relating to eligibility part of such balance that exceeds the base- for or entitlement to the payment of such line in the President’s Budget for third party mat as the Secretary may prescribe, includ- ing a requirement for the use of a digital sig- benefits.’’; and deposits in that fund for that fiscal year, ‘‘(2) by amending the table of sections for which shall be retained by VA and distrib- nature or other individually identified elec- tronic designation of the reporting or cer- such chapter by adding at the end the follow- uted to VA health care facilities for use in ing new item: improving the quality of health care pro- tifying party on the electronic reports and ‘‘§ 5320. Verification of education benefits in- vided by those facilities.’’. certifications submitted. Such a digital sig- nature or other electronic designation will formation’’. TITLE II—BENEFIT PROGRAMS be deemed to be the original signature of the SEC. 211. ELECTRONIC FUNDS TRANSFER FOR PART A—LOAN GUARANTY PROGRAM reporting or certifying party.’’. EDUCATION BENEFITS PAYMENTS. SEC. 201. TERMINATION OF MANUFACTURED (b) Section 3680(g) amended— Section 5120(d) is amended— HOUSING LOAN PROGRAM. (1) by inserting ‘‘(1)’’ after the ‘‘(g)’’ at the (a) by striking out ‘‘Notwithstanding’’ and Section 3712 is amended— beginning; and inserting in lieu thereof ‘‘(1) Except as pro- (1) by striking out subsection (l) in its en- (2) by adding at the end the following new vided in paragraph (2) of this subsection, and tirety; paragraph: notwithstanding’’; and (2) by redesignating subsection (m) as sub- ‘‘(2) The Secretary may require that any (b) by adding a the end thereof the follow- section (l); and report or certification required under this ing new paragraph: (3) by inserting after subsection (l), as so section be submitted to the Department ‘‘(2)(A) Notwithstanding the provisions of redesignated, the following new subsection: electronically by such means and in such for- section 3680(d)(4) of this title and subsection October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15353 (a) of this section, the Secretary is author- intentionally limits home care to health requirements that VA furnish outpatient ized to require, pursuant to an agreement services and does not include health-related care to many veterans only if it is needed as with the Secretary of the Treasury under services such as homemaker or social sup- pre-hospital care, post-hospital care, or to which the Secretary certifies such benefits port services. The definition also includes obviate the need for hospital care. Addition- for payment, that education benefits pro- language stating that the term does not in- ally, the changes would permit the Depart- vided under laws administered by the De- clude care or services that any other person ment to furnish needed prosthetic and partment be paid through electronic funds or entity has a contractual or legal obliga- orthotic devices to any veteran eligible for transfer, to include a program combining use tion to furnish. The purpose of that language health care regardless of whether care is fur- of vouchers and federally established elec- is to ensure that VA not be required to fur- nished on an inpatient or outpatient basis. tronic benefit transfer accounts or any other nish home care to a veteran who resides in a Subsection (a) of the revised section 1710 electronic funds transfer program designated board and care facility, a residential care fa- would also make the provision of all health by the Secretary. cility, a nursing home, or other institution care subject to the prioritization scheme de- ‘‘(B) For purpose of this paragraph, the where the institution has a legal or contrac- scribed in subsection (d) of the revised sec- term ‘‘electronic funds transfer’’ means any tual responsibility to provide the type of tion 1710. Finally, subsection (a) would in- transfer of funds, other than a transaction care included in home care. clude language explicitly providing that the originated by cash, check or similar paper Definition of residential care Department shall furnish care only to the instrument, that is initiated through an extent that Congress appropriates funds for electronic terminal, telephone, computer, or The bill would add a definition of the term residential care to section 1701 referring to that purpose in advance of delivering the magnetic tape, for the purpose of ordering, care. instructing, or authorizing a financial insti- the new type of residential care which would Authority to furnish nursing home, domiciliary, tution to debit or credit an account.’’. be authorized in section 1730. The definition is patterned on the definition of the term respite and home care SECTION BY SECTION ANALYSIS ‘‘community residential-care’’ that is now Subsection (b) of the revised section 1710 SECTION 101—DEFINITIONS included in 38 U.S.C.§ 1730(f). The term would would provide that the Secretary ‘‘may’’ fur- Section 101 of the draft bill would amend 38 be defined as the provision of room and board nish needed nursing home care, home care, U.S.C. § 1701, which defines a number of and such limited personal care and super- respite care, and domiciliary care to any vet- terms that are important for administering vision of residents as the Secretary deter- eran, subject to the limits of available re- VA health care eligibility laws. The defini- mines, in regulations, is needed for the sources, and subject to the same priority tions of several terms are revised to make health, safety and welfare of residents. The scheme described in subsection (d). Under them simpler. In addition to revising defini- definition of ‘‘community residential-care’’ current law, all veterans have so-called dis- tions, the bill would add definitions of the now in 1730 would be deleted. In lieu of that, cretionary eligibility for nursing home care, terms ‘‘health care’’ and ‘‘residential care’’ the new definition would provide that com- and that is unchanged. However, the lan- to section 1701, and transfer definitions of munity residential care is simply residential guage making the provision of nursing home, terms into section 1701. For example, the def- care furnished in a non-VA facility. domiciliary, respite and home care subject inition of the term respite care is moved Definition of respite care and preventive health to available resources, and subject to a prior- from section 1720B. services ity scheme is new. Definition of health care Section 101 would add a definition of the Priorities for the purpose of furnishing health The term ‘‘health care’’ is at the heart of term ‘‘respite care’’ to section 1701 that is es- care the reformed eligibility system established sentially the same as the definition of that Subsection (c) of the revised section 1710 by other provisions of the draft bill. The def- term now included in 38 U.S.C. § 1720B. Sec- would require the Secretary to furnish inition of the term first states that it means tion 101 would also revise the definition of health care benefits in accordance with spec- the most appropriate care and treatment of preventive health services to make it some- ified priorities. The provision would apply to the patient, furnished in the most appro- what shorter and more concise then the ex- nearly all health-care benefits VA furnishes. priate setting. The definition further states isting definition. Subsection (c) would set up five priority that the term ‘‘health care’’ includes all of groups. It further provides that the Sec- the generally accepted modes of health care SECTION 102—BASIC HEALTH CARE ELIGIBILITY retary could, by regulation, establish addi- that VA furnishes to veterans. Thus, the Section 102 of the draft bill would com- tional priorities within each statutory prior- term is defined as including hospital care, pletely revise 38 U.S.C. § 1710. The revised ity group. nursing home care, domiciliary care, out- section 1710 would become the basic eligi- patient care, rehabilitative care, home care, bility provision for most of the conventional Priority group one respite care, preventive care, and dental health care benefits VA furnishes, including The first priority group includes veterans care. The definition also states that health hospital, nursing home, domiciliary, and with compensable service-connected disabil- care includes pharmaceuticals, supplies, outpatient care. ities and former prisoners of war. In addi- equipment, devices, appliances and other Authority to furnish health care tion, this group includes two smaller cat- necessary materials. The intent of that lan- Subsection (a) of the revised section 1710 egories of veterans, those discharged from guage is to include all of the different types would provide that the Secretary ‘‘shall’’ the military for a service-related disability, of medical equipment, prosthetic and furnish certain veterans with needed health but who for various reasons have not sought orthotic devices, and other supplies the De- care, subject to specified conditions and lim- service-connection, and those injured as a re- partment now furnishes to veterans, many of itations, and ‘‘may’’ furnish such care to sult of care rendered by VA who are receiv- which are included in the current definition other veterans. Those veterans to whom the ing benefits under 38 U.S.C. § 1151. of the term ‘‘medical services.’’ Secretary ‘‘shall’’ furnish care, those with Priority group two Definition of hospital care, nursing home care so-called mandatory eligibility, would gen- The second priority group includes veter- and outpatient care erally be the same as those who currently ans who receive certain specialty care under Section 1701 would also include specific have mandatory eligibility for VA hospital one of the following four special treatment definitions of the various terms used in the care under the current 38 U.S.C. § 1710(a)(1). authorities. definition of health care. Included are defini- Those veterans are commonly referred to as 1. Veterans receiving care for disabilities tions of hospital care, nursing home care, category A veterans, and include veterans which may possibly be associated with expo- and outpatient care. Each of those three having service-connected disabilities, former sure to herbicides (such as Agent Orange) in terms are defined simply and it is intended prisoners of war, World War I veterans, and Vietnam, to radiation during nuclear weap- that they carry the same meanings that are nonservice-connected veterans with incomes ons testing, or as a result of the bombing of commonly understood in the medical com- below the statutorily established income Hiroshima and Nagasaki, Japan, or to envi- munity. threshold commonly referred to as the ronmental hazards or other toxins in the Definition of domiciliary care means test threshold. Subsection (a)(1) of the Persian Gulf. A revised section 1712 would be A new definition of the term ‘‘domiciliary revised section 1710 specifically provides that the basic authority for this care. care’’ is added to section 1701. It provides the requirement that the Secretary ‘‘shall’’ 2. Veterans receiving readjustment coun- that such care is applicable only to veterans furnish health care would not apply to den- seling. Section 1712A is the basic authority with no adequate means of support. That tal care, nursing home care, home care, res- for this care. language is intended to continue in effect pite care and domiciliary care. Those veter- 3. Veterans receiving increased pension or one of the eligibility requirements for domi- ans to whom the Secretary ‘‘may’’ furnish compensation benefits because they are ciliary care that is now included in 38 U.S.C. health care under the bill would be the so- housebound or in need of aid and attendance, § 1710(b). called category C veterans, generally those who obtain medication from VA based on having no service-connected disabilities who prescriptions written by their private physi- Definition of rehabilitative care have incomes above the means test income cians. A revised section 1719 would be the au- The definition of the term ‘‘rehabilitative threshold. thority for the Department to furnish the care’’ remains unchanged from existing law. Because ‘‘health care’’ is defined in section medication. Definition of home care 1701 as including outpatient care, the revised 4. Veterans receiving sexual trauma coun- The bill would add a definition of the term section 1710 would have the effect of com- seling. A revised section 1720 would provide ‘‘home care’’ to section 1701. The definition pletely eliminating the currently existing authority for this counseling. S 15354 CONGRESSIONAL RECORD — SENATE October 19, 1995 Priority group three the Department with authority to furnish would have authority to provide the treat- The third priority group includes veterans outpatient care. Much of the language in the ment under that section. Under current law, with service-connected disabilities rated 0%, current section 1712 is unnecessary given the the Department’s authority to provide care veterans of the Mexican Border period, vet- changes in basic eligibility for outpatient for those exposed to herbicides in Vietnam or erans of World War I, and veterans receiving care and would be deleted. Language in the to ionizing radiation expires on June 30, 1995. increased pension based on the need of regu- current section that must be retained is The draft bill would extend the herbicide lar aid and attendance or by reason of being transferred to other sections in chapter 17. treatment authority through December 31, permanently housebound. Finally, the so-called Agent Orange, Radi- 1996, and would make the ionizing radiation ation, and Persian Gulf treatment authori- authority permanent. The Department cur- Priority group four ties would be moved from the current section rently may provide care for those exposed to The fourth priority group includes 1710(e) to the revised section 1712. toxic substances or environmental hazards in nonservice-connected veterans with incomes Deletion of current outpatient eligibility rules the Persian Gulf through December 31, 1995. below the current means test income thresh- Subsection (a) of the current section 1712 The draft bill would extend that authority olds who also sign a declaration that their now includes all of the eligibility require- through September 30, 1997. family net worth does not exceed $50,000. The ments that pertain to outpatient medical income thresholds are the same as those now SECTION 104—MENTAL HEALTH SERVICES AND services. Under the proposed eligibility BEREAVEMENT COUNSELING FOR FAMILIES in effect, which are set forth in 38 U.S.C. scheme, encompassed in the revised section Section 104 would add a new section 1712C § 1722. For calendar year 1995, they are $20,469 1710, which would authorize the Secretary to for a single veteran, $24,585 for a veteran furnish all needed health care, including out- entitled ‘‘Mental health services and be- with one dependent, and $1,368 for each addi- patient care, there is no need for any of reavement counseling for family members.’’ tional dependent. If the veteran’s net worth those existing requirements. Accordingly, Under current law, those services are author- exceeds $50,000, or the veteran refuses to sign section 103 of the bill would delete them. The ized via the definition of medical services. a declaration that it is less than that rules in question are those which provide All of the details and limits on the Depart- amount, the veteran is included in priority that the Secretary shall furnish outpatient ment’s furnishing the services are presently group five described below. This fourth prior- medical services to certain veterans, and contained in the definitions of ‘‘hospital ity group also includes veterans receiving may furnish such services to other veterans. care’’ and ‘‘medical services’’ in the current screening, counseling, and treatment for They are also the requirements which limit section 1701. Those definitions would be re- sickle cell anemia under 38 U.S.C. § 1751. outpatient care in certain cases to that need- vised under this bill, as discussed above, and Priority group five ed as pre-hospital care, post-hospital care, or written much more simply. The content of to obviate the need for hospital care. A pri- the old definitions related to mental health The fifth priority group includes services and bereavement counseling for nonservice-connected veterans with incomes ority scheme now set forth in subsection (i) of section 1712 would also be deleted as un- family members is being transferred to the above the current means test income thresh- new section. The counseling and other serv- olds. It also includes nonservice-connected necessary because the proposed new section 1710 includes priority provisions. Finally, the ices would be furnished under the new sec- veterans with incomes below that level, but tion 1712B, not as a form of health care under who have family net worth in excess of copayment provisions applicable to VA’s fur- nishing outpatient care, now set forth in the proposed new section 1710. However, $50,000, or who refuse to sign a declaration there would be no substantive change in ex- that net worth is less than that amount. subsection (f) of section 1712, have been moved to the proposed new subsection (e) of isting authority to furnish the services. Care furnished by other Government entities section 1710. SECTION 105—SPECIAL AUTHORITIES RELATED TO Subsection (d) of the revised section 1710 is Outpatient dental care requirements FURNISHING PROSTHETIC DEVICES, AND AIDS identical to subsection (g) in the current sec- The current section 1712 also includes eligi- FOR THE BLIND AND HEARING IMPAIRED tion 1710, which provides that VA is not obli- bility requirements which pertain to VA pro- Section 105 would amend 38 U.S.C. § 1714, gated to provide care to veterans, such as vision of outpatient dental services. The those who are incarcerated, to whom another which currently authorizes VA to furnish draft bill would make no changes in those re- veterans who receive a prosthetic appliance governmental entity is legally obligated to quirements. However, the bill would move furnish care. from VA with proper fitting of the device, all of the dental provisions now included in and training in it use. It further authorizes Copayments section 1712(b), (c), (d), and (e) to a new sec- guide dogs and devices and appliances for the Subsection (e) of the revised section 1710 tion 1715, which would be entitled ‘‘Dental blind. Section 105 would retain those existing retains the currently existing copayment care.’’ provisions in section 1714, and add other pro- structure with one substantive change. Gen- Privately prescribed medications and visions, now located in other parts of chapter erally, veterans with incomes above the immunizations 17, to the section. The proposed new section means test income thresholds must agree to Two other provisions included in the cur- 1714 would not include any authority that pay copayments amounting to the Medicare rent section 1712 would also be retained, but does not already exist in chapter 17 of title deductible for each 90 days of care, and must moved to another section. First, subsection 38. pay per diem amounts of $10 for each day of (h) of the existing 1712 authorizes the Sec- Devices for the hearing impaired hospital care and $5 for each day of nursing retary to fill prescriptions written by non- home care. The first substantive change has VA physicians for veterans who are receiving Section 1717(c) currently contains author- to do with the outpatient care copayment. increased pension or compensation benefits ity for VA to furnish devices to assist veter- Currently, veterans required to pay a because they are housebound or in need of ans in overcoming the handicap of deafness. copayment must pay 20% of the average cost aid and attendance. Second, subsection (j) of Section 105 would transfer that language to of an outpatient visit. Subsection (e) would the current section 1712 authorizes the Sec- section 1714, where it more logically belongs. change that to provide that veterans pay 20% retary to provide immunizations to veterans Repair of prosthetic devices of the estimated cost of the care. The change as part of national immunization programs Section 1719 currently authorizes VA to re- would be made to bring copayments more in administered by the Department of Health pair or replace prosthetic appliances and and Human Services. The provisions of sub- line with the actual cost of furnishing care. other medical equipment and devices dam- sections (h) and (j) would be moved to a new Furnishing inpatients with dental and aged by a fall or accident caused by a serv- section 1719, which would be entitled ‘‘Medi- outpatient care ice-connected disability. Section 105 would cations prescribed by non-VA physicians; im- transfer that language to section 1714. Two provisions now included in section munization programs.’’ 1710(c) would be deleted from the revised sec- Agent Orange, radiation, and Persian Gulf Acquisition of prosthetic devices tion 1710. The first provision permits the De- Language now included in 38 U.S.C. partment to furnish dental care to inpatients In place of other provisions deleted or § 1712(d), which authorizes the Secretary to when needed to continue safe and effective transferred from section 1712, the draft bill purchase or manufacture medical equipment, treatment of other disabilities for which the would insert in section 1712 provisions now prosthetic devices, and similar appliances, veteran is receiving care. That provision has set forth in subsection (e) of section 1710. would be transferred to section 1714. been simplified and included as subsection The provisions provide authority for VA to (a) of the revised section 1715, which is the treat disabilities which may possibly be as- SECTION 106—DENTAL CARE sociated with exposure to herbicides, such as section concerned with dental care. The sec- Abolition of authority to furnish tobacco ond provision pertains to furnishing out- Agent Orange, during service in Vietnam, ex- Section 106 would completely revise 38 patient care to inpatients. It has been de- posure to ionizing radiation from nuclear U.S.C. § 1715. Currently, that section author- leted because it would be unnecessary with testing or in post-War Japan, and exposure izes the Secretary to furnish tobacco to vet- the other changes in law the bill would make to environmental hazards and contaminants erans receiving hospital or domiciliary care. it simplify eligibility for outpatient care. in the Persian Gulf area. The provisions would be transferred from the current sec- Because it is Departmental policy that to- SECTION 103—AGENT ORANGE, RADIATION, AND tion 1710, generally without substantive bacco ordinarily not be used in health-care PERSIAN GULF TREATMENT AUTHORITIES legal change. facilities, section 106 would repeal the au- Section 103 would completely revise the The revised section 1712 would, however, thority to furnish tobacco. In its place, sec- current 38 U.S.C. § 1712, which now provides extend the time period during which VA tion 106 would place in section 1715 all of the October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15355

eligibility requirements governing VA’s pro- SECTION 108—PRIVATELY PRESCRIBED amendments would allow VA to more easily vision of dental care, which are now con- MEDICATIONS AND IMMUNIZATIONS acquire services for veterans, and would per- tained in subsection (c) of section 1710, and Section 108 would completely revise 38 mit VA to provide health care services to subsections (b), (c), and (d) of section 1712. U.S.C. § 1719. That section currently author- other providers in the community when it Inpatient dental care izes VA to repair or replace prosthetic appli- would be beneficial to both parties, and when ances and other medical equipment and de- there would be no diminution of services to Language currently in subsection (c) of vices damaged by a fall or accident caused veterans. section 1710 permits the Department to fur- by a service-connected disability. Section 105 Basic sharing authority nish dental care to inpatients when needed of the draft bill would transfer that author- Subsection (b) of section 111 would amend to continue safe and effective treatment of ity to section 1714. In its place, section 108 38 U.S.C. § 8153, VA’s basic sharing authority, other disabilities for which the veteran is re- would insert two authorities now included in to allow VA to share a wider array of re- ceiving care. That provision has been sim- section 1712. The first is authority for the sources with a wider array of other care pro- plified and included as subsection (a) of the Secretary to fill prescriptions written by viders than is now the case. It would delete revised section 1715. Additionally, subsection non-VA physicians for veterans who are re- language in that section which lists the dif- (a) would authorize the Secretary to furnish ceiving increased pension or compensation ferent types of providers with whom the De- inpatients with any other dental care for benefits because they are housebound or in partment may share, and in lieu thereof, which they would be eligible to receive on an need of aid and attendance. The second is au- would authorize sharing with ‘‘health care outpatient basis. thority for the Secretary to provide immuni- providers.’’ It would also allow VA to share Outpatient dental care zations to veterans as part of national im- any ‘‘health care resource.’’ munization programs administered by the Currently, VA has very detailed eligibility Definitions Department of Health and Human Services. requirements governing the provision of den- Those two authorities are currently included Section 111(c) would add to 38 U.S.C. § 8152, tal care on an outpatient basis. Those re- in subsections (h) and (j) of section 1712. a definition of the term ‘‘health-care provid- quirements are set forth in subsections (b), ers’’ which would include insurers, health (c), and (d) of section 1712. Section 106 of this SECTION 109—COMMUNITY NURSING HOME CARE care plans, and any organization, entity, or bill would transfer the language now in sec- Section 109 would amend 38 U.S.C. § 1720, individual that furnishes health care re- tion 1712 into section 1715, virtually un- VA’s authority to contract for nursing home sources. VA currently lacks authority to changed. No substantive legal changes in the care. The changes would permit VA to di- share with insurers and with individuals eligibility requirements for outpatient den- rectly admit a nonservice-connected veteran such as physicians or other solo providers. It tal care are intended. to a contract community nursing home. would also add a definition of ‘‘health-care Under current law, only service-connected SECTION 107—HOME IMPROVEMENTS AND resources.’’ The term would be defined to in- veterans may be admitted directly. Addi- STRUCTURAL ALTERATIONS clude health care as defined in section 1701, tionally, section 109 would delete obsolete as well as any other health-care service, and Deletion of home care provisions language in section 1720 which authorizes VA any other health-care support or administra- Section 107 would revise 38 U.S.C. § 1717. to furnish veterans with adult day health tive resource. Under existing law VA is lim- Section 1717 currently authorizes the Depart- care. That special authority to furnish adult ited to sharing ‘‘specialized medical re- ment to furnish home health services as a day health care expired in 1991. More impor- sources.’’ form of outpatient medical services. The sec- tantly, the definition of the term ‘‘health Finally, section 111(a) would amend 38 tion further provides that the department care’’ which would be added to section 1701 U.S.C. § 8151, which states the purpose of may furnish certain veterans home improve- would include adult day health care. VA’s sharing program, so that it conforms ments and structural alterations as a form of SECTION 110—RESIDENTIAL CARE with the changes which would be made by home health services. Section 107 would de- Section 110 would revise 38 U.S.C. § 1730, subsections (b) and (c). lete the references to home health services. which now authorizes a community residen- SECTION 112—AUTHORIZATION OF The language is unnecessary because home tial care program under which VA refers vet- APPROPRIATIONS health care is included in the new definition erans to board and care homes that the vet- Section 112 would add a new section 1720D of ‘‘health care’’ in the revised section 1701, erans pay for with their own resources, often to subchapter II of chapter 17 of title 38, and such care would be furnished pursuant to VA monetary benefits such as compensation United States Code, authorizing appropria- section 1710. However, the language regard- or pension. The draft bill would add a new tions of such sums as are necessary to carry ing the furnishing of home improvements subsection (a) to section 1730 to authorize out the subchapter. and structural alterations would be retained VA to furnish such care to certain veterans. SECTION 113—CONFORMING AMENDMENTS in section 1717. The authority to provide the care would be Section 113 would amend fourteen different completely discretionary, and quite limited. Home improvements and structural alterations sections in chapter 17 to make conforming The Secretary could authorize transfer of a changes needed as a result of other amend- The current language in section 1717 per- veteran into such care only if the veteran is ments made by the bill. The section would taining to home improvements and struc- actually receiving VA hospital care in a VA repeal two currently existing sections. Sec- tural alterations would be revised somewhat facility, and the residential care is an alter- tion 1720B, which authorizes respite care, so that it provides stand alone authority for native to continued hospital care. Moreover, would be repealed. Respite care would be pro- the improvements and alterations. The im- such a transfer could be authorized only vided as a form of health care. The bill would provements and alterations would not be a when the veteran has no resources to pay for also repeal section 1704, which requires VA form of outpatient care, as is now the case. the services. During the period of time that to submit an annual report on the provision Rather, section 1717 would be the authority a veteran is receiving residential care, VA of preventive health services. Finally, the for the benefit. All of the existing limits on officials would be undertaking efforts to as- current section 1720D, which authorizes a furnishing home improvements and struc- sist the veteran in securing alternative fund- sexual trauma counseling program, would be tural alteration would be retained without ing, such as public assistance, for the care of redesignated as section 1720B. change. the veteran. Care would be furnished on a Invalid lifts and therapeutic and rehabilitative contract basis, and could continue for no SECTION 120—MEANS TEST REFORM devices more than 90 days in any year. Section 120 would amend 38 U.S.C. § 1722 to The amendments made by section 110 simplify administration of VA’s health care Section 1717 currently contains authority would not alter the existing community resi- benefits ‘‘means test.’’ VA uses the means for furnishing certain veterans with invalid dential care referral program. Veterans who test to determine both a veteran’s priority lifts and therapeutic and rehabilitative de- qualify for that program could not qualify for receiving VA health care and whether a vices. That authority is now largely duplica- for the proposed new program under which veteran must agree to pay certain tive of other authority to furnish the items VA pays for the care because they would copayments in exchange for care. as a form of medical services. Section 107 have alternative arrangements for payment would delete the authority as it is unneces- Income thresholds for the care. Thus, they could not meet the The draft bill would first amend subsection sary. The definition of ‘‘health care’’ in the eligibility requirements of the new program. revised section 1701 would include the lifts (a) of section 1722. It would abolish use of the and devices, and the Secretary’s authority to SECTION 111—SHARING HEALTH CARE RESOURCES term ‘‘unable to defray the expenses of nec- furnish health care would provide authority Section 111 would amend three sections in essary care.’’ The subsection would simply to furnish such items. chapter 81 of title 38 that authorize VA’s pro- state that for purposes of the eligibility pro- gram to share health-care resources. The visions and priority provisions of section Aids for the hearing impaired provisions would expand VA’s ability to ob- 1710, certain income thresholds shall apply. Section 1717(c) currently contains author- tain health-care resources to serve the needs The thresholds would be unchanged from ity to furnish devices to assist veterans in of veterans in the changing health care envi- those currently in effect for distinguishing overcoming the handicap of deafness. Sec- ronment. Changes to these sections would fa- between category A (higher priority veter- tion 105 of the draft bill would transfer that cilitate the successful implementation of the ans) and category C (lower priority veterans) authority without change to the proposed reformed eligibility system that other sec- veterans. As under existing law, the thresh- new section 1714. tions of the draft bill would establish. The olds would be increased each year by the S 15356 CONGRESSIONAL RECORD — SENATE October 19, 1995 same percentage that rates of pension are in- e.g., in connection with the sale of VA ac- major programs, and developed several excit- creased. quired properties, known as ‘‘vendee loans,’’ ing initiatives to enable the Department to Net worth and direct loans to Native American veter- better serve veterans, and serve them in a Section 120 of the bill would strike lan- ans. It also includes guaranteed loans of cost-effective manner. Several of those ini- guage in the currently existing section which VA took an assignment, a procedure tiatives can be implemented only through 1722(d) which provides for consideration of commonly referred to as ‘‘refunding.’’ VA enactment of legislation. This draft bill net worth in making the determination of would permit the contractor to retain a por- would provide the needed changes in law. whether a veteran is unable to defray the tion of the interest collected on the loans as HEALTH-CARE ELIGIBILITY REFORM cost of care. That language is unnecessary payment for services rendered. This would Perhaps the single most important need in due to language included in the proposed new permit VA to have the contract bid for the VA health-care system at this time is section 1710(c)(1)(D), and its elimination will ‘‘basis points’’ in a manner similar to servic- the need for reform of the eligibility system. make administration of the means test much ing contracts used in the private sector. Currently, the process required for a veteran VA would be permitted to let a servicing easier and less costly. The language in sec- to receive care from VA can be confusing and contract for up to 15 years. Current Federal tion 1710(c)(1)(D) would provide that a frustrating. Complicated and irrational stat- contract law generally limits contracts to a nonservice-connected veteran eligible for utory eligibility rules sometimes cause ab- 5-year term. health care on the basis of low income must surd outcomes. Existing law discourages VA This section would also provide that, for sign a declaration that family net worth from effectively managing care, and often budgeting purposes under the Federal Credit does not exceed $50,000. If the veteran does promotes the use of expensive and unneces- Reform Act of 1990, the cost of a servicing not sign such a declaration, that veteran sary inpatient care. contract authorized by this section would be would have lower priority, and would be re- VA designed the eligibility reform proposal treated as a cost of the loan or loan guar- quired to make copayments. The $50,000 fig- in the draft bill to achieve several important anty, and not as an administrative expense. objectives. ure is used because that is the figure VA now Section 203(b) would make a conforming First, the eligibility system should be one uses under the existing net worth test to amendment to the table of sections for chap- that both the persons seeking care and those trigger a review of a veterans net worth to ter 37 of title 38. determine whether a part of net worth providing the care are able to understand. SECTION 210—ELECTRONIC SIGNATURES FOR should be used to help defray the costs of Second, the eligibility system should en- care. EDUCATION BENEFITS sure that VA is able to furnish patients the Section 210 would amend several provisions most appropriate care and treatment that is SECTION 121—VA RETENTION OF THIRD PARTY of title 38, United States Code, to clarify medically needed, cost effectively and in the COLLECTIONS that claimants for VA education benefits, most appropriate setting. Third party collections State approving agencies, and schools may Third, veterans should retain eligibility for Section 121 would amend 38 U.S.C. § 1729, transmit documents with their signature those benefits they are now eligible to re- the section which allows VA to recover the electronically to permit VA to award bene- ceive. cost of care it provides to veterans from fits. These electronic documents, submitted Fourth, VA management should gain the third parties, particularly insurance compa- in the regular course of business, would be flexibility needed to manage the system ef- nies. Under current law, VA returns to the accepted as the legal equivalent of a signed, fectively. Treasury all amounts that it collects from written, paper document. As such, they Fifth, the proposal should be budget neu- third parties, less the costs of collection. could be used to make benefits determina- tral. Each year, the President’s Budget antici- tions in an expedited manner with reduced Sixth, the proposal should not create any pates that VA will collect a certain amount, errors. new and unnecessary bureaucracy. The draft bill would provide that the De- referred to as the baseline. As an incentive SECTION 211—ELECTRONIC FUNDS TRANSFER FOR partment ‘‘shall’’ furnish a specified core to collect even more, section 121 would EDUCATION BENEFITS PAYMENTS amend subsection (g) of section 1729 to per- group of veterans with needed ‘‘health care.’’ Section 211 would amend section 5120(d) of This would include hospital care, outpatient mit VA to retain 25 percent of the amounts title 38, United States Code, to authorize VA it collects over and above the baseline care, disease prevention services, pharma- to implement, under an agreement with the ceuticals, medical equipment, and prosthetic amount. The provision further provides that Treasury, a system requiring that payment VA must use the additional amounts it equipment and devices. Persons in the core of educational assistance allowances under group would generally be those veterans now would retain for improving the quality of all education benefits programs adminis- health care furnished by VA facilities. commonly referred to as category A veter- tered by VA would be made by electronic ans: those with service-connected disabil- SECTION 201—MANUFACTURED HOUSING LOAN funds transfer. The amendment defines PROGRAM ities, former prisoners of war, World War I ‘‘electronic funds transfer’’ (EFT) to include veterans, and nonservice-connected veterans Section 201 would terminate VA’s author- the various electronic systems and devices with incomes below the current means test ity to guarantee a loan for the purchase of a prevalent today for such purposes, as distin- income threshold. The Department would re- manufactured home. Any such loan closed guished from transactions originated by tain authority to furnish the core group vet- after September 30, 1995, would not be eligi- cash, check, or other paper instrument. erans with other types of health care, includ- VA would be required to develop a plan for ble for guaranty. An exception would be ing nursing home care. VA would also retain phasing in the conversion from a paper in- made for a loan to refinance an existing VA authority to furnish all health care to veter- strument to an EFT system for education guaranteed manufactured loan with a new ans not included in the core group. The De- benefits payments, and would be given dis- loan at a lower interest rate. Under existing partment would furnish all care in accord- cretionary authority to prescribe regulations law, which remains unchanged a veteran ance with five priority groups set forth in needed to implement the EFT system. Such may not receive cash under an interest rate the bill. Finally, the bill would continue in regulations may include authority to modify reduction refinancing loan. place the current copayment structure, and Section 201 would also repeal the require- any provision of the EFT system designated would retain, essentially unchanged, the so- ment that the Secretary’s annual report to by the Secretary, as well as to waive or mod- called Agent Orange, Radiation, and Persian the Congress contain information about VA ify the system’s application in cir- Gulf treatment authorities. cumstances where it would be impractical. manufactured home loans, and make other The most significant change in the pro- technical and conforming amendments. posal would be the complete elimination of SECRETARY OF VETERANS AFFAIRS, SECTION 202—LOAN FEES the complicated and archaic eligibility rules Washington, DC, September 12, 1995. Section 202 would make technical and con- governing the provision of outpatient care. Hon. AL GORE, forming amendments, consistent with the The bill would also permit wider use of cost- President of the Senate, termination of the manufactured housing effective preventive health measures, and Washington, DC. loan program as proposed by section 201 of use of residential care when that would alle- DEAR MR. PRESIDENT: We are transmitting this bill, to Section 3729 of title 38, United viate the need for hospital care. These key a draft bill, ‘‘To amend title 38, United States Code, relating to the fee veterans and features will allow VA to provide the right States Code, and various other statutes, to other borrowers and assumers pay to VA for care at the right place and the right time for reform eligibility for Department of Veter- housing loans. No change would be made in the right price. ans Affairs health-care benefits, improve the the amount of existing fees. operation of the Department, and improve HEALTH-CARE SHARING These amendments would take effect Octo- the processes and procedures the Department Today’s competitive health-care environ- ber 1, 1995. uses to administer various benefit programs ment demands that all types of service pro- SECTION 203—CONTRACTING FOR PORTFOLIO for veterans; and for other purposes.’’ viders cooperate and work together for each LOAN SERVICES In 1993, the Administration, led by Vice to survive. The VA health-care system is an Section 203(a) would add a new section 3736 President Gore, launched its effort to im- integral part of the larger health-care indus- to title 38, United States Code, which would prove Federal Government operations try and must be able to work with partners authorize VA to contract with a private firm through the ‘‘reinventing government’’ pro- in both the private and public sectors. How- to service VA portfolio loans. The term gram. This year, in phase II of that effort, ever, current law imposes undue limitations ‘‘portfolio loans’’ includes loans made by VA VA examined its basic missions, reviewed its on VA’s ability to obtain needed health-care October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15357 resources to serve veterans. Similarly, VA is the servicing of loans that bear a 30-year ma- nue Code of 1986 to clarify provisions unable to fully share, even when it is mutu- turity. The draft bill would permit the serv- relating to church pension benefit ally advantageous to do so, its resources icing contract to have a 15-year term. Sec- plans, to modify certain provisions re- with others in the community who could ond, current law requires a contract servicer lating to participants in such plans, to benefit from the Department’s expertise. To to remit immediately to the Government all remedy that situation, the draft bill includes money collected. The bill would allow the reduce the complexity of and to bring provisions to expand VA’s ability to share contractor to retain a portion of the loan workable consistency to the applicable resources with other community health-care payments collected as its fee as is customary rules, to promote retirement savings providers. in the private sector. Finally, the draft bill and benefits, and for other purposes. The draft bill would amend existing law to would clarify the budget treatment of the S. 969 permit the Department to share all types of cost of this contract under the Federal Cred- At the request of Mr. BRADLEY, the health-care resources with all types of it Reform Act of 1990 as a cost of the loan name of the Senator from Hawaii [Mr. health-care providers in the community. It rather than as administrative overhead, would define ‘‘health care resource’’ to in- which more accurately reflects private sec- INOUYE] was added as a cosponsor of S. clude conventional health-care services such tor accounting practices. 969, a bill to require that health plans as hospital care, nursing home care, out- ELECTRONIC SIGNATURES AND ELECTRONIC provide coverage for a minimum hos- patient care, rehabilitative care, and preven- FUNDS TRANSFERS—EDUCATION BENEFITS pital stay for a mother and child fol- tive care. Additionally, it would include In the modern world, information is com- lowing the birth of the child, and for other health-care support or administrative monly transmitted electronically. Yet stat- other purposes. services essential to the operation of a utes are often slow to catch up with tech- S. 984 health-care system. The draft bill would also nology. This draft bill would amend various more broadly define the term ‘‘health care At the request of Mr. GRASSLEY, the laws to modernize administration of VA’s provider’’ to include insurers, health-care name of the Senator from North Caro- education benefit programs. The bill would plans, and health-care management organi- lina [Mr. FAIRCLOTH] was added as a co- clarify that claimants for VA education ben- zations, as well as individuals such as physi- sponsor of S. 984, a bill to protect the efits, State approving agencies, and schools cians or other solo providers. The expanded may transmit documents with their signa- fundamental right of a parent to direct sharing authority is essential for the reform ture electronically to permit VA to award the upbringing of a child, and for other of the entire VA health-care system. benefits. The bill would also authorize VA to purposes. VA RETENTION OF INCREASED MEDICAL implement, under an agreement with the S. 1043 COLLECTIONS Treasury, a system requiring that payment At the request of Mr. STEVENS, the Current law permits the VA to recover the of educational assistance allowances under names of the Senator from Rhode Is- cost of care it provides to veterans from all education benefits programs adminis- land [Mr. CHAFEE] and the Senator third parties, particularly insurance compa- tered by VA would be made by electronic nies. Funds collected are turned over to the funds transfer. from North Dakota [Mr. DORGAN] were Treasury. The Department currently does an The Omnibus Budget Reconciliation Act added as cosponsors of S. 1043, a bill to excellent job of collecting these funds. How- (OBRA) requires that all revenue and direct amend the Earthquake Hazards Reduc- ever, as an additional incentive to VA medi- spending legislation meet a pay-as-you-go tion Act of 1977 to provide for an ex- cal centers to increase collections, the draft requirement. That is, no such bill should re- panded Federal program of hazard bill would authorize the Department to re- sult in an increase in the deficit; and if it mitigation, relief, and insurance tain a portion of amounts it collects over the does, it will trigger a sequester if it is not against the risk of catastrophic natu- amounts anticipated in the budget each fully offset. Outlay savings in this bill would ral disasters, such as hurricanes, earth- year. Providing an incentive such as this is equal its increase in direct spending, result- a classic example of how to ‘‘reinvent’’ Gov- ing in a net zero PAYGO effect. Thus, consid- quakes, and volcanic eruptions, and for ernment. ered alone, this bill meets the pay-as-you-go other purposes. TERMINATION OF MANUFACTURED HOME LOAN requirement of OBRA. S. 1150 PROGRAM We are advised by the Office of Manage- At the request of Mr. SANTORUM, the The draft bill would repeal the authority ment and Budget that there is no objection names of the Senator from North Da- for VA to guarantee loans to purchase manu- to the transmittal of this draft bill to the kota [Mr. CONRAD] and the Senator Congress and its enactment would be in ac- factured homes. The number of veterans ob- from Pennsylvania [Mr. SPECTER] were cord with the program of the President. taining manufactured home loans has de- added as cosponsors of S. 1150, a bill to clined significantly over the years, from a Sincerely, JESSE BROWN.∑ require the Secretary of the Treasury high of 13,502 in fiscal Year 1983 to only 24 in to mint coins in commemoration of the Fiscal Year 1994. Manufactured home loan f foreclosure rates are significantly higher 50th anniversary of the Marshall Plan than those for site-built homes. The cumu- ADDITIONAL COSPONSORS and George Catlett Marshall. S. 1163 lative foreclosure rate for manufactured S. 704 home loans is 38.7 percent compared to 5.58 At the request of Mr. LEAHY, the percent for site-built homes. The high fore- At the request of Mr. SIMON, the name of the Senator from Connecticut names of the Senator from New York closure rates in the manufactured home loan [Mr. MOYNIHAN], the Senator from New program have adversely affected the finan- [Mr. LIEBERMAN] was added as a co- Hampshire [Mr. SMITH], the Senator cial solvency of the loan guaranty program, sponsor of S. 704, a bill to establish the and resulted in substantial debts being es- Gambling Impact Study Commission. from Massachusetts [Mr. KENNEDY], and the Senator from Massachusetts tablished against veterans whose loans were S. 743 liquidated and homes repossessed. Due to [Mr. KERRY] were added as cosponsors At the request of Mrs. HUTCHISON, the this low volume, there is virtually no lender of S. 1163, a bill to implement the rec- interest in using the VA manufactured home name of the Senator from Virginia [Mr. ommendations of the Northern Stew- loan program. However, VA is required to WARNER] was added as a cosponsor of S. ardship Lands Council. maintain expertise in consumer installment 743, a bill to amend the Internal Reve- S. 1228 finance, which differs in many respect from nue Code of 1986 to provide a tax credit At the request of Mr. SMITH, his real estate finance. for investment necessary to revitalize name was added as a cosponsor of S. This provision will not affect the ability of communities within the United States, 1228, a bill to impose sanctions on for- veterans to obtain VA guaranteed loans to and for other purposes. purchase, construct, or improve convention- eign persons exporting petroleum prod- ally-built homes, or refinance existing liens S. 837 ucts, natural gas, or related technology on such homes. At the request of Mr. WARNER, the to Iran. CONTRACTING FOR PORTFOLIO LOAN SERVICING name of the Senator from Mississippi At the request of Mr. D’AMATO, the The draft bill would permit VA to contract [Mr. COCHRAN] was added as a cospon- names of the Senator from Florida [Mr. for servicing of its loan portfolio in a manner sor of S. 837, a bill to require the Sec- MACK], the Senator from Utah [Mr. which is consistent with private sector loan retary of the Treasury to mint coins in HATCH], the Senator from Iowa [Mr. servicing. VA believes it is in the best inter- commemoration of the 250th anniver- GRASSLEY], the Senator from Mis- ests of the Government to contract out this sary of the birth of James Madison. sissippi [Mr. COCHRAN], the Senator function. Several provisions of existing law, S. 881 however, preclude VA from privatizing this from Alaska [Mr. STEVENS], the Sen- function in the most effective manner. At the request of Mr. THURMOND, his ator from Ohio [Mr. DEWINE], the Sen- Current law limits Federal contracts to a name was added as a cosponsor of S. ator from Virginia [Mr. WARNER], the term of 5 years. This is too short a term for 881, a bill to amend the Internal Reve- Senator from Colorado [Mr. BROWN], S 15358 CONGRESSIONAL RECORD — SENATE October 19, 1995 the Senator from Alabama [Mr. SHEL- ico without specific authorization from the I think it is time that Mexico pays BY], the Senator from Kansas [Mr. United States Congress, and that, all loans up—and on time. DOLE], the Senator from Colorado [Mr. made to Mexico should be repaid in full and Mr. President, for this reason, I am on time, and that such debts should not be CAMPBELL], the Senator from Okla- introducing a sense of the Senate that extended, rescheduled, or reduced in any loans to Mexico be paid on time and in homa [Mr. INHOFE], the Senator from manner. Pennsylvania [Mr. SANTORUM], the Sen- full. Mr. FAIRCLOTH. Mr. President, ator from Texas [Mr. GRAMM], the Sen- The principle needs to be established today I am submitting a sense of the ator from Utah [Mr. BENNETT], the early on in this relationship that these Senate regarding Mexico. loans should be repaid in full and re- Senator from Georgia [Mr. COVERDELL], From day 1, I have been opposed to the Senator from Wyoming [Mr. THOM- paid on time. the Mexican bailout. It was never the If not, these so called loans will AS], the Senator from Idaho [Mr. sole responsibility of the United States KEMPTHORNE], and the Senator from quickly become foreign aid. The Con- to help Mexico pay its debtors. gress did not vote for foreign aid. The Kentucky [Mr. MCCONNELL] were added These economic problems were of as cosponsors of S. 1228, supra. American taxpayer cannot afford more Mexico’s own making, driven by poli- foreign aid. And the loans to Mexico S. 1280 tics, corruption, and poor economic shouldn’t become foreign aid. At the request of Mr. MACK, the name policy. Further, if Mexico can’t make this of the Senator from Indiana [Mr. Nevertheless, the President, without small repayment in full and on time— LUGAR] was added as a cosponsor of S. the approval of the Congress, went only $2 billion of the $12.5 billion—how 1280, a bill to amend the Internal Reve- ahead and loaned $12.5 billion to Mex- will it ever repay the remaining bal- nue Code of 1986 to provide all tax- ico. ance. payers with a 50-percent deduction for This was a terrible mistake. We can- The bulk of the United States loans capital gains, to index the basis of cer- not continue to be the world’s banker. to Mexico don’t come due until 1997. tain assets, and to allow the capital We cannot continue to loan money to They won’t be fully repaid until the loss deduction for losses on the sale or countries that have no intention of re- year 2000. But if Mexico can’t repay its exchange of an individual’s principal paying it. short term loans on time—then I do residence. I might add that the Clinton admin- not have any hope that the loans com- S. 1322 istration has proposed the creation of ing due in 1997 through 2000 will ever be At the request of Mr. DOLE, the an international bailout fund to deal repaid. names of the Senator from Massachu- with future problems like Mexico. I Mr. President, in conclusion, Mexico setts [Mr. KERRY], the Senator from cannot think of a worse idea. Once the made a great public relations move by Arizona [Mr. MCCAIN], and the Senator Congress establishes a fund—any repaying some of its loans last week. from Maryland [Ms. MIKULSKI] were fund—it will be used. Has money ever But the real story may be that they added as cosponsors of S. 1322, a bill to been appropriated by the Congress and will never pay anymore. The real test provide for the relocation of the U.S. not used? The answer is no. That is will come shortly, by October 30 when Embassy in Israel to Jerusalem, and why I have introduced a bill, S. 1222, to Mexico should pay the United States for other purposes. stop the creation of this new inter- $1.3 billion. S. 1323 national bailout fund. We need to be firm. We need to stand At the request of Mr. DOLE, the Mr. President, returning to the Mex- our ground now. Mexico must pay the names of the Senator from Massachu- ico issue, I would suggest that the first United States back. This is what this setts [Mr. KERRY], the Senator from priority of this Congress and adminis- sense of the Senate calls for. Arizona [Mr. MCCAIN], and the Senator tration should be getting our own eco- f from Maryland [Ms. MIKULSKI] were nomic house in order before we can af- added as cosponsors of S. 1323, a bill to ford to engage in international bail- SENATE RESOLUTION 186—REL- provide for the relocation of the U.S. outs, like Mexico. ATIVE TO THE SENATE LEGAL Embassy in Israel to Jerusalem, and This means getting Federal spending COUNSEL for other purposes. under control. I have to wonder if we Mr. DOLE (for himself and Mr. SENATE RESOLUTION 146 keep putting ourselves deeper and DASCHLE) submitted the following reso- At the request of Mr. JOHNSTON, the deeper in debt—who will bail us out. lution; which was considered and name of the Senator from New Mexico Mr. President, I firmly believe that agreed to: [Mr. BINGAMAN] was added as a cospon- the loans to Mexico will never be re- S. RES. 186 sor of Senate Resolution 146, A resolu- paid. The American taxpayer will bear Whereas, the defendant in Triangle MLP tion designating the week beginning the burden of the Mexico bailout. United Partnership v. United States, No. 95– November 19, 1995, and the week begin- I think this is very wrong—and I in- 430C, a civil action pending in the United ning on November 24, 1996, as ‘‘National tended to do everything I can to stop States Court of Federal Claims, is seeking Family Week,’’ and for other purposes. it—starting today. testimony at a deposition from Charles Stek Mr. President, last week, Mexico re- and Rebecca Wagner, employees of the Sen- f paid $700 million of the nearly $12.5 bil- ate who are on the staff of Senator Paul S. lion in loans that they owe to the Unit- Sarbanes; SENATE RESOLUTION 185—TO EX- Whereas, by the privileges of the Senate of PRESS THE SENSE OF THE SEN- ed States. This was a great public rela- the United States and Rule XI of the Stand- ATE REGARDING REPAYMENT OF tions move for Mexico—but for those ing Rules of the Senate, no evidence under LOANS TO MEXICO that read between the headlines there the control or in the possession of the Senate Mr. FAIRCLOTH submitted the fol- was something very troubling. can, by administrative or judicial process, be lowing resolution; which was referred Mexico owes the United States $2 bil- taken from such control or possession but by lion on October 30, 1995. Mexico was permission of the Senate; to the Committee on Foreign Rela- Whereas, when it appears that evidence tions: making payment of $700 million to- wards that loan. under the control or in the possession of the S. RES. 185 Instead of paying that loan off in Senate is needed for the promotion of jus- tice, the Senate will take such action as will Whereas the United States has provided full, however, Mexico apparently in- Mexico with approximately $12,500,000,000 in promote the ends of justice consistent with loans to Mexico; tends to have the balance of what is the privileges of the Senate; Whereas these loans were not authorized owed by October 30—$1.3 billion—rolled Whereas, pursuant to sections 703(a) and by the United States Congress; over past that deadline. 704(a)(2) of the Ethics in Government Act of Whereas the taxpayers of the United This short term swap of $2 billion 1978, 2 U.S.C. §§ 288b(a) and 288c(a)(2), the States should not be responsible for any was extended to Mexico on February 2, Senate may direct its counsel to represent losses incurred from these loans; and 1995. It came due in May, but was employees of the Senate with respect to sub- Whereas certain loans to Mexico will be- rolled over in May for 90 days. It was poenas or requests for testimony issued or come due and payable on October 30, 1995: made to them in their official capacities: Now, therefore, be it rolled over in August for another 90 Now, therefore, be it Resolved, That, it is the sense of the Senate days. Now, its falling due again for a Resolved, That Charles Stek, Rebecca Wag- that no further loans should be made to Mex- third time. ner, and any other employee of the Senate October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15359 from whom testimony may be required are tee on Agriculture, Nutrition, and For- ADDITIONAL STATEMENTS authorized to testify and to produce docu- estry be allowed to meet during the ments in the case of Triangle MLP United session of the Senate on Thursday, Oc- Partnership v. United States, except con- tober 19, 15 9:00 a.m., in SR–332, to con- HEALTH CARE ANTIFRAUD AND cerning matters for which a privilege should ABUSE EFFORTS be asserted. sider the nomination of Mr. Michael V. Sec. 2. That the Senate Legal Counsel is Dunn to be assistant secretary for mar- ∑ Mr. COHEN. Mr. President, over the authorized to represent Charles Stek, Re- keting and regulatory programs and to last week there has been substantial becca Wagner, and any other employee of the be a member of the board of directors criticism levied against the health care Senate in connection with the testimony au- for the Commodity Credit Corporation, fraud and abuse provisions contained in thorized by this resolution. and Mr. John David Carlin to be assist- the House Medicare and Medicaid re- f ant secretary for congressional rela- form proposals. Unfortunately, some of tions. the headlines and attacks imply that AMENDMENTS SUBMITTED The PRESIDING OFFICER. Without all Republican Budget Reconciliation objection, it is so ordered. legislation is soft on fraud and abuse. THE NATIONAL AERONAUTICS AND Headlines such as ‘‘GOP Medicare SPACE ADMINISTRATION ACT COMMITTEE ON ENVIRONMENT AND PUBLIC Bill Seen to Favor Fraud,’’ and ‘‘GOP WORKS FOR FISCAL YEAR 1996 Plan to Ease Medicare Fraud Rules Mr. HELMS. Mr. President, I ask ‘Terrible,’ May Go,’’ and ‘‘Beneath Sur- unanimous consent that the full Com- face, Health Care Plan Is Offering PRESSLER AMENDMENT NO. 2939 mittee on Environment and Public Boons’’ are leading the public to be- Works be granted permission to con- lieve that all Republican Medicare pro- Mrs. KASSEBAUM (for Mr. PRES- posals are going light on those who are SLER) proposed an amendment to the duct a hearing Thursday, October 19, 1995, at 9:00 a.m. on S. 1316, the Safe ripping off Medicare while honest Med- bill (S. 1048) to authorize appropria- icare providers and some beneficiaries tions for fiscal year 1996 to the Na- Drinking Water Act Amendment of 1995. are being asked to make sacrifices to tional Aeronautics and Space Adminis- save Medicare. tration for human space flight; science, The PRESIDING OFFICER. Without As the author of fraud and abuse pro- aeronautics, and technology; mission objection, it is so ordered. visions in the Senate reconciliation support; and inspector general; and COMMITTEE ON SMALL BUSINESS bill that was recently marked up by other purposes. the Finance Committee, I feel that I On page 46, line 2, after ‘‘Center’’ insert a Mr. HELMS. Mr. President, I ask must set the record straight, at least comma and the following: ‘‘and of which unanimous consent that the Commit- as it concerns the Senate version. $2,000,000 shall be allocated in fiscal year tee on Small Business be authorized to I commend the Senate Finance Com- 1996, and such sums as are necessary there- meet during the session of the Senate mittee and the Senate leadership for after, for the operation of the Upper Midwest on Thursday, October 19, 1995, at 9:30 Aerospace Consortium (UMAC) of institu- its strong commitment to tough anti- tions in the Upper Great Plains Region for a.m., in room 428A Russell Senate Of- fraud measures. Many law enforcement the purpose of making information derived fice Building, to conduct a hearing fo- officials have indicated to me that the from Mission to Planet Earth data available cusing on revitalizing America’s rural Senate bill contains the toughest and to the general public’’. and urban communities. most comprehensive—but fair—health On page 57, line 18, strike ‘‘shall’’ and in- The PRESIDING OFFICER. Without care antifraud bills to come out in dec- sert ‘‘is authorized to’’. ades. It pains me to see headlines stat- On page 57, line 25, strike ‘‘The’’ and insert objection, it is so ordered. ing that Republican efforts on health ‘‘If initiated, the’’. SUBCOMMITTEE ON OVERSIGHT AND On page 58, line 15, strike ‘‘Within’’ and in- care fraud fall short. INVESTIGATIONS sert ‘‘If this project is initiated, then with- Let me tell you about what my Sen- in’’. Mr. HELMS. Mr. President, I ask ate colleagues and I have incorporated f unanimous consent that the Sub- in the Senate budget reconciliation committee on Oversight and Investiga- bill. My legislation: NOTICE OF HEARINGS tions of the Committee on Energy and Creates an antifraud program to co- COMMITTEE ON SMALL BUSINESS Natural Resources be granted permis- ordinate Federal, State, and local law Mr. BOND. Mr. President, I wish to sion to meet during the session of the enforcement efforts to combat fraud announce that the Senate Committee Senate on Thursday, October 19, 1995, and abuse; on Small Business will held a joint for purpose of conducting a subcommit- Appropriates a mandatory $200 mil- hearing with the House Committee on tee hearing which is scheduled to begin lion in fiscal year 1996 for antifraud in- Small Business on ‘‘the report of SBA’s at 9:30 a.m. The purpose of this hearing vestigators and auditors with a 15-per- Chief Counsel of Advocacy on the Cost is to examine the role of the council on cent increase every year thereafter for of Regulations on Small Business’’ on environmental quality in the decision- 7 years; Makes it mandatory for the Sec- Tuesday, October 24, 1995, at 10 a.m., in making and management processes of retary of Health and Human Services room G50 of the Dirksen Senate Office agencies under the committee’s juris- to exclude individuals from receiving Building. diction—Department of the Interior, payment from Medicare and Medicaid For further information, please con- Department of Energy, and U.S. Forest when convicted of felonies relating to tact Keith Cole at 224–5175. Service. health care fraud and allows the Sec- SPECIAL COMMITTEE ON AGING The PRESIDING OFFICER. Without retary to exclude individuals convicted Mr. COHEN. Mr. President, I wish to objection, it is so ordered. of a criminal misdemeanor related to a announce that the Special Committee SUBCOMMITTEE ON TERRORISM, TECHNOLOGY, health care offense; on Aging will hold a hearing on Thurs- AND GOVERNMENT INFORMATION Sets minimum periods of exclusion day, October 26, 1995, at 9:30 a.m., in from Medicare and Medicaid payments; room 628 of the Dirksen Senate Office Mr. HELMS. Mr. President, I ask Allows the Secretary to exclude indi- Building. The hearing will discuss qual- unanimous consent that the Sub- viduals who have direct or indirect ity of care in nursing homes. committee on Terrorism, Technology ownership or control interest of 5 per- f and Government Information of the cent or more in an entity—or is an offi- Senate Committee on the Judiciary, be cer or managing employee—if the en- AUTHORITY FOR COMMITTEES TO authorized to meet during a session of tity is already excluded from Medicare MEET the Senate on Thursday, October 19, or Medicaid; 1995, at 10:00 a.m., in Senate Hart room COMMITTEE ON AGRICULTURE, NUTRITION, AND Allows the HHS Secretary to impose FORESTRY 216, on Ruby Ridge incident. intermediate sanctions on a Medicare Mr. HELMS. Mr. President, I ask The PRESIDING OFFICER. Without HMO if the HMO fails to carry out the unanimous consent that the Commit- objection, it is so ordered. contract such as in quality of care S 15360 CONGRESSIONAL RECORD — SENATE October 19, 1995 areas. These penalties range from the establishment of an antifraud account— LUNCH OF STONES $10,000 to $100,000 depending on the vio- are tremendously innovative and helpful tools . . . A straightforward health care ∑ Mr. LEAHY. Mr. President, today on lation. Suspension of continued enroll- Capitol Hill a number of religious orga- ment or payments can also be used as fraud statute would simplify prosecution of these cases and greatly enhance the ability nizations concerned with hunger in the sanctions; of law enforcement to attack this problem. United States are gathering to high- Establishes a national health care light what I believe is one of the great fraud and abuse data collection pro- At that same hearing that I convened on health care fraud and abuse, the injustices being perpetrated in the gram for reporting final adverse ac- name of welfare reform in this Con- tions against health care providers, HHS Inspector General June Gibbs Brown testified: gress. suppliers, or practitioners. The infor- Most of my colleagues, I believe, had We strongly support the bill . . . which mation in the data base is required to the best of intentions when they voted be available to Federal and State gov- proposes a number of innovative ways to ad- dress health care fraud and abuse . . . for H.R. 4, the welfare reform package. ernment agencies and health plans ac- But I am very concerned with the im- cording to procedures that the Sec- strengthening existing legal remedies for ad- dressing fraud and abuse, amending current pact of the final welfare reform pack- retary will set by regulation; criminal laws, as well as enhancing adminis- age on the nutritional safety net for Increases civil monetary penalties trative sanction authorities available to the children, families, and senior citizens. from $2,000 to $10,000 for a number of Department such as civil monetary penalties Quite simply, under either the House current fraud and abuse violations; and program exclusions which would aid in or Senate versions of this bill, more Adds new prohibited practices to the the fight against health care fraud and children will go hungry. current law for which civil monetary abuse. The majority of the savings in the penalties can be assessed such as: in- The health care fraud provisions con- correct coding; medically unnecessary Senate version of welfare reform have tained in the Senate bill have received come out of nutrition programs, whose services; and persons offering remu- endorsements and support from the Na- neration—including waiving coinsur- main beneficiaries are children. H.R. 4 tional Association of Attorneys Gen- contains a little bit of reform. But even ance and deductible amounts—to in- eral and the Medicaid fraud control duce the individual to order from a par- the Senate version contains a whole lot units. In addition, we worked very of cuts—more than $30 billion in total ticular provider or supplier receiving closely with the Department of Justice Medicare or Medicaid; cuts, including more than $20 billion in to create a fair, workable proposal that reduced nutrition benefits to children Allows the HHS Secretary to impose cracks down on fraud while not penal- civil monetary penalties of up to alone. Less than one-half of 1 percent izing honest health care providers. of the bill’s savings come from anti- $10,000 per violation for criminal anti- Once more, the Senate provisions kickback violations; fraud provisions, according to CBO es- save billions of taxpayers dollars with- timates. Over half of the savings come Establishes enhanced fraud and abuse out cutting services or raising taxes. guidelines to enable the provider com- from across-the-board cuts, and an- Specifically the antifraud provisions other 12 percent of the savings come munity to better comprehend anti- yield over $4 billion in savings. kickback requirements; from households with high utility In addition, many of my colleagues Amends the criminal code to include: costs. A new health care fraud statute; both Republican and Democratic have Under the Senate bill, by 2002, a Forfeiture of property that is ob- supported and encouraged this bill for working-poor family of four supported tained from the proceeds traceable to a long time including the majority by a full-time minimum wage worker health care fraud; leader, the chairmen of the Budget would lose $324 a year in food stamp Injunctive relief on activities related Committee, the Banking Committee, benefits from the across-the-board ben- to health care fraud; the Veterans’ Committee, and the Ap- efit reductions, according to the Center Grand jury disclosure for health care propriations Committee. I am also on Budget and Policy Priorities. An el- fraud proceedings; pleased to point out that several of my derly SSI recipient, typically a poor Criminal penalties for false state- colleagues from the other side of the woman living alone, would lose $228 a ments; aisle have cosponsored this antifraud year—that’s a 32-percent reduction. Criminal penalties for obstruction of legislation, including Senators PRYOR, The Senate bill also contains an op- a criminal investigation; NUNN, BRADLEY, GRAHAM, and tional block grant that will allow Criminal penalties for theft or em- MOSELEY-BRAUN. States to cancel the national nutri- bezzlement; Mr. President, that is why I stand be- tional safety net, divert funds away Criminal penalties for laundering of fore the Senate today to respond to from food, and slash benefits during a money used in health care fraud of- this onslaught directed at the House recession. fenses; and provisions. We in the Senate have Wrongheaded as it is, however, the Subpoena authority to the Attorney worked too hard and too long to come Senate version is actually preferable in General for health care fraud cases. up with a strong health care antifraud many ways to the House version of Extends the authority of the State and abuse bill, that not even the most H.R. 4. The House bill repeals school Medicaid fraud units by allowing the partisan among us could attack. We lunches, school breakfasts, WIC, the units to investigate other Federal must not, Mr. President, let ourselves Child and Adult Care Food Program, fraud abuses at the approval of the rel- get wrapped up in the criticism that is and other programs for children. These evant Federal agency; and allowing in- being directed at the House provisions. are among the great success stories of vestigation and prosecution in the case It is my understanding that the public policy in the 20th century. Con- of patient abuse in non-Medicaid board House has made some changes to its servative House Republicans seem to and care facilities. earlier proposals in order to toughen say, ‘‘If it works—but it does not fit This legislation has received the en- its response to health care fraud. Spe- our ideology—break it.’’ I am pleased thusiastic endorsement of law enforce- cifically, provisions have been added to that many moderates of both parties ment and prosecution agencies. At a toughen criminal sanctions against are rebelling against this position. hearing of the Senate Special Commit- fraudulent health care providers. While The House bill would replace real tee on Aging that I chaired this past I am very pleased that the House lead- food with junk food in school cafe- March, FBI Director Louis Freeh testi- ership took this step, I still have terias. It would reduce food stamp ben- fied: strong concerns regarding some re- efits so they no longer pay for a decent The legislation . . . addresses for the first maining provisions in the House bill diet. It would end scientifically based time in a comprehensive way not only the that could severely weaken our efforts nutritional supplements for pregnant problem, but some of the important solu- to combat health care fraud. women. It would cancel the guarantee tions which we in law enforcement look to .. . Aspects of the bill—the establishment of I thank my colleagues for all their of free meals for poor schoolchildren. a fraud and abuse database, the coordination longstanding support on this issue and This is bad public policy, and it is that would be required in antifraud efforts for letting me have the opportunity to immoral. If we are going to turn school between the Department of Justice and HHS, set the record straight. ∑ lunches into junk-food bonanzas and October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15361 shrivel food stamps down to a meaning- the U.S. Army Coast Guard Artillery The most memorable event in Bill’s less few pennies per meal, we might as and the U.S. Army Ski Troopers from military career happened when three well feed our children stones. 1941 to 1945. He was one of the very first B–29 planes were flying in formation Today, the Christian citizens’ group men drafted from Custer County. when Bill’s B–29 caught on fire. He and Bread for the World and other religious Jean’s camp was located on a mountain the whole crew were forced to bail out and antihunger groups are gathering and everything had to be hauled up the into the ocean between Guam and on Capitol Hill to ponder Jesus’ ques- mountain by hand. Jean’s commanding Tokyo. When he bailed out, he just tion in the New Testament (Matthew officer was so disciplined that Jean did about drowned when he got so tangled 7:9): ‘‘Is there anyone among you who, not have even 1 day off while he was in his parachute shroud that he if your child asks for bread, will give a there. He was always on alert or patrol. couldn’t even upright his one-man life stone?’’ To symbolize this concern, One day they were on patrol skiing raft. He had to lay there holding on to they are holding a ‘‘lunch of stones.’’ down the mountain when Jean’s ski tip his upside down raft. When he finally Members of these groups, which in- got stuck in the snow toward the bot- got into the raft, he couldn’t see any of clude the Salvation Army, the Second tom of the mountain that he suffered a the rest of the crew as they were all Harvest National Network of Food broken leg. He was so afraid of his com- scattered. One guy in the crew hap- Banks, Lutheran Social Services, the manding officer that he did not seek pened to have a whistle and he kept NETWORK Catholic social justice treatment and hobbled around on his blowing it. They all paddled toward the lobby, and other national religious and broken leg. Jean was given a military sound and that is how they all got back charitable leaders, will be visiting of- disability and was in Walter Reed Hos- together. They were always concerned fices on Capitol Hill. These groups rep- pital for 6 months after his discharge. about sharks so they used shark repel- resent tens of thousands of concerned Clayton Hocking served in the U.S. lent. The crew was adrift for 3 days be- citizens who donate their time and ef- Army Air Corps 9th Engineering fore being picked up by the ship. That fort to improving the diet and health of Squadron S.A.C. from 1942 to 1967. He episode made Bill a member of the Cat- children, families, and senior citizens. served all over the Pacific and retired erpillar Club. A patch was given as spe- These dedicated citizens and I urge as a well-decorated staff sergeant. cial recognition for surviving a bail Members of this Congress to protect Clayton received a Phillipine Libera- out. the national nutritional safety net tion Medal with one Bronze Service Glen Hocking served in the 90th that Republicans and Democrats to- Star, a Good Conduct Medal, a World Naval Construction Battalion Combat gether have constructed over the last War II Victory Medal, and an Asiatic Fleet Action from 1945 to 1946. Glen 25 years. The safety net ensures that, Pacific Medal. He is currently in a rest was 17 years old when he enlisted to even during recessions and natural dis- home in Arco, ID. follow in his older brothers’ footsteps. asters, children in need receive food as- Frank Hocking served in the U.S. He was told that his outfit was training sistance so they do not go hungry. I Navy and the U.S. Marines from 1942 to to invade Japan. They were on their urge my colleagues to listen carefully 1945. Frank served both the Navy and way to Japan when the bomb dropped to the concerns voiced in the ‘‘lunch of the Marines as the Marines had no on Hiroshima. He saw all the devasta- stones.’’ medical corps. So the Navy furnished tion over there. He was there for 9 I also want to caution my colleagues the Marines with a Medical Corps. The months occupation duty. Glen came against some of the phony arguments first place Frank was shipped to over- away from service with the Asiatic Pa- being bandied about on this topic. None seas was to New Caledonia. While there cific Area Campaign Medal and World of these gigantic cuts will reform wel- Frank went to town one day. As he was War II Victory Medal. fare. And these cuts are not necessary walking down the street, he literally These five brothers all came home to balance the budget—the President ran into his brother Clayton. Frank alive, but still felt the sacrifices of has put forward a plan to balance the had not seen Clayton since joining, and war. Two of their cousins did not make budget without such gigantic cuts in had no idea where Clayton was sta- it home. There were killed in the line nutrition programs. I believe these tioned. Frank and Clayton were able to of duty. This is one of the many family cuts are, quite simply, mistakes and visit each others camps while there. stories that make up the heroism and errors in judgment. Right now there is After leaving New Caledonia, Frank valor that led the United States and still time to correct these errors, be- went to New Zealand where he joined our allies to victory in World War II. fore more children must go hungry.∑ the Second Marine Division and The five Hocking brothers fell very f trained before the battle of Tarawa. He blessed and lucky to have all come was on the first wave who landed on home. We are very blessed that they TRIBUTE TO THE HOCKING Tarawa in the Gilbert Islands of the and many others were there to serve BROTHERS South Pacific. The Marines were told their country and to fight for democ- ∑ Mr. CRAIG. Mr. President, I rise they had to take the well-fortified Jap- racy and the freedom all Americans today to pay tribute to the Hocking anese defenses of the island in 6 hours hold dearly.∑ brothers from Idaho who served to- or they wouldn’t be able to take it. It f gether courageously during World War took them 4 days to take the island. II. The battle cost 1,000 Marines lives and PUBLIC FORUM IN GREENLEAF, They were a family of 10 children, 4 2,300 men were wounded. Japanese WI, WITH SECRETARY OF AGRI- girls and 6 boys, and lived in Moore, ID losses totaled about 8,500. The taking CULTURE, DAN GLICKMAN in 1929. In 1935 they moved to Mackay, of the island of Saipan of the Marianas ∑ Mr. FEINGOLD. Mr. President, on ID. Mackay was considered home for Islands was another major battle. July 31 of this year, in an extraor- all of them. Presently, one brother Frank was one of the original two Ma- dinary gathering on a 200-acre dairy lives in each of the following Idaho rine divisions that tried to take the is- farm in Greenleaf, WI, 300 farmers, cities or towns: Mackay, Arco, Black- land from the 30,000 Japanese defend- rural business people, and others in the foot, Lewiston, and Deary. All of the ers. Frank was on the island from June agricultural sector came together to brothers who are able are active fisher- 15 to July 7 when the remaining Japa- convey to Secretary of Agriculture Dan men and hunters. Two sisters and the nese resistance tried the largest suici- Glickman the importance of reforming oldest are now deceased. The oldest dal counterattack in the war. The loss an archaic agricultural program, brother Pat Hocking, was not in the of Saipan was so devastating to the known as the Federal Milk Marketing service as he had five children and Japanese that Prime Minister Tojo Order System. This program, created worked at the Naval Gun Rellning Hideki and his entire cabinet resigned in the late 1930’s has discriminated Plant in Arco, ID. The remaining five after word of the defeat reached them. against the Wisconsin dairy industry brothers served in one branch or an- Bill Hocking served in the 20th Air for years other of the military service. Force Division on Guam of the South Those who attended this forum rep- Jean Hocking was drafted before the Pacific from 1944 to 1946. He was the resent different segments of our dairy war and was stationed for 38 months of first aerial gunner on a B–17. Later, he industry which have divergent political continuous service in Kodiak, AK in became a belly gunner on the B–29’s. views and affiliations, but they all S 15362 CONGRESSIONAL RECORD — SENATE October 19, 1995 agreed on one fundamental issue—Fed- am pleased with his admission that the the situation experienced by these eral orders must be reformed. For an system is broken. farmers and their families will be industry that is made up of individuals Mr. President, as the Congress moves taken into account as these issues are whose only shared characteristic is toward final action on the budget rec- debated in the days and weeks ahead. their independence and staunchly self- onciliation and moves toward the 1995 PARTICIPANTS IN THE FORUM WITH SECRETARY reliant nature, this type of unanimity farm bill, I think it is important that GLICKMAN AT GREENLEAF, WI, JULY 31, 1995 is rare. They wanted their message to the Secretary heard the message of Mark Mayer, Frank Dillon, Rodney R. be heard by one of the few people with Wisconsin farmers. I hope that my col- Littlefield, Randy Knapp, Kathi Millard, the power to make Federal milk mar- leagues will hear that message as well. Stephen I. Rishette, Marc A. Schultz, Tim keting orders both consistent with Action on these items, the Secretary Rehbein, Tom Kruezer, Mary Behm, Sue milk markets of the 1990’s as well as conceded, will be a challenge in that Beitlich, Betty Plummer, Kevin Larson, Rod equitable to all those affected by them. other regions will fight to maintain Webb, Randy Anderson, Judy Derricks, Kelly The current program for regulating their current artificial advantages. De- Olson, Julie Dokkestul, Bob Oropp, Dwight Swenson, Nolan Anderson, Lee Gross, Roger the pricing and sale of milk provides spite the deregulatory rhetoric of Johnson. higher prices for fluid milk to produc- many in the 104th Congress, the Sec- Kevin Connors, Bob Bjorklund, Gordon ers distant from the Upper Midwest. retary’s prediction is proving to be Rankin, Dave Williams, Tom Syverod, John While that scheme might have made true based on recent action by the Sen- Markus, Ralph Rounsville, Alvin Erickson, sense when Wisconsin was the primary ate Committee on Agriculture, Nutri- M. Kopecky, Laura Wind-Norton, Dan dairy producing State in the United tion, and Forestry. Butterbrodt, Russ Dufek, Ken Horton, Randy States, but in 1995, it defies logic. This The legislation reported by the Agri- Cochart, Clifford Duffeck, Mahlon Peterson, system not only creates an artificial culture Committee fails to address Bob Bosold, Sandy Webb, William Dacholm, Joel McNair, Paul Rodriguez. incentive for greater milk production, needed reform of this system, despite Dolores Rodriguez, Craig W. VerKuilun, but has led to increased production of the tremendous budget savings and Tom Cochren, Deborah Van Dyk, Linda manufactured dairy products driving consumer benefits that could result Leger, Marty Mackers, Shawn W. Pfaff, Ar- down prices throughout the Nation and from such action. That is a disappoint- nold Grudey, Duane Tetzloff, Paul Gruber, increasing Government surpluses. Fed- ment, Mr. President. Instead, Mr. Tom Badth, Leonard and Betty eral milk marketing orders are a per- President, the committee chose to take Wajciehowski, Myron McKinley, Dennis fect example of excessive Government the easy road by cutting support Donohue, Elmer R. Kitzeron, Gerald Van regulation creating a system which is prices, instead of making the difficult Asten, Orvell A. Debruin, John J. Peters, Connie Seefeldt, Dick Vaitihauer. completely out of sync with current choices associated with milk market- Ken Jenks, James Kalkofin, Jim Harris, marketing conditions and which dis- ing order reform. Rep. Bill VanderLoop, Robert Fryda, Katy criminates against Wisconsin and And indeed, as the Secretary pointed Duwe-Fryda, Ray Diederich, Gerlinda Upper Midwest dairy producers. out at Greenleaf, these are very dif- Dueholm, Jeremy Herrscher, Len Maurer, Mr. President, Secretary Dan Glick- ficult decisions. They are so difficult Roger Wyse, Stewart Huber, Dick Hauser, man listened for over an hour to farm- that the House of Representatives, un- Renea Heinrich, Pete Kappelman, Don Nor- ers frustrated not only by the existence able to reach agreement on reform, is ton, Bill Pamperin, Dave Mennig, Jerry Leh- of this system, but also by its institu- moving on a path toward total deregu- man, Brad Brunner, Grant E. Staszak, Reuel tional resilience. I commend him for Robertson, Jerome Blaska. lation of the dairy industry, including Gregory Blaska, Norma Norton, John T. that. It is the first time in a long time the elimination of Federal milk mar- Vinhoefer, Allen Schuh, Steve Pamperin, Je- that Wisconsin dairy farmers have felt keting orders. rome Pamperin, Nelda J. Harris, Duane Patz, that a Secretary of Agriculture actu- Mr. President, total deregulation of Tes VanDyke, Fred Huger, Dan Krebsbach, ally cared about what they had to say. the dairy industry, is not my first Steve Kellerman, Rudy and Margaret Klug, Dan Glickman came not to talk to lob- choice. I would rather work with my Ron Hillman, Jim Jolly, John Rouch, Kevin byists, not to talk to politicians and colleagues to achieve reasonable and Erb, Jim and Lorraine Shellcox, Paul not to talk to Government officials, responsible reform of Federal orders. Krause, Greg Hines, Robert Zimban, Michael but to listen to those whose livelihood However, for the last 3 years, many Mengar. Gerald H. Vander Heiden, Gary Anderson, depends, in part, on the decisions he dairy farmers in Wisconsin have been Jon Bechle, Bill Penterman, Tom Davies, makes. telling me that if they cannot get re- Robert Karls, Gary Terlinden, Vicki Wiese, This was a unique forum in that av- form, if other regions of the country Jim Hunt, James E. Burns, Audrey Sukinger, erage farmers spoke directly to the will not compromise, deregulation Tom Walsh, Earl Walsh, Pat Leavenworth, Secretary. It linked 54 of Wisconsin’s 72 would be a farsight better than the raw Rama Stoviak, Ron Jones, Dan Natzke, Mel- counties to the meeting via satellite. deal they are getting now. vin Blarke, Irv Possin, Mike Rankin, Jay While the time did not allow all those Mr. President, I want to work with Rudolph, and Harold Epp.∑ who attended to speak, those producers my colleagues during the budget rec- f who did represented the diversity of onciliation process and the farm bill my home State’s agricultural sector— deliberations to reach agreement on WORLD POPULATION AWARENESS dairy, soybeans, corn, wheat, alfalfa, Federal orders. However, if others are WEEK and specialty products such as mink. unwilling to move toward a level play- ∑ Ms. SNOWE. Mr. President, I would Each, in turn, talked about what is ing field, dairy farmers in their States like to speak briefly this morning on a good and what is bad about our current may end up with nothing at all. matter of great importance; namely, Federal policies. Primarily, though, Mr. President, in Greenleaf, WI, the world population. World Population they talked about dairy policy. Secretary of Agriculture heard loud Awareness Week will be held this year At the outset of our meeting, the and clear that Upper Midwest dairy from October 22–29, and is designed to Secretary conceded that discrimina- farmers are fed up with the current foster awareness of the environmental, tion exists within the Federal order program that regulates milk markets. economic, political, and social con- program benefiting some regions more I urge my deregulation-minded col- sequences of rapid worldwide popu- than others. In response, he pledged his leagues to listen to what the Upper lation. support to try to change the existing Midwest is saying on this issue as well. Let us reflect a moment on the impli- number and administration of current It is time to do the right thing—reform cations of the current population milk marketing orders. He further Federal milk marketing orders or end growth rate. In 1830, the world’s popu- pledged his support to try to consoli- them. lation reached 1 billion. Today, the date those orders, make periodic ad- I want to publicly thank the many world’s population is nearly 6 billion. justments in price differentials, and to people who took part of the day to Unless something is done, world popu- potentially create multiple price-set- travel to this small community to lation in 2020 will reach 8 billion and by ting base points. While I am not en- make their voices heard to Secretary 2035 it will reach 12 billion. tirely pleased with the Secretary’s Glickman. I ask to include the names Current levels of population growth choice to attempt these changes of the participants at the conclusion of are unprecedented. This year alone, the through the administrative process, I my remarks. I hope the seriousness of world’s population will grow by almost October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15363 100 million people. This is like adding a The proclamation follows: I have so many thoughts now. I can’t help new country the size of Nigeria to the PROCLAMATION mentioning one—since President Hartley mentioned the day we had your magnificent world every year, or a city the size of Whereas, world population is currently 5.7 women’s basketball team there, we also had billion and increasing by nearly 100 million New York City every month. Virtually the UCLA men’s team there. You may not each year, with virtually all growth added in all this growth takes place in the poor- remember who UCLA defeated for the na- the poorest countries and regions—those who est countries and regions across the tional championship—(laughter)—but I do can least afford to accommodate current world—those who can least afford to remember that UCONN defeated the Univer- populations let alone massive infusions of sity of Tennessee. And that made my life accommodate such rapid population humanity; and growth. Whereas, the annual increment to world with Al Gore much more bearable. (Laugh- Rapid population growth is one of the population is projected to exceed 86 million ter.) So I was doubly pleased when UCONN world’s most serious problems, posing a through the year 2015, will three billion peo- won the national championship. (Applause.) I also did not know until it was stated here ple—the equivalent of the entire world popu- long-term threat to U.S. national in- at the outset of this ceremony that no sit- lation as recently as 1960—reaching their re- terests in the areas of security, trade, ting President had the privilege of coming to and the environment. There are many productive years within the next generation; and the University of Connecticut before, but developing countries in the world Whereas, the environmental and economic they don’t know what they missed. I’m glad which are finally taking steps to insti- impacts of this level of growth will almost to be the first, and I know I won’t be the tute the kind of free market reforms certainly prevent inhabitants of poorer coun- last. (Applause.) that offer them their best hope for tries from improving their quality of life, I also want to pay a special public tribute and, at the same time, have deleterious re- to the Dodd family for their work on this en- long-term sustainable development. terprise, and for their devotion to each other But high population growth rates percussions for the standard of living in more affluent areas; and and the memory of Senator Thomas Dodd. If, threaten their economic development Whereas, the 1994 International Conference as so many of us believe, this country rests accomplishments. on Population and Development in Cairo, in the end upon its devotion to freedom and Moreover, the environmental impli- Egypt crafted a 20-year Program of Action liberty and democracy, and upon the cations of such population growth is for achieving a more equitable balance be- strength of its families, you could hardly startling. A child born today can ex- tween the world’s population, environment find a better example than the Dodd family, pect by the year 2000 a world where al- and resources, that was duly approved by 180 not only for their devotion to liberty and de- most one-half of the world’s forests nations, including the United States. mocracy, but also for their devotion to fam- Now, therefore, I, Angus S. King, Jr., Gov- ily and to the memory of Senator Tom Dodd. will be gone and one-fifth of the world’s ernor of the State of Maine, do hereby pro- It has deeply moved all of us, and we thank plant and animal species will be ex- claim October 22–29, 1995 as ‘‘World Popu- you for your example. (Applause.) tinct. Ground water supplies are dwin- lation Awareness Week’’ throughout the Tom Dodd spent his life serving America. dling; rivers and lakes are fouled with State of Maine, and urge all citizens to sup- He demonstrated an extraordinary commit- pollutants from industries, municipali- port the purpose and spirit of the Cairo Pro- ment to the rule of law, beginning with his ties, and agriculture. Currently, at gram of Action, and call upon all govern- early days as an FBI agent then federal at- least 1.7 billion people, nearly one- ments and private organizations to do their torney. He was equally passionate in his op- utmost to implement that document, par- position to tyranny in all its forms. He third of the planet’s population, lack ticularly the goals and objectives therein fought the tyranny of racism, prosecuting an adequate supply of drinking water. aimed at providing universal access to fam- civil rights cases in the South in the 1930s, The developing world already produces ily planning information, education and long before it was popular anywhere in the 45 percent of all gases contributing to services, as well as the elimination of pov- United States, and helping to shepherd the global warming. erty, illiteracy, unemployment, social dis- landmark Civil Rights of 1964 into law. He Rapid population growth, especially integration and gender discrimination that fought the tyranny of communism through- when overlaid with sharp social or eco- have been reinforced by the 1995 United Na- out his years in elected office. And while he nomic divisions, places great strains on tions International Conference on Social De- bowed to none in his devotion to freedom, he political institutions. To the extent velopment and endorsed by 118 world lead- also stood bravely against those who ers.∑ wrapped themselves in the flag and turned population pressures contribute to f anti-communism into demagoguery. weakening economic and political Tom Dodd was in so many ways a man structures, they adversely affect inter- DEDICATION OF THOMAS J. DODD ahead of his time. He was passionate about national stability and peace. And this RESEARCH CENTER civil rights, three decades before the civil directly affects our own national secu- rights movement changed the face of our na- ∑ Mr. LIEBERMAN. Mr. President, tion. In the Senate, he pioneered programs rity interests around the world. yesterday I addressed my colleagues I am very pleased that the theme of to fight delinquency and to give the young about the dedication of the Thomas J. World Population Awareness Week this people of our country a chance at a good edu- Dodd Research Center at the Univer- cation and a good job. And that is a task, my year is gender equality and the imple- sity of Connecticut this past Sunday, fellow Americans, we have not yet finished mentation of the Cairo Program of Ac- October 15. I asked that remarks made doing. He saw the dangers of guns and drugs tion, which was approved by more than by President Clinton at the dedication on our streets, and he acted to do something 180 countries, including the United about that. Had we done it in his time, we be included in the RECORD but, unfortu- States, at the International Conference would not have so much work to do in this nately, part of that speech was not re- on Population and Development last time. printed. year. This is especially significant be- Tom Dodd’s passion for justice and his ha- I ask to have printed in the RECORD tred of oppression came together, as all of cause the goals and objectives of the the full text of the President’s re- you know, most powerfully when he served Cairo Program of Action include pro- marks. I also ask that the remarks of as America’s executive trial counsel at the viding universal access to family plan- my colleague, Senator CHRIS DODD, at Nuremburg War Crimes Tribunal. It was the ning information, education, and serv- the dedication ceremonies also be pivotal event of his life. He helped to bring ices; as well as eliminating poverty and justice to bear against those responsible for printed in the RECORD. illiteracy among girls and women who the Holocaust, for the acts that redefined The remarks follow: our understanding of man’s capacity for evil. are disproportionately denied access to TRANSCRIPT OF PRESIDENT CLINTON’S RE- education, increasing women’s employ- Through that path-breaking work, he and his MARKS AT DEDICATION OF THOMAS J. DODD fellow jurists pushed one step forward the ment opportunities, reducing infant RESEARCH CENTER, OCTOBER 15, 1995 historic effort to bring the crimes of war mortality, and eliminating all forms of Thank you very much, President Hartley. under the sanction of law. gender discrimination. Governor Rowland, Senator Lieberman, Senator Dodd left many good works and re- Several Governors throughout the members of Congress, and distinguished minders of his achievement. Some bear his United States, from the State of Wash- United States senators and former senators name—the children who have followed in his ington to my home State of Maine, who have come today; Chairman Rome, steps and served the public, who carried for- have issued proclamations recognizing members of the Diplomatic Corps; to all of ward his ardent support for an American for- World Population Awareness Week. I you who have done anything to make this eign policy that stands for democracy and great day come to pass; to my friend and freedom, who maintain his commitment to submit for the RECORD the proclama- former colleague, Governor O’Neill, and social justice, to strong communities and tion of this important event issued by most of all, to Senator Dodd, Ambassador strong families. They have also upheld their Gov. Angus S. King, Jr., Governor of Dodd, and the Dodd family: I am delighted to father’s tradition of loyalty. And as one of the State of Maine. be here. the chief beneficiaries of that lesson, let me S 15364 CONGRESSIONAL RECORD — SENATE October 19, 1995 say that I am grateful for it, and again, NATO, the United Nations—these were ex- who served as a member of the board of grateful for its expression in this remarkable traordinary acts of collective sacrifice, vi- directors for 6 years, is truly dedicated project which will help the people of Con- sion, and political courage in the fact of sig- to the cause and she hopes to put the necticut and the United States to under- nificant opposition here at home. organization in the public spotlight stand their history. In remembering the achievements of that I am delighted that this center will bear generation, it is fitting that we here today during her tenure as president. The ex- the Dodd name because it is fitting that a li- are joined by President Bill Clinton. In 1995, ecutive director of the Older Women’s brary, a place that keeps and honors books President Clinton has not forgotten the les- League, Deborah Briceland-Betts, says and records, will honor Tom Dodd’s service, sons of 1945. members of the group are delighted his passion for justice and his hatred of tyr- Like my father’s generation, Mr. Presi- that Marshall is now leading them. anny. Where books are preserved, studied dent, you understand that no nation which And they hope she will continue her ex- and revered, human beings will also be treat- proclaims the virtue of freedom can ignore traordinary commitment to find cre- ed with respect and dignity, and liberty will the deprivation of others. ative and effective ways to improve the be strengthened. Mr. President, you understand that though Dedicating this research center today, we the Soviet Empire no longer threatens our lives of midlife and older women and remember that when the Nazis came to world, the job of securing the peace is still their families. power, one of the very first things they did far from complete. Not only is Ms. Marshall a national was burn books they deemed subversive. The Over the past 21⁄2 years you have dem- leader in the fights for the rights of road to tyranny, we must never forget, be- onstrated over and over and over again the others, she also worked on behalf of in- gins with the destruction of the truth. role we must play in the cause of freedom terests in the Bluegrass State. For In the darkest days of the war, President and justice. nearly 20 years, Ms. Marshall was exec- Roosevelt, with those awful bonfires fresh in Ireland, Haiti, the Middle East, Asia, Latin utive director of Louisville’s Opportu- his memory, reflected upon how the free pur- America, and most recently, in Bosnia, have suit of knowledge protects our liberty. And profitted from our principled, patient insist- nities Industrialization Centers, Inc., he put it well when he called books ‘‘the ence that all men and women have a right to which was responsible for training wel- weapons for man’s freedom.’’ I am glad that shape their own destiny. fare recipients for jobs. She also served Tom Dodd will be remembered here, in this At the same time, there remain many as regional coordinator of the Prichard place, in this building, with this center, in parts of the world that still desperately need Committee for Academic Excellence in the state he loved, with the very best arsenal our engagement and example. Lexington, and during that time she for the freedom he fought to defend his en- Abroad and at home, you Mr. President, worked hard to promote education re- tire life. carry within your heart the same wise and form. She was also the director of Sen- Thank you very much. (Applause.) generous spirit that guided the generation of my father. You have proven yourself to be a ior Services, Inc., executive director of REMARKS OF SENATOR CHRISTOPHER J. DODD worthy inheritor of their unbending faith in Kentucky’s Opportunities Industrial- Mr. President, Governor Rowland, Presi- a future where people can live not in fear but ization Center, past president of the dent Hartley, colleagues distinguished with hope. For that, Mr. President, you have Louisville Section of the National guests, members of my family, friends: On earned our everlasting gratitude. Council of Negro Women, and was the behalf of my family—allow me to express my On behalf of the Dodd family, the Univer- first African American woman chair of thanks to you, Mr. President, for your pres- sity of Connecticut, and our Constitution the March of Dimes’ Kentuckiana State, we thank you for honoring us with ence here today. You honor my father, my chapter. And in the 1960’s and 1970’s, your presence.∑ family, my State and our University. You she investigated racism in Ohio, Ten- are the first sitting American President to f nessee, and Kentucky as a member of ever visit this University in the 114 year his- tory of this institution, we are grateful. TRIBUTE TO JOHNETTA the Presbyterian Church task force. We are grateful as well to those of you MARSHALL As you can tell from her list of ac- with whom my father worked over the complishments, Ms. Marshall has had a Mr. MCCONNELL. Mr. President, I years—his colleagues—his staff—his con- ∑ long and distinguished career, and it stituency and friends for being here to join rise today to pay tribute to a Kentuck- does not look like it will slow down with us in the celebration of his life of public ian who for many years has displayed a anytime soon. Even with the demand- service. great deal of courage in standing up for ing pace of her public advocacy, she For nearly 40 years my father served his what she believes. Louisville native still always found time for her real State and Nation. It was a full life—a life of Ms. Johnetta Marshall has traveled the love, her six children whom she suc- engagement with the great issues of his world to fight for the rights of others, time. cessfully raised as a single mother. and now she’s being recognized here at Mr. President, I ask my colleagues to We are here to dedicate a new home for his home as the new president of the Na- papers and artifacts of the past. In so doing, join me in paying tribute to this out- we preserve delicate fragments of history tional Older Women’s League, a not- standing Kentuckian. I also ask that which this and future generations should for-profit organization that promotes an article from the October 10 Courier- find instructive. health, housing, and Social Security is- Journal be printed in the RECORD. We are also here today to remember the sues for women over the age of 50. The article follows: achievements of those who came before us— Recently, Ms. Marshall traveled to [From the Courier-Journal, Louisville, KY, who made and recorded the history on which China to march for equality of the Oct. 10, 1995] our present world is built. My father is one sexes at the United Nation’s Fourth A PIONEERING SPIRIT—LOUISVILLE NATIVE such person. Today we commemorate—and World Conference of Women. While celebrate—his faith, his love of country, and HAS MARCHED IN THE SOUTH AND IN CHINA his life of service. that trip ended peacefully, some of her FOR RIGHTS OF OTHERS Today we recall not only my father’s ac- journeys have taken a violent turn. (By Lawrence Muhammad) complishments, but the achievements of his One such incident occurred in the Deep Johnetta Marshall won’t tell her age but generation. It is now 50 years since the end South in the late 1950’s when Ms. Mar- ‘‘pioneer’’ is definitely a title that fits her. of World War II, a war which tore apart a shall was pelted with rocks while The Louisville native was pelted with western civilization. It is 50 years since marching for civil rights. She recently rocks while marching for civil rights in the thousands of young Americans fought and recounted in a story for Louisville’s Deep South in the late 1950s and early ’60s. died to defend tyranny. It is 50 years since Courier-Journal, that while in Merid- More recently, she marched for sex equality the effort to rebuild that civilization began under the watchful eyes of government po- with the Nuremberg Trials—truly the trial ian, Mississippi, ‘‘we had to go in the lice at the United Nation’s Fourth World of the century. back way at hotels and ride the freight Conference of Women in China. Many recall the stern justice rendered at elevator. They made us a dining room In the ’60s, in Meridian, Miss., she recalled, Nuremberg against those who committed the in the bedroom rather than have us eat ‘‘we had to go in the back way at hotels and atrocities of Nazism. But we should also re- with the rest of the guests.’’ While this ride the freight elevator. They made us a member that 3 of the accused at Nuremberg kind of treatment may have disparaged dining room in the bedroom rather than have were acquitted. In those verdicts of acquit- some, it gave Ms. Marshall a reason to us eat with the rest of the guests.’’ tal, as well as in the verdicts of guilt, the continue her fight for civil rights. Decades later, Marshall attended the China United States and her allies helped to reas- conference as the new president of the Wash- sure the world that justice could, indeed, One of the highlights of Ms. Mar- ington, D.C.-based Older Women’s League. would prevail over evil and chaos. shall’s career came in March of this Carrying a banner and chanting, she and After Nuremberg, my father’s generation year, when she was named president of other conferees marched onto the conference rebuilt Europe and Asia. The Marshall Plan, the Older Women’s League. Marshall, grounds and into workshops. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15365 Although no one in her group had trouble executive from a major city, had the floor Annual dues start at $15; sterling, silver with Chinese authorities, she said, ‘‘there and was waxing eloquent. Finally Johnetta, and platinum memberships also are avail- were people with video cameras. . . . We without even raising her voice, said firmly, able.∑ wanted them to see the banner. But there ‘OK, that’s enough. Sit down.’ Now, it took f was no harassment.’’ most of us by surprise that she would tell Marshall, who lives in Jeffersontown, was this guy to shut up. But she did, and he sat NATIONAL SCHOOL LUNCH WEEK named president of the Older Women’s down.’’ League in March. It’s a nationwide, not-for- Marshall is widely know as a nurturer too. ∑ Mr. LEAHY. Mr. President, in honor profit organization that promotes health, She grew up in Louisville’s Limerick neigh- of National School Lunch Week I want housing and Social Security issues for borhood, daughter of concrete finisher John to talk about one of the great public women over the age of 50. Marshall who died when she was 10, and policy success stories of this century— The appointment caps a career of distin- Emma Marshall, who supported the family guished service. with domestic work. Marshall had wanted to the National School Lunch Program. For nearly 20 years until it closed in 1988, be a surgeon, but being black and female in Passed by Congress and established by Marshall was executive director of Louis- the segregated 1930s and ’40s, it was difficult President Truman in 1946, this program ville’s Opportunities Industrialization Cen- to aspire to so lofty a vocation. by law has the mission ‘‘to safeguard ters Inc., once a nationwide non-profit group A divorcee, she raised six children on her the health and well-being of the Na- with headquarters in Philadelphia that own, has four grandchildren and two great- tion’s children.’’ By fighting hunger trained welfare recipients for jobs. grandchildren. The fruits of her labors are and promoting good nutrition among She was also the first chairman of the Ken- plentiful among her children: Samuel is a tucky Minority AIDS Council. San Francisco stockbroker; Charles, a geri- children, we can help them grow and Sam Robinson, president of the Lincoln atric doctor in Los Angeles; and John, a su- mature into healthy, productive Foundation and also a founding member of pervisor of correctional officers in Los Ange- adults. the AIDS council, recalled suggesting Mar- les County, Glenna is a Louisville graphic The program has been a resounding shall to the group because of her work with artist; Marilyn, a bookkeeper in Atlanta; success in meeting this mission. Any the National Council of Negro Women and and Jo, a computer systems engineer in Lou- parent or teacher can tell you that a the National Association for the Advance- isville. hungry child cannot learn. More and ment of Colored People. ‘‘And when we were Marshall also served as a role model for ready to elect officers, everybody looked to scores of other people’s children at the Pres- more scientific evidence has made it her for leadership,’’ Robinson said. byterian Community Center at 760 S. Han- clear that hunger and malnutrition can Lead she has, also serving stints as a Pres- cock St. undermine a child’s progress in school. byterian Church organizer, propagating ra- ‘‘She’d ask questions like, ‘How are you Hunger remains a serious problem in cial fairness among Southern members dur- doing at home? How are you doing at this country, and school meals are an ing the 1960s and ’70s; as director of Senior school?’ ’’ said Ernest ‘‘Camp’’ Edwards, 63, important part of the effort to fight it. Services Inc. in Louisville; as past president an associate executive presbyter for the Today, the National School Lunch of the National Council of Negro Women’s Presbytery of Louisville. ‘‘I was sort of mis- Louisville section; and as the first African- chievous, throwing stuff on the floor and Program serves over 25 million stu- American woman to chair the March of blaming somebody else, so she always dents in 92,000 schools across the coun- Dimes’ Kentuckiana chapter, among other preached that I should be accountable for my try. More than 90 percent of all public posts. own behavior and not blame others. schools participate in the program. For Last month in China, Marshall led a 32- ‘‘That really stuck with me over the almost 50 years, it has provided com- member delegation to the Non-governmental years,’’ Edwards said. ‘‘She has a kind of plete and nourishing meals to children, Organizations Forum on Women in Huairou. presence and talks to you so that it makes a nearly half of them from low-income It was an unofficial gathering held in con- difference. I’m a social worker by profession, junction with the U.N. conference in Beijing. and, because of her, I decided to work with families. The school lunch program has Marshall and her group, co-sponsored by people. She was a ‘significant other.’ and I reduced malnutrition and improved the the American Society on Aging, met officials decided I could be a significant other.’’ health and well-being of children. of the China National Committee on Aging Charles Hammond, the 52-year-old mayor Since 1946, we have learned a great and China Research Center on Aging and of Fairfield, Calif., first met Marshall at the deal about the relationship between toured hospitals and welfare homes for the community center when he was 14. It was diet and health. We have learned that elderly. It was an effort to promote concerns ‘‘where we virtually lived after we got out of it is not enough to provide children of older women that past world forums had school, and she was one of our youth direc- inadequately addressed, Marshall said. tors. They basically kicked our behinds and with calories. They need the right For example, women over 65 are dispropor- kept us in line. We’d have our dances and kinds of food to keep them healthy. tionately poor, spend more on home repairs, she’d give us rules—no cursing, no smoking, Too much fat, saturated fat, choles- more frequently develop breast cancer and treat the ladies like ladies * * * But she al- terol, and sodium can increase the risk suffer more chronic ailments than older men, ways had time for us. There was never a of heart disease and some forms of can- according to an Older Women’s League study question that went unanswered. And that’s cer. Low-income and minority groups done in 1993. what we admired about her. Seven days a The study also showed 60 percent of mar- are at greatest risk for those problems. week, any time you looked around, there she Those risks begin in childhood. Good ried women are widowed and living alone by was, just like our mothers.’’ 75, and 30 percent require home care, double eating habits established in childhood JOHNETTA MARSHALL’S ADVICE FOR SINGLE the percentage for men. are critical to staying healthy MOMS ‘‘Back in the civil-rights days, women were throughout one’s life. I am very proud Johnetta Marshall successfully raised six suffering, and there have been some improve- of the bipartisan legislation we passed ments, but not enough,’’ Marshall said. children along. Some now have families of their own, and all pursue rewarding careers. last year to improve the nutritional ‘‘Women can work side by side with men, and content of school meals. maybe have better skills, but men get more ‘‘It wasn’t easy then,’’ said Marshall, ‘‘and pay. And if you happen to be an older even though women have more advantages Mr. President, let me sum up by reit- women, you are counted out completely.’’ now, it is lots more difficult.’’ erating how important these programs Marshall clearly would not be counted out. She offered this advice for today’s single have been, and how important they are Leading the local Opportunities Industrial- mothers: ‘‘Recognize that you are only one today. Just as they were 50 years ago, person, that you can never by a mother and ization Center, she smashed the gender bar- school meals remain a critical part of rier in the early 1980s to head the group’s ex- a father. Just be the best role model you can. ‘‘As the mother, you instill in your chil- this country’s effort to promote our ecutive directors association, a male-domi- most precious resource—the health and nated network of about 85 OIC insiders. dren some ideals by the way you live. Always ‘‘For Johnetta to run for that position, and be honest and frank with the children. Don’t well-being of our children. We have win it, was akin to Shannon Faulkner enter- let them think you can give them the moon worked hard to build a program that is ing The Citadel,’’ said Gene Blue, president when you can only give them a piece of the ready to meet its statutory health mis- of the Phoenix, Ariz., OIC. ‘‘She became a earth. sion well into the 21st century. As we ‘‘And don’t give up. You can do it.’’ spokes-person who accompanied the founder, consider proposals to block-grant or Dr. Leon Sullivan, at congressional hearings. ABOUT THE OLDER WOMEN’S LEAGUE cut these programs, let us not forget She had to overcome significant male egos Founded in 1980, the Washington, D.C.- how successful they have been in the to preside over all these dudes at meetings based Older Women’s League promotes issues and workshops, which usually got loud and of health care, Social Security and housing past and how important it is to main- emotional.’’ for women over 50. tain them at the Federal level to fulfill Blue recalled one particular meeting, There are 20,000 members nationwide and our national responsibility to fight where ‘‘one of the most vociferous, a senior chapters in every state. hunger and promote good nutrition.∑ S 15366 CONGRESSIONAL RECORD — SENATE October 19, 1995 MEREDITH MILLER Williams was in the midst of the 17th distresse called the place Providence, I ∑ Mr. GRAHAM. Mr. President, I would century. He was almost alone in believ- desired it might be a shelter for per- like to articulate my deep sorrow as ing that all citizens should be free to sons distressed for conscience.’’—Early this week marks the anniversary of the worship as their conscience dictated. Records of Providence senseless murder of Meredith Miller. Roger Williams was a determined and We owe a tremendous debt to Roger Meredith, a native of Tampa, FL, dedicated man. In 1672, when he was Williams as the first champion of true graduated with honors from Princeton nearly 70, he rowed all day to reach religious freedom and for translating University where she majored in politi- Newport for a 4-day debate with three principles of democracy and tolerance cal science. After her graduation she Quaker orators. Both his settlement from concepts into substance.∑ came to Washington to further her and his ideas have survived and pros- f studies at George Washington Univer- pered. sity and to work on the issues pertain- For most of his life, Roger Williams SPECIAL INTERESTS HIT STUDENT ing to women. On October 17, 1994, after was a deeply religious man. Even with- LOANS returning from a study group, Meredith out a church to call his own, his ideas ∑ Mr. SIMON. Mr. President, Roger became the victim of a carjacking. flourished in Providence and remain Flaherty, now an editor at the Chicago The dream that Meredith held so alive today. Sun-Times, has followed the Federal dearly was to make a difference in the Documents, such as our Bill of student loan program for a number of lives of others. Her fellow students at Rights and Declaration of Independ- years. I would urge my colleagues to George Washington University would ence can be traced directly back to the consider what he has to say about the like Meredith’s parents in Tampa to hardfought freedoms earned by Roger role of special interests in the current know that Meredith did make a dif- Williams and his followers. budget debate. ference in the lives of those fortunate I encourage my colleagues to visit I ask that an article that appeared in enough to have known her and that the statue of Roger Williams in the Ro- the Chicago Sun-Times on September their thoughts and prayers are with tunda of the Capitol. When you do, re- 27, 1995, be printed in the RECORD. them today and always. Her friends member that even the principles of de- The article follows: miss her and learned much from her mocracy and religious liberty did not [From the Chicago Sun-Times, Sept. 27, 1995] come easily. Roger Williams gave them special outlook on life. She will always SPECIAL INTERESTS HIT DIRECT LOAN form and substance more than 350 remain a vital part of their lives, in PROGRAM HEAD-ON years ago. spirit. (By Roger Flaherty) Mr. President, today let us not forget These principles also founded the basis of our belief that all people are When I was younger, I walked side by side the contributions Meredith Miller one day with Wilbur Mills, the Arkansas made in her short time here with us, created with equal rights and should Democrat then always described as ‘‘chair- and let us be diligent in our efforts to not be denied opportunities to succeed man of the powerful House Ways and Means find a solution to the ever-growing because of their race, gender, or reli- Committee,’’ asking about tax reform. In a number of senseless violent crimes.∑ gion. moment of candor, he said, ‘‘If you want to f I sponsored the Senate legislation reform the tax system, you’ve got to end all that authorized the creation of the deductions.’’ ROGER WILLIAMS NATIONAL ME- Roger Williams National Memorial and Why not do it? I asked. Mills responded MORIAL CELEBRATES 30TH ANNI- I have watched it take shape on the with a dismissive look—sort of sneer and VERSARY site of his original settlement in Provi- condescension—and turned to another re- porter. So I learned that Washington people ∑ Mr. PELL. Mr. President, I rise to dence, RI. don’t do as they think or say. We should share with my colleagues the happy This anniversary comes at an impor- keep that in mind as the Congress plows into news that the Roger Williams National tant time. One purpose of the memorial a fall agenda that promises more moves to Memorial is celebrating the 30th anni- is to emphasize the linked principles of ‘‘get government off our backs.’’ versary of its authorization. tolerance and freedom. As recent Like tax deductions, government-run pro- I want to take this chance to tell you events have demonstrated, we need to grams are bad until they are good for you or your friends. You usually hear this truism about Roger Williams, a Founding Fa- focus on these principles. I am delighted to share with my col- about defense contracts and farm subsidies. ther that you will not encounter here, But there’s one I’ve observed closely in re- except in the rotunda of the Capitol. leagues today the news that the Na- cent years—the student loan program. Sev- He was the founder of Rhode Island and tional Park Service is planning new eral years ago, along with Sun-Times re- a champion of Democracy and religious initiatives to strengthen the impact of porter Leon Pitt, I uncovered enormous liberty. the Roger Williams National Memorial abuses by for-profit trade schools that were There is no national memorial to and its vital message. using student loans like government vouch- Roger Williams here, unlike the monu- If you have any doubts about the sig- ers they could squander any way they chose. ments to other national heroes like nificance of Roger Williams in our his- They enrolled students into programs they were unable to complete or that were so poor Washington, Jefferson, and Lincoln. tory, consider how his philosophy has resonated through our other Founding in quality as to be useless. When students Our national memorial is in Rhode Is- dropped out, within hours sometimes, the land, where he lived and left us a philo- Fathers and found its way into our schools kept the loan money in violation of sophical legacy of incomparable worth. most sacred documents. the law. The United States was being de- Roger Williams was banished for his Just a few examples, culled from his frauded of billions of dollars. beliefs from the Massachusetts Bay writings, should help to sound his call But when reformers tried to tighten loan Colony in 1635, but survived both ban- for freedom: rules, school industry lobbyists fought them, ishment and subsequent efforts to take ‘‘The sovereign, original, and founda- arguing the reforms were an assault on free over the settlement he named Provi- tion of civil power lies in the Peo- enterprise. It was a strange argument, con- ple.’’—The Bloody Tenent of Persecu- sidering that these schools generally re- dence. ceived more than 90 percent of their income ‘‘The air of the country is sharp,’’ tion for Conscience Discussed (1644). from government loans and grants. Roger Williams said of Providence, ‘‘The civil state is humbly to be im- Well, that odd assertion is again being ‘‘the rocks many, the trees innumer- plored to provide in their high wisdom made in Congress, where conservative Re- able, the grass little, the winter cold, for security of all the respective con- publicans under the guise of getting govern- the summer hot, the gnats in summer sciences.’’—The Hireling Ministry None ment off our backs are attacking the direct biting, the wolves at night howling.’’ of Christs student loan program. The program, which is Thirteen householders in the popu- ‘‘No person in this colony shall be scheduled to be phased in over several years, lation of 32 in the first year formed the molested or questioned for the matters operates successfully at several Illinois in- of his conscience to God, so he be loyal stitutions, including the University of Illi- first genuine democracy—also the first nois. The program allows loans to be made church-divorced and conscience-free and keep the civil peace.’’—Letter to directly from the federal treasury through community—in modern history. Major John Mason (1670) college financial aid offices. I cannot emphasize enough how ‘‘And having in a sence of God’s mer- This is bad, congressional opponents say, unique and utopian the vision of Roger ciful providence unto me in my because it furthers big government and hurts October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15367 business. How ingenuous can you get? Under [NLRA] which authorizes the imposi- Journal of October 11 be printed in the the old loan system still being used by most tion of forced union dues contracts on RECORD. schools, a student applies to a bank for a employees. The editorial follows: loan. Checking his or her qualifications is a loan guarantee agency, commonly run by Nearly every poll taken on this issue [From the Providence (RI) Journal, Oct. 11, state governments, but also by private enter- over the last few decades has shown 1995] prise. The agencies then issue a guarantee of that about 8 out of 10 Americans are THE CHALLENGE OF AMERICORPS repayment to the banks. The federal govern- opposed to forcing workers to pay (By Lawrence K. Fish) ment pays banks subsidies to forgive part of union dues. It is tough to get 8 out of Not surprisingly, the debate in Washington the interest payments and pays fees to the 10 Americans to agree on anything. I over continued funding of the Corporation guarantee agencies for their services. think this is a call for action. for National Service has become laser-fo- If a student defaults on a loan, the bank is And if you look at job creation in cused on the politics of embarrassing Presi- reimbursed—making student loans the safest dent Clinton, and not on the people for whom loans a bank can make. Loan guarantee States that have implemented right to work laws, it is hard to ignore the re- AmeriCorps has been a ringing success. agencies are paid fees to hound defaulters. Is And the reason is not surprising. It is that this not big government? Can this be free en- sults. Hundreds of thousands of manu- Washington, to the frustration of just about terprise? facturing jobs have been created in everyone outside the District of Columbia, There’s more. The old system created a right-to-work States. And in forced-un- just can’t resist playing an inside-the-Belt- secondary loan business, including the huge ionism States, hundreds of thousands way version of Gotcha! From the politicians public-private Sallie Mae association based of jobs have been lost. to the pundits to the press, the emphasis re- in Washington, and smaller ones, like one I have supported this bill in the past mains on the politics of issues, not on the operated by the Illinois Student Assistance substance of issues or their impact on real Commission. These groups make money by and I truly believe that this is the year to finally make this change. Working people. buying loans from banks and packaging For whom has AmeriCorps been successful? them in large blocks for resale. They were men and women in Montana want the It’s been a success here in Rhode Island to created by Congress and the states to free freedom to work and they are not the 250 AmeriCorps members who have money for more student loans, but as was alone. I urge my colleagues to listen to signed up for this domestic Peace Corps and said of some missionaries to Hawaii, Sallie what their constituents are saying as whose efforts, mostly in education, have Mae and its emulators came to do good and well. If you do, you will feel compelled made better, dramatically better, the lives ended up doing well. They are big businesses to join me and the other cosponsors in of thousands of our neighbors. Giver and re- with highly paid executives. ceiver have been enriched by the effort, and The direct loan program, a plan advanced supporting the National Right to Work for that, Rhode Island is a better place. by Sen. Paul Simon (D–Makanda), elimi- Act. ∑ Let me try to explain why AmeriCorps’ nated this entire pyramid. No government f success here in Rhode Island ought to serve subsidy or risk-free lending for banks, no as a model for programs in the 49 other government payments to loan-guarantee THE IMPORTANCE OF CONTINUED states, and why that success and our promise agencies, no Sallie Maes with executives FEDERAL SUPPORT FOR for the future stand as far more compelling paid from profits extracted from government points in the debate than political one- loan subsidies. AMERICORP upmanship. But odds are increasing that Congress this ∑ Mr. PELL. Mr. President, this month AmeriCorps members have served in cities fall will stop the direct loan program in its marks the start of a new class of and towns from Woonsocket to Newport, tracks, led by the same people who claim AmeriCorps members who are dedi- bringing with them a wealth of desire, expe- they are trying to get government off our rience and cultural diversity. They have got- backs. And so far, it seems to be going down cated to serving this Nation. As ten results—good results that are measur- like a cold, sweet Coke on a hot summer’s AmeriCorps celebrates its first success- able. You can see the results on paper and day.∑ ful year and the new class begins its you can see them on the faces of children f service, I would like to take this oppor- tunity to reiterate my support for con- getting their first ‘‘A’s’’ and in adults read- ing for the first time. NATIONAL RIGHT TO WORK ACT tinued Federal funding of this impor- Rhode Island’s AmeriCorps program has ∑ Mr. BURNS. Mr. President, I am tant national service initiative. been very successful—and has been recog- pleased to add my name as a cosponsor Over the past year, 20,000 AmeriCorps nized as such. For the second straight year, to S. 581, the National Right to Work members worked in schools, hospitals, after a very competitive process that pitted Act. As a strong supporter of the right national parks, and law enforcement us against 49 other states, we received more AmeriCorps funding on a per capita basis to work, I feel this legislation is vital. organizations to meet the most crucial needs of individual communities. than any other state. In this our second year We have spent the first part of this Rhode Island will field 250 AmeriCorps mem- Congress fighting for freedom—the AmeriCorps clearly helps to provide a bers in eight programs that will touch the freedom from Government interven- more promising future for Americans lives of thousands of our neighbors. Once tion, the freedom of speech, the free- by expanding educational opportunities again, they will work predominantly in edu- dom to choose your health care and for the young whole simultaneously cation, because that’s where many believe even the freedom to succeed. This bill, improving the public services in hun- the greatest need is. though it does not add a single letter dreds of communities. Linking public service and education, we to Federal law, guarantees the freedom In my own State of Rhode Island, approached the leaders of the state’s col- AmeriCorps has been particularly suc- leges, universities and technical schools to to work free of union imposition. see if they would accept our AmeriCorps Why is this important? Americans cessful due to the efforts of Lawrence challenge to inaugurate a public-private have always been independent. No mat- K. Fish, chairman of the Rhode Island partnership from which they will get the les- ter where they came from, they came Commission for National and Commu- sons of service and commitment from to America to see their hard work pay nity Service. Mr. Fish challenged high- AmeriCorps veterans and to which they will off. And they are not afraid of hard er education institutions in Rhode Is- provide a quality education. work. This is especially true of Mon- land to grant scholarships to The Rev. Philip Smith of Providence Col- tanans. AmeriCorps members. Many of our col- lege was the first to meet the challenge, and leges and universities answered Mr. Vartan Gregorian of Brown was close behind. But when a worker is forced to pay They were followed almost immediately by union dues in order to get a job or keep Fish’s challenge and have begun lend- our other higher-education leaders—Bob a job, they have lost part of their free- ing their support in the form of college Carothers of URI, Sister Therese Antone of dom. They may get some benefits from scholarships. His endeavor to expand Salve Regina, Bill Trueheart of Bryant, joining a union—I am not saying there AmeriCorps has offered more students Roger Mandle of RISD, Jack Yena of John- is no role for unions here—but they access to an otherwise unaffordable son and Wales and Ed Liston of CCRI. I men- lose the freedom to choose. education. Mr. Fish’s exemplary work tion them to dramatize that AmeriCorps Mr. President, Congress created the in Rhode Island serves as the quin- runs cost-effective, successful, nonpartisan law which allows union officials to tessential example of building the nat- programs. I accompanied the presidents of seven of force dues in any State back in 1935. ural bridge between public service and the state’s public and private colleges and Now we need to correct that. All we educational opportunities. In this re- universities to Washington for meetings on need to do is to repeal that portion of gard, I ask that an opinion editorial by Capitol Hill and in the White House. There the National Labor Relations Act Lawrence Fish from the Providence we outlined the Rhode Island Challenge to S 15368 CONGRESSIONAL RECORD — SENATE October 19, 1995 Higher Education, a challenge to provide by offering to build the SEC a new FEDERAL EMPLOYEES EMER- scholarships to AmeriCorps members that headquarters building in Silver Spring, GENCY LEAVE TRANSFER ACT complement the stipends they receive for MD. The plaintiff alleges in this law- OF 1995 their year of service. The result is a win/win suit that the Government violated pro- for both sides: Higher education gets the Mr. DOLE. Mr. President, I ask unan- kind of committed students who are poten- curement law in connection with the imous consent that the Senate proceed tial campus leaders; and AmeriCorps mem- SEC headquarters procurement. to the immediate consideration of Cal- bers pass through another gateway to oppor- The Government has determined that endar No. 197, S. 868 tunity. the group of individuals who may have The PRESIDING OFFICER. The The foundation for the Rhode Island Chal- relevant information about this case clerk will report. lenge to Higher Education was laid a year includes two employees on Senator The legislative clerk read as follows: ago. Rhode Island’s bipartisan congressional SARBANES’ staff. In addition to his in- A bill (S. 868) to provide authority for delegation, each member of which played a terest in this matter arising out of the leave transfer for Federal employees who are role in the passage of the legislation that adversely affected by disasters or emer- brought about AmeriCorps, joined other dig- SEC’s potential selection of a site in gencies, and for other purposes. nitaries at Slater Junior High School in Maryland for its headquarters building, Pawtucket in AmeriCorps’s debut. The set- Senator SARBANES is the ranking mi- The PRESIDING OFFICER. Is there ting, a junior high school in the heart of one nority member of the Committee on objection to the immediate consider- of our older, struggling cities, provided a fit- Banking, Housing, and Urban Affairs, ation of the bill? ting backdrop for the Rhode Island which has oversight jurisdiction over There being no objection, the Senate AmeriCorps members and the educational the SEC. proceeded to consider the bill. programs they would serve. Senator SARBANES would like the Mr. DOLE. Mr. President, I ask unan- In the year since, AmeriCorps members imous consent that the bill be deemed have farmed out across the state, serving as Senate to authorize the employees in teachers’ assistants in public schools, tutors his office to testify in response to the read a third time and passed; that the in after-school mentoring programs, and Government’s request. This resolution motion to reconsider be laid upon the teaching English as a Second Language and would authorize them to testify with table; and that any statements relating GED classes to adults. And they’ve had an representation by the Senate legal to the bill be placed at the appropriate impact, all because they are 100 percent be- counsel. place in the RECORD. hind keeping their end of a bargain to make Mr. President, I ask unanimous con- The PRESIDING OFFICER. Without AmeriCorps work the way in which Congress sent that the resolution be agreed to; objection, it is so ordered. and the President intended. that the motion to reconsider be laid So the bill (S. 868) was deemed read Rhode Islanders would have been proud to the third time and passed, as follows: have joined me and some of the presidents in upon the table; and that any state- S. 868 the White House Cabinet Room recently ments relating to the resolution appear when we introduced the Rhode Island Chal- at the appropriate place in the RECORD. Be it enacted by the Senate and House of Rep- lenge to Higher Education to President Clin- The PRESIDING OFFICER. Without resentatives of the United States of America in ton. From the smallest state to the other 49 objection, it is so ordered. Without ob- Congress assembled, That this Act may be came the challenge for their colleges and jection, the preamble is agreed to. cited as the ‘‘Federal Employees Emergency universities to match our commitment of So the resolution (S. Res. 186) was Leave Transfer Act of 1995’’. SEC. 2. (a) Chapter 63 of title 5, United scholarships to AmeriCorps members. agreed to. Our hope, and that of AmeriCorps members States Code, is amended by adding after sub- The preamble was agreed to. chapter V the following new subchapter: around the country and others committed to The resolution, with its preamble, is public service, is that our Challenge to High- ‘‘SUBCHAPTER VI—LEAVE TRANSFER IN er Education can help overcome the cyni- as follows: DISASTERS AND EMERGENCIES cism that has come to mark the debate in S. RES. 186 ‘‘§ 6391. Authority for leave transfer program Washington.∑ Whereas, the defendant in Triangle MLP in disasters and emergencies. f United Partnership v. United States, No. 95– ‘‘(a) For the purpose of this section— 430C, a civil action pending in the United ‘‘(1) ‘employee’ means an employee as de- ORDER OF PROCEDURE States Court of Federal Claims, is seeking fined in section 6331(1); and testimony at a deposition from Charles Stek ‘‘(2) ‘agency’ means an Executive agency. Mr. DOLE. Mr. President, first, I in- and Rebecca Wagner, employees of the Sen- ‘‘(b) In the event of a major disaster or dicate there will be no further votes ate who are on the staff of Senator Paul S. emergency, as declared by the President, this evening. Sarbanes; that results in severe adverse effects for a f Whereas, by the privileges of the Senate of substantial number of employees, the Presi- the United States and Rule XI of the Stand- dent may direct the Office of Personnel Man- AUTHORIZING TESTIMONY AND ing Rules of the Senate, no evidence under agement to establish an emergency leave LEGAL REPRESENTATION the control or in the possession of the Senate transfer program under which any employee can, by administrative or judicial process, be in any agency may donate unused annual Mr. DOLE. Mr. President, I ask unan- taken from such control or possession but by leave for transfer to employees of the same imous consent that the Senate proceed permission of the Senate; or other agencies who are adversely affected to the immediate consideration of S. Whereas, when it appears that evidence by such disaster or emergency. Res. 186, submitted earlier by Senator under the control or in the possession of the ‘‘(c) The Office of Personnel Management DOLE and Senator DASCHLE. Senate is needed for the promotion of jus- shall establish appropriate requirements for The PRESIDING OFFICER. The tice, the Senate will take such action as will the operation of the emergency leave trans- clerk will report. promote the ends of justice consistent with fer program under subsection (b), including the privileges of the Senate; appropriate limitations on the donation and The legislative clerk read as follows: Whereas, pursuant to sections 703(a) and use of annual leave under the program. An A resolution (S. Res. 186) to authorize tes- 704(a)(2) of the Ethics in Government Act of employee may receive and use leave under timony by Senate employees and representa- 1978, 2 U.S.C. §§ 288B(a) and 288c(a)(2), the the program without regard to any require- tion by Senate legal counsel. Senate may direct its counsel to represent ment that any annual leave and sick leave to The PRESIDING OFFICER. Is there employees of the Senate with respect to sub- a leave recipient’s credit must be exhausted objection to the immediate consider- poenas or requests for testimony issued or before any transferred annual leave may be ation of the resolution? made to them in their official capacities: used. There being no objection, the Senate Now, therefore, be it ‘‘(d) A leave bank established under sub- Resolved, That Charles Stek, Rebecca Wag- chapter IV may, to the extent provided in proceeded to consider the resolution. ner, and any other employee of the Senate regulations prescribed by the Office of Per- Mr. DOLE. Mr. President, the U.S. from whom testimony may be required are sonnel Management, donate annual leave to Government is the defendant in a pend- authorized to testify and to produce docu- the emergency leave transfer program estab- ing case in the U.S. Court of Federal ments in the case of Triangle MLP United lished under subsection (b). Claims arising out of a dispute with a Partnership v. United States, except concern- ‘‘(e) Except to the extent that the Office of private real estate developer over the ing matters for which a privilege should be Personnel Management may prescribe by Government’s procurement to lease a asserted. regulation, nothing in section 7351 shall SEC. 2. That the Senate Legal Counsel is new headquarters building for the Se- apply to nay solicitation, donation, or ac- authorized to represent Charles Stek, Re- ceptance of leave under this section. curities and Exchange Commission. becca Wagner, and any other employee of the ‘‘(f) The Office of Personnel Management The plaintiff developer responded to Senate in connection with the testimony au- shall prescribe regulations necessary for the the Government’s request for proposals thorized by this resolution. administration of this section.’’. October 19, 1995 CONGRESSIONAL RECORD — SENATE S 15369 (b) The analysis for chapter 63 of title 5, fense for the fiscal year ending Sep- with Senators permitted to speak for United States Code, is amended by adding at tember 30, 1996. up to 5 minutes each, with the excep- the end thereof the following: The PRESIDING OFFICER laid be- tion of the following: Senator WARNER, ‘‘SUBCHAPTER VI—LEAVE TRANSFER IN fore the Senate the following message 10 minutes; Senator BAUCUS, 10 min- DISASTERS AND EMERGENCIES from the House of Representatives: utes; Senator KERREY, 20 minutes. So ‘‘6391. Authority for leave transfer program Resolved, That the House disagree to the there will be an additional 40 minutes in disasters and emergencies’’. amendment of the Senate to the bill (H.R. for those who would like to participate SEC. 3. The amendments made by section 2 2126) entitled ‘‘An Act making appropria- in morning business. of this Act shall take effect on the date of tions for the Department of Defense for the The PRESIDING OFFICER. Without enactment of this Act. fiscal year ending September 30, 1996, and for objection, it is so ordered. f other purposes’’, and ask a further con- ference with the Senate on the disagreeing f TIED AID CREDIT PROGRAM votes of the two Houses thereon. REAUTHORIZATION Ordered, That Mr. Young of Florida, Mr. PROGRAM McDade, Mr. Livingston, Mr. Lewis of Cali- Mr. DOLE. Mr. President, I ask unan- Mr. DOLE. For the information of all fornia, Mr. Skeen, Mr. Hobson, Mr. Bonilla, Senators, at 10:30 it will be the major- imous consent that the Senate proceed Mr. Nethercutt, Mr. Istook, Mr. Murtha, Mr. to the immediate consideration of cal- Dicks, Mr. Wilson, Mr. Hefner, Mr. Sabo, and ity leader’s intention to turn to Cal- endar No. 203, S. 1309. Mr. Obey be the managers of the conference endar No. 207, S. 1322, regarding the re- The PRESIDING OFFICER. The on the part of the House. location of the Embassy in Israel to Je- clerk will report. Mr. DOLE. Mr. President, I ask unan- rusalem. Votes could occur in connec- The legislative clerk read as follows: imous consent that the Senate agree to tion with that bill and the Senate could be asked to turn to the State De- A bill (S. 1309) to reauthorize the tied aid a request for a further conference with credit program of the Export-Import Bank of the House and that the Chair be au- partment reorganization if the man- the United States, and to allow the Export- thorized to appoint conferees on the agers’ amendment could be agreed to. Import Bank to conduct a demonstration part of the Senate. Therefore votes can be expected to project. The PRESIDING OFFICER. Without occur. The PRESIDING OFFICER. Is there objection, it is so ordered. f objection to the immediate consider- The PRESIDING OFFICER (Mr. BEN- ation of the bill? NETT) appointed Mr. STEVENS, Mr. NEGOTIATIONS WITH THE There being no objection, the Senate COCHRAN, Mr. SPECTER, Mr. DOMENICI, PRESIDENT proceeded to consider the bill. Mr. BOND, Mr. MCCONNELL, Mr. MACK, Mr. DOLE. Mr. President, I will just Mr. DOLE. Mr. President, I ask unan- Mr. SHELBY, Mr. GREGG, Mr. HATFIELD, make one brief statement before we re- imous consent that the bill be deemed Mr. INOUYE, Mr. HOLLINGS, Mr. JOHN- cess. I will just say this. read a third time and passed; that the STON, Mr. BYRD, Mr. LEAHY, Mr. BUMP- I think, for the first time, the Presi- motion to reconsider be laid upon the ERS, Mr. LAUTENBERG, and Mr. HARKIN dent of the United States, President table; and that any statements relating conferees on the part of the Senate. Clinton, indicated today that he was to the bill be placed at the appropriate f prepared to negotiate with the leaders place in the RECORD. of the Congress concerning a balanced The PRESIDING OFFICER. Without APPOINTMENT OF CONFEREES— budget in 7 years. It is the first time he objection, it is so ordered. H.R. 1617 suggested 7 years. He also mentioned So the bill (S. 1309) was deemed read The PRESIDING OFFICER. Pursuant capital gains, taxes, and other matters. the third time and passed, as follows: to the order of October 11, 1995, the That may be the beginning, at least a S. 1309 Chair appoints the following Senators glimmer of hope that we might be able Be it enacted by the Senate and House of Rep- to serve as conferees on the part of the to come together in some negotiation resentatives of the United States of America in Senate on H.R. 1617, a bill to consoli- with the President of the United Congress assembled, date and reform workforce develop- States, myself, and the Speaker of the SECTION 1. EXTENSION OF TIED AID CREDIT ment and literary programs. House, Speaker GINGRICH. And I hope PROGRAM. The PRESIDING OFFICER (Mr. BEN- that is a sincere offer by the President (a) TIED AID CREDIT FUND.—Section 10(c)(2) of the United States, that we can prop- of the Export-Import Bank Act of 1945 (12 NETT) appointed Mrs. KASSEBAUM, Mr. U.S.C. 635i–3(c)(2)) is amended by striking JEFFORDS, Mr. COATS, Mr. GREGG, Mr. erly pursue it at the appropriate time. ‘‘the September 30, 1995’’ and inserting ‘‘Sep- FRIST, Mr. DEWINE, Mr. ASHCROFT, Mr. f tember 30, 1997’’. ABRAHAM, Mr. GORTON, Mr. KENNEDY, (b) AUTHORIZATION.—Section 10(e) of the Mr. PELL, Mr. DODD, Mr. SIMON, Mr. RECESS UNTIL 9:30 A.M. Export-Import Bank Act of 1945 (12 U.S.C. HARKIN, Ms. MIKULSKI, and Mr. TOMORROW 635i–3(e)) is amended by striking ‘‘1993, 1994, WELLSTONE conferees on the part of the and 1995’’ and inserting ‘‘1996 and 1997’’. Mr. DOLE. Mr. President, if there is Senate. no further business to come before the SEC. 2. AUTHORITY TO CONDUCT A DEMONSTRA- TION PROJECT. f Senate, I now ask unanimous consent that the Senate stand in recess under Notwithstanding section 4701(a)(1)(A) of ORDER FOR FRIDAY, OCTOBER 20, title 5, United States Code, the Export-Im- the previous order. 1995 port Bank of the United States may conduct There being no objection, the Senate, a demonstration project in accordance with Mr. DOLE. Mr. President, I ask unan- at 7:11 p.m., recessed until Friday, Oc- section 4703 of such title. imous consent that when the Senate tober 20, 1995, at 9:30 a.m. f completes its business today, it stand f in recess until the hour of 9:30 a.m. on DEPARTMENT OF DEFENSE Friday, October 20, 1995; that following NOMINATIONS APPROPRIATIONS ACT, 1996 the prayer, the Journal of proceedings Executive nomination received by Mr. DOLE. Mr. President, I ask unan- be deemed approved to date, the time the Senate October 19, 1995: imous consent that the Chair lay be- for the two leaders be reserved for their fore the Senate a message from the use later in the day; that there then be DEPARTMENT OF DEFENSE House on H.R. 2126, an act making ap- a period for the transaction of morning AUTHUR L. MONEY, OF CALIFORNIA, TO BE AN ASSIST- ANT SECRETARY OF THE AIR FORCE, VICE CLARK G. propriations for the Department of De- business until the hour of 10:30 a.m., FIESTER. October 19, 1995 CONGRESSIONAL RECORD — Extensions of Remarks E 1979 EXTENSIONS OF REMARKS

OPPOSITION TO H.R. 2425, THE Ms. Erline Chess is a 78-year-old widow TRIBUTE TO MAJ. GEN. JERRY C. MEDICARE PRESERVATION ACT who has been receiving home oxygen for HARRISON OF 1995 nearly 10 years. She is concerned that the in- creased cost of care could put an end to her HON. IKE SKELTON HON. LOUIS STOKES existence. OF MISSOURI OF OHIO Mr. Eli Strinic has had the same doctor for IN THE HOUSE OF REPRESENTATIVES IN THE HOUSE OF REPRESENTATIVES over 15 years and does not want to be forced Thursday, October 19, 1995 Thursday, October 19, 1995 into a HMO-type health care system. Mr. Mr. SKELTON. Mr. Speaker, today I pay Mr. STOKES. Mr. Speaker, I rise in strong Strinic is proud of the fact that his doctor tribute to a great American, a great Army offi- opposition to H.R. 2425, the Medicare Preser- knows his medical history, and understands cer, a great Missourian, and a great soldier. vation Act of 1995. While cloaked in an inno- his health care needs. This month Jerry Harrison will complete over cent, nonthreatening title, when you peel off 32 years of dedicated service to our country. the title and clear the smoke and mirrors, what Mr. Speaker, I think that Ms. Anita Wood- As a soldier, leader, and finally as a trusted you find is that H.R. 2425 authorizes a legal- ward, a health professional in my district sums advisor to the Secretary of the Army and the ized assault, and an all-out attack on the up the situation most appropriately. She Chief of Staff of the Army he has provided health of the Nation's seniors. writes, ``I fear not only the loss of quality. I dedicated and distinguished service. The measure destroys our Nation's health worry that the sick will be forgotten, and pa- Today as we honor his retirement, Jerry care system for the elderlyÐMedicareÐby tients that I see every day will really have to Harrison serves as the Army's Chief of Legis- cutting $270 billionÐfrom health care services make the choice between the prescription lative Liaison. This is the capstone of a re- for the elderlyÐin order to pay for a tax cut for blank and the grocery list.'' markable career which started in 1959 when the wealthy. It is absolutely essential for the Mr. Speaker, I strongly urge you and my he entered the U.S. Military Academy at West Point and where he was commissioned as a American people to be aware that this figure colleagues to listen to the plea of America's isÐthree times moreÐthan the $89 billion second lieutenant of field artillery in 1963. seniors in particular, and the American people which the medicare actuaries and the medi- Over the course of the past three decades, he in general. Do not destroy medicare. Join me care trustees have determined is needed to served in a variety of exceptionally challenging in voting ``No'' on H.R. 2425. ensure Medicare's solvency. troop and staff assignments in the United The Republican measure forces the Amer- f States, Germany, Korea, and Vietnam. ican people to needlessly pay more for less. As a leader, he has commanded at the bat- Seniors' health care premiums will double. WELCOME BACK LOUISVILLE tery, battalion, and brigade levels, culminating Gone are the limitations on the amount that SLUGGER in his command of the U.S. Army Laboratory doctors and hospitals can charge patients. In Command. As a staff officer and commander, fact, the Republicans' balance billing provision he saw duty in many tough and challenging allows providers to charge patients as much HON. MIKE WARD positions, validating the confidence the Army as they want, well beyond what Medicare placed in his demonstrated abilities. He com- pays. OF KENTUCKY manded the 1st Battalion 29th Field Artillery at With respect to choice, seniors' choice of IN THE HOUSE OF REPRESENTATIVES Fort Carson, Colorado, followed by a staff as- provider is seriously restricted. Seniors are signment as Chief, High Technology Test Divi- forced through a maze of financial maneuvers Thursday, October 19, 1995 sion, Office of the Deputy Chief of Staff for under the Republican Medicare-Plus provi- Operations and Plans. His skills were recog- sions. These provisions are specifically de- Mr. WARD. Mr. Speaker, I would like to take nized when he was chosen for higher com- signed to make it increasingly difficult for sen- this opportunity to welcome the Louisville mand and served as the Division Artillery iors to remain with their current private doctor, Slugger, the world's finest baseball bat, back Commander, 2nd Infantry Division, Camp forcing seniors into HMO-type health care sys- to its hometown of Louisville, Kentucky. Stanley, Korea. This was followed by a tour tems. This Saturday, October 21, 1995, the Louis- with the Deputy Chief of Staff for Research, Mr. Speaker, where will our Nation's frail, ville Slugger will return to the Louisville skyline Development, and Acquisition as the Deputy poor, and sick elderly turn for care, when H.R. at the future site of the Hillerich and Bradsby Director. His selection to Brigadier General led him to 2425 seriously erodes and threatens the very headquarters at Eighth and Main Streets in survival of the Nation's safety net hospitals. Fort Sill, Oklahoma where he served as the downtown Louisville. The factory will open in Assistant Commandant of the Field Artillery Uncompensated care will escalate. Louisville this January. This event will also As if these destructive provisions were not School, followed by an assignment as the enough, H.R. 2425 provides fertile ground for correspond with the first day of the World Se- Chief of Staff, Army Materiel Command. Upon fraud and abuse. Current provisions that are ries. In front of the future headquarters, the his selection for promotion to Major General, designed to prevent kickbacks and promote world's largest baseball bat will be installed, he was given command of the U.S. Army Lab- accurate billing are repealed. CBO estimates reaching a height of 120 feet. This giant bat oratory Command. Since January 1992, he that this provision alone will cost the American will represent not only the quality product has served with distinction as the Chief, Army people over $1 billion. These are but a few of manufactured by Hillerich and Bradsby, but Legislative Liaison. H.R. 2425's life threatening provisions. will also come to embody our Nation's love for During his tour as the Chief, Army Legisla- Mr. Speaker, I know the standard of living the game. A public street party and other tive Liaison, he shepherded the Army's rela- and quality of life for the 1.6 million bene- events will take place to welcome Hillerich and tionship with Congress wielding a deft and ficiaries in my State, Ohio, will be drastically Bradsby and the large bat back to Louisville. skillful touch during a period of tremendous change. Throughout this period, Jerry Harrison reduced. They certainly cannot absorb the Mr. Speaker, I would like to congratulate the over $8 billion that Ohio will lose under the ably assisted the Army's senior leadership in company of Hillerich and Bradsby on their Republican proposal. This 20Ðballooning to its dealings with Members of the Congress dedication to producing a high quality product, 30Ðpercent cut will devastate Ohio's health and helped them to understand the needs of on their dedication to the game of baseball, care systems. America's Army as it transformed itself from a Let me take just a moment to share with and on their dedication to the city of Louisville. forward deployed force to a power projection you just a snapshot of the worries and fears Mr. Speaker, in Louisville, we may speak soft- force. Drawing on this years of experience he that haunt the seniors in my district as they ly, but we carry a big bat. skillfully charted the way for an enhanced un- see medicare being ripped apart just for the derstanding of the Army's role in the legisla- sake of providing a tax cut for the wealthy. tive process and for telling the Army story. His

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. E 1980 CONGRESSIONAL RECORD — Extensions of Remarks October 19, 1995 leadership resulted in cohesive legislative emy for its 40th reunion. The U.S. Naval ACADEMICS AND TECHNOLOGY strategies, well-prepared Army leaders, and a Academy was founded in October 1845. In The angled wall to the right of the map il- coherent Army message. recognition of the Academy's 150th anniver- lustrates the role of the Naval Academy in Jerry Harrison's career reflects a commit- sary, this evening the president of the class of preparing midshipmen for future intellectual ′ ′ challenges. Some of the most amazing tech- ment to our Nation, characterized by dedi- 1955 will formally present an 85 x 10 mural nological advances in history occurred dur- cated selfless service, love for soldiers, and a to the superintendent of the U.S. Naval Acad- ing the years spanned by the service of the commitment to excellence. Major General emy. The mural is mounted in Alumni Hall and Class of ’55. As midshipmen, we used the Jerry C. Harrison, the consummate profes- is described by the following text: slide rule for general calculations and analog sional, whose performance in over three dec- WINNING THE COLD WAR computers for gun laying. A few years after graduation, the digital computer entered our ades of service, in peace as well as in war, On the occasion of our 40th reunion, the professional careers and triggered an expo- personified those traits of courage, com- Class of 1955 proudly presents this mural to petency, and integrity that our Nation has nential technological explosion. The solid salute the 150th Anniversary of The United academic foundation provided by the Naval come to expect from its Army officers. On be- States Naval Academy. Conceived and com- Academy enabled graduates to master half of the Congress of the United States and missioned by the class, the mural reminds emerging technologies and lead their subor- the people of this great Nation, I offer our today’s midshipmen of the Cold War’s scope dinates through the challenges of the com- heartfelt appreciation and best wishes for a and complexity. Through numerous exam- puter and nuclear age. The glass overlays on ples, the mural illustrates the extensive ef- soldier who served his country so admirably. each end of the central panel, together with forts by our nation to win the longest war in the adjacent painted scenes, illustrate rep- f our history. The mural makes the point that resentative ship, submarine and aircraft sys- winning the war occurred in part as a result TRIBUTE TO MABEL HOGGARD tems of steadily increasing complexity in of values imparted to midshipmen of all the which Naval Academy graduates served dur- classes of the era by the Academy. ing the Cold War. The consistent ability of HON. BARBARA F. VUCANOVICH The historical purpose of the mural is to our nation to stay ahead of the former USSR OF NEVADA portray the world as it evolved during the in the development and application of tech- period of sustained tension between the free IN THE HOUSE OF REPRESENTATIVES nology forced a series of Communist leaders world and the Communist nations from the to recognize that they could not compete Thursday, October 19, 1995 late 1940’s to the early 1990’s. This period successfully in a military confrontation with Mrs. VUCANOVICH. Mr. Speaker, I rise generally coincides with the active duty the United States. service of the Class of ’55. The images of his- ATHLETICS today to take time to honor and pay tribute to toric events and Naval Academy activities The angled wall to the left of the map il- an individual who spent her life in the service are chosen to remind viewers that the na- lustrates the important contribution of the of others. In doing so, Mabel Hoggard became tional security environment during the Cold Naval Academy athletic programs in devel- War was very different than today’s, and a pioneer, both for her race and for women. oping high quality graduates. Over the years, Born on March 10, 1905, in Pueblo, CO, that the Naval Academy environment was brilliant performances by individuals, com- Mabel left her home State after high school to different in many ways as well. bined with a unique Naval Academy empha- attend the University of Tennessee at Nash- The Cold War is but one of many periods in sis on teamwork, resulted in significant vic- ville, then known as Tennessee A&M, to pur- our nation’s history in which Naval Acad- tories over national colleges and universities emy graduates made significant contribu- sue a teaching degree. Upon completion, she with much stronger and heavily subsidized tions to the preservation of our freedom. De- athletic programs. As an example, the ‘‘team started teaching in a two-room schoolhouse in spite the changing nature of the challenges, the coal fields of Jenkins, KY, for $100 a called DESIRE’’, led by the Class of ‘55, over- the Naval Academy prepares midshipmen to powered favored Army and then defeated month. Mabel went on to do graduate work in make these important contributions by em- Mississippi, the Southeastern Conference education at Chicago University, University of phasizing a traditional set of core values Champions, 21–0 in the 1955 Sugar Bowl. Utah, and the University of Nevada, Las that provide the foundation for continued Other teams and individuals represented on Vegas. success by Academy graduates. These values the panel won Olympic, National, Eastern A lifelong Republican, Mabel was the first are illustrated by the four themes in the Intercollegiate, and League Championships. mural: Leadership, Academics and Tech- black writer for the Williamson, West Virginia A fierce competitiveness, the will to win, and nology, Athletics, and Excellence and Pro- a refusal to quit characterize the perform- News and the first black administrative staff fessionalism. person for the Williamson Housing Authority. ance of Navy teams across a wide spectrum LEADERSHIP of collegiate sports. The special tolerance for Mabel Hoggard was not to be satisfied with pressure and for leadership under stress de- these important contributions, however. In The Naval Academy consistently produces high quality graduates who understand and veloped by participation in Navy sports en- 1944, she moved to Las Vegas and became practice the fundamental principles of lead- abled Academy graduates to withstand the the first black teacher in the State of Nevada. ership. Academy graduates of every rank physically demanding requirements of com- Mabel spent 25 years with the Clark County lead men and women in training and battle, bat operations, space flight and in some School District, teaching at a number of in the execution of supporting technical and cases prolonged detention as a prisoner of schools including Matt Kelly, Highland, administrative duties, and rise to the most war. The Naval Academy athletic programs Westside, and C. V.T. Gilbert. In 1975, the senior positions in their services. During the also motivate graduates to remain phys- Cold War, Naval Academy graduates (includ- ically fit and apply the same winning habits Board of Trustees honored her by changing to their professional careers. the name of the former Bonanza Elementary ing many members of the Class of ’55) com- manded ships, planes, squadrons, companies, EXCELLENCE AND PROFESSIONALISM to the Mabel Hoggard School. The University battalions and other fighting units in the The plebe at the left end of the mural rep- of Nevada, Las Vegas in 1977, awarded Navy, Marine Corps and Air Force. The two resents all midshipmen entering the Naval Mabel the ``Outstanding Citizen'' award. glass panels flanking the central world map Academy. Each new plebe class contains in- Mr. Speaker, Mabel Hoggard was a true present the insignia of all the services, the dividuals from every state, a few foreign na- pioneer in the great spirit of Nevada and we Department of Defense, and the Naval Acad- tions, and some with previous military serv- honor her memory today as an inspiration not emy. ice. These fledgling midshipmen represent a only for Nevadans, but all Americans. The central panel of the mural illustrates wide range of value systems, family back- the enormous geographic size of the Com- grounds and ethnic cultures. During their f munist Empire directed by the very large four years at the Academy, these young peo- NAVAL ACADEMY’S CLASS OF 1955 and powerful Soviet Union. The compara- ple grow in their sense of ethics, truthfulness tively small United States mounted a sus- PRESENTS COLD WAR MURAL and honor, and learn to respect the need for tained 40 year campaign of moral, military, spiritual guidance. The first class mid- economic, and technical superiority to de- shipman at the right end of the mural is HON. CHARLES W. STENHOLM feat the Communist threat to our free exist- about to graduate, well prepared for commis- OF TEXAS ence. The hexagon shaped panels illustrate sioning as an officer in one of the armed some of the significant events that collec- services. The habit of excellence developed IN THE HOUSE OF REPRESENTATIVES tively contributed to Winning The Cold War. as midshipmen is transformed into the pro- Thursday, October 19, 1995 Naval Academy graduates participated in fessionalism that distinguishes Naval Acad- these events that resulted in the total col- Mr. STENHOLM. Mr. Speaker, in June emy graduates as they lead military organi- lapse of the Soviet Union and subordinate zations, work on the frontiers of technology, 1955, 742 young men graduated from the U.S. nations of the Communist Empire. The and participate in programs of national im- Naval Academy and received commissions in mural suggests the internal decay of that portance. the Navy, the Marine Corps and the Air Force. empire by the rusty steel and popped rivets The Cold War is over. Our national ability Today the Class of 1955 returns to the Acad- around the borders of Communist countries. to remain strong and unyielding for over 40 October 19, 1995 CONGRESSIONAL RECORD — Extensions of Remarks E 1981 years in the face of a hostile and persistent felt there was a need for an organization that Over its 20-year history and some 1 million Communist threat to our freedom was due in would monitor and defend the rights of Afri- PET scans, the technique has demonstrated significant part to dedicated service by can-Americans in Northwest Indiana. The na- the ability to reduce the number, cost, physical Naval Academy graduates. Unfortunately, tional organization, of which the Hammond pain, and mortality of expensive surgical pro- the world is still a dangerous place and our country will continue to call upon the armed branch is a member, focuses on providing bet- cedures. services to preserve our freedom. The men ter and more positive ways of addressing the This results not only in improved care, but and women in the service uniform of their important issues facing minorities in social and also reduced health care delivery costs. choice will continue to answer the call and job-related settings. For example, in the case of breast cancer, will add new chapters to the proud history of The Annual Fund Dinner is a major fund most patients undergo an expensive and pain- the Naval Academy developed over the past raiser for the Hammond branch of the NAACP. ful surgery to evaluate the tumors. This proce- 150 years. In addition, the dinner serves to update and dure often requires hospitalization and anes- f keep the community aware of the accomplish- thesia and can lead to complications. PET ments of the local and national chapters on an scans allow doctors to screen out the 75 per- SEPA annual basis. cent of patients who can be treated by partial Moreover, awards are presented at the din- mastectomy and thereby avoid surgery. Al- HON. PAT DANNER ner to members who have given of them- most 74,000 women per year would be spared OF MISSOURI selves above and beyond the planned agenda the risk and the cost associated with this sur- IN THE HOUSE OF REPRESENTATIVES or the President's request. Those special indi- gery. viduals who will receive awards are the follow- Similarly, lung cancer patients would avoid Thursday, October 19, 1995 ing: Rocharda Moore Morris, President's 10,000 surgeries and 17,000 biopsies each Ms. DANNER. Mr. Speaker, today I rise in Award; The Reverend Albert Johnson, Jule Al- year with the use of PET scans. opposition to a provision that may be included exander Award; Officer Pete Torres, Commu- With today's rising health care costs, we in the House version of the budget reconcili- nity Service Award; and Anthony Higgs, Pro- need to push those technologies which pro- ation package. Specifically, I strongly oppose gram Support Award. Pearline Jenkins Schol- vide cost savings into the mainstream of medi- the auction to the highest bidder of the South- arship Awards, whose joint contributors are cal practice. eastern Power Administration [SEPA] and the the Hammond NAACP and the Northern Indi- Data collected from peer review studies consideration of the auction of any of the other ana Public Service Co., will be presented to shows that PET technology offers the potential Power Marketing Administrations [PMA's]. Peter Adams, of Hammond High School, and to reduce national health care costs by a net The House Resources Committee, by a 1 Marquist L. Spencer, of Morton Senior High of $5 billion a year. Approximately $1 billion of vote margin, approved language that would re- School. The Master of Ceremonies is Bernard these savings would be in Medicare alone. quire the Corps of Engineers to auction to the Carter, Lake County Prosecutor, and the Key- I would like to commend my colleague, Mr. highest bidder contracts to all SEPA gen- note Speaker is Norman Van Lier, former star THOMAS of California, for his efforts to include erated power plus all land and facilities related of the Chicago Bulls. In addition, Norman will PET scans in the Medicare Preservation Act to the generation of electricity. This includes receive a special recognition award. we will vote on tomorrow. His language clari- generators, dams, locks, reservoirs, and the Mr. Speaker, it is my honor to congratulate fies the scope of coverage and amount of pay- land surrounding the reservoirs. It is important the Hammond Branch of the NAACP for com- ment under the Medicare program. This would to note that other than the generated power, mending these outstanding men and women, ensure that cutting-edge and cost-saving tech- those assets are under the jurisdiction of the who have taken the extra step to improve the nologies like PET are reimbursable. House Transportation and Infrastructure Com- quality of life for the residents of Indiana's This language is an important step in ena- mittee, not the Resources Committee. First Congressional District. bling Americans who rely on Medicare to ben- efit from innovative new technologies while at In response, the Transportation and Infra- f structure Committee, of which I am a member, the same time generating considerable sav- passed language that prohibits the sale of the PET TECHNOLOGY ings to the Federal Government. As important for me as the cost savings is Corps of Engineer's assets as they relate to the fact that the largest manufacturer of PET SEPA. If the Transportation and Infrastructure HON. JOHN J. DUNCAN, JR. scan equipment in the world, CTI, is located in Committee language stands, which it should, OF TENNESSEE my district in east Tennessee. The technology all that is left of the Resources Committee lan- IN THE HOUSE OF REPRESENTATIVES and personnel that founded the company guage is the sale of the generated power. Thursday, October 19, 1995 came from the Oak Ridge National Laboratory However, according to the Congressional Mr. DUNCAN. Mr. Speaker, last month I just outside of Knoxville, TN. Budget Office, the sale of the power genera- was invited to the University of Tennessee The savings from PET technology could tion alone does not score as a budget sav- Hospital where I was given a tour and briefing start today. One million PET scan studies ings. If there are no budget savings the argu- concerning a new medical technology, have been performed with no known negative ment favoring such a sale, simply does not Positron Emission Tomography, or PET for reactions. Patients have avoided unnecessary make sense. short. I should say that this is the latest ad- surgery because of PET. Again, I say we are We must defeat all proposals, now and in vance in medical technology for humans and not talking about animal pets, but a medical the future, to auction to the highest bidder any does not apply to pet animals. breakthrough called Positron Emission Tomog- of the PMA's. This proposed auction would as- PET technology is the latest advance in di- raphy. suredly result in higher electric rates for rural agnosing diseases such as breast cancer, The Health Care Financing Administration and small town consumers. colon cancer, lung cancer, brain cancer, heart (HCFA) has not made a decision on reim- f disease, and epilepsy. bursement while the Food and Drug Adminis- I have introduced H.R. 2194, the Medicare tration [FDA] drags its feet in making a deci- ANNUAL FUND DINNER FOR THE PET Coverage Act of 1995, because it is time sion on whether and how to regulate PETÐ INDIANA BRANCH OF THE NAACP that the average American has access to both something that States have already been this technology and the benefits from cost sav- doing. HON. PETER J. VISCLOSKY ings that PET scans provide. My bill would ex- For over 7 years, the developers of PET OF INDIANA pand PET from research into widespread clini- scans have complied with HCFA and FDA IN THE HOUSE OF REPRESENTATIVES cal use by permitting Medicare and Medicaid procedures and requests only to have the Thursday, October 19, 1995 reimbursement for PET scan procedures. rules changed and inquiries about progress Despite the fact that CHAMPUS and private met with minimal response. Mr. VISCLOSKY. Mr. Speaker, I rise today insurers like Blue Cross/Blue Shield already While there has been some recent move- to congratulate the members of the Hammond, reimburse for this safe, cost effective proce- ment on the part of the FDA, the fact remains IN branch of the National Association for the dure, Medicare and Medicaid do not. that we have no consistent regulatory plan Advancement of Colored People [NAACP]. On PET scan technology is a diagnostic proce- that applies industry-wide to all uses of PET. Thursday, October 19, 1995, they will hold the dure that doctors can use without surgery to Mr. THOMAS' language will help move PET, Annual Freedom Fund Dinner. determine the rate of growth of a tumor and and other technologies like it, out of this need- The Hammond NAACP, which has chosen tell if it is malignant or benign. This knowledge less bureaucratic standstill. the theme of ``Building Family Values,'' was saves patients from unnecessary surgery and Under this language, HCFA can no longer organized in 1934 by a group of residents that even eliminates the need for many biopsies. prevent Americans who rely on Medicare from E 1982 CONGRESSIONAL RECORD — Extensions of Remarks October 19, 1995 the benefits of PET scan technology. It will no issues. He reported the development of the ognition of their great feat of transporting tons longer be able to keep the Federal Govern- Dolores project from the early 1960s until its of military equipment from the Port of Balboa ment from realizing the savings that PET fruition, and he accomplished the delicate on the Pacific side of the Panama Canal to balancing act required of an objective re- scans can generate. porter who was also an ardent supporter. Jefferson City, MO. The following is the fact A hallmark of our health care system is the Writers are often remembered for the sub- sheet for the project: ability to constantly improve patient treatment jects about which they’ve written, but the SEAGOING BARGES MOVE MILITARY EQUIPMENT by introducing new technology. Better tech- true story of a newspaper man’s career is the FROM THE PORT OF BALBOA, PANAMA nology often means a more intelligent ap- story of line after line of copy, year after Late 1994.—The Missouri National Guard, proach to the diagnosis and treatment of ill- year of deadlines, meeting after meeting to in cooperation with the 102nd Army Reserve ness. This often translates into better care at attend, newspaper after newspaper after Command, ships over 340 pieces of military a lower cost. newspaper to put out. equipment to Panama for a Jan.–May 1995 That’s why the profession is called journal- To the person who can avoid surgery, the exercise that was part of the ongoing nation ism, because a newspaper done well is a jour- building program in the US Southern Com- access to PET is an immediate health con- nal of life in its community. A newspaper is mand theater. The equipment ranged from cern. For the taxpayer or individual insurance not a collection of stories, but thousands of giant earthscrapers to light trucks, collected consumer, reimbursement can help relieve the chapters in a single story. For 8 years as this at Fort Leonard Wood and Camp Crowder, burden of rising costs. Medicare and Medicaid newspaper’s editor, ‘‘Mac’’ has been respon- MO and loaded onto railcars and shipped to reimbursement of PET technology provides sible for telling that story. His accuracy, Beaumont, TX. It was unloaded there and access to a medical benefit that Americans fairness, persistence and dedication are ap- then loaded onto a ship for the trip to Pan- should not be denied 1 more day. preciated by his readers and by those of us ama. Four high dollar items, UH–1 ‘‘Huey’’ Mr. Speaker, PET scans can save lives, dis- who follow in his footsteps. helicopters, were flown by C–5 ‘‘Galaxy’’ Thanks, Mac. Cortez and Montezuma Coun- from Whiteman AFB to avoid potential rail covering things that other types of medical ty will miss you, and so will the Sentinel and movement and transloading damage. scanning miss. the Journal, and myself. February, 1995.—Changes at Fort Leonard It will not be long before people will be de- f Wood made it impossible to plan on the fort manding this technology. We should not deny as a return site. Regardless, the gear had to its benefits to our senior citizens because of STATEMENT ON MEDICARE BY eventually come to National Guard head- bureaucratic delays or unfair medical rules. CLAIRDA POTTS quarters along the Missouri River in central Missouri for maintenance after five months f in Panama, and there is no rail yard there. TRIBUTE TO BYRON McKELVIE HON. MIKE WARD Guard officials begin discussing barge move- OF KENTUCKY ment with military transportation and sea- IN THE HOUSE OF REPRESENTATIVES lift planners. The idea of shipment by sea- HON. SCOTT McINNIS going barge became a plan and a contract Thursday, October 19, 1995 OF COLORADO was let. IN THE HOUSE OF REPRESENTATIVES Mr. WARD. Mr. Speaker, Clairda Potts is a June, 1995.—At the port of Balboa on the Pacific side of Panama two 400 by 100 foot Thursday, October 19, 1995 constituent of mine who came to Washington to make a statement regarding her concerns barges are loaded with all equipment, includ- Mr. MCINNIS. Mr. Speaker, I rise today to about the proposed drastic changes in the ing the helicopters (protected by plastic shrink wrap), towed through the canal and pay tribute to Mr. Byron McKelvie of Cortez, Medicare system that the House is consider- CO, who recently retired after more than 30 up to the Gulf of Mexico to New Orleans, ing today. I am a Member of Congress for the then pushed up the Mississippi and Missouri years in the news business. As an acknowl- sole purpose of representing Clairda Potts and Rivers and in mid-July unloaded at a tem- edgement of the many years of service Mr. all of my constituents who would not have a porary wharf less than half mile from the McKelvie gave as an objective reporter and voice before this body. Therefore, I am includ- Guard’s maintenance shops. The helicopters editor of the Cortez Sentinel and Montezuma ing here for printing Ms. Potts concerns in her are unwrapped and flown straight from the Journal, those papers recently printed a won- own words. I believe her statement really says barge deck two miles to their maintenance derfully written farewell. I would like to insert facility. it all. The Results.—With four handlings en route that editorial into the RECORD, Mr. Speaker, My name is Clairda Potts and I am from and I ask that my colleagues join me in honor- to Panama, there was damage to numerous Louisville, KY. items of equipment, including significant ing Mr. McKelvie's devotion to his work, his I have worked since I was 9 years old and damage to vehicle windshields. With the community, and our country. for much of that time I paid into Medicare and equipment handled only twice on the return [From the Cortez Sentinel, Sept. 9, 1995] Social Security. (by its ‘‘owners’’ both times) damage was al- There’s an old joke about a little boy When Social Security and first developed, most zero. Personnel injury risk exposure whose parents were very concerned that he Congress made a commitment to the Amer- was cut in half, and the offload was com- could not talk. He seemed to function quite ican peopleÐif we paid in to Social Security, pleted in the Missouri River bottoms with well in every other way, and the years went daytime highs in the mid to upper 90s with- we would be free from financial worry in our out a single injury or heat casualty among by until, lo and behold, one night at the sup- senior years. per table an amazing thing occurred. ‘‘This the soldiers. I am appalled that here in our great country, The move demonstrated the ability of an roast beef is burnt,’’ he said, quite clearly. there are actually senior citizens who go to inland location to serve as a power projec- His parents and siblings were amazed. tion platform for direct overseas movement ‘‘Jimmy,’’ they said, ‘‘you can talk! Why bed hungry or without their medication. or receipt of equipment in situations where have you never said anything before?’’ ‘‘You Now, we have a new contract with America, seagoing barges can be used effectively as a never burned the roast beef before,’’ he said. to give tax cuts to the rich and solvent. means of filling shortfalls in current lift ca- That’s the way the newspaper business I ask that Congress keep its first contract pability. The move avoided the costs associ- works; until we publish something disagree- with America before it starts manufacturing ated with intermediate transloading oper- able, every one of our thousands of readers new ones. ations, including avoiding personnel injury remain silent. Much of an editor’s time is I ask you honorable Members of Congress, risk exposures and potentially significant spent fielding complaints about not printing please do not take from the vulnerable and equipment damage. enough information, printing too much in- formation, printing information too soon or needy in order to satisfy the wants of the f too late, and occasionally but not nearly as greedy. often as one might think, printing incorrect f TRIBUTE TO AUTUMN KEYES-ITA information. Newspaper work is thankless, but the time has come to say thanks to a TRIBUTE TO MISSOURI NATIONAL HON. BARBARA F. VUCANOVICH GUARD man who has spent much of his life contrib- OF NEVADA uting to the public exchange of information. Byron McKelvie retired this week, after 36 IN THE HOUSE OF REPRESENTATIVES years in the news business, most of them at HON. IKE SKELTON Thursday, October 19, 1995 Cortez Newspapers. First as a reporter and OF MISSOURI columnist and then as editor, he has been re- IN THE HOUSE OF REPRESENTATIVES Mrs. VUCANOVICH. Mr. Speaker, I rise today to honor an outstanding citizen of the sponsible for shining a clear light on issues Thursday, October 19, 1995 of great importance to Montezuma County. great State of Nevada. Autumn Keyes-Ita has While covering topics too numerous to list, Mr. SKELTON. Mr. Speaker, today I pay been active in Republican and civic duties for his primary area of expertise has been water tribute to the Missouri National Guard in rec- the past 30 years. She has put many hours October 19, 1995 CONGRESSIONAL RECORD — Extensions of Remarks E 1983 into improving the lives of her fellow Nevadans Dick has built a highly successful construc- In this century, Fairfield has grown and through her work at the Community College of tion business known for excellence of its work thrived, just as America has grown and southern Nevada, as well as representing Ne- and its ethical practices. Janice has served thrived. While nearby Cincinnati grew into a vada at three Republican national conven- the community by her active participation in a truly large world class city, Fairfield maintained tions. Presently doing post-graduate work at host of community and philanthropic organiza- its uniquely American, town-of-the-heartland, the University of California, Dominquez Hills, tions, including Hadassah, of which she is a entrepreneurial character. Incorporated as a Autumn was awarded a fellowship to research life member. Dick and Janice have set won- village on July 10, 1954, it officially became a her paternal family, one of the founding fami- derful examples for those around them by city on October 20, 1954. Today, its outlook lies of Gonzales County TX, during the time making pubic service an integral part of their for the future is as sure as its roots in the that Texas was still a territory. lives. past. As a thriving center of the small busi- Autumn has served under three Governors It has been my privilege to get to know such nesses that will lead America into the next and two Presidents, as well as running the giving and consequential people. I am happy century, Fairfield is truly an illustration of how Clark County office of the Republican Party in to join in honoring Dick and Janice for their citizens, politically and economically empow- 1972. Along with these accomplishments, Au- years of humanitarian efforts and dedication to ered, can take control of their lives and make tumn has spent her life in the service of chil- their community, and wish all the best to both a better world for themselves and their fami- dren and adults who are mentally challenged. of them and to their entire family. lies. I sincerely and enthusiastically congratu- Her love of the arts has led her to serve an f late Fairfield on its 40th year of independent assistant directorship of two major Broadway FORTIETH ANNIVERSARY OF life as a city, and look forward to many more hits, Oklahoma and Carousel. successful years to come. Mr. Speaker, today I recognize Autumn FAIRFIELD, OH Keyes-Ita for her outstanding accomplish- f ments and civic pride. She is a shinning ex- HON. JOHN A. BOEHNER ample of women making a difference in their OF OHIO 50TH ANNIVERSARY OF THE CITY community. IN THE HOUSE OF REPRESENTATIVES OF OAK PARK f Thursday, October 19, 1995 A TRIBUTE TO RICHARD AND Mr. BOEHNER. Mr. Speaker, today, the city HON. SANDER M. LEVIN JANICE SAMBOL of Fairfield, OH, marks its 40th anniversary. OF MICHIGAN On this proud day, I extend my heartiest con- HON. DICK ZIMMER gratulations to its citizens, who have made IN THE HOUSE OF REPRESENTATIVES OF NEW JERSEY Fairfield what it is today and what it promises Thursday, October 19, 1995 IN THE HOUSE OF REPRESENTATIVES to be tomorrow. Although Fairfield became a city only 40 Mr. LEVIN. Mr. Speaker, on October 29, Thursday, October 19, 1995 years ago, it boasts a proud history. Early in 1995, the city of Oak Park, MI, marks the end Mr. ZIMMER. Mr. Speaker, I rise today in 1787, the New Jerseyite John Cleves Symmes of its 50th anniversary celebration. order to recognize two remarkable individuals, heard from Major Benjamin Stites of a place in Since its incorporation 50 years ago, Oak Richard and Janice Sambol of Middletown, the western territories that was ``the garden Park's recent immigrants and long-time resi- NJ. The Sambols will be honored this evening spot of any place that he had seen.'' Moved dents have helped transform it from semirural at the 1995 Testimonial Dinner and Journal to visit the land, Judge Symmes formed a origins into a thriving community that is a good Tribute for the Center for Holocaust Studies at company to buy a large tract of land between place to live, to work, and to raise families. Brookdale Community College. the Little Miami and Big Miami Rivers, and ulti- With the strong support of the Oak Park Our community has been enhanced by the mately, Judge Symmes was successful in buy- business community and the tireless efforts of Sambol's civic endeavors and their personal ing just less than 1 million acres, at approxi- city staff and volunteers, Oak Park has cele- generosity. The Ocean County Association of mately 66 cents per acre. brated this milestone with fireworks, public Children with Learning Disabilities named Dick Revolutionary war veterans moved into safety programs, beautification projects, an Sambol Man of the Year; the Monmouth/ Ohio, seeking better lives for their families international festival, recreation programs, and Ocean Counties National Conference of Chris- from the richness of the land. They traveled musical shows by nationally known performing tians and Jews has honored him with the the country roads now recognized as U.S. artists. Brotherhood Award; the Ocean County Coun- Route 127 and S.R. 4. These pioneers began cil, Boy Scouts of America has presented him the statehood application process, and Ohio The year-long celebration comes to an end with its Citizen of the Year Award; and the was accepted as a State in 1803. The opening October 29, with the annual dinner that honors Kimball Medical Center Foundation has given of the Erie and Miami Canals in the 1820's more than 200 volunteers who serve on Oak him the Kimball Humanitarian Award. In 1990, brought greater prosperity and immigration to Park's many boards and commissions. both Dick and Janice were honored with the Fairfield's promising pastures, as farm goods It is my pleasure to share in the celebration first annual Theodore Herzl Leadership Award and people moved freely between Ohio and and best wishes for continued success and by the Ocean County Jewish Federation. major markets on the east coast. prosperity for the city of Oak Park, MI. Thursday, October 19, 1995 Daily Digest

HIGHLIGHTS Senate passed Cuban Liberty and Democratic Solidarity Act. House passed Medicare Preservation Act. Senate Cuban Liberty and Democratic Solidarity Act: Chamber Action By 74 yeas to 24 nays (Vote No. 494), Senate passed Routine Proceedings, pages S15297–S15369 H.R. 927, to seek international sanctions against the Measures Introduced: Eleven bills and two resolu- Castro government in Cuba, and to plan for support tions were introduced, as follows: S. 1335–1345, and of a transition government leading to a democrat- S. Res. 185–186. Pages S15337±38 ically elected government in Cuba, after taking ac- Measures Reported: Reports were made as follows: tion on amendments proposed thereto, as follows: S. 187, to provide for the safety of journeymen Pages S15315±25 boxers. (S. Rept. No. 104–159) Adopted: S. 1004, to authorize appropriations for the Unit- (1) Dole Amendment No. 2898, in the nature of ed States Coast Guard, with an amendment in the a substitute. Pages S15315±25 nature of a substitute. (S. Rept. No. 104–160) (2) Helms Amendment No. 2936 (to Amendment S. 673, to establish a youth development grant No. 2898), to strengthen international sanctions program, with an amendment in the nature of a sub- against the Castro government and to support for a stitute. (S. Rept. No. 104–161) free and independent Cuba. Pages S15315±25 S. 1012, to extend the time for construction of Rejected: certain FERC licensed hydro projects. (S. Rept. No. (1) Simon Modified Amendment No. 2934 (to 104–162) Amendment No. 2936), to protect the constitutional H.R. 1266, to provide for the exchange of lands right of Americans to travel to Cuba. (By 73 yeas within Admiralty Island National Monument. (S. to 25 nays (Vote No. 492), Senate tabled the amend- Rept. No. 104–163) ment.) Pages S15315±23 S. Res. 177, to designate October 19, 1995, as (2) Dodd Amendment No. 2906 (to Amendment ‘‘National Mammography Day’’. Page S15337 No. 2936), to seek international sanctions against Measures Passed: the Castro government in Cuba, and to plan for sup- National Mammography Day: Senate agreed to port of a transition government leading to a demo- S. Res. 177, to designate October 19, 1995, as ‘‘Na- cratically elected government in Cuba, and Dodd Amendment No. 2908 (to Amendment No. 2936), tional Mammography Day.’’ Pages S15311±12 to seek international sanctions against the Castro NASA Authorizations, 1996: Senate passed S. government in Cuba, and to plan for support of a 1048, to authorize appropriations for fiscal year 1996 transition government leading to a democratically to the National Aeronautics and Space Administra- elected government in Cuba. (By 64 yeas to 34 nays tion for human space flight, science, aeronautics and (Vote No. 493), Senate tabled the amendments en technology, mission support, and the Inspector Gen- bloc.) Pages S15315±24 eral, after agreeing to a committee amendment in the nature of a substitute, and the following amend- Senate Legal Representation: Senate agreed to S. Res. 186, to authorize testimony by Senate employ- ment proposed thereto: Pages S15298±S15311 Kassebaum (for Pressler) Amendment No. 2939, ees and representation by Senate Legal Counsel. to authorize funds for operation of the Upper Mid- Page S15368 west Aerospace Consortium, and to clarify an author- Federal Employees Emergency Leave Transfer ization. Pages S15303±06 Act: Senate passed S. 868, to provide authority for D 1225 D 1226 CONGRESSIONAL RECORD — DAILY DIGEST October 19, 1995 leave transfer for Federal employees who are ad- Record Votes: Three record votes were taken today. versely affected by disasters or emergencies. (Total—494) Pages S15323, S15324, S15325 Pages S15368±69 Recess: Senate convened at 10 a.m., and recessed at Tied Aid Credit Program Authorization: Senate 7:11 p.m., until 9:30 a.m., on Friday, October 20, passed S. 1309, to reauthorize the tied aid credit 1995. (For Senate’s program, see the remarks of the program of the Export-Import Bank of the United Majority Leader in today’s RECORD on page States, and to allow the Export-Import Bank to con- S15369.) duct a demonstration project. Page S15369 Department of Defense Appropriations—Further Committee Meetings Conference: The Senate agreed to a further con- ference with the House on H.R. 2126, making ap- (Committees not listed did not meet) propriations for the Department of Defense for the NOMINATIONS fiscal year ending September 30, 1996, and the Chair appointed the following conferees: Senators Committee on Agriculture, Nutrition, and Forestry: Com- Stevens, Cochran, Specter, Domenici, Bond, McCon- mittee concluded hearings on the nominations of nell, Mack, Shelby, Gregg, Hatfield, Inouye, Hol- Michael V. Dunn, of Iowa, to be an Assistant Sec- lings, Johnston, Byrd, Leahy, Bumpers, Lautenberg, retary of Agriculture for Marketing and Regulatory and Harkin. Page S15369 Programs, and to be a Member of the Board of Di- rectors of the Commodity Credit Corporation, and Workforce Development Act—Conferees: Pursu- John David Carlin, of Kansas, to be an Assistant ant to the order of October 11, 1995, the Chair ap- Secretary of Agriculture for Congressional Relations, pointed conferees on H.R. 1617, to consolidate and after the nominees testified and answered questions reform workforce development and literacy pro- in their own behalf. Mr. Dunn was introduced by grams, as follows: Senators Kassebaum, Jeffords, Senator Leahy, and Mr. Carlin was introduced by Coats, Gregg, Frist, DeWine, Ashcroft, Abraham, Senator Kassebaum. Gorton, Kennedy, Pell, Dodd, Simon, Harkin, Mi- kulski, and Wellstone. Page S15369 ROLE OF COUNCIL OF ENVIRONMENTAL Messages From the President: Senate received the QUALITY following messages from the President of the United Committee on Energy and Natural Resources: Sub- States: committee on Oversight and Investigations con- Transmitting a report of deferrals of budgetary re- cluded hearings to examine the role of the Council sources; which was referred jointly, pursuant to the of Environmental Quality in the decision-making order of January 30, 1975, as modified by the order and management processes of the Department of the of April 11, 1986, to the Committee on Appropria- Interior, Department of Energy, and the U.S. Forest tions, to the Committee on the Budget, to the Com- Service, after receiving testimony from Kathleen A. mittee on Foreign Relations, to the Committee on McGinty, Chair, Council on Environmental Quality. Labor and Human Resources, and to the Committee SAFE DRINKING WATER ACT on Finance. (PM–88). Page S15336 AMENDMENTS Nominations Received: Senate received the follow- Committee on Environment and Public Works: Commit- ing nomination: tee concluded hearings on S. 1316, to revise and au- Arthur L. Money, of California, to be an Assistant thorize funds for programs of the Safe Drinking Secretary of the Air Force. Page S15369 Water Act, after receiving testimony from Carol M. Messages From the President: Page S15336 Browner, Administrator, Environmental Protection Messages From the House: Pages S15336±37 Agency; Nebraska Governor E. Benjamin Nelson, Lincoln, and Ohio Governor George V. Voinovich, Measures Referred: Page S15337 Columbus, both on behalf of the National Governors Communications: Page S15337 Association; Mayor Jeffrey N. Wennberg, Rutland, Statements on Introduced Bills: Pages S15338±57 Vermont, on behalf of the National League of Cities and the National Association of Counties; Gurnie C. Additional Cosponsors: Pages S15357±58 Gunter, Kansas City Department of Water Services, Amendments Submitted: Page S15359 Kansas City, Missouri, on behalf of the Association Notices of Hearings: Page S15359 of Metropolitan Water Agencies; Erik D. Olson, Natural Resources Defense Council, Washington, Authority for Committees: Page S15359 D.C., on behalf of the Campaign for Safe and Afford- Additional Statements: Pages S15359±68 able Drinking Water; Donald Satchwell, East Green October 19, 1995 CONGRESSIONAL RECORD — DAILY DIGEST D 1227

Acres irrigation District, Post Falls, Idaho, on behalf hearings to examine certain Federal law enforcement of the American Water Works Association; Dan actions with regard to the 1992 incident at Ruby Keil, Montana Rural Water Systems, Conrad, on be- Ridge, Idaho, receiving testimony from Louis J. half of the National Rural Water Association; David Freeh, Director, Federal Bureau of Investigation, De- Ozonoff, Boston University School of Public Health, partment of Justice. Boston, Massachusetts; Richard J. Bull, Battelle Pa- Subcommittee recessed subject to call. cific Northwest Laboratories, Richland, Washington; and William R. Mills, Jr., Orange County Water RURAL AND URBAN COMMUNITY District, Orange County, California, on behalf of the REVITALIZATION Association of California Water Agencies. Committee on Small Business: Committee held hearings BUDGET RECONCILIATION on proposals to revitalize American rural and urban Committee on Finance: Committee completed its re- communities, including provisions of S. 743, S. view of certain spending reductions and revenue in- 1184, and S. 1252, receiving testimony from Sen- creases to meet reconciliation expenditures as im- ators Abraham, Lieberman, and Ashcroft; Jack posed by H. Con. Res. 67, setting forth the congres- Kemp, Empower America, Marc Bendick, Jr., sional budget for the United States Government for Bendick and Egan Economic Consultants, Inc., and fiscal years 1996, 1997, 1998, 1999, 2000, 2001, Paul S. Grogan, Local Initiatives Support Corpora- and 2002, and agreed on recommendations which it tion, all of Washington, D.C.; Blair Forlaw, East- will make thereon to the Committee on the Budget. West Gateway Coordinating Council, St. Louis, Mis- souri; and Randall C. Gideon, KVG Gideon/Toal, RUBY RIDGE Inc., Fort Worth, Texas, on behalf of the American Committee on the Judiciary: Subcommittee on Terror- Institute of Architects. ism, Technology, and Government Information held Hearings were recessed subject to call. h House of Representatives Medicare Preservation Act: By a yea-and-nay vote Chamber Action of 231 yeas to 201 nays, Roll No. 731, the House Bills Introduced: 8 public bills, H.R. 2507–2514; passed H.R. 2425, to amend title XVIII of the So- and 2 private bills, H.R. 2515, 2516; and 1 resolu- cial Security Act to preserve and reform the medicare tion, H. Res. 240, were introduced. Page H10484 program. Pages H10328±H10464 Reports Filed: Reports were filed as follows: Rejected the Gephardt motion to recommit the H. Res. 239, providing for the consideration of bill to the Committees on Ways and Means and H.R. 2492, making appropriations for the Legisla- Commerce with instructions to report it back forth- tive Branch for the fiscal year ending September 30, with containing an amendment that strikes language 1996 (H. Rept. 104–283); and relating to the extension of Part B premiums (re- H.R. 994, to require the periodic review and jected by a recorded vote of 183 ayes to 249 noes, automatic termination of Federal regulations, amend- Roll No. 730). Pages H10462±64 ed (H. Rept. 104–284, Part 1). Pages H10464, H10484 Agreed to the amendment in the nature of a sub- stitute made in order by the rule (text of H.R. Speaker Pro Tempore: Read a letter from the 2485), as modified by the rule. Page H10461 Speaker wherein he designates Representative Rejected the Gibbons amendment in the nature of LaHood to act as Speaker pro tempore for today. a substitute that sought to reduce medicare by $90 Page H10309 billion over seven years, reduce Part A spending by Committees To Sit: The following committees and an amount sufficient to extend the solvency of the their subcommittees received permission to sit today Part A hospital trust fund to 2006, and reduce cost during proceedings of the House under the 5-minute sharing by medicare beneficiaries by freezing the rule: Committees on Agriculture, Commerce, Gov- Part B premium for one year and providing that the ernment Reform and Oversight, International Rela- monthly premium in succeeding years would be tions, the Judiciary, Resources, Science, Small Busi- below the level under current law (rejected by a re- ness, and Transportation and Infrastructure. corded vote of 149 ayes to 283 noes, Roll No. 729). Page H10314 Pages H10388±H10461 D 1228 CONGRESSIONAL RECORD — DAILY DIGEST October 19, 1995 H. Res. 238, the rule under which the bill was Administrator, Foreign Agricultural Service, USDA; considered, was agreed to earlier by a recorded vote and public witnesses. of 227 ayes to 192 noes, Roll No. 727. Agreed to order the previous question on the rule by a yea-and- MISCELLANEOUS MEASURES nay vote of 231 yeas to 194 nays, Roll No. 726. Committee on the Judiciary: Subcommittee on Com- Pages H10314±28 mercial and Administrative Law approved for full Late Report: Conferees received permission to have committee action the following measures: H.R. until midnight Friday, October 20, to file a con- 2064, to grant the consent of Congress to an amend- ference report on H.R. 2002, making appropriations ment of the Historic Chattahoochee Compact be- for the Department of Transportation and related tween the States of Alabama and Georgia; and H.J. agencies for the fiscal year ending September 30, Res. 78, amended, to grant the consent of the Con- 1996. Page H10465 gress to certain additional powers conferred upon the Presidential Message—Budget Deferrals: Read a Bi-State Development Agency by the States of Mis- message from the President wherein reports three de- souri and Illinois; and H.R. 394, amended, to amend ferrals of budgetary resources, totaling $122.8 mil- title 4 of the United States Code to limit State tax- lion and affecting the International Security Assist- ation of certain pension income. ance program, and the Departments of Health and Prior to this action, the Subcommittee held a Human Services and State—referred to the Commit- hearing on H.R. 2064 and H.J. Res. 78. Testimony tee on Appropriations and ordered printed (H. Doc. was heard from Representatives Everett and Talent. 104–125). Page H10465 Quorum Calls—Votes: One Quorum call (Roll No. OVERSIGHT—UNITED STATES 728), two yea-and-nay votes, and three recorded COMMISSION ON CIVIL RIGHTS votes developed during the proceedings of the House Committee on the Judiciary: Subcommittee on the Con- today and appear on pages H10327, H10327–28, stitution held an oversight hearing on the U.S. Com- H10459–60, H10461, H10463–64, and H10464. mission on Civil Rights. Testimony was heard from Adjournment: Met at 9 a.m. and adjourned at 8:56 Representatives Foley, Slaughter, Shaw, and p.m. Rohrabacher; Mary Mathews, Staff Director, U.S. Commission on Civil Rights; and a public witness. Committee Meetings FOOD FOR PEACE PROGRAM MEDICAL PROCEDURES INNOVATION AND REAUTHORIZATION AFFORDABILITY ACT; INVENTOR PROTECTION ACT Committee on Agriculture: Subcommittee on Depart- ment Operations, Nutrition, and Foreign Agriculture Committee on the Judiciary: Subcommittee on Courts approved for full Committee action amended H.R. and Intellectual Property held a hearing on the fol- 2493, Food for Peace Reauthorization Act of 1995. lowing bills: H.R. 1127, Medical Procedures Innova- tion and Affordability Act; and H.R. 2419, Inventor DISTRICT OF COLUMBIA APPROPRIATIONS Protection Act of 1995. Testimony was heard from Committee on Appropriations: Approved for full Com- Senator Lieberman; Representatives Ganske and mittee action the District of Columbia appropria- Wyden; G. Lee Skillington, Counsel, Office of Legis- tions for fiscal year 1996. lative and International Affairs, Patent and Trade- POSTMARK PROMPT PAYMENT ACT mark Office, Department of Commerce; and public Committee on Government Reform and Oversight: Sub- witnesses. committee on Postal Service held a hearing on H.R. 1963, Postmark Prompt Payment Act of 1995. Tes- MISCELLANEOUS MEASURES timony was heard from Representatives Boehlert, Committee on the Judiciary: Subcommittee on Crime Romero-Barcelo´, Jacobs, Stockman, Barrett of Wis- approved for full Committee action the following consin, and Blute; and public witnesses. bills: H.R. 2418, amended, DNA Identification FARM BILL TRADE PROVISIONS Grants Improvement Act of 1995; H.R. 1533, to amend title 18, United States Code, to increase the Committee on International Relations: Subcommittee on penalty for escaping from a Federal prison; and H.R. International Economic Policy and Trade held a 2359, amended, to clarify the method of execution hearing on the Trade Provisions in the 1995 Farm bill. Testimony was heard from August Schumacher, of Federal prisoners. October 19, 1995 CONGRESSIONAL RECORD — DAILY DIGEST D 1229

NUCLEAR WASTE POLICY ACT of Public Aircraft by the FAA under Public Law AMENDMENTS 103–411 and on proposed Restrictions on the use of Committee on Resources: Met to consider H.R. 1020, to Certain Special Purpose Aircraft under H.R. 1320, amend the Nuclear Waste Policy Act, but no action to impose restrictions on the use of certain special was taken thereon. purpose aircraft. Testimony was heard from public witnesses. LEGISLATIVE BRANCH APPROPRIATIONS Committee on Rules: Granted, by voice vote, a closed Joint Meetings rule providing 1 hour of debate on H.R. 2492, mak- ing appropriations for the legislative branch for the APPROPRIATIONS—TRANSPORTATION fiscal year ending September 30, 1996. The rule pro- Conferees, agreed to file a conference report on the vides for consideration of the bill in the House. Fi- differences between the Senate- and House-passed nally, the rule provides one motion to recommit. versions of H.R. 2002, making appropriations for Testimony was heard from Representatives Packard the Department of Transportation and related agen- and Fazio. cies for the fiscal year ending September 30, 1996. UNITED STATES-JAPANESE COOPERATION f IN HUMAN SPACEFLIGHT COMMITTEE MEETINGS FOR FRIDAY, Committee on Science: Held a hearing on United States- OCTOBER 20, 1995 Japanese Cooperation in Human Spaceflight. Testi- mony was heard from Donald S. Goldin, Adminis- (Committee meetings are open unless otherwise indicated) trator, NASA; Ambassador Takakazu Kuriyama, Em- Senate bassy of Japan; and public witnesses. Committee on the Budget, business meeting, to mark up EFFECTS OF SUPERFUND LIABILITY ON proposed legislation to provide for reconciliation pursuant SMALL BUSINESS to H. Con. Res. 67, setting forth the congressional budg- Committee on Small Business: Held a hearing on Effects et for the United States Government for fiscal years 1996, 1997, 1998, 1999, 2000, 2001, and 2002, 1:30 p.m., of Superfund Liability on Small Business. Testimony SD–608. was heard from Lois J. Schiffer, Assistant Attorney Committee on the Judiciary, to resume hearings to exam- General, Environmental and Natural Resources Divi- ine the status of religious liberty in the United States, 10 sion, Department of Justice; and public witnesses. a.m., SD–226. PUBLIC AIRCRAFT REGULATION House Committee on Transportation and Infrastructure: Sub- committee on Aviation held a hearing on Regulation No committee meetings are scheduled. D 1230 CONGRESSIONAL RECORD — DAILY DIGEST October 19, 1995

Next Meeting of the SENATE Next Meeting of the HOUSE OF REPRESENTATIVES 9:30 a.m., Friday, October 20 10 a.m., Friday, October 20

Senate Chamber House Chamber Program for Friday: After the recognition of three Sen- Program for Friday: No legislative business is sched- ators for speeches and the transaction of any morning uled. business (not to extend beyond 10:30 a.m.), Senate may consider S. 1322, regarding the relocation of the Embassy in Israel.

Extensions of Remarks, as inserted in this issue

HOUSE Levin, Sander M., Mich., E1983 Visclosky, Peter J., Ind., E1981 McInnis, Scott, Colo., E1982 Vucanovich, Barbara F., Nev., E1980, E1982 Boehner, John A., Ohio, E1983 Skelton, Ike, Mo., E1979, E1982 Ward, Mike, Ky., E1979, E1982 Danner, Pat, Mo., E1981 Stenholm, Charles W., Tex., E1980 Zimmer, Dick, N.J., E1983 Duncan, John J., Jr., Tenn., E1981 Stokes, Louis, Ohio, E1979

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