[Congressional Record Volume 140, Number 138 (Wednesday, September 28, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 28, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  DISTRICT OF COLUMBIA APPROPRIATIONS ACT, 1995, DISTRICT OF COLUMBIA 
         SUPPLEMENTAL APPROPRIATIONS AND RESCISSIONS ACT, 1994

  The Senate continued with the consideration of the amendments in 
disagreement to the conference report.
  Mr. BURNS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BURNS. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Without objection.
  Mr. BURNS. Mr. President, I want to associate myself with the remarks 
of my friend from Maine, Senator Cohen, and I want to commend him for 
his work on the Select Committee on Aging, of which I serve on that 
committee, and the work that he and his staff has done with regard to 
the fraud in the Medicare and Medicaid system. We have seen many 
examples of where fraud has taken place in that program, and, yes, even 
where our elderly have been taken advantage of by just plain old down-
to-earth shysters.
  We also heard a lot of testimony to that effect. If you couple with 
the figures--and there is no reason to believe that the figures that 
the Senator has shown us here today with regard to fraud in that 
system, and what it costs us--if you couple that with what we know as 
to be defensive medicine in our health care system, then we are talking 
about at least a 25- to 35-percent savings in our Medicare system. And 
you know right now we have probably taken some moneys out of the 
Medicare system to provide moneys to other programs. The President's 
tax plan did call for that.
  And what essentially we did, every time we rolled back and put caps 
on services, fee for services, then we find ourselves in this business 
of--especially among the elderly--of selecting who is going to receive 
the services in health care.
  We all hate to say it, but rationing does take place whenever we 
lower the caps down to below the cost of providing the service with our 
health care system.
  So I want to commend my friend, the ranking member on the Select 
Committee on Aging, and the work that he has done.
  And I would hope that the Members of this body, and the other body, 
would take a look and see what he is trying to do, what we are trying 
to do when we talk about fraud in a system.
  When I was home on this last trip I was talking to the physical 
therapists of Montana, and they are bringing up some bad things that 
are happening in their industry or their part of the health care 
system. Whether it be through licensing and certifying those people who 
are equipped to do the work.
  I congratulate my friend from Maine, and the work he has done, and I 
would hope that this body and the other body would take very seriously 
what we are trying to do with this amendment as this bill moves 
forward.
  Mr. SASSER. Mr. President, I rise in support of an amendment offered 
by my colleague from Maine, Mr. Cohen, that would help the Government 
detect health care fraud while discouraging fraudulent practices by 
health providers.
  For years I have held hearings and introduced legislation in an 
effort to reduce the stunning amount of waste and fraud in our health 
care system. Many of my proposals have been adopted either 
legislatively or through regulation. I believe Senator Cohen's 
amendment, of which I am a cosponsor, builds on some of the changes I 
have worked for and offers some fresh ideas for improvement.
  Among its more noteworthy provisions, the amendment would establish a 
national fraud control group to act as a sort of clearinghouse and 
facilitator for all public and private fraud control efforts. In other 
words, efforts by the HHS inspector general, the FBI, Medicaid fraud 
control units and private companies could be coordinated under one 
umbrella. Such a centralized fraud control group would dramatically 
improve our current scatter-shot of good intentions that duplicates 
efforts while leaving some trouble spots untouched.
  The amendment would also increase civil and criminal penalties for 
those convicted of fraud. And it would establish an account, dedicated 
to fraud prevention, into which a percentage of those proceeds would be 
placed.
  Finally, the amendment would bar those convicted of fraud felonies 
from participating in Federal health programs in the future. It would 
also assist providers by offering them guidance for new regulations and 
making them familiar with new fraud and abuse laws.
  Mr. President, this amendment will be a welcome tool for fraud 
control agents on the front lines of the battle against wasteful health 
care spending. I am pleased to be a cosponsor, and I urge its swift 
adoption.
  I thank the President, and I would suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. COHEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. Moseley-Braun). Without objection, it is 
so ordered.
  Mr. COHEN. Madam President, while we are awaiting decision as to 
whether any Member of the Senate wishes to raise a point of order 
against this amendment, I thought I would take a few more moments to 
try and demonstrate the magnitude of the problem we face.
  I have several charts that were prepared by my staff on the Aging 
Committee, and you can see from this chart alone the dimensions of the 
problem.
  In 1990, the health care fraud and abuse losses totaled some $66.6 
billion. In 1991, it went up to $73.8 billion. In 1992, it climbed to 
$80.9 billion. In 1993, it is up to $93.9 billion. And the estimate for 
this year is $103.4 billion.
  This other chart shows, I think in very dramatic terms, exactly how 
much we are losing and have lost through health care fraud and abuse in 
the past 5 years.
  By way of comparison, the losses in the savings and loan scandal was 
$119 billion. We have lost, over the past 5 years, $418 billion to 
health care fraud and abuse.
  As I have tried to demonstrate, the ways in which the taxpayers are 
being robbed are shockingly easy.
  The Aging Committee minority staff conducted a year-long 
investigation. I have a rather colorful cover of this report called, 
Gaming the Health Care System. It more or less looks like a monopoly 
board.
  The types of things that take place are upcoding, prescription drug 
diversion, billing for professional patients; inflating charges for 
ambulance and taxi services; paying kickbacks for referrals; phony 
medical billing services; untrained home care workers; targeting 
nursing home residents; money laundering; falsifying prescriptions for 
supplies; fraudulent providers; making false claims; falsifying 
diagnoses; ``phantom'' therapy sessions; exorbitant prices for 
supplies; billing for inferior products; billing for items never 
provided; ghost patients; billing for excessive or unnecessary 
services; and unbundling.
  Those are just a few examples.
  I thought I would read portions of the executive summary of the Aging 
Committee Investigative Report to give a bit more detail of what we are 
talking about.

       Physicians-owners of a clinic in New York stole over $1.3 
     million from the State Medicaid program by fraudulently 
     billing for over 50,000 ``phantom'' psychotherapy sessions 
     never given to Medicaid recipients.
       A speech therapist submitted false claims to Medicare for 
     services ``rendered to patients'' several days after they had 
     died;
       A home health care company stole more than $4.6 million 
     from Medicaid by billing for home care provided by 
     unqualified home care aides. In addition to cheating 
     Medicaid, elderly and disabled individuals were at risk from 
     untrained and unsupervised aides;
       Nursing home operators charged personal items such as 
     swimming pools, jewelry, and the family nanny to Medicaid 
     cost reports;
       1,500 workers lost their prescription drug coverage because 
     a scam drove up the cost of the insurance plan for their 
     employer. The scam involved a pharmacist who stole over 
     $370,000 from Medicaid and private health insurance plans by 
     billing over one thousand times for prescription drugs that 
     he did not actually dispense;
       Large quantities of sample and expired drugs were dispensed 
     to nursing home patients and pharmacy customers without their 
     knowledge. When complaints were received from nursing home 
     staff and patient relatives regarding the ineffectiveness of 
     the medications, one of the scam artists stated ``those 
     people are old, they'll never know the difference and they'll 
     be dead soon anyway'';
       Durable medical equipment suppliers stole $1.45 million 
     from the New York State Medicaid program by repeatedly 
     billing for expensive orthotic back supports that were never 
     prescribed by physicians;
       A scheme involved the distribution of $6 million worth of 
     reused pacemakers and mislabeled pacemakers intended for 
     ``animal use only.''

  How about that, Madam President. You are a patient who needs a 
pacemaker and one is installed that is intended for animal use only or 
one is installed when the time for the batteries has expired.

       The scheme involved kickbacks to cardiologists and surgeons 
     to induce them to use pacemakers that had already expired; 
     and
       A clinical psychologist was indicted for having sexual 
     intercourse with some of his patients and then seeking 
     reimbursement from a federal health plan for these encounters 
     as ``therapy'' sessions.

  Madam President, we have been at this a long time. Back in 1981, the 
Senate Special Committee on Aging sought out an expert in health care 
fraud--in 1981. Let me repeat that date. Here it is 1994, we are still 
talking about health care fraud. We are still pointing to charts in 
which the numbers are going off the chart. And yet, Members say, ``We 
can't act now.''
  But in 1981, the committee turned to a cardiologist from 
Philadelphia. Let me tell you, Madam President, his credentials were 
impeccable. He was a noted physician. He also happened to be a 
convicted felon who had defrauded both the public and private insurers 
in three States for more than $500,000 by submitting more than $1.5 
million in medical services he had never performed. Here is what he 
told the committee. He said:

       The problem is nobody is watching. Because of the nature of 
     the system, I was able to do what I did. The system is 
     extremely easy to evade. The forms I sent in were absolutely 
     outrageous. I was astounded when some of the payments were 
     actually made.

  This is a physician/convicted felon testifying as an expert witness 
before the Senate Aging Committee.
  Well, we did not learn very much from this doctor's testimony, 
because now, 13 years later, he allegedly is up to his old tricks. 
Several months ago, he was arrested by FBI agents in Philadelphia and 
once again he was charged with defrauding health insurers for millions 
of dollars by filing claims for procedures that were never performed. 
Bail was set at $2 million, and apparently he is currently awaiting 
trial.
  I raise this point because, according to the U.S. attorney in 
Philadelphia, since 1974 this physician has had a total of seven 
arrests and five convictions for fraud in New York, Connecticut, and 
Texas. And despite his record, 4 years ago he was able to get his 
Pennsylvania physician's license reinstated, and he might still be in 
business today if a former patient who was angry about the false 
billings had not agreed to go undercover.
  But I raise all of this late this afternoon, early evening, to point 
out that we have been dealing with this issue over and over again. That 
was in 1981. In 1994, we still do not have the kind of antifraud 
legislation that is desperately needed. And here we are this evening 
waiting to see whether someone is going to raise a point of order to 
say this is either not germane or it violates the Budget Act because it 
may cost a couple of million to implement, when in fact we are losing 
$100 billion a year.
  Explain that one to the American people. We are losing $100 billion a 
year and yet we are standing here paralyzed and do not know whether to 
take action or not.
  No one wants to put it on the crime bill. It does not belong on the 
crime bill. Where does it belong? We have Government people engaging in 
fraudulent criminal activities, but we cannot put it on the crime bill. 
They dropped it out of the crime bill.
  We cannot put it on Health and Human Services appropriations. That is 
not appropriate. We cannot put it on the health care reform bill. We do 
not have a bill.
  So here we are looking for some vehicle to say, ``Can't we take one 
large step on behalf of the American taxpayers and at least try to stop 
the overt, outrageous forms of abuse with measures that the Justice 
Department would like to see, that the FBI would like to see, that 
attorney generals would like to see, that President Clinton would like 
to see, that Senator Mitchell would like to see, that Senator Dole 
would like to see.'' And we all agree.
  I am still waiting here this afternoon for someone to say, ``Well, 
there might be a point of order or some technicality that we don't want 
to vote on this.''
  So I hope in the next several minutes, perhaps the next hour, or 
within the hour, someone will either raise the objection so we can vote 
or express the sentiment that we ought to pass this unanimously and let 
it go to the House.
  I am told that, even if we pass this measure, it will be stripped out 
by the House of Representatives. Well, if that is the case, so be it. 
At least the Senate will go on record as saying we need this 
legislation. If the House of Representatives once again wants to take 
it out, as they took it out of the crime bill, let them do it. If they 
want to strip it out of this bill, let them do it again and be 
accountable to the American people.
  I know a great deal has been raised about the Contract with America, 
with a group of Republicans who say if we are elected and being allowed 
to occupy the majority position in the House we will do the following 
things. And that has been attacked and criticized by a number of 
editorial observers.
  But I must say, aside from their criticism, this is one thing we can 
all agree on. Republicans and Democrats alike, we can all agree. This 
is an issue we have not measured up to meeting. This is an issue which 
there is no disagreement upon. This is an issue which ought to have 
overwhelming support in both Houses.
  But, we are told, ``Wait until next year.'' We were told that last 
year. I introduced a bill over a year ago. A loss of $100 billion again 
last year. We have lost $85 billion this year so far and counting.
  So, Madam President, just think of those numbers. I keep repeating 
them over and over again--$100 billion a year. That is $275 million a 
day, $11.5 million an hour. That is what is going out in fraud and 
abuse.
  So we have an opportunity to pass legislation which will give the 
tools to our Justice Department and to our enforcement agencies to say 
we are going to do our level best to stop this. They are certainly 
overwhelmed with cases, as I mentioned earlier this afternoon--one 
full-time investigator for every 8 million claims.
  But, Madam President, this legislation will give some measure of hope 
to those who are charged with investigating these claims, some measure 
of hope that they will have added resources; that the fines and the 
penalties and forfeitures will go into a working fund and these funds 
distribution will be decided upon by both the Attorney General and the 
Secretary of HHS. No bounty hunting here. That is what some are worried 
about, that we are going to set up a bounty-hunting mechanism. This is 
just something that the Department of Justice and the Department of 
Health and Human Services will agree upon, to put the fines and 
forfeitures into a working account to expand the ability of these 
agencies to oversee the millions and millions of claims they are 
required to process.
  So I hope that whoever has reservations about this will come to the 
floor and express them. And if a point of order is to be raised, we 
will have an opportunity to vote on that point of order. And if there 
are no points of order to be raised, that we go forward and take up 
other amendments.
  I hope we can do that certainly within the hour.
  Mr. BURNS. Madam President, will the Senator yield for a question?
  Mr. COHEN. I yield to the Senator from Montana.
  Mr. BURNS. I say to the Senator, the last time I was home, we were 
talking to some people who offered specialty services in the health 
care system, like physical therapists. It was their idea that, maybe in 
our certification and licensing of those people, we could do ourselves 
a big favor by tightening down those rules of certification and 
licensing, because they feel that it is too easy for some people to get 
into the field--and I think this is with all specialty fields--that 
there has to be something, a code of ethics or something, that goes 
along with this licensing and this certification.
  Did the Senator find that in his hearings? Because I know he has held 
extensive hearings with regard to this.
  Mr. COHEN. What we did find was that in a number of cases people who 
are untrained and unqualified to be delivering services are in fact 
being hired and their services are being billed out at professional 
rates.
  So, indeed there has to be some tightening up at the State level. We 
are not seeking to impose Federal standards. This is something the 
State historically has regulated and should continue to regulate; that 
is, the licensing of individuals who qualify for these various 
specialties.
  But it seems to me that is one of the classic cases of abuses where 
those who are engaged in these scams will hire individuals who are not 
properly trained. They put at risk the very people who are receiving 
some of these services. And they are being billed out at the highest 
possible professional rates. So that is another aspect of the type of 
scamming that is going on.
  Mr. BURNS. I thank the Senator.
  Mr. COHEN. Madam President, I do not see others who are rushing to go 
the floor to debate this particular matter.
  I yield the floor for the moment.
  Mr. DOMENICI. Madam President, before the Senator yields the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Senator, might I first tell you that I appreciate your 
permitting me to be an original cosponsor of the amendment. Frankly, I 
compliment you wholeheartedly for what you are doing.
  Actually, I think frequently we get so busy with ideas of reforming 
the system and changing everything that we forget that standing right 
in front of us stark visible is fraud and gaming of this health care 
system. I do not think we really have to wait around to do that. I 
think now is the time.
  Everybody knows that with the best of commitments--and I understand 
there are commitments from both sides of the aisle to start up again 
next year, hopefully in a more bipartisan way and perhaps without such 
an ambiguous agenda on reform, that we might get something done.
  But, why should we wait? As I understand it, the fraud and abuse and 
gaming of this system is so incredibly big that the sooner we get 
started the sooner we are going to save some money.
  Frankly, it is not going to work in 1 month or 1 year, or maybe even 
2 years. So why do we want to put that off? We are worried about the 
excessive costs in the health care delivery system. Whatever those 
excessive costs are pushed by and caused by, we ought to try to fix. If 
the numbers that the Senator has received in his indepth testimony and 
hearings are anywhere close to right, one of the big reasons inflation 
is so high in the health care delivery systems is because of the gaming 
and fraud and abuse.
  As a matter of fact, the Senator knows, as I understand it--he and I 
have spoken to this on the floor--one of the big reasons we started 
health care reform--while everybody now thinks it is a health care 
reform motivated by covering everybody, by so-called ``when do we get 
to universality?'' Actually the prime reason 12 years ago, in this most 
current episode that we started talking about reform, was because of 
the excessive cost. In fact it was the single pillar prompting and 
promoting reform for a long time.
  Why is it 12 and 14 percent a year when inflation is 4? Why was it 16 
when inflation was 6; going right through the roof? That was the 
predicate for reform. Now we have added some reasons, clearly, for 
reform. But this is one that contributes to that very first pillar, 
that you cannot keep delivering health care with current excessive 
annual increases in costs. Why we would not do this is beyond me, and 
perhaps the Senator has explained why we would not do it. But maybe he 
might tell me one more time, what is the trepidation or hangup on 
adopting something as simple as this?
  Mr. COHEN. Madam President, if the Senator will yield, let me give my 
explanation as to what has taken place. First of all, we were told that 
this antifraud amendment--which, ironically, everybody is for, from the 
President to the majority and minority leaders and virtually everybody 
in this Chamber--should not go on the crime bill. I attached a portion 
of it to the crime bill. I attached Title 18, Criminal Sanctions, to 
the crime bill by unanimous consent. Nobody disagreed with it. It went 
over to the House and they stripped it out saying we have to wait until 
the health care bill comes out because we will use this to pay for the 
health care bill. So the savings that would be realized from this, $100 
billion, we continue to lose on an annual basis.
  Then they are saying that would pay for this expansive health care 
reform package when it comes to the floor, so take it out of the crime 
bill and wait until the health care reform comes and we will deal with 
it there. Then we are at a situation where we do not have a health care 
reform bill, and we are not going to get a bill until next year. The 
question is, ``Should we wait another year?'' And we begin, not in 
January, perhaps late February or early March. We start the hearings 
all over again with new bills being introduced. We go through the 
Finance Committee, we go through all the other committees, we come to 
the floor, we debate. There will be great debate as to which approach 
is the better approach. We will go to the House. The House will do the 
same thing. And finally we will come back here, I suspect, in September 
of next year, and maybe, just maybe we might have a health care reform 
bill at that time. But in the meantime we are going to be out another 
$100 billion.
  What is happening, and the reason the costs are going up, as my 
colleague pointed out so dramatically, at the rate of 14 percent as 
opposed to 3 or 4 percent, is that hospitals and others that are 
providing services and equipment are covering their costs. They are 
covering the costs they are losing by padding the bills to make up for 
the fraud. I used this example yesterday and again today. A woman from 
Maine who had a slight cut required really not more than a Band-Aid. 
She got this 6- by 8-inch transparent dressing. She used 14 of them. 
The cost should have been $40. The cost ultimately billed for Medicare 
to pay was $2,800. So it went from a $40 cost to $2,800. It was 
actually higher than that because there were additional gels and 
supplies sent to this woman, totaling $3,700, almost $3,800 for a cut 
less than an inch long. So somebody is picking up these costs and the 
people who are picking it up are the taxpayers in the form of their 
Medicare costs or Medicaid costs and also in their private insurance 
costs.
  To give a couple of other examples. Two New York durable medical 
equipment suppliers stole $1.4 million from the New York State Medicaid 
program by repeatedly billing for expensive orthotic back supports that 
were never prescribed by physicians. The DME sales force used an 
aggressive personal solicitation and telemarketing campaign offering--
think about this--``free Angora underwear to Russian immigrants in 
Brooklyn in exchange for their Medicaid ID numbers.'' The State was 
then charged for the costly medical supplies that were never authorized 
by doctors and only rarely, if ever, delivered to the patients. And as 
described, these Angora underwear solicitations were again used as an 
inducement to obtain beneficiaries' Medicare numbers. They are offering 
Angora benefits to Russian immigrants to get their ID numbers so they 
can bill Medicaid for services never rendered or goods never supplied. 
It is an outrage, what is taking place.
  The Justice Department, to prosecute these cases successfully, has to 
use mail fraud and wire fraud statutes. It is complicated. They would 
like to have a nice, clean piece of legislation saying we can go after 
these people, and we can penalize heavily those who engage in 
fraudulent behavior. So I say to myself, why is it taking us so long to 
do this? As I mentioned before, in 1981 we went looking for expert 
testimony to describe how easy it is to rip off the system. We called 
upon a physician who had an impeccable record, so to speak. He not only 
was a prominent physician, he was also a convicted felon. He came and 
testified before our Aging committee and said it was so simple. He was 
astonished it was so simple. He could not believe they actually 
reimbursed him for things which he never provided.''
  We sat back in astonishment. Guess what? Madam President, 13 years 
later he is back out there doing it again. He got reinstated, and he 
was just recently arrested and charged with fraud and more felonies. He 
is now being held on $2 million bail.
  We can stand here and wait and raise points of order and say it does 
not belong here, it does not belong on appropriations bills, it does 
not belong on Health and Human Services appropriations, it does not 
belong on the crime bill; it belongs on health care reform--but we do 
not have a health care reform bill. In the meantime, the losers are the 
American taxpayers.
  Madam President, I hope at some point this evening we will have a 
chance to either vote on this measure up or down. If a point of order 
is raised, then we will vote on the point of order. But I hope my 
colleagues would see, not the wisdom, but just the practicality just 
the plain common sense of doing something to combat fraud. Which is not 
to say it is a panacea--that if we pass the legislation, we will save 
$100 billion. We will never catch all the fraud. But if we got 10 
percent or 20 percent or a third or even 50 percent, that would be $50 
billion we could use to help cover the people who are currently going 
uninsured.
  We have 37 million people who have no insurance. We want to cover 
them. We could do that if we had mechanisms in place that would cut 
down on the kinds of outlandish, overt, preposterous schemes that are 
inflicted upon us day after day. And we sit back here and say we have 
these technical provisions here. It may violate the jurisdiction of the 
Finance Committee. It may trespass upon the sensibilities of the House 
Ways and Means Committee. Judiciary really has a piece of the 
jurisdictional action here in both Houses. And we bounce this ball back 
and forth, back and forth. The American people look at us and say, 
``What are they doing? What in the world are they doing? Fiddling, 
while Medicaid and Medicare burn up with higher and higher costs. And 
private health insurance continues to escalate to the point where 
employers are canceling their policies for their employees, throwing 
more and more of them into the rolls of the uninsured.'' But we sit 
here or have extended quorums, waiting for someone to raise a technical 
point of order saying: We cannot do it this year. Next year we will be 
back and we will be out another $100 billion.
  Madam President, I see there are others on the floor who perhaps wish 
to seek recognition and I now yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.


                Amendment No. 2595 to amendment No. 2594

 (Purpose: To disqualify Members of Congress from participating in the 
  Federal Employee Health Benefits Program and chapter 89 of title 5, 
                          United States Code.)

  Mr. WOFFORD. Madam President, I would like to introduce a second-
degree amendment and send it to the desk, to be added at the end of 
Senator Cohen's amendment, and ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Pennsylvania [Mr. Wofford] proposes an 
     amendment numbered 2595 to amendment No. 2594.

  The amendment is as follows:

       At the end of the pending amendment, add the following new 
     section:

     SEC.   . DISQUALIFICATION OF MEMBERS OF CONGRESS FROM 
                   PARTICIPATING IN THE FEDERAL EMPLOYEE HEALTH 
                   BENEFITS PROGRAM.

       (a) Findings.--The Congress finds that--
       (1) the Congress has failed to enact legislation that 
     extends health insurance to all Americans and reduces 
     inflation in health care costs;
       (2) Members of Congress may obtain health insurance through 
     the Federal Employees Health Benefits Program, which provides 
     Members of Congress with guaranteed and affordable private 
     health insurance, choice of health plans and choice of 
     doctor, and no exclusions for preexisting medical conditions; 
     and
       (3) Members of Congress currently receive on average a 72 
     percent contribution of their health insurance premiums from 
     their employer, the taxpayers.
       (b) Purpose.--The purpose of this section is to provide 
     that Members of Congress shall not obtain taxpayer-financed 
     health insurance under the favorable conditions established 
     through the Federal Employees Health Benefits Program unless 
     Congress enacts health reform legislation that gives the 
     American people the type of affordable, guaranteed health 
     insurance that Members of Congress have provided for 
     themselves.
       (c) Limitation on Federal Employee Health Benefits Plan 
     Coverage for Members of Congress.--Effective on January 1, 
     1995.--
       (1) the Office of Personnel Management shall--
       (A) terminate the enrollment of any Member of Congress in a 
     health benefits plan under chapter 89 of title 5, United 
     States Code; and
       (B) prohibit the original enrollment, re-enrollment, or 
     change of enrollment of any Member of Congress in such a 
     plan; and
       (2) The Secretary of the Senate and the Clerk of the House 
     of Representatives shall cease making applicable employee 
     withholdings and Government contributions under section 8906 
     of title 5, United States Code, for any Member of Congress.
       (d) Continued Coverage.--A Member of Congress who is 
     enrolled in a health benefits plan under chapter 89 of title 
     5, United States Code, on December 31, 1994, may receive 
     continued coverage under section 8905a of such title.

  Mr. COHEN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Pennsylvania has the floor.
  Mr. COHEN. I believe he lost the floor in sending his amendment to 
the desk.
  The PRESIDING OFFICER. The Senator from Maine.
  Mr. COHEN. I thank the Chair.
  Madam President, I think this is an example of what is wrong with 
this system. Here we have pending an amendment which I was told was 
going to be either voted upon, in the way of a point of order being 
lodged against it, or accepted. Now the Senator from Pennsylvania has 
introduced a health care amendment which, if not so designed, will, in 
fact, result in killing any vote on something that he and everybody 
else ought to be in favor of. So I suppose at this particular point we 
can take the rest of the evening to talk about another health care 
bill. We have lots of them. We have the mainstream health care proposal 
that we can introduce this evening. We have Senator Dole's health care 
proposal. We have Senator Gramm's health care proposal. All of those 
can be debated. But this particular amendment now being attached to the 
amendment addressing fraud is really going to, for all practical 
purposes, end the debate for this evening and perhaps into the rest of 
tomorrow and beyond.
  I do not question the motivation of the Senator from Pennsylvania. I 
know he has felt strongly about treating Members of Congress the same 
as the public is treated with respect to its health care. But I might 
respectfully suggest that this is going to result in ``no'' vote coming 
on the health care fraud amendment, which is supported by everybody.
  So I think it ought to be known to all the people who are watching 
and all the people who are engaged in their races, that while we had an 
opportunity to talk about eliminating fraud that is costing the 
American people $100 billion a year, in all likelihood that is not 
going to take place now as a result of the Senator's offering his 
amendment to this particular piece of legislation.
  I do not believe that was his intent. That is the result. Once again, 
this Chamber will be deprived of an opportunity to vote in favor of 
something that everyone agrees with and we will, instead, take up the 
rest of the evening and perhaps tomorrow debating health care reform, 
the proposal of the Senator from Pennsylvania. So I must say I regret 
he has chosen to attach his amendment to the pending amendment. It is 
certainly within his right. But the ultimate consequence is while 
Members at least would have an opportunity to vote on reforming our 
fraudulent system now, the health care fraud provisions which I believe 
would have been accepted by an overwhelming if not unanimous vote of 
the U.S. Senate, we will no longer have a chance to do that.
  I regret that he has chosen to proceed with his amendment on this 
one. He has a perfect right to do that. I certainly will carry this 
message to whoever will listen, whether in Maine, Pennsylvania, or 
California, that once again Congress has ducked the opportunity to 
eliminate fraudulent practices which are robbing us blind and bleeding 
us dry.
  We will not have an opportunity to vote on that for the balance of 
this session, because there are many people on this side of the aisle 
who have their own health care proposals. I was one of those who worked 
with the Senator from Pennsylvania--who became part of the mainstream 
coalition--who was seeking a way to come up with health care 
legislation that all of us could support or most of us could support, 
we were not able to do that. We were not able to do that. We were not 
able to do that. But I must say there was no disagreement on this 
amendment and I think it is regrettable that we will not have a chance 
to do that.
  With that, Madam Chairman, I will yield the floor to the Senator from 
Pennsylvania. He can proceed as he sees fit. But I must say I am 
disappointed that we will not have a chance to vote on the antifraud 
provisions that are contained in my amendment.
  (Mr. WOFFORD addressed the Chair.)
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. WOFFORD. I thank the Senator from Maine. I look forward to voting 
in support of his amendment. I trust we will move to his amendment. It 
will have my full and strong support.
  I am introducing this second-degree amendment for the same reason 
that he took this opportunity to present his amendment; namely, that 
the opportunities for action are running out and I would like to put 
forth the case for my amendment. We will look at the procedure as we go 
forward. I want to put this amendment forth clearly and strongly to my 
colleagues and to the country, and I look forward in due course to 
supporting Senator Cohen's amendment with enthusiasm.
  Mr. President, like most Americans, I am angry with Washington's 
petty partisanship and special interest gridlock. I'm not interested in 
the debate over who killed health reform this year. This issue was 
brought to life by people and killed by politics. Special interests 
spent it to death, and Congress talked it to death.
  But I know health care will rise again. Because for families and 
companies who are paying more and getting less each year, the need for 
action will not fade away. The need will only grow.
  Luckily, there are many Democrats and Republicans of good will, 
including the Senator for Maine, and the majority leader from Maine, 
who share the goal of affordable private health insurance for all 
Americans, and have made their own serious effort to reach it. I hope 
that we will pick up those efforts right where we left off when 
Congress returns.
  For the past 2 years, I have been reaching out across the aisle, 
working with colleagues in both parties to craft a commonsense health 
reform bill that would provide all Americans with the kind of 
affordable coverage and choice of private health plans that Members of 
Congress now have. Not Government-run health care, but private health 
insurance choices, built on what people like best about our current 
health system.
  I have talked about how that first inadequate step that we took back 
in 1957 on the long march toward full civil rights for black Americans 
is an analogy for the kind of first step we could take this year toward 
affordable private health coverage for all Americans. Today, more than 
ever, I am determined to find the way to move forward. Not only here in 
Congress, but in States and communities across the country. Because 
health reform has to go forward, with or without Washington.
  On this front, here in Congress, I have repeatedly said, on this 
floor and around the country, that it is wrong for Members of Congress 
to block other Americans from having the same kind of affordable 
coverage and choice of private plans that the taxpayers provide to 
Members of Congress. So now it is time for Members of Congress to 
support the plan they live under, or live under the plan they support.
  Today I am introducing an amendment that turns that commonsense 
proposition into a reality. I know it will not be popular in these 
Chambers. I was not popular when I introduced the bill to end the free 
care that Members used to get from the attending physician. But we did 
it, because it was the right thing to do.
  Under my proposal, Members of Congress will lose their taxpayer-
financed health care benefits effective January 1, 1995.
  Private citizens who lose their health insurance when they lose a job 
can get something called COBRA coverage that allows them to keep their 
current coverage for up to 18 months by paying for it themselves. 
Members of Congress will be in the same boat under this proposal. But 
the American taxpayers will no longer pick up 72 percent of the bill as 
they do now. Congress Members will have to pay the entire cost of their 
health insurance, as I have been doing for the last few months myself.
  Translated into dollars and cents this amendment means that for 
Members of Congress who choose the standard Blue Cross family coverage, 
the taxpayers will no longer pay the monthly $303.75 employer 
contribution. Instead of only $101.25, Members will have to pay the 
full $405 premium themselves. After 18 months, if Congress still has 
not been able to agree on real reform, Members of Congress will be 
dropped from the Federal employee plan entirely. They will no longer 
enjoy the choices, the cost savings, and the consumer protections that 
come from being part of a large group plan. They will have to either 
purchase their own insurance with no help from their employer or go 
without.
  It may be a hardship. I know. That is exactly what happens to million 
of other Americans every single day; no more, no less.
  If Members of Congress want more time to study, as some claim, let us 
study what it is like to be a middle-class American, caught up in the 
health care mess. Let us find out just how difficult it is to pay for 
health insurance if your employer does not contribute a fair share. Let 
us experience what it is like to find a decent health plan without the 
help of our employer. Because that is the worry facing more and more 
Americans every day.
  There are Members of Congress who say that doing nothing on health 
care will not hurt them a bit; who have celebrated their success at 
blocking action. I hope this amendment will help in some small way to 
show them that there is noting to celebrate. Not for the American 
people, not for us.
  Doing nothing about that may not hurt some special interests, but it 
sure hurts the public interest. Health care delay is health care 
denied.
  When the Senate floor debate began this past summer, I quoted Abraham 
Lincoln who said ``We cannot escape history. We of this Congress and 
this administration will be remembered in spite of ourselves.'' But 
whether we will together rise to the occasion; or fall, divided and 
defeated, remains very much in doubt. That is what I said then.
  I would like to believe that in the days and nights ahead we will be 
guided as Lincoln put it, ``by the better angels of our natures,'' that 
those watching us will witness self-government, not civil war. Because 
this debate is not about politics. It is about people's lives. That is 
what I said then.
  Well now, one thing is for sure. This Congress will be remembered. 
Not for being angels, though.
  Mr. President, I hoped I would never have to introduce this 
amendment. I did not come to the Senate to take away the health 
benefits of Members of Congress. I came to help see to it that the 
American people would finally be guaranteed the same kind of benefits 
for themselves that we have: a choice of affordable private health 
insurance plans. But until we act, American families will continue to 
have a health insurance maze in which the insurance companies make all 
the rules, while people fall through the loopholes and get caught in 
the fine print.
  Until we act, health care costs will continue to rise out of control, 
putting an ever greater strain on businesses and devouring an ever-
greater share of Federal, State, and local tax dollars, and family 
budgets.
  Until we act, Americans will continue to suffer and die from diseases 
that could have been prevented or cured, if only they had been treated 
sooner.
  Until we act, America will keep the distinction of being the only 
industrialized nation in the world, besides South Africa, that does not 
guarantee its citizens the right to see a doctor when they are sick.
  And until a new Congress does stand up to special interests, and 
rises above partisan interests to turn that right to see a doctor when 
you are sick into a reality, we should not be taking from the American 
people what we cannot guarantee for the American people.
  Madam President, I would like to ask unanimous consent to add Senator 
Lautenberg as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WOFFORD. I yield to Senator Domenici.
  (Mr. DOMENICI addressed the Chair.)
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Could I just discuss with you for a moment what we have 
been discussing here?
  Senator Boren and I have an amendment that we want to offer which is 
essentially the sum total of the recommendations of the Joint Committee 
on Congressional Reform encapsulated in one piece of legislation, and 
we do not find any other way to offer this amendment before we close 
the session other than to offer it as an amendment in disagreement on 
this bill, and to do that, I understand you are not necessarily in any 
hurry to have your amendment reach the point of disposition, and I 
understand our friend from Maine has no objection to us proceeding to 
consider this amendment that I have described, so with that in mind----
  Mr. COHEN. Reserving the right to object, but am I correct that the 
Senator from Pennsylvania would have every opportunity to offer his 
amendment to any of the amendments in disagreement that come before the 
Senate on the District of Columbia appropriations bill?
  Mr. DOMENICI. We would have to ask the Chair. I understand there are 
still amendments in disagreement available for further amending?
  The PRESIDING OFFICER. That's correct.
  Mr. DOMENICI. Parliamentary inquiry. Are there not other amendments 
in disagreement, aside from the one that Senator Cohen has amended?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. COHEN. I simply wanted to point out to my friends from 
Pennsylvania and New Mexico that the Senator from Pennsylvania has now 
introduced a controversial amendment to a noncontroversial amendment 
dealing with health care fraud, and as a result of that particular 
process, thereby jeopardized the vote that I thought we were about to 
have momentarily on health care fraud.
  So now we have something that virtually everybody agreed to and, upon 
being amended with a controversial amendment, that will take perhaps 
several hours, if not days, can now be opened up by others who have 
their own health care proposals.
  So I would appeal to my colleague from Pennsylvania that this was not 
the only opportunity for the Senator to offer an amendment. The Senator 
is within his rights. But I respectfully suggest to him that he has at 
least jeopardized the opportunity for the Senate to go on record to try 
to persuade our House colleagues that we ought to pass health care 
fraud provisions now as opposed to encumbering that with a very 
controversial proposal of the Senator's which could in fact be attached 
to any of the other amendments in disagreement on the D.C. 
appropriations bill. So I would hope that if we agree to set aside our 
amendments, the Senator might take that into consideration.
  Mr. WOFFORD. Madam President, I am fully agreeable to what Senator 
Domenici has proposed in terms of his moving forward now. I look 
forward to talking with the Senator from Maine about the procedure. My 
case is a simple one. It has been made. I have no reason to think there 
will be a long debate on the amendment, whether it is controversial or 
not. I look forward very much to supporting the amendment of the 
Senator from Maine.
  Mr. BYRD addressed the Chair.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. BYRD. Who has the floor?
  The PRESIDING OFFICER. The Senator from Pennsylvania had the floor.
  Mr. BYRD. Will the Senator yield?
  Mr. WOFFORD. I yield the floor to the President pro tempore.
  Mr. BYRD. Will the Senator yield without losing his right to the 
floor while I might make one more parliamentary inquiry and help to 
propound the request, without losing his right?
  Mr. WOFFORD. I do.
  Mr. BYRD. Madam President, is there an amendment pending to the first 
amendment in disagreement, the amendment by Mr. Gramm?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BYRD. Is there an amendment pending to the second amendment in 
disagreement?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BYRD. And is the amendment pending to the second amendment in 
disagreement the amendment by Mr. Wofford?
  The PRESIDING OFFICER. The amendment by the Senator from Maine, as 
amended by the Senator from Pennsylvania, is the amendment to the 
second amendment in disagreement.
  Mr. BYRD. I thank the Chair. Is there any amendment pending to the 
third amendment in disagreement?
  The PRESIDING OFFICER. No, there is no amendment pending to the third 
amendment in disagreement that is Senate amendment numbered 12.
  Mr. BYRD. Are there eight amendments in disagreement between the two 
Houses?
  The PRESIDING OFFICER. That is correct.
  Mr. BYRD. I ask unanimous consent that the distinguished Senator from 
New Mexico may be permitted to offer an amendment at this point to the 
third amendment in disagreement, and only for the purpose of offering 
the amendment, but that such action not suspend action on the previous 
two amendments in disagreement.
  The PRESIDING OFFICER. Is there objection?
  Mr. BYRD. The purpose being only to let the Senator offer his 
amendment. There are eight amendments in disagreement. At some point he 
will offer his amendment to one of those amendments. He wants to offer 
the amendment tonight, not debate it but just have it in line when the 
other amendments are disposed of.
  Mr. DOMENICI. Reserving the right to object, and I greatly appreciate 
the distinguished chairman of the Appropriations Committee offering the 
unanimous-consent proposal in my behalf, let me say to Senator Byrd I 
thought I had already worked out with the Senator from Pennsylvania, by 
talking to his staff at length, and Senator Cohen, I had already worked 
out an arrangement where a consent would be granted that I offer the 
amendment and that theirs be set aside temporarily. So not only would 
the amendment of the Senator from New Mexico be pending, be in order 
but it would be pending. I think they would agree to that, and I would 
like to propound that unanimous consent in lieu of the Senator's.
  Mr. BYRD. Very well. That is agreeable with me. I did not realize 
they were willing.
  Mr. COHEN. Reserving the right to object----
  Mr. WOFFORD. That is correct.
  The PRESIDING OFFICER. The Senator from Maine.
  Mr. COHEN. I hope that the Senator from West Virginia would withhold 
his unanimous-consent request, as well as the Senator from New Mexico, 
for a moment.
  Mr. BYRD. Madam President, I withdraw my request.
  Mr. DOMENICI. And I withhold mine.
  Mr. COHEN. I wish to have an opportunity to suggest the absence of a 
quorum. I think we may be able to resolve this issue so we will not run 
into a conflict with the proposal.
  The PRESIDING OFFICER. The absence of a quorum has been suggested. 
The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BYRD. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BYRD. Madam President, I ask unanimous consent that the pending 
amendments be temporarily laid aside for the purpose only of allowing 
the Senator from New Mexico [Mr. Domenici] to call up an amendment and 
Mr. Boren to call up an amendment to the Domenici amendment; that both 
amendments be considered as read, printed, and no debate thereon occur 
tonight.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


     amendment in disagreement to the senate amendment numbered 12

  The PRESIDING OFFICER. The pending question is Senate amendment 12, 
which the clerk will report.
  The bill clerk read as follows:

       Resolved, That the House recede from its disagreement to 
     the amendment of the Senate numbered 12 to the aforesaid 
     bill, and concur therein with an amendment as follows:
       In lieu of the matter stricken and inserted by said 
     amendment, insert: ``forecast which shall be supported and 
     accompanied by cash forecasts for the general fund and each 
     of the District government's other funds other than the 
     capital projects fund and trust and agency funds.''.


amendment no. 2596 to amendment in disagreement to the Senate Amendment 
                              Numbered 12.

 (Purpose: To improve the operations of the legislative branch of the 
              Federal Government, and for other purposes)

  Mr. DOMENICI. Madam President, I send an amendment to the desk and 
ask for its immediate consideration.
  I think a unanimous consent agreement has already been granted that 
it be considered as read.
  The PRESIDING OFFICER. The clerk will report the amendment by number.
  The bill clerk read as follows:

       The Senator from New Mexico [Mr. Domenici] proposes an 
     amendment numbered 2596 to the amendment in disagreement to 
     the Senate amendment numbered 12.

  The text of the amendment is printed in today's Record under 
``Amendments Submitted.''


                Amendment No. 2597 to amendment no. 2596

 (Purpose: To improve the operations of the legislative branch of the 
              Federal Government, and for other purposes)

  Mr. BOREN. Madam President, I send an amendment in the nature of a 
second-degree amendment to the desk and ask for its immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows.

       The Senator from Oklahoma [Mr. Boren] proposes an amendment 
     numbered 2597 to amendment numbered 2596.

  The text of the amendment is printed in today's Record under 
``Amendments Submitted.''
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Madam President, I thank Senator Byrd for his 
assistance here tonight and I thank Senator Wofford and Senator Cohen 
for their consideration. I apologize for having made their evening a 
little longer than it should have been.
  I yield the floor.
  The PRESIDING OFFICER. Who seeks recognition?
  Mr. BYRD. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The absence of a quorum has been suggested. 
The clerk will call the roll.
  Mr. KOHL. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


         gramm amendment to the third amendment in disagreement

  Mr. DURENBERGER. Mr. President, I rise to explain why I will oppose 
the amendment offered by my distinguished colleague from Texas, Senator 
Gramm.
  Last August, I cast certain procedural votes on the crime bill 
conference report that were designed to allow the consideration of 10 
different Republican amendments. This did not mean that I agreed with 
the substance of these amendments; it meant only that I believed more 
bipartisan input should be injected into the process.
  Republicans did not get a chance to offer these amendments during 
consideration of the conference report, so the 10 proposals have 
returned as 1 consolidated amendment to this appropriations bill. I 
must go on record opposed to this amendment for three reasons.
  First, this amendment would strike a provision--the Family Unity 
Demonstration Project Act--which is based on a bill I introduced last 
year. This bill would authorize demonstration projects that would allow 
nonviolent incarcerated mothers to serve their sentences in supervised 
community programs with their children.
  Children who are separated from incarcerated parents have a high risk 
of developing social and emotional problems, of dropping out of school, 
and of becoming criminals themselves. Family unity demonstration 
projects will minimize the trauma to children and place them in a 
stable, caring, healthy environment. The parents will participate in 
parenting classes, substance abuse treatment, and educational and 
vocational training.
  In addition to being more cost-effective than incarceration and 
saving the costs of foster care placement, these programs produce 
results. In communities that have tried this approach, the participants 
have been much less likely to repeat their crimes and more likely to 
emerge as better parents and productive members of society. Unlike many 
of the provisions in the crime bill. I believe that this proposal will 
be an effective tool in the war on crime.
  Second, I am opposed to this amendment because of its expansion of 
mandatory minimum penalties. The consensus in the judicial community is 
that mandatory minimum sentences are terrible policy. In many cases, 
they have swelled our prison population with people who aren't a threat 
to the community and who would probably do better in an alternative to 
incarceration.
  Mandatory minimum sentences have not succeeded in reducing crime, and 
in many cases have reduced the prospects for rehabilitation. Our 
increasing use of incarceration for first-time, nonviolent offenders 
has done little more than create more hardened criminals at the 
taxpayer's expense.
  Few people have more experience dealing with criminals than judges. 
But mandatory minimums take away the ability of judges to do their 
job--to make the punishment fit the crime. They do not allow judges to 
take factors into account like the offender's age, role in the offense, 
or prospects for rehabilitation.
  Finally, I am concerned that this amendment would allow less 
flexibility for States who apply for prison funding. The crime problem 
is intensely local; I believe that States are more capable than 
Washington politicians to craft their own sentencing policy and 
determine the most effective use of prison dollars.
  For all of these reasons, I intend to vote against this amendment.

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