[Congressional Record Volume 141, Number 88 (Thursday, May 25, 1995)]
[House]
[Pages H5581-H5584]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    APPOINTMENT OF CONFEREES ON H.R. 483, MEDICARE SELECT EXPANSION

  Mr. STARK. Mr. Speaker, we have heard today about ideas and proposals 
being proposed. But these same proponents of these ideas have put forth 
a budget that destroys children in this country, destroys clean air, 
destroys safe water, reduces law enforcement, all in the name of 
providing tax cuts to the rich. All I can say is, please leave our 
seniors alone.
  The gentleman who preceded me a few speakers ago in the well, who 
chairs the Subcommittee on Health and the Environment of the Committee 
on Commerce, has already cut $84 billion out of the trust fund for 
Medicare just to give tax cuts to the very rich. Do not help us 
anymore, Mr. Chairman. You have done enough harm already.
  Medicare Select is nothing but a political payoff to big insurance 
companies. Prudential Life Insurance Co. has already been convicted of 
stealing billions of dollars from seniors. Golden Rule Insurance Co. is 
under more litigation with State insurance commissioners than any other 
insurance company in the country. The staff who drafted this silly bill 
was paid hundreds of thousands of dollars by the insurance industry 
last year, and they are telling you they are here to help seniors?
  Mr. Speaker, do not believe that. They have already cut $3,000 out of 
seniors' pockets by changing the taxes that they will pay, to pay for 
their silly budget which is designed only to give tax cuts to the rich.
  So, yes, let us balance the budget, let us help kids become healthy, 
let us have education and a clean environment, but do not louse up 
Medicare with silly ideas that are untried, that are just a payoff to 
the major insurance companies in this country, that will do nothing but 
deny medical benefits to the seniors who are already happy with their 
health care. This is free enterprise to pay off Republican campaign 
contributions run amok.
  Mr. BLILEY. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from Connecticut [Mrs. Johnson], the prime author of this 
legislation.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I rise in opposition to 
this motion to instruct conferees. We have 35 days left before this 
program expires. We have 20 legislative days left before this program 
expires.
  The preceding speaker talked about this being a payoff to big 
insurance companies. It is absolutely true that insurance companies are 
in the business of providing insurance, and that people buy insurance 
voluntarily and because they value it, because it gives them some 
security in their lives.
  My interests and my concern is not the insurance companies. My 
interests and my concern are the seniors of America, the people. And 
people who buy Medicare Select policies are getting more health care at 
a lower cost. That is why they buy Medicare Select policies rather than 
some other MediGap policy.
  In some instances the premiums are 40 percent less. If you are living 
on a fixed income, Mr. Speaker, that matters. Not only are the premiums 
less, but they get coverage for annual medicals, sometimes for 
pharmaceuticals, prescription medications, for some vision, some 
dental.
  People are buying these policies voluntarily, and because they offer 
them more at a cheaper price. Our job is not to steer seniors in this 
market. Our job is only to assure that there is a market that offers 
choice.
  The Medicare Select policies are regulated exactly like every other 
MediGap policy. These policies are not out there in the market with any 
less government oversight than any other MediGap policy.
                              {time}  1040

  So let us get on with this conference, let us make sure that this 
option for seniors in America that offers more health care for less 
dollars does not expire, let us try this time to meet our 
responsibilities, to renew the law without a gap.
  Let me just add one other comment. My colleagues on the other side 
have said that we are cutting Medicare, and somehow we should not renew 
this program because we are cutting Medicare.
  Now remember, it is the trustees, that is the Secretary of HHS, the 
Secretary of Labor, other members of the President's Cabinet who are 
saying Medicare is going bankrupt, it goes broke next year. That means 
it takes in less than it is going to pay out and it goes bankrupt, that 
means it eats all of its assets in 6 more years. So it is not the 
Republicans who are saying this. It is the Republicans who are saying 
we are going to do something about it, we are going to protect seniors 
in America, preserve Medicare. Under no, [[Page H5582]] no scenario are 
we cutting spending. In fact, Medicare in the last 7 years for seniors 
in America spent out $844 million. In the next 7 years if we reform 
Medicare to serve seniors it will pay out $1.6 billion, almost twice as 
much.
  So, the figures are simply there. We are going to increase spending 
on Medicare and we are going to increase the amount we spend per 
beneficiary, not only more beneficiaries but per beneficiary, and we 
are going to do it in a way that will provide seniors better quality 
health care.
  Let us not mix debates here. Let us focus this debate on simply 
preserving a right, a choice for seniors in America, preserving their 
access to a plan that offers in the 15 States it is available more 
health care benefits at a lower cost.
  This is only about preserving existing choice for seniors, existing 
access to cost-effective care, and I urge the body, remember, almost 
everyone in this body voted for this bill when it went through, so vote 
against the motion to recommit, to support timely action on behalf of 
America's seniors.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the distinguished 
gentlewoman from Connecticut [Mrs. Kennelly].
  Mrs. KENNELLY. Mr. Speaker, I support providing Medicare 
beneficiaries with more choices, and that is why I worked with the 
previous speaker to back this legislation, the Medicare Select Program. 
It does provide more choice for seniors.
  However, it is absolutely impossible to have this debate this morning 
and talk about choice and not talk about the budget that was recently 
passed on this floor.
  The cold facts are that $283 billion in Medicare reductions were 
contained in that budget and will increase premiums, copayments, and 
deductions, and that will leave seniors with a choice of what they 
spend their money on, their fixed-income money for many of them. That 
budget we passed drastically reduces Medicare reimbursement for doctors 
and hospitals because that is a fact. When you are reducing an increase 
by $283 billion and as more and more doctors become unwilling to accept 
a Medicare assignment, we will reduce choice for seniors. Even though 
Select Medicare that we are talking about today increases the choice, 
the fact of the matter of the budget we recently passed decreases the 
choice.
  Along with this, the budget would also address nursing care coverage. 
Once more, again, seniors will be faced with diminishing choices on how 
to cope with enormous costs.
  I support Medicare Select because it provides more choice. Everybody 
in this body wanted to do this for the seniors. Unfortunately this 
legislation follows on the heels of a budget that could do more to 
limit choices for Medicare beneficiaries than any piece of legislation 
ever passed on this floor.
  So yes, we are talking about two things, but the fact of the matter 
is you cannot be in a vacuum when you talk about Medicare; it is too 
big and too important. And of course we are all going to differ, but 
the fact of the matter is, with the budget, choices will be limited.
  Mr. BLILEY. Mr. Speaker, I yield 4 minutes to the gentleman from 
Texas, Mr. Sam Johnson.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I rise in opposition to this 
motion to instruct. It frankly puts the cart before the horse. This is 
an amendment to the current Medicare Program and wholly inappropriate 
to require the conferees to resolve differences in the context of 
contemplated changes to Medicare.
  We all know the House-passed budget calls for reduction in the rate 
of growth of the Medicare Program. What we do not know, however, is how 
it will be achieved.
  It is interesting to me that the gentleman from Texas [Mr. Doggett] 
showed us a blank chart. You know what? The blank is in the White 
House, not in the House of Representatives.
  The blank chart has been filled up with Republican ideas and I will 
tell you what, before we are through, we are going to have Medicare 
fixed, it is going to be a super program for all our seniors, and we 
are not trying to take away from the seniors. We are trying to help the 
seniors protect the program and make it something that will be viable 
in the future.
  It is interesting also to note that the gentleman from California 
[Mr. Waxman] and the gentleman from Texas [Mr. Doggett] both voted for 
this Medicare Select when it was passed on the floor by overwhelming 
vote. It is interesting to note that the gentleman from Texas [Mr. 
Doggett] has now changed his mind. It makes one wonder how can you have 
convictions on anything and vote on the floor in a different manner.
  Medicare is going broke. I think the gentleman from Florida [Mr. 
Bilirakis] has said that, all our speakers have said it, it is going 
broke in the year 2002, and there is no way that this Government can 
pay anyone over 65 once that trust fund is to zero. The bills will not 
be paid. That is why Medicare needs to be fixed and fixed in a hurry 
and that is our goal, our aim, and it has been transferred to a scare 
tactic for the seniors of this Nation. We are not trying to scare 
anybody, we are just telling you the facts. The President's own people 
reported that Medicare is broke, going broke, and we are going to fix 
it and we are going to make it a system that is viable for all 
Americans, forever I hope.
  I would just like to add that as of October 1994, approximately 
450,000 beneficiaries were enrolled in Medicare Select. While a 
majority are covered through Blue Cross/Blue Shield plans, 
approximately 50 companies offer Medicare Select products. Medicare 
beneficiaries are old and these policies save 10 to 37 percent in 
premiums over traditional fee-for-service MediGap policies. And in 
August 1994, Consumer Reports rated the top MediGap insurance 
nationwide; 8 out of the top rated 15 MediGap plans were Medicare 
Select.
  Failure to pass this legislation will lead to higher premiums for 
enrollees and the potential withdrawal of insurers from the market, 
meaning our seniors in that case would not have a choice of plans.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Michigan [Mr. Stupak].
  Mr. STUPAK. Mr. Speaker, we are here talking about Medicare Select at 
the same time the Republican leadership has passed a bill making 
unprecedented cuts to the Medicare and Medicaid Programs which will 
result in limited access to or complete elimination of rural health 
care. The cuts of $250 billion by the Republicans are the deepest 
spending reductions in the 30-year history of the health industry for 
our senior citizens. In fact, Medicare cuts hurt not just seniors but 
everybody, including our small hospitals.
  Nearly 10 million Medicare beneficiaries live in rural America where 
there is often only a single hospital in the county. These rural 
hospitals tend to be small and serve primarily Medicare patients. 
Significant cuts to the Medicare Program will force many rural 
hospitals to cut back on the services they offer, or they will have to 
turn to the taxpayers for assistance in order to survive.
  Most significantly, these devastating cuts would force many rural 
hospitals to close their doors completely. This would mean that many of 
us will have no hospitals to turn to in a time of medical crisis. 
Medicare Select, coupled with the cuts, will require increasing the 
cost of not just Medicare, but also the Medicare Select policy, or the 
MediGap policy, no matter what we have.
  It is projected that each of the 25 hospitals in my district in 
northern Michigan will lose an average of $746 per Medicare patient in 
the year 2000. Medicare Select will not replace this lost revenue. 
Seniors will be forced to replace the lost revenue.
  Meanwhile, Republicans have already voted to give a $20,000 per year 
tax cut to the wealthiest 1.1 million Americans in this country. That 
is Medicare Select: A select few will benefit while the seniors will 
suffer.
  It is imperative the people of northern Michigan have access to 
quality medical care. That is why I will continue to fight against the 
Medicare Select proposal. I will continue to fight against the 
Republican proposal to cut Medicare and Medicaid which is so 
devastating to Michigan hospitals.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Massachusetts [Mr. Markey].
  Mr. MARKEY. Mr. Speaker, I am very glad that the gentleman from 
Michigan has brought this resolution out on the floor, because it is 
absolutely timely for us to discuss this very [[Page H5583]] central 
issue. The Republicans are proposing 300 billion dollars' worth of tax 
cuts, mostly for the wealthy. And they are proposing 300 billion 
dollars' worth of reductions in Medicare, largely for the 83 percent of 
the elderly who have $25,000 or less income per year.
  Three hundred billion dollars' worth of tax cuts for the wealthy, 300 
billion dollars' worth of cuts in Medicare over the next 7 years. Now 
you do not have to be Dick Tracy to figure out that the elderly are 
going to be paying for the tax cuts of the rich.
  The only request that is made by this resolution is that the 
conferees look at this issue, and try to make a determination as they 
are looking at Medicare Select as to what other recommendations they 
should be making to this body in that context. I do not think that that 
is an unreasonable request at all at this time, and in fact for us not 
to discuss it is to avoid, ignore the single most pressing issue on us, 
which is whether or not we should give this $300 billion to the wealthy 
as we are taking it away from the poorest and the most elderly in our 
country. That is what this whole debate is all about.
  Back in 1981 David Stockman on this floor tried to harness voluminous 
amounts of information to defend a knowingly erroneous premise. That 
erroneous premise was you could cut taxes for the wealthy, increase 
defense spending, and balance the budget simultaneously.
  Fool me once, shame on you. Fool me twice, shame on me.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from New Jersey [Mr. Pallone].
  Mr. PALLONE. Mr. Speaker, what I wanted to point out in this debate 
today is that the Republicans who put together this proposal on the 
Committee on the Budget sent a letter to the chairman of our 
Subcommittee on Health, the gentleman from Florida [Mr. Bilirakis], and 
in it they outlined various proposals that could be implemented in 
order to achieve the cuts in Medicare that many of the speakers have 
talked about today.
  The options that exist in this document, I think there are 35 
proposals, in my opinion limit choice rather than expand choice, and 
some of the speakers on the other side of the aisle today talked about 
how Medicare Select is going to provide more choices. The bottom line 
is if this budget resolution that the Republicans have passed is 
implemented, the choices, and by their own admission, the choices that 
are proposed in order to achieve these Medicare cuts are going to be 
less.
  Let me give you an idea. One of the things that is discussed is 
increasing premiums for new beneficiaries who choose Medicare fee-for-
service. One of the problems that my senior citizens are concerned 
about is that they do not want to be forced into managed-care systems 
when they prefer fee-for-service where they can choose their own doctor 
or their own hospital. Although I think Medicare Select is good as an 
option, we do not want the situation to arise where the cost 
differential, if you will, between having a fee-for-service system 
where you can choose your own doctor or having to go into a managed-
care system, where the cost differential is so great that in effect you 
are forced into a managed-care system. In effect, by increasing the 
premiums for new beneficiaries and saying it is going to cost more for 
a fee-for-service system, you are forcing a lot of people who have no 
choice into managed care, into HMO's, into not being able to choose 
their own doctor or their own hospital.
  Another one of the proposals that is put forward by the House 
Republican budget is essentially to simply give people a voucher, 
$5,100 a year, they give you a voucher and you can go out as a senior 
citizen and find whatever policy you can to pay for your health 
insurance. Think about how many senior citizens because of their 
disability, because of the problems that they have, how difficult is it 
for them to go out and shop around and get a health care policy.
  The choices are being limited by these Republican proposals, and 
Medicare Select is not going to solve the problem.
  The SPEAKER pro tempore. The gentleman from Texas [Mr. Doggett] has 7 
minutes remaining, and the gentleman from Florida [Mr. Bilirakis] has 9 
minutes remaining.
  Mr. BILIRAKIS. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the gentleman from 
Pennsylvania [Mr. Klink].
  Mr. KLINK. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, you know some of the speakers who were up here today 
talked about how overwhelmingly the House passed this Medicare Select 
extension. At the time that we passed that, we did not realize that the 
Republican budget that was going to come out was going to cut Medicare 
so deeply, cut Medicaid so deeply, and that the cuts in Medicare were 
going to be exactly reflective of the tax breaks that were going to be 
given to the wealthiest citizens of this country. That is the message 
that many of us are carrying here to the floor today. We did not know 
all of this back then, and when you take a look at the impact on your 
district and on your State, you begin to see that Medigap is truly the 
gap, the credibility gap, the Republican Party now has on the issue of 
Medicare, and that is why we have these concerns.
  There will be some people on the other side who say we have not made 
cuts. Well, the fact of the matter is if you do not believe you have 
made cuts, talk to the CFO's at the hospitals, talk to the CEO's at the 
hospitals. In Pennsylvania we now know, and we met with some of our 
CEO's and CFO's last week, many of them are Republicans, many of them 
are Democrats, but they share one message, 54 hospitals across the 
State of Pennsylvania, because of the cuts that the Republicans are 
planning, 54 hospitals across our State are on the critical list. Forty 
thousand health care workers across the State of Pennsylvania could 
lose their jobs; 348,000 citizens in the State of Pennsylvania alone 
will be risking not having direct access to hospitals, when and if many 
of these hospitals are forced to close.
  You see many of these hospitals get as much as 60 percent or more of 
the funds that they take in from Medicare. That money will not be there 
in those amounts right now, and so when you start talking about 
Medicare Select, when you start talking about making up the difference, 
there is going to be a lot more of a difference to make up.
  One in five citizens across the State of Pennsylvania happens to be 
on Medicare; one in six of them happen to be senior citizens. Many of 
our senior citizens in a State that has the largest rural population in 
this entire Nation, many of our citizens are on both Medicare and 
Medicaid because they are elderly and they are poor.
  Mr. DOGGETT. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Ohio [Mr. Brown], representing Oberlin and environs.

                              {time}  1100

  Mr. BROWN of Ohio. Mr. Speaker, there is an old country and western 
song that goes, ``She got the gold mine, and I got the shaft.'' 
Republicans want to give the gold mine to wealthy special interests and 
give the shaft to America's elderly, $300 billion in tax breaks, $300 
billion in cuts in Medicare.
  The Republicans indignantly cry that these are not really cuts, they 
are only slowing the growth in Medicare. Tell that to the literally 
millions of Medicare people in Ohio and Pennsylvania and California and 
all over this country who will have $3,500 more taken out of their 
pocket over the next 7 years in higher premiums, in deductibles, in 
copayments. Tell those people these are not really cuts.
  These are cuts in services. These cuts in services are to pay for tax 
breaks for the wealthiest Americans, tax breaks for special interests, 
tax breaks for people that really do not read those kinds of tax 
breaks, the highest income people in this country.
  Mr. Speaker, I support Medicare Select because it provides choice, 
but as Republicans move to make these cuts in Medicare, what they are 
talking about is rationing health care, and what they are talking about 
is taking away physician choice.
  We should reject that, Mr. Speaker. We should reject that kind of 
thinking. It is not good for America's elderly. It is not good for the 
American people overall.
  Mr. BLILEY. Mr. Speaker, I yield such time as he may consume to the 
[[Page H5584]] gentleman from California [Mr. Thomas].
  (Mr. THOMAS asked and was given permission to revise and extend his 
remarks.)
  Mr. THOMAS. Mr. Speaker, well, I guess we are not going to talk about 
the motion to instruct. Obviously, that was not the reason you offered 
what purportedly is a motion to instruct conferees.
  The factual information in the motion to instruct is simply wrong. 
There is no instruction in the motion to instruct. It simply says that 
you want to talk about what is going on in this year's budget process. 
That is what the motion to instruct says.
  So, if you do not want to talk about your motion to instruct, and I 
am quite sure you do not expect it to pass because it would be rather 
bizarre to pass a motion to instruct that has no instructions to the 
conferees, so what you really want to do is talk about the issue of 
Medicare, and you want to talk about the issue of Medicare in terms of 
what Republicans are trying to do to make sure that the Medicare trust 
fund does not go bankrupt.
  I think you need to remember that in April the trustees of the health 
insurance trust fund, the Secretary of Health and Human Services, Donna 
Shalala, the Secretary of the Treasury, Mr. Rubin, Secretary of Labor, 
all President Clinton's appointees to the Board of Trustees, said if we 
do nothing, if we do nothing, Medicare goes bankrupt in 2002.
  What Republicans are proposing to do is take the $4,700 that is spent 
on each senior today and grow that to $6,400 in 2002. If we can do 
that, if we can accomplish an increase in the program at that rate, we 
save Medicare from bankruptcy.
  The Democrats have had some difficulty in understanding that concept. 
I want to commend the gentlewoman from Connecticut [Mrs. Kennelly] 
because the gentlewoman from Connecticut said it right. What we are 
talking about is reducing the increase. The job for all of us is to 
create a Medicare which has more choice for seniors, which grows in the 
amount that is available, but that fundamentally makes sure the program 
does not go bankrupt.
  You have heard the word ``cut'' over here from virtually every 
speaker. It is a word that is somewhat pejorative, that is loaded, that 
is a political term that they want to use. They cannot deny themselves 
the use of the term ``cut.'' The gentlewoman from Connecticut [Mrs. 
Kennelly], to her commendable credit, did not say ``cut,'' because she 
knows it is not a cut. It is a reduction in the increase, and, frankly, 
when you have increases going up at 10.5 and 11 percent a year in an 
old 1960's bill-paying structure, when today's marketplace is half 
that, taxpayers should want us to make sure that we get the savings 
from the marketplace in the Medicare Program. That is what we propose 
to do.
  And we are looking for people to join us in the effort to save 
Medicare. I did not hear one person on this floor today talk about 
joining in the effort to save Medicare.
  But I want this voice to be heard on the floor. I want my Democrat 
colleagues and friends to listen carefully to the words of this 
individual. This is what he said: ``Today, Medicaid and Medicare are 
going up at 3 times the rate of inflation. We propose to let it go up 
at 2 times the rate of inflation. That is not a Medicare or Medicaid 
cut.'' Repeat, ``That is not a Medicare or Medicaid cut.''
  So when you hear all of this business about cuts, let me caution you 
that is not what is going on. Who said that? William Jefferson Clinton, 
President of the United States and a Democrat. He believes we have to 
reduce the rate of increase, just as the gentlewoman from Connecticut 
[Mrs. Kennelly] said. We
 have to reduce the rate of increase.

  What we are proposing is to reduce the rate of increase. What 
President Clinton has said must be done, what he believes should be 
done is to reduce the rate of increase. How we do that is going to be a 
very, very positive exercise as we open up a 1960's fee-for-service 
bill-paying bureaucracy to all of the exciting changes that are going 
on out there in the health care world, one very small, modest change 
that has been a pilot program for 3 years, called Medicare Select, that 
has almost a half million folks in that program, with only nine 
complaints to date.
  It is a program that we want to continue for a 5-year period. We have 
told the Secretary of Health and Human Services, ``Keep an eye on that 
program. If it does not do what it is supposed to do, that is, increase 
choice and save money, we will sunset the program. We will come up with 
another idea.'' Right now what we need are new ideas, not the same old 
arguments, new ideas.
  Medicare Select is a promising new idea. We want to send the program 
to the 50 States who want to join it. The States voluntarily take up 
the program. it is not imposed upon them. People voluntarily buy their 
insurance. It is not imposed upon them. It is a slightly different way 
of doing business in the insurance and health care area. We want to see 
if it has some promise.
  We are going to try some other ideas. We are going to bring the 
sunshine from the outside, the positive reduction in expenses from the 
outside, into this archaic system, by choice. Republicans are going to 
do that. We would really love to have our Democratic colleagues join 
their President in reducing the increase in positive ways.
  Instead, what you hear is pure political propaganda. They do not want 
to talk about Medicare Select.
  I will tell you, you just heard a number of Democrats come to the 
microphone, the gentlewoman from Connecticut [Mrs. Kennelly], the 
gentleman from Texas [Mr. Doggett], the gentleman from California [Mr. 
Waxman], the gentleman from Massachusetts [Mr. Moakley], the gentleman 
from New Jersey [Mr. Pallone], the gentleman from Pennsylvania [Mr. 
Klink], they all voted for the Medicare Select measure when it left 
here, 408 to 14.
  This is a good idea. What you have here today on the part of the 
Democrats is an exercise largely in futility. They are now the minority 
party. They do not get to ram proposals down people's throats by pure 
quantitative measures because they have more votes than someone else. 
We are asking them to come to the table with your ideas. Let us hear 
them.
  Over the next several months there is going to be a feeding frenzy of 
ideas in the Health Subcommittee of Ways and Means and Health 
Subcommittee of Commerce. We are going to put together a proposal that 
will make sure the Medicare trust fund will not go broke, that seniors 
will have a better choice, we will grow the Medicare Program from 
today's $4,700 to $6,400 for every American. We will save the program.
  This is a modest beginning. Vote down the motion to instruct, which 
instructs nothing, and let us get on with change.

                          ____________________