[Congressional Record Volume 141, Number 159 (Friday, October 13, 1995)]
[House]
[Pages H10071-H10076]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            REPUBLICANS RUSHING MEDICARE REFORM LEGISLATION

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from New Jersey [Mr. Pallone] is recognized for 
60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I probably will not use all the hour, but I 
will ask for at least that initially.
  I wanted to come because of the developments that have occurred in 
the last few weeks particularly this week with regard to Medicare and 
the Republican leadership proposal to change Medicare.
  I happen to be a member of the House Committee on Commerce. The 
Committee on Commerce spent this past Monday and Tuesday doing a markup 
of the Medicare bill and did report the bill out on Tuesday late in the 
evening. I am very concerned about that bill. I understand it may be 
coming to the floor sometime next week, perhaps as early as next 
Thursday.
  I think it is a terrible thing that this legislation is coming to the 
floor of the House of Representatives without ample opportunity for 
hearings and sufficient debate.
  As I have mentioned before on the floor of this House, Mr. Speaker, 
our Committee on Commerce did not have hearings on the legislation. In 
fact, a substitute bill, which was actually the bill that we voted on 
just this past week, we only received about 24 hours before the time we 
were actually asked in committee to mark up the bill. So what, in 
effect, the Republican majority is doing is rushing Congress into these 
Medicare changes without most of us even knowing what the changes are 
and what the implications are going to be on America's seniors.
  Just to illustrate that point, I wanted to start out, Mr. Speaker, by 
entering into the Record, ands I think part of it may already be in the 
Record, but I wanted to mention some highlights of an editorial that 
was in my hometown newspaper, the Asbury Park Press, on Tuesday, 
October 10. And if I could just highlight some of the statements that 
were made in the editorial, it is captioned ``Explain The Changes'':
  Congress should not be rushing on Medicare. The editorial starts out 
by saying that congressional Republicans are moving too fast on 
reforming Medicare, the Federal health insurance program for the 
elderly. They propose to squeeze $270 billion from Medicare spending 
over the next 7 years, about a 14-percent reduction. And, as they did 
in their first 100 days, the Republicans plan to speed up the voting on 
their Medicare spending bills without taking much time for floor 
debate.
  Given their importance, the revolutionary changes the Republicans 
propose are worth at least as much time and attention as they have 
given to, say, the Whitewater affair. As it stands, two House 
committees plan to complete action on the Medicare changes by tomorrow 
night. That was earlier this week, just 2 days after revised versions 
of the bill were distributed to committee members. And again, that is 
exactly what we did.
  Under one major GOP proposal to save money, senior citizens would be 

[[Page H 10072]]
  given incentives to switch to managed care plans instead of the 
traditional and more expensive fee-for-service. Yet Congress so far has 
given short shrift to some of the reservations expressed by seniors and 
others about managed care.
  Polls indicate that most senior citizens as well as other Americans 
fear that congressional Republicans seeking not only to slow the growth 
of Medicare spending but also to wring enough savings for a tax cut 
that would benefit mostly the wealthy.
  Finally, the editorial says that it is difficult to determine just 
how the Republicans arrived at their numbers because too few details 
have been released. That is not information the Republicans should 
shield the public from. The debate should be open, robust and based on 
a complete understanding of the facts. Anything else invites 
misperceptions and misinterpretations.
  I think what we are seeing in this editorial is that more and more 
the media around the country, the newspapers, are coming to the 
realization that these Medicare reforms by Speaker Gingrich and the 
Republican majority are being moved too fast without adequate 
opportunity for debate, without anyone really knowing exactly what the 
changes are going to mean other than the fact that we know that the 
savings are going to be used for a tax cut, which, once again, goes 
mostly to wealthy Americans.
  Now, one of the things that I was most upset about this week, and I 
know it has received a lot of attention in the media, but I want to 
mention it myself because I was there, and that is on the second day of 
our hearings earlier this week, there were senior citizens 
representatives. I did not know where they were from, but they turned 
out to be people from the National Council of Senior Citizens, who came 
to our Committee on Commerce room. Some of them were very elderly. Some 
were as old as 90, and wanted an opportunity to address the committee. 
They basically were told that that opportunity would not be presented 
and, after they tried to speak, they were arrested.
  They were handcuffed and they were basically led out of the Rayburn 
Office Building into a paddy wagon where they were taken down by the 
Capitol Police, potentially to be booked, although I understand later 
that they were released and not charged with any kind of trespass.
  Mr. Speaker, I subsequently got a couple of pictures of these senior 
citizens. Just to give you an idea of the situation, I would just like 
to point them out here. This is the woman who initially tried to speak 
and basically was told that she could not. You can see there where she 
is being taken away, essentially. Then afterward, out in the corridor, 
there were additional senior citizens, as I said, who were actually 
handcuffed and taken away.

                              {time}  1330

  I do not want to get into all the details of this, but it was very 
upsetting to me, because I think it would not have happened if the 
opportunity had presented itself for seniors and their representatives 
to actually have addressed the House Committee on Commerce, and the 
fact that they were not given that opportunity is the reason why so 
many of them were upset and why we had this very unfortunate incident. 
I only point it out again because I think it is important, and it is 
not just individual seniors. It is also the newspapers, including my 
own in my own area, the part of New Jersey that I represent, who have 
expressed outrage and astonishment over the fact that there has not 
been an opportunity for seniors and other Americans to make their case 
about these Medicare changes that are so important to the country.
  The previous speaker, the person who spoke before me, suggested, and 
I know this has been a basic tenet of the Republican leadership that 
somehow Medicare is broke; it faces bankruptcy if we do not do 
something about it that that is significant, we are going to be faced 
with a situation where it will not exist any more. Nothing could be 
further from the truth with a lot of statements made by the previous 
speaker about the trustees' report and how the trustees have predicted 
insolvency in 7 years.

  One of the things I want to point out in response to that is that 
every year the Medicare trustees issue a report, and they predict how 
many years it will be before the fund that finances Medicare will be 
insolvent, and if you look at it, there are great variations over the 
years. Starting in 1970, I have a chart here where if trustees 
predicted insolvency in 2 years, in 1971, again, in 2 years, in 1972 in 
4 years, most recently in 1995, the report that the gentleman, my 
previous speaker mentioned, 7 years, in 1994 it was 7, in 1993 it was 
6, and it goes on and on. The point of the matter is that a tremendous 
amount of attention has been focused by the Republic leadership on 
these trustees' reports, but they fail to mention that many times over 
the last 30 years or so or the last 25 years, that these reports have 
come out that indicated a certain number of years in the future when 
this program would possibly be insolvent.
  It has really been an issue before except that Congress periodically 
steps in and tries to correct the situation. The bottom line is this is 
nothing new. This is not an emergency situation that requires the level 
of cuts and the level of changes that the Republican leadership is 
basically suggesting.
  Mention was also made of Secretary Rubin, the Secretary of the 
Treasury Rubin letter of September 21 to the Speaker and to Senator 
Dole wherein he points out, and I will quote that:

       No Member of Congress should vote for $270 billion in 
     Medicare cuts, believing that reductions of this size have 
     been recommended by the Medicare trustees or that such 
     reductions are needed now to prevent an imminent funding 
     crisis. That would be factually incorrect.

  So basically not only Secretary Rubin but other trustees I could cite 
have specifically said that the Republican proposal to cut this huge 
amount of money out of Medicare, $270 billion, 14 percent, is not the 
answer to the trustees' concerns and, in fact, by cutting the program 
by that amount of money, all you are really doing is making the 
situation even worse for the Medicare Program and for those who benefit 
from it.
  I also wanted to address the fact, and I was very concerned when the 
previous speaker mentioned Medicare savings accounts as somehow being 
the answer to all of our problems. My concern with these so-called 
Medicare savings accounts, which is one of the new ideas that the 
Republican leadership have come up with in this Medicare plan, is that 
what it is going to do is make the situation even more serious in terms 
of the amount of money that is available to the Medicare Program, in 
other words, aggravate the situation so that even less money is 
available in the program. What we know now is that 90 percent of 
Medicare beneficiaries basically cost the Government about $1,000 a 
year, in other words, most, the overwhelming 90 percent of seniors who 
receive Medicare basically do not take advantage of much health care 
activity, if you will, over the course of the year, because they are 
not sick and they only cost the Government, the Medicare Program, about 
$1,000 a year. So if all of these, or a significant number of these 
well seniors who do not need a lot of medical attention end up getting 
Medicare savings accounts and the Government has to contribute 
something like $4,000 a year to these Medicare savings accounts, the 
Government is basically going to be losing money, because it would 
normally cost them only about $1,000 a year to maintain the health of 
those seniors, and now the Government is transferring all of these 
additional funds to these Medicare savings accounts.

  It is nice, I mean, I am not going to be critical of the fact that 
some of the seniors may actually end up having some more money as a 
result of this, but in a situation where the Republican leadership is 
talking about the insolvency or suggesting that Medicare is insolvent 
and how we have to cut $270 billion out of the program, why in the 
world are we trying to, in effect, inflate the program by costing the 
Government as much as $3,000 more per person if the majority of the 
people who go into Medicare savings account are people who are fairly 
well? And those are the people that are likely to do it, because if you 
think that your health is not that great, you are not going to want to 
risk going into the Medicare savings account where you might have to 
shell out a lot of money. 

[[Page H 10073]]
So we know that these Medicare savings accounts are going to cost the 
Government a lot of money, and I think it is fiscally irresponsible to 
rob the Medicare Program of billions of dollars by setting up these 
savings accounts when theoretically your reason for Medicare reform is 
to try to save the Medicare Program some Federal dollars.
  I think that what we really have here, I know what we really have 
here, and it is documented well based on the statements that were made 
in the Committee on Commerce when we marked up the Republican Medicare 
bill this week. What we really have here is an effort to try to come up 
with some money by squeezing Medicare to pay for a tax cut, and I know 
that my Republican colleagues deny this is the case, but if you look at 
the way this program is set up, the way this bill has come out of 
committee, there is no question in my mind that that in fact is what is 
going on. Now, let me explain why I say that. Of the $270 billion that 
is proposed for reduction in Medicare by the Republicans, nearly half 
of that money would not even go to shoring up the Medicare hospital 
trust fund, known as Medicare part A, which the Republican leaders 
claim faces insolvency. This part A, the hospital trust fund, is what 
is discussed in the trustees' report, not part B, which is the separate 
program that seniors pay into which goes to pay for their doctor bills, 
and basically part A is where if we have extra money, if we ever have 
the money, we should be trying to put it in order to shore up the plan.
  We estimate that about $90 billion would be needed to shore up, if 
you will, and to avoid that potential insolvency 7 years from now in 
part A. So if you took about $270 billion, compared to the $90 billion 
that the trustees really need, you can see that the difference is 
essentially what would be used for the tax cut.
  What they are doing with part B, instead of, in order to guarantee 
that there is a lot more money available there that could be used for a 
tax cut is increasing premiums. We have heard over and over again on 
the floor of this House that the part B premium will go from about $46 
a month that the seniors pay right now to over $90 a month by the year 
2002, in a sense doubling, and the problem is that this part B, the 
money that goes into part B, including all that additional money that 
is going to come from the increased or doubling of the premiums, the 
seniors would pay under the Republican plan, that comes out of the same 
fund or goes into the same fund as it used for the $245 billion in tax 
cuts that has been proposed by the Republican leadership. Since 
any changes to part B do not impact the insolvency of part A, again 
they are separate funds, it is highly likely that the part B cuts could 
be used for tax cuts, again which I said much of which goes to the 
wealthiest Americans.

  In an effort to try to make sure that was not the case, in other 
words, that whatever cuts came to this Medicare Program under the 
Republican bill would not be used for tax cuts, we, the Democrats on 
the Committee on Commerce, tried a number of amendments earlier this 
week, because our point was, well, if you on the other side are saying 
that you are not going to use this for tax cuts, well then, fine, you 
know, go along with some of the amendments that will make that 
perfectly clear that this money that is being cut from Medicare is not 
going to be used for tax cuts, and so we came up with a few amendments. 
I actually proposed the first amendment, which was basically to say 
that since part B is not insolvent, since part B, which is generated 
through these premiums as well as general revenues, is not a program 
that faces potential insolvency or bankruptcy, why do we need to deal 
with part B at all? So the amendment that I proposed basically struck 
part B from the Medicare bill, the idea being that we would only deal 
with part A, since that is where the potential problem is. Well, that 
amendment was, of course, defeated. I would maintain the reason it was 
defeated is primarily because the fact of the matter is the Republican 
leadership intends to use this money for tax cuts.
  But then in the Committee on Commerce, the gentleman from California 
[Mr. Waxman] offered another amendment after mine that basically I 
called directed scorekeeping. It is sort of a technical term. But what 
it means is that if the money is saved in Medicare and it is put aside 
under the budget rules, a tax cut can be implemented, because he knows 
that that money for Medicare from the cuts in Medicare has been set 
aside and is sitting there as part of the Federal budget. In other 
words, the idea is that since the money is there, you can score against 
it or charge against it to implement a tax cut, and so the gentleman 
from California [Mr. Waxman] had an amendment that basically said that 
the Director of the Congressional Budget Office shall not include 
estimates of net reduction in outlays under the Medicare Program for 
fiscal years 1996 through 2002, the 7 years, to the extent that such 
net reductions exceed $89 billion. So what he was saying is that you 
can score $89 billion of that $279 billion for the savings to shore up 
the part A hospital trust fund, but you cannot score any more of it 
that could possibly be used for a tax cut, and again that amendment was 
defeated. I think that the defeat of the amendment offered by the 
gentleman from California [Mr. Waxman] showed definitively that what 
the Republican leadership has in mind is to use this money for a tax 
cut, because if they did not have that intention, they would not have 
found it necessary to use that money for scoring for budget purposes.

  Now, what is it, what is this Republican Medicare? What are these 
Medicare changes essentially going to do? We know they are trying to 
save $270 billion or cut $270 billion. I believe very strongly that is 
going to be used for a tax cut.
  How are they going to do it? In other words, what is actually going 
to happen to the Medicare Program, and how is that going to translate 
into the type of health care, quality of health care that seniors will 
actually get if that level of cuts is implemented? Basically what the 
Republicans are doing is they are limiting Medicare spending to 
specific dollar amounts in the law. It is what we call caps. In other 
words, they are saying that only so much money can be spent on 
Medicare, and that is it. It is capped. The problem though is that if 
you look at these caps and the level of spending that is going to be 
allowed with all the cuts is that they do not bear any relationship to 
the actual cost of health care.
  All of us would like to save money. Frankly it would be wonderful if 
we could save billions of dollars in the Medicare Program, and we can 
to some extent. But if you put artificial caps on the amount of 
spending that is available because you want to use that other money for 
a tax cut, well, the problem is if they have no relation to the actual 
costs of health care, what you are doing is squeezing the Medicare 
system. You are making it so that traditional care and the quality of 
care that hospitals and physicians give you they can no longer give 
you, because the money is not there to pay for it.
  What I think that the most important or the most significant aspect 
of this initially is that a lot of seniors are going to lose their 
choice of doctors. In other words, the Republicans feel very strongly 
that if they put a lot of seniors, if they force a lot of seniors in 
effect into what we call HMO's or managed care where they do not have a 
choice of doctors, the Republicans believe that that will then 
accomplish a lot of savings, and they will save a lot of money, because 
they feel that the HMO's or managed care ultimately will save money.

  I would argue that the jury is definitely out on whether or not HMO's 
or managed care actually save dollars in the long run, but clearly what 
the Republican leadership is doing here in coercing seniors into HMO's 
or managed care. I know that the previous speaker said that, you know, 
seniors are going to continue to have choices if they want to stay in a 
traditional fee-for-service plan where they have their choice of 
doctor; they go to the doctor that they have been seeing for years, and 
he just gets reimbursed. They can continue to do that; they do not have 
to necessarily sign up for an HMO. But there are some very cute 
budgetary gimmicks in this Republican Medicare proposal that are going 
to make it increasingly difficult for you to stay in a traditional fee-
for-service plan where you have your own doctor, and the reason for 
that, there are many reasons, 

[[Page H 10074]]
but one of the key reasons is because the cuts impact much greater on 
the traditional fee-for-service plan than they do on HMO's or managed 
care. This is in the bill that came out of the Committee on Commerce, 
what we call a fail-safe that says that after a few years if savings 
are not achieved in this sufficiently to reach that goal of $270 
billion--through the changes that we have suggested in Medicare, if we 
find after a couple of years that we are not saving that level of 
money, we are not likely to save that level of money over the seven 
years--then a fail-safe comes into play that cuts back on the 
reimbursement rate that doctors and hospitals and other health care 
providers get from Medicare. But the fail-safe, the cutbacks at that 
point, do not come on the HMO's or the managed care patients or systems 
but strictly on the fee-for-service side. So in essence what is 
happening is after a couple of years the squeeze, if you will, the 
amount of money that goes into the traditional fee-for-service plan 
where you can choose your own doctor and get reimbursed, the squeeze is 
solely on the people that remain in those traditional fee-for-service 
plans. So what it is going to mean is less and less money is going to 
go to doctors or hospitals that are in the traditional fee-for-service 
plan and you will find increasingly that you cannot find a doctor 
through a traditional fee-for-service plan, and you have to go to an 
HMO if you want to get any kind of attention.
  It is very unfortunate, but it is a rather cynical way, if you will, 
of eventually abolishing or making it impossible for seniors to stay in 
the traditional fee-for-service system.
  I wanted to just talk a little bit more about some of the amendments 
that Democrats proposed in the Committee on Commerce to try to improve 
on this terrible proposal that the Republican leadership has put 
forward on Medicare. I think a lot of us recognize that even though we 
thought the overall plan was terrible that if there was some way we 
could amendment it in committee to lessen some of the worst aspects of 
it, at least we would have accomplished something. But every one of 
these amendments, every one of these attempts on our part to try to 
correct the bill or make it a little less onerous failed. Some of these 
amendments though, or corrections if you will, do point out how 
sinister this plan is in various ways. I just want to talk about a few 
of them. I do not want to talk about too many of them, because we could 
stay here all day, and I do not want to take up that much time.

  The gentleman from Massachusetts [Mr. Markey] offered an amendment 
basically that would have decreased the part B premiums and taking the 
law back, the Medicare law back to what it is today. A lot of people, a 
lot of the Republicans have come on this floor and they have said, well 
look, why are you Democrats talking about doubling the part B premiums, 
the premiums that you pay for doctors, when in reality the part B 
premiums would be going up anyway over the next few years? Well, the 
fact of the matter is under the current law the part B premiums do go 
up. It is now about $46 a month, and under current law by the year 
2002, 7 years from now, the premiums would go up to about $60 a month. 
But I would point out that that $60 a month under current law, assuming 
current inflation, is significantly less than what Speaker Gingrich has 
proposed. Speaker Gingrich's proposal and the bill that came out of 
committee would double the premiums. They'd probably be at least $90 
per month as opposed to the $60 that exists under the current law.
  The reason for that is very simple. Under the current law, the 
percentage that senors pay actually goes down in the next few years, 
because it was understood that it is very, very difficult for a lot of 
seniors who live on fixed incomes to pay very high premiums, and so if 
we do not change the law you will see the actual percentage seniors 
have to pay out of pocket for part B go down, and that even with 
inflation, although there will be some increase in your part B 
premiums, it will not be anywhere near as great as what Speaker 
Gingrich has proposed.
  That amendment, of course, by the gentleman from Massachusetts [Mr. 
Markey] to try to strike those drastic increases in the part B premiums 
also failed because of Republican opposition.

                              {time}  1350

  The other thing I think is particularly sad, when you talk about the 
part B premiums, and, again, something we tried to change in committee 
unsuccessfully, is that under current law Medicaid pays the total cost 
of the part B premium for seniors who fall below a certain income, who 
are low-income seniors.
  Well, the Medicare bill and the Medicaid bill that we passed out of 
the Committee on Commerce a week earlier has eliminated the requirement 
for the Federal Government to pay the part B premiums, the $40-some odd 
a month for those low-income seniors. And there are millions of them.
  What we did in committee this week is we tried to incorporate into 
Medicare, into this Republican Medicare bill, a requirement that that 
premium for the low-income seniors would be paid under Medicare. Again, 
that amendment was defeated.
  I think some of my colleagues on the other side have suggested that, 
well, that is OK, because these low-income seniors can all go into an 
HMO and the HMO will take care of their physicians' bills, so they do 
not need part B anymore.
  That is a false assumption. First of all, there is absolutely nothing 
in this Republican Medicare legislation that guarantees anyone that 
they are going to have an HMO in their area that will pay for 
physicians' bills that is available to them at a decent cost. So I 
think what you are going to see is a lot of low-income seniors, or even 
middle-income seniors, will simply not be able to pay for their part B 
premiums, and the consequence of that is they simply go without part B 
and they do not have health insurance that pays for their doctors' 
bills.
  The other thing we tried in committee that I was very supportive of 
is if you have this terrible Republican bill that basically forces a 
lot of seniors into HMO's or managed care where they do not have a 
choice of doctor, at least change the law when we pass this bill, let 
us put into the bill what we call a point of service provision, that 
says that if you are in an HMO or managed care system, and all of a 
sudden you need to go to a specialist or a doctor that is not part of 
the system, that is not on the list, so-to-speak, that at least you can 
opt out of the system and go to that other doctor, even if it means you 
have to pay a little more out-of-pocket in order to see the doctor that 
is not part of the HMO.
  I am not saying that is a great alternative, because you have to 
shell out more money out of your pocket. But at least the option would 
exist under point of service, as we call it, so that if you were forced 
into the HMO or managed care, but you wanted to go see a doctor not in 
the system in a particular circumstance, if you could afford a little 
extra copayment, you could operate to do that.
  Again, that point of service provision was defeated. It was actually 
an amendment that was offered by a Republican member of the committee, 
the gentleman from Iowa [Mr. Ganske], who is a physician, but we did 
not have sufficient votes on the Republican side in order to guarantee 
that the point of service option would be available.
  One of the most sinister things in this Republican Medicare bill the 
way it came out of committee, again, is that there has been an effort 
to try to change the current law that limits the amount of money that 
seniors have to pay a physician out-of-pocket. In other words, under 
current law if you are under Medicare and if you are covered by 
Medicare and you see a physician, they can only charge you a certain 
percentage increase for a copayment. But in this bill that came out of 
our committee that is going to be voted on the floor of this House 
probably next week, those provisions were changed in certain 
circumstances.
  If you decide to join that we call a hospital network, or doctors 
network system, in other words, if you decide to join a managed care 
system which is put together by a hospital or by a certain group of 
doctors, rather than the ones that are advertised on TV, the large 
ones, the large HMO's, managed care systems, then they allow what is 
called balanced billing in those systems, where the doctors can charge 
you 

[[Page H 10075]]
basically whatever they want for a copayment.
  This is the first time under Medicare in my memory that any exemption 
has existed from the limitation on what the doctors can charge for a 
copayment. And what I would say is happening here, and the reason this 
is happening, is very simple: So much money is being squeezed out of 
the Medicare system, so much money for health care needs is being 
squeezed by these cuts in Medicare, that the recognition is out there 
on behalf of the Republican leadership that they need to provide a 
situation where seniors can be charged a lot more by their physicians 
in order to provide quality care. So they are building this exemption, 
knowing full well that some seniors may want to get into a better 
quality system through a hospital or doctor network in their area that 
is going to provide the quality physicians, that is going to provide 
the quality care, but the only way to pay for it is by charging the 
seniors more out-of-pocket so the physicians can charge whatever they 
want.

  I think it is a terrible recognition of the fact that there is not 
going to be enough money in this Medicare system the way the 
Republicans have put their bill together to provide for quality care. 
That is just a beginning, I think, of what you are going to see, where 
more and more money has to be paid out of pocket by senior citizen in 
order to guarantee them quality care.
  I had a little chart, which I do not actually have in front of me, 
but to give you an idea I will read from it, that gives the percent of 
income spent on out-of-pocket costs by adults 65 and older in 1994. Of 
the total elderly population, 21 percent of their income is basically 
spent for out-of-pocket health care costs. If you look at senior 
citizens who are below poverty, that shoots up to 34 percent. Low-
income seniors, 34 percent of their income was actually spent on out-
of-pocket costs for health care.
  So already we are in a situation where a lot of senior citizens spend 
a significant amount of their money out-of-pocket to make up for 
deductibles, copayments, and other health care necessities. And with 
this bill, you are going to see even more of that occurring, 
particularly when it comes to the balanced billing provisions.
  I just wanted to mention a couple more things, because I think they 
are particularly egregious, and these again were things that the 
Democrats tried to change in the bill, in the Medicare bill in the 
Committee on Commerce, but, again, we were unsuccessful.
  The Republican leadership, and particularly the Speaker, have made 
such an issue over the fact that there is a tremendous amount of fraud 
and abuse in the Medicare Program under current law, and that is 
certainly true. Estimates are that something like 10 percent or perhaps 
more of the money in the Medicare Program is wasted, either because of 
fraud or abuse or just general waste. All of us, I think, on both sides 
of the aisle, Republican and Democrat, would like to see certain things 
done to correct that. And we were hoping that any kind of Medicare 
reform legislation that came out of the Committee on Commerce as a 
result of this Medicare debate would seriously try to address the fraud 
and abuse problems.
  The sad thing is this bill that was reported out of committee 
actually makes it more difficult for the Federal Government to go after 
those who are committing fraud and to weed out the abuse in the system.
  I think it is a particularly sad commentary on the fact that here was 
an opportunity, particularly in a climate where we are trying to save 
money and we know there is a tremendous amount of money that could be 
saved, to make it more difficult for the Government to go after fraud 
and abuse.
  If I could just read from some of the statements that were made by 
the inspector general of the Department of Health and Human Services 
about the bill and why it would make it more difficult for the 
Government to go after those who are defrauding the system.
  Over the course of 7 years, the 7 years we are talking about here, it 
is estimated that $126 billion could be saved by reducing fraud and 
abuse. But the GOP bill actually makes the existing civil monetary 
penalties and antikickback laws considerably more lenient. According to 
the inspector general, the Medicare restructuring legislation:

       Would substantially increase the government's burden of 
     proof in cases under the Medicare-Medicaid antikickback 
     statute. Although a fund would be created to direct moneys 
     recovered from wrongdoers, this fund would not go to further 
     law enforcement efforts.

  What the inspector general said is that the one way that we can 
significantly crack down on fraud and abuse is if there are more 
enforcers out there. This bill actually makes it more difficult for 
enforcement to take place, because, on the one hand, it increases the 
standard of proof of the Government in going after those who are taking 
advantage of the Medicare system, and that whatever money is recovered 
does not go to hire more people to do law enforcement. So actually 
there ends up being less people out there who are going after the 
abusers.
  I just think that is a particularly egregious situation, because so 
much has been played about the need to deal with the fraud and abuse 
problem.
  I would like to conclude in just a couple more minutes by saying that 
although I talked about Medicare today, and that is what we are going 
to be voting on next week, the problem of what seniors are going to 
face with Medicare because they are going to have to pay so much more 
money out of pocket is aggravated because of what is happening on other 
fronts with regard to senior citizen concerns.
  A couple weeks ago in the Committee on Commerce we reported out a 
Medicaid bill which, and, again, the Republican leadership is trying to 
cut about $180 billion in the Medicaid program in order to pay for 
their tax cuts. If you combine the cuts in Medicaid, $180 billion, with 
the cuts in Medicare, $270 billion, you see a tremendous amount of 
money is going toward cuts that primarily impact the elderly, because 
70 percent or so of the money that is spent on Medicaid, which is the 
program for the poor, health care for the poor, still goes to pay for 
senior citizens, most of whom are in nursing homes.
  So what we are going to see is that senior citizens are going to have 
to pay more out of pocket for Medicare, they or their families are 
going to have to pay more out of pocket because of the cuts in 
Medicaid.
  Then looking on the horizon, and it had a lot of attention in the 
media today, is the proposed cut in the COLA for Social Security. I 
mention that again, first of all, because I am opposed to the cuts in 
the COLA that are being presented; but even more important because, 
think, about the senior citizen.
  Let me give you an example, let's say a senior citizen of low income, 
who now is being told that your Medicare part B premium is going to go 
up, it is going to be doubled over the next 7 years; that the 
supplement, the Medicaid provision that pays for part of your Medicare 
part B is possibly going to be eliminated; and then you are not going 
to get the COLA that you expect to take into consideration inflation 
over the next few years.
  Well, if you think of that combination, less of a COLA, more out of 
pocket for Medicare, and loss of any kind of supplement for Medicaid, 
you are talking about senior citizens that are getting a double, 
triple, or even more possibly with cutbacks in other programs like 
nutrition or outpatient care, a double, triple, quadruple whammy.

  The thing that is amazing to me is how so many of our colleagues on 
the other side just refuse to recognize how the combination of all 
these cuts and increased out-of-pocket expenditures and less of a COLA 
are going to have such a devastating impact on people who have fixed 
incomes.
  I have to say, and I am not just talking in an insider's sense here, 
when I go home on weekends, when I am in the district, when I am in New 
Jersey, seniors come up to me on the street, they come up to me in my 
district offices, and they explain how they have budgeted down to the 
last penny or the last dollar, and they simply cannot afford the types 
of increases that we are going to see here. These increases are not 
necessary.
  If we eliminated or even cut back significantly on the tax cut, 
particularly those provisions that are going to the wealthy, then we 
would not have to make these kinds of cuts and cause 

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these out-of-pocket expenditures to occur.
  So, again, this is a needless effort on the part of the Republican 
leadership. I think it is a shame. I hope that more and more Americans 
will see the light on these terrible changes that are being proposed.

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