[Congressional Record Volume 142, Number 33 (Tuesday, March 12, 1996)]
[House]
[Pages H2041-H2048]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
REPEAL MEDICARE AND MEDICAID COVERAGE DATA BANK
The Clerk called the bill (H.R. 2685) to repeal the Medicare and
Medicaid coverage data bank.
The Clerk read the bill, as follows:
H.R. 2685
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. REPEAL OF MEDICARE AND MEDICAID COVERAGE DATA
BANK.
(a) In General.--Section 1144 of the Social Security Act
(42 U.S.C. 1320b-14), as added by section 13581(a) of the
Omnibus Budget Reconciliation Act of 1993 (in this section
referred to as ``OBRA-93''), is repealed.
(b) Conforming Amendments.--
(1) Medicare.--Section 1862(b)(5) of such Act (42 U.S.C.
1395y(b)(5)), as amended by section 13581(b)(1) of OBRA-93,
is amended--
(A) in subparagraph (B), by striking the dash and all that
follows through the end and inserting ``subparagraph (A) for
purposes of carrying out this subsection.'', and
(B) in subparagraph (C)(i), by striking ``subparagraph
(B)(i)'' and inserting ``subparagraph (B)''.
(2) Medicaid.--Section 1902(a)(25)(A)(i) of such Act (42
U.S.C. 1396a(a)(25)(A)(i)), as amended by section 13581(b)(2)
of OBRA-93, is amended by striking ``including the use of''
and all that follows through ``any additional measures''.
(3) Data matches.--Section 552a(a)(8)(B) of title 5, United
States Code, as amended by section 13581(c) of OBRA-93, is
amended--
(A) by adding ``or'' at the end of clause (v),
(B) by striking ``or'' at the end of clause (vi), and
(C) by striking clause (vii).
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California [Mr. Thomas] and the gentleman from California [Mr. Stark]
will each be recognized for 30 minutes.
The Chair recognizes the gentleman from California [Mr. Thomas].
Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 2685, a bill I
introduced to repeal the so-called Medicare and Medicaid coverage data
bank. This particular bill was favorably reported by the Committee on
Ways and Means last November by a unanimous voice vote.
Mr. Speaker, this bill is particularly well suited to be considered
here under the corrections procedure as we are doing today. Under the
Medicare secondary payer program a person's employer based insurance
may be the primary payer in certain cases. In other cases, it may not
be.
The 1993 budget reconciliation bill created a data bank to identify
Medicare secondary payer cases. In principle, this was, I guess, at the
time a good idea. However, its implementation was misguided and heavy-
handed.
Under the 1993 law, employers were required to submit health
insurance information on all their employees, not just those subject to
the secondary payer provisions. Health and Human Services also said
this was to begin in 1994.
Many employers voiced strong opposition to this cumbersome
requirement, in large part because employers were required to report
information which they did not routinely collect, and what started out
as a good idea became, in part, a hunt for information which was not
then currently asked for or even needed in the system.
In response to these objections, a fiscal year 1995 Labor, Health and
Human Services appropriations bill directed that no funds be used for
the implementation of the bank. In addition, the General Accounting
Office issued a report in May 1994 which found that the data bank would
create burdensome and unnecessary paperwork for both the Health Care
Financing Administration and employers and would achieve little or no
savings. As the witness from the GAO testified on February 23, 1995,
``The proposed data bank would create an avalanche of unnecessary
paperwork for both HCFA and employers and will likely achieve little or
no savings while costing millions.''
It is also believed that the data bank would cost the private sector
as well as Government that money, that burden not being solely on one
group or the other.
H.R. 2685 puts an entirely appropriate final nail in the coffin by
repealing the underlying data bank law. The data bank notwithstanding,
the idea of making sure that the Government paid only its fair share
was a misplaced idea from the start.
I am pleased to be able to help send it to its final resting place
here today. This is a relatively straightforward bill. It has very
narrow scope of subject matter. There is, I believe, universal support
for the repeal of this Medicare-Medicaid coverage data bank law, and I
urge its swift adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
I, too, support this legislation. It is a provision of 1993 which the
House reluctantly accepted in conference as part of a package from the
other body, and at the time, then-chairman of the Committee on Ways and
Means predicted we would be back repealing it at some later point, and
it is appropriate that we are doing so today.
In addition, the administration has been unable to implement the law,
and the administration also supports the repeal as a necessary
correction.
It is interesting that we are here today to talk about data banks,
because the data bank is, Mr. Speaker, a record, just so that my
colleagues understand; this is very arcane computer talk, and this
gentleman from California is no expert, but I understand that a data
bank is a record, a record not unlike this Congress under the
Republican leadership which has passed no legislation. That is a data
bank, and I am sure that it is one that the Republicans would like to
repeal at some point so they do not have to run on the data bank that
they have established in this Congress.
There are lots of data banks that perhaps are needed, and I hope that
none of my colleagues will feel that doing away with this data bank, we
should forego all data banks in the future.
Somebody a while ago mentioned nails in a coffin. Now, I would like
to have a data bank on how many coffins will be nailed shut by the
Republican Medicare plan, how many poor people would be denied.
Parliamentary Inquiry
Mr. THOMAS. Mr. Speaker, parliamentary inquiry.
The SPEAKER pro tempore. Does the gentleman from California yield for
a parliamentary inquiry?
Mr. STARK. Certainly.
Mr. THOMAS. I fully understand the intent and purpose of the
gentleman from California, and all of us, I think agree that we come
here not to praise data banks but to bury this particular one, and I
know he must, because of the rules of the House, walk a very fine line
in talking about the subject matter in front of us. I would urge him
that I would not want to continually ask this parliamentary inquiry.
But were the gentleman's statements referring to any data bank,
including data banks collecting information about the record of this
Congress, germane to the subject matter in front of us?
The SPEAKER pro tempore. The gentleman must maintain a nexus between
the subject being debated and the bill.
Mr. THOMAS. My parliamentary inquiry is: Is mentioning the word
``data bank'' and then talking about what you want to put in any data
bank you so conceive, is that an appropriate and parliamentary nexus?
The SPEAKER pro tempore. At this point the Chair will simply remind
the Members that discussions should remain relevant to the bill under
consideration.
Mr. THOMAS. I thank the Speaker, I thank the gentleman for yielding.
Mr. STARK. My pleasure. I will try and keep my nexus in focus. I am
not sure I know what a nexus means, either. But I will do my best.
Mr. THOMAS. Mr. Speaker, will the gentleman yield?
Mr. STARK. I yield to the gentleman from California.
Mr. THOMAS. Perhaps we could have a data bank collecting nexus. Then
we could examine them.
Mr. STARK. I thank the gentleman for his suggestion. In all
seriousness, the collection of health data has been an important facet
in the Medicare Program, which has been the perhaps leading social
legislation since 1965, when Lyndon Johnson and a Democratic Congress
and Senate enacted Medicare. And we have kept much in
[[Page H2042]]
the way of health data. We have talked about outcomes research, which
is a data bank which will not, I believe, he repealed in this bill.
That is good.
But we do need a data bank to see, as I mentioned, nails in coffins,
we passed nursing home legislation some years back. We have records of
data banks, if you will, of the number of----
parliamentary inquiry
Mr. THOMAS. Parliamentary inquiry, Mr. Speaker.
The SPEAKER pro tempore. Does the gentleman yield for an inquiry?
Mr. STARK. I will be happy to yield.
The SPEAKER pro tempore. The gentleman will state his parliamentary
inquiry.
Mr. THOMAS. The gentleman has now moved from a data bank to records,
and I believe the statement will show that he is now talking about
records in the context of a data bank, if you will.
Does moving from a data bank, the specific subject matter of this
bill, to records which are akin to a data bank suffice for the Speaker
to continue to allow for this direction? Is that a sufficient nexus, in
the Chair's opinion?
The SPEAKER pro tempore. The Chair is of the opinion that the
gentleman has maintained a sufficient nexus or connection.
Mr. THOMAS. He is doing a good job.
Mr. STARK. I thank the gentleman. It is this data bank or collection
of records that will tell us how well we have done with regulating
nursing homes and the data bank will illustrate for us the number of
lives that have been saved, the number of senior citizens that are no
longer medicated into being zombies, the number of senior citizens in
nursing homes in various States who are living in unhealthy conditions,
and this data bank will illustrate for us what will happen if we were
silly enough to pass the Republican Medicare plan.
parliamentary inquiry
Mr. THOMAS. Mr. Speaker, I am constrained to ask a parliamentary
inquiry.
The SPEAKER pro tempore. Does the gentleman yield for an inquiry?
Mr. STARK. I will be glad to yield one more time.
Mr. THOMAS. This gentleman is at a complete loss, having read the
legislation in front of us, with no reference to nursing homes
whatsoever, how a discussion of nursing homes and legislation or
desired legislation surrounding nursing homes has any nexus whatsoever
with the subject matter in front of us, and Mr. Speaker, I would like
you to rule on the nexus of a discussion of nursing homes and data or
records collected around the nexus of nursing homes and how that has a
relationship to the legislation which we are supposed to be discussing
on the floor.
Mr. PALLONE. Following up on that parliamentary inquiry----
The SPEAKER pro tempore. The gentleman is not recognized at this
time. The Chair is prepared to respond.
Mr. PALLONE. Could I ask on that point if the gentleman from
California [Mr. Stark] could yield to me?
The SPEAKER pro tempore. The Chair is prepared to respond.
The Chair is prepared to give the gentleman from California the
opportunity to establish that connection between data banks covered by
the bill and nursing homes.
Mr. THOMAS. The parliamentary inquiry was to the legislation in front
of us, not to data banks in general and nursing homes, but to the
Medicare-Medicaid data bank and nursing homes.
The SPEAKER pro tempore. The Chair is willing to allow the gentleman
the opportunity to establish that connection.
The Chair recognizes the gentleman from California [Mr. Stark].
Mr. STARK. Mr. Speaker, will the Chair tell me how much time I have
consumed in establishing my nexus?
The SPEAKER pro tempore. The gentleman has consumed 8\1/2\ minutes.
Mr. STARK. I thank the Chair.
The important issue is that if we were to even consider doing away
with the data bank, we could not have the records to support the fact
that we ought not to do away with nursing home regulations as the
Republican Medicare bill would suggest.
{time} 1430
Mr. STARK. Now, there are other data banks. We keep data banks on the
income of seniors who qualify under QMB. That is a poor senior with low
income.
POINT OF ORDER
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore (Mr. Camp). The gentleman will state his
point of order.
Mr. THOMAS. QMB's, who are qualified Medicare-Medicaid beneficiaries,
are seniors. We are dealing with legislation that deals with people who
are employed by employers to collect data for purposes of determining
primary and secondary payers, and I believe the gentleman's statements
are not germane.
The SPEAKER pro tempore. The gentleman from California [Mr. Stark]
must confine his remarks to the subject of the bill.
Mr. DOGGETT. Mr. Speaker, will the gentleman yield?
Mr. STARK. I yield to the gentleman from Texas.
Mr. DOGGETT. Mr. Speaker, I wanted to inquire whether any of the data
bank information that would be affected by this legislation would
relate to complaints of patient abuse in nursing homes, the kind of
violation of Federal standards. I am referring to the standards that
the Gingrichites propose to just eliminate entirely in their proposal
last year and deny our seniors any kind of safety in nursing homes.
Would that be affected by this legislation?
POINT OF ORDER
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore. The gentleman will state his point of order.
Mr. THOMAS. Mr. Speaker, is the question propounded by the gentleman
from Texas germane to this legislation and therefore a question that
should be answered?
Mr. DOGGETT. Mr. Speaker, I would like to be heard on the point of
order.
The SPEAKER pro tempore. The gentleman will be heard.
Mr. DOGGETT. Mr. Speaker, surely it is permissible in the course of
one of these debates, and I can understand the gentleman's desire not
to get into this destruction to the health care of our seniors across
the country by raising this issue, but surely it is appropriate under
the rules of the House to make an inquiry of someone who is opposed to
this legislation as to what the legislation affects. That is all I have
asked, is whether or not the seniors in America are going to be
affected by changing this data bank to seniors who would lose out if
there are no standards to protect them in nursing homes.
Mr. THOMAS. Mr. Speaker, may I be heard on the point of order?
The SPEAKER pro tempore. The gentleman from California.
Mr. THOMAS. The gentleman from Texas is at a disadvantage. He arrived
on the floor not hearing the gentleman from California's opening
statement, in which the said he was not opposed to this legislation.
There is no opposition to this legislation.
In addition, Mr. Speaker, I would be more than willing to engage in a
discussion of the shortfall of the Medicare fund, which was not
adequately reported by this administration in any form that allows us
to understand it. But that is a debate that will take place at another
place and another time.
The purpose of this debate under the rules is to discuss the matter
in front of us, and all this gentleman from California is trying to do
is to maintain decorum and order in the house and request that the
Speaker enforce the Rules of the House so that we may have an orderly
debate and not traverse the countryside in any and all directions by
any individual who may have an honest and earnest attempt to discuss
this issue or may be motivated by other reasons.
The SPEAKER pro tempore. The gentleman has made his point of order.
The Chair is prepared to rule.
The question is relevant to the extent of coverage of the data bank
under this bill, and the gentleman from Texas may inquire in order.
Mr. THOMAS. Mr. Speaker, continuing my point of order, it is for
employees only. The question is about nonemployees. How can it be
germane?
The SPEAKER pro tempore. The Chair will ask the gentlemen from Texas
and California to proceed in order.
Mr. DOGGETT. Mr. Speaker, I appreciate the opportunity to ask a
question as to what this legislation does, because whether you were
here at the
[[Page H2043]]
very beginning of the debate or at the very end of the debate, whether
the gentleman is opposed to or for this legislation, it should be
proper, as the Speaker has ruled, for a Member of this House to be able
to determine whether the legislation will have an adverse effect by
changing this data bank on the seniors of America.
Now, does this legislation have any impact on all this proposed
Gingrichite repeal for standards of health and safety in nursing homes
across this country?
Mr. STARK. Mr. Speaker, reclaiming my time, in response to the
question of the gentleman from Texas, this legislation will have no
effect. The Gingrich-Thomas legislation will so destroy nursing home
regulations that even if it did have an effect, it would not make any
difference, because the nursing home regulations would be tossed out
the window by the Republicans and it would be moot as to whether this
does. But the legislation does not.
Mr. PALLONE. Mr. Speaker, will the gentleman yield?
Mr. STARK. I yield to the gentleman from New Jersey.
Mr. PALLONE. Mr. Speaker, I just wanted to make the point, I
understand that the gentleman favors this bill in the sense that he
thinks that the data bank at this point in this particular case perhaps
does not make sense, but my concern is over the whole issue of data
banks.
In other words, we know that the Republican leadership proposes to
cut back on Medicare, to cut back on Medicaid. Some of the changes they
are now advocating under the guise of health care insurance reform
essentially are going to make some major changes for our health care
system. For example, when you talk about Medicaid, the Medicaid
proposal that the Republican leadership has put forward I believe,
because it block grants money to the States, will have a lot of people
simply not eligible for Medicaid and not having any kind of health care
anymore.
So I am a little concerned that when we talk about eliminating data
banks, we may need some of these data banks if some of these Republican
proposals go forward, because I would like to know how many people are
not going to be eligible for Medicaid anymore, how many medigap
recipients will not be able to take advantage of it.
point of order
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore. The gentleman will state his point of order.
Mr. THOMAS. Mr. Speaker, the items that the gentleman is ticking off
on his finger have no relationship to the information to be collected
in this data bank, or any other data bank.
Mr. PALLONE. Mr. Speaker, I would like to be heard on the
parliamentary inquiry.
Mr. Speaker, I am concerned that that in fact is not the case. The
fact of the matter is when you talk about the data bank, which I
understand for this specific purpose is linked to how many employees
receive private health insurance as opposed to Medicare and what the
impact of that is going to be, we have the same thing now with the
proposal by Senator Kassebaum and Senator Kennedy and the gentlewoman
from New Jersey, Mrs. Roukema, where we are trying to get passed on the
House floor health care insurance reform that will eliminate
preexisting conditions and that will allow for portability. The
Republican leadership, from what I can see, will not allow it to come
to the floor.
The SPEAKER pro tempore. The Chair will again rule that the gentleman
from New Jersey's remarks must be confined to the bill at hand.
Mr. STARK. Mr. Speaker, could I inquire whether the time for these
points of order come out of my time?
The SPEAKER pro tempore. The Chair would state that argument on
points of order do not.
Mr. PALLONE. Mr. Speaker, if the gentleman will yield further, if I
can just ask the gentleman from California, the way I understand this
data bank, it was set up to gather information about whether or not
someone who was employed privately and had private health insurance,
how that would relate to Medicare coverage.
Mr. STARK. Mr. Speaker, reclaiming my time, the gentleman is quite
correct in his presumption. That was the initial suggestion or intent
created by the other body in establishing this legislation.
Mr. PALLONE. Mr. Speaker, I would ask the gentleman, is not that type
of information possibly valuable in terms of this ongoing debate on the
Kennedy-Kassebaum bill as to whether or not insurers are covering
people whether or not they have preexisting conditions or whether or
not they could carry their health insurance with them to another job?
Mr. STARK. Mr. Speaker, the gentleman is quite correct, because as
the number of layoffs continue and as the Republicans continue to do
nothing to provide health insurance for the unemployed or extended
COBRA benefits, which cost no one anything, except the Republicans do
not like it because it would be a Federal involvement, we do not have
the data.
This data would not be useful to fulfill what I believe the gentleman
has in mind, and that is how can we, as the Democrats would like,
assure people who would pay for their benefits and be cut off by the
Republican indifference, how can we insure that people could continue
their health insurance even if they were willing to pay for it? Without
the data, and I think it is important that we emphasize that this bill
repealing this one limited data bank should in no way prejudice the
establishment of a data bank as the number of people, for example,
climb from some 37 million to now almost 45 million uninsured, you have
not heard one mention of that out of the Republican presidential
candidates or certainly from that side of the aisle in this house. They
do not care about the uninsured in this country. they only care about
the rich and the big insurance companies. That is who is getting
protected.
This data bank that we are repealing would not be helpful in
following our democratic precept of assurance that people have a fair
chance to purchase insurance at a fair price.
Mr. PALLONE. Mr. Speaker, if the gentleman will yield further, that
is the only point that I was trying to make, which is, and I think the
gentleman from California said it well, that we may very well need data
banks like this in order to ensure that more people are not taken off
the rolls or be able to move from one job to another or denied health
insurance because of preexisting conditions.
So that whatever happens here today under the corrections day
calendar will not somehow get out into the general public as something
that we will not need for other purposes, because we are determined as
Democrats that we want to bring this Kennedy-Kassebaum bill to the
floor and eliminate preexisting conditions as a reason for health
coverage and also allow people to be able to carry their health
insurance with them when they lose their job or go from one job to
another.
Mr. DOGGETT. Mr. Speaker, if the gentleman will yield further,
sharing the concern with the gentleman from New Jersey about those who
lack health insurance, let me ask the gentleman about this particular
bill, about this data bank which has been brought to the floor under an
unusual procedure never used before by this Congress, that by the very
nature of the procedure bringing it to the floor, we are as Members
denied an opportunity to amend this bill to address some of these very
real problems that relate to the health care and the lack of access to
insurance that affect millions of working families across this country.
Mr. STARK. Mr. Speaker, reclaiming my time, if I may respond, the
gentleman makes a very good point. These particular bills are brought
to the floor under a euphemism referred to as ``correction day.'' Now,
I think we need a correction week. As a matter of fact, for some folks
we might need a correctional institution. The fact we are ignoring this
piddling little data bank, which somebody had to fuss around to find to
make into a bill to bring to the floor today, is not the important
issue.
Data banks contain tremendous amounts of information. They contain
information, for example, on quality in hospitals. A nonpartisan group
of experts the other day, PROPAC, said that maintaining updates as low
as the Republicans would do in their Medicare bill would have a severe
impact on hospitals.
[[Page H2044]]
point of order
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore. The gentleman will state his point or order.
Mr. THOMAS. Mr. Speaker, I rise to this point of order with the
understanding that apparently Members are no longer held to the rule of
germaneness. The current dialog is nowhere near the intersection of
nexus with the legislation, in this gentleman's opinion. I would ask a
ruling of the Chair.
The SPEAKER pro tempore. The Chair would remind the Members that on
November 14, 1995, the Chair sustained a similar point of order where a
Member was unable to maintain a constant connection or nexus between
the subject of the bill and his remarks on health care generally. The
Chair would ask the Members to proceed with that in mind.
Mr. STARK. Mr. Speaker, I thank the chair for his admonition, and
would request my colleagues to join with me in joining in the spirit of
his request.
Mr. DOGGETT. Mr. Speaker, if the gentleman will yield further, in
other words, this is a so-called corrections day bill, but it does not
correct any of the real problems that affect the American families that
are out there struggling to make ends meet.
Mr. STARK. Mr. Speaker, in the spirit, I happen to agree with the
gentleman's statement, but I think that I cannot find the nexus for the
gentleman of Texas's question.
Mr. DOGGETT. Mr. Speaker, if the gentleman will continue to yield, as
far as the nexus, is there any nexus between this bill and any other
bills that are pending there in the committee from whence this bill
came that do deal with the very real problems of American families? Or
is this just an isolated correction of some problem that is not really
a problem?
Mr. STARK. Mr. Speaker, reclaiming my time, quite frankly, the
committee that deals with this topic has not met, and it is responsible
for Medicare, and it does nothing except worry and tell us that
Medicare is going to go broke. It is in fact fiddling with this type of
data bank, when the major data bank, which is the trust fund, is not
being corrected. So there is a great deal of blame to justly be placed
on the administration of the health committee under its current
leadership.
{time} 1445
Mr. DOGGETT. Well, I thank the gentleman for trying to put some
perspective on the little bit that is being done here and the whole lot
that is not getting any correction at all.
Mr. STARK. The other issue of data banks, Mr. Speaker, is in the
field of insurance regulation. This data bank was designed to find a
correlation between private insurance that an employee might have and
Medicare.
We have further need for a data bank that would deal with the
question of selling insurance that is duplicative. This is a rule that
we have had to protect seniors, and it is being eliminated by the
Republican Medicare bill.
The sales rules are also being eliminated. Now, without keeping a
data bank on the unscrupulous sales practices of health insurers who
sell Medigap, and allowing these duplicative policies to reappear, we
will have no way of knowing how much harm is being done to the seniors.
We estimate that several billions of dollars were paid prior to our
passing the bill which eliminated duplicative Medigap sales to seniors,
but we have not kept that data bank, assuming that those rules would be
affected.
Without any prejudice to the ability to reinstate a data bank, I
think it is necessary to point out that these seniors will need
protection from the unscrupulous insurance agency and this bill----
point of order
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore (Mr. Camp). The gentleman will state it.
Mr. THOMAS. Mr. Speaker, this gentleman is constrained once again to
request that the Speaker, in this gentleman's opinion, understand that
the simple mention of a data bank does not make the discussion germane
to the bill in front of us, to the extent that it would allow the
gentleman from California [Mr. Stark], who quite rightly is pushing the
envelope as he is trying to do, to discuss the sales of Medigap
policies and potential unscrupulous salesmen who might sell these
products.
If, in fact, the Chair rules that that is germane, then these rules
have no meaning at all, in the opinion of the gentleman from
California.
The SPEAKER pro tempore. Would the gentleman from California [Mr.
Stark] like to respond to the point of order?
Mr. STARK. Mr. Speaker, I certainly would, only to suggest to the
Chair that in whichever way the Chair sees fit to rule, the Chair
certainly understands the issues and has been extremely fair, and I
would have no quarrel with him in any event.
The SPEAKER pro tempore. The notion of data banks generally and the
notion of data banks as contained in the bill are not necessarily the
same issue. Again, the Chair would ask the gentleman from California
[Mr. Stark] to confine his remarks to the legislation at hand.
Mr. STARK. The Speaker's admonition is well received.
Mr. Speaker, I would like to return to the issue of the data banks
collected by employers. Part of the reasoning behind repealing this
data bank was the feeling that it was overly intrusive; that the
Federal Government requiring an employer to do something for the common
good is something that the Republicans find antithetical, requiring
employers to obey OSHA rules or good labor relations is somehow
overburdening them.
Thusly, this data bank was considered as intrusive and something
difficult for the employers to maintain.
By the same token, there has been a resistance to say a COBRA
extension. I would submit, Mr. Speaker, that the issue of collecting
this health data in the data banks in H.R. 2685 was probably three or
four times more expensive than keeping data for COBRA extensions for
workers who have been laid off or disabled.
It is difficult for this gentleman to be enthusiastic about moving
limited amounts of restrictions on employers when, as under COBRA, we
have over 30 million Americans who have had their health insurance
extended because we did that, and we have perhaps as many as 4 million,
as we speak today, who have their health insurance under COBRA because
we required those employers to maintain a small data bank.
Now, it escapes reason, or it does to this gentleman, why the
Republicans should oppose extending COBRA. it costs no one anything. No
Federal cost; no cost to the employer; no cost to the insurance
company. It has been offered at 110 percent of the previous premium
instead of the 102, and the data bank collection for that is so much
simpler.
I do not want to see this correction take on a life of its own and be
considered as a policy to remove any responsibility from employers when
they are required by minor Federal regulations to do something that is
in the public interest, something that would be for the good of all
people.
Now, with these layoffs that are coming left and right, American
Telephone laying off 40,000 people or whatever, and I am not about to
suggest that the Republicans are responsible for that. I imagine the
CEO's are Republicans but I do not blame that on the party.
But what I am suggesting is that underlying this bill, the unsung
agenda is that there is something wrong with the Federal Government
requiring an employer, or anybody, to do the right thing. That is
wrong, Mr. Speaker.
The Federal Government, for example, provides Social Security. It has
provided, happily, Medicare, and we do require some businesses or
employers to keep records for that to make sure they are not stealing
from us. That is a data bank. Under no circumstances would I like to
have this bill considered as a precursor for removing other
restrictions on collecting data.
For example, we are finally starting, this was a bipartisan bill when
we used to have bipartisan Medicare bills, to collect outcomes
research, a data bank. We are requiring hospitals, even profit
hospitals, and physicians to begin to build a data bank about how
health policy or health procedures work after 5 or 10 years. That is a
vital part of health research, and in no way should that get mixed up
with this kind of a data bank, which was not well conceived in the
beginning. We have data banks that are useful.
There are other areas that, if I just might mention, as I suggested,
the
[[Page H2045]]
Medigap rules, the question of block granting seniors without knowing
if we do not have data banks, and somebody says, gee, this is
intrusive, we may miss a chance to protect those seniors and those
poorer citizens who do not have the option of being covered under major
policies by their employers.
What I am suggesting is that this correction is worthy of taking care
of. I am not sure it is worthy of spending as much money as we have
assumed here today in printing costs. But I do think that it is a
potential danger, that we ought not to let it set a standard that says
just because we are asking private citizens or private businesses to
collect information, do we feel that that is not something that could
be useful.
Mr. DOGGETT. Mr. Speaker, will the gentleman yield?
Mr. STARK. I yield to the gentleman from Texas.
Mr. DOGGETT. Mr. Speaker, I have just received a copy of the House
Republican National Strategic Plan for 1996, and I am wondering if the
gentleman has an opinion as to how this piece of legislation, which I
believe is the first piece of legislation dealing specifically with any
aspect of Medicare, might fit into that plan, which I will tell the
gentleman specifically calls and says, and I quote, not you and me of
course, but the Republicans ``will pursue a targeted inoculation
strategy on Medicare.'' Does this bill have relevance to that targeted
inoculation strategy on Medicare?
point of order
Mr. THOMAS. Mr. Speaker, I rise to a point of order.
The SPEAKER pro tempore. The gentleman will state it.
Mr. THOMAS. Mr. Speaker, the Speaker knows well my point of order. It
is the subject matter and the content of the bill and the question
propounded by the gentleman from Texas [Mr. Doggett], which has no
relevance or germaneness, as we say in our rules, to the subject matter
before us.
Mr. DOGGETT. Mr. Speaker, may I be heard on the point of order?
The SPEAKER pro tempore. The gentleman has propounded a point of
order to the relevance of the matter at hand.
Mr. STARK. May I be heard on the point of order Mr. Speaker?
The SPEAKER pro tempore. The Chair will allow the gentleman from
California [Mr. Stark] to respond.
Mr. STARK. Mr. Speaker, on the point of order, before you restate it,
it is beyond the capacity of this gentleman to explain Republican
strategy and whether or not it is germane. I would choose not to answer
the question, because I am sure it is one of those mysteries of the
universe that deny intelligent response.
However, inoculation is germane to this because many of these
employers kept records or were to keep records of who was paying for
the inoculations in the Republican Medicare plan, so many people will
be denied inoculations. It is, in fact, very important that we point
out that the inoculations they are talking about are not the same
inoculations that little children are not going to get when the
Medicaid cuts come down from the Republicans.
The SPEAKER pro tempore. In response to the point of order, the Chair
cannot respond to the rhetorical nature of the question stated by the
gentleman from Texas [Mr. Doggett] by necessarily ruling it irrelevant.
Mr. STARK. Mr. Speaker, I reserve the balance of my time.
Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the gentleman from Texas, apparently within the rules,
propounded a question about the fact that this bill is being brought up
under a procedure that we did not have in previous Congresses.
Apparently it is clearly within the scope of germaneness, as ruled by
the Speaker, for me to indicate that there are a lot of things that we
are doing in this Congress that we did not do in previous Congresses.
For example we are auditing the books in this Congress. That was not
done in previous Congresses. We have placed Members of Congress under
the laws that apply to everyone else. That was not done in previous
Congresses, and so there are a lot of things that we are doing in this
Congress that were not done in previous Congresses.
Mr. Speaker, I do want to say that the gentlewoman from Florida [Mrs.
Fowler] has been very interested in this subject matter, and were it
not for the primary in her State and district, the gentlewoman would be
with us today.
Mr. Speaker, I yield 4 minutes to the gentleman from Indiana [Mr.
McIntosh], someone who has had an interest in this for a long time.
Mr. McINTOSH. Mr. Speaker, I am pleased to rise in support of the
bill of the gentleman from California [Mr. Thomas] to repeal the
Medicare-Medicaid data bank requirement. As cochairman of the Speaker's
Advisory Committee on Corrections, I want to commend the gentleman and
his committee for their work on this very good corrections bill.
Before I describe the bill and the reason the Corrections Committee
supports it, let me pause for a moment and say the real issues here is
one of jobs. Jobs, jobs, jobs.
The reason is that what we are doing is getting rid of an obsolete,
unnecessary paperwork requirement that makes it more expensive for
businesses, particularly small businesses, to create new jobs. It is
the Republican hope, along with many Democrats who have supported this
bill, that we will be able to help small businesses create jobs by
passing this bill, eliminating unnecessary redtape and paperwork.
Now, this bill does just what a corrections bill should do. It
eliminates a government-imposed paperwork burden that is not achieving
any conceivable intended result.
The Medicare-Medicaid data bank was established in 1993 with good
intentions, to compile data on secondary insurers for Medicare
subscribers, to help identify those cases in which an employer-based
insurance company should be the primary insurance provider rather than
Medicaid. That is to say, if somebody needs additional coverage from
the Medicare coverage they are receiving, should the government pay for
it through Medicaid or should the employer pay for it through their
primary insurance coverage for their employees?
{time} 1500
Potentially this could have saved the government a great deal of
money by identifying those cases where the government, under the
Medicaid Program, would not need to pay for that secondary insurance.
Unfortunately it has not, and will not, work. The Government Accounting
Office has testified regarding this data bank that, and I will quote
from their statement:
Enormous administrative burden the data bank would place on
the Health Care Financing Administration, known as HCFA here
in Washington, and the Nation's employers likely would do
little or nothing to enhance the current efforts to identify
those beneficiaries who have other health insurance coverage,
* * *
That is to say the health care Medicare-Medicaid data bank has not
been able to do what it was supposed to do, which is streamline the
process and make it less costly for the government.
There are several reasons to be against this program and the need for
this bill. The first is it is a burden on the government itself. The
Health Care Finance Administration has itself stated that the costs
involved in collecting the information will outweigh the costs that may
be recovered by the data bank. That is to say it frankly does not save
the government any money whatsoever.
Second, it is a burden on citizens, particularly small businesses
that have limited resources. They are currently required to compile the
names and Social Security numbers of all of their employees and their
immediate family and report this not only to the IRS, but also the
HCFA. Now gathering and reporting this information takes time and
money, and many small companies, quite frankly, just do not have it in
their budgets to be able to do that. It is more redtape and does very
little good.
And the third reason is that this system is a burden for the
taxpayers. But at least Congress has had the wisdom, up until today, to
make sure that we did not fund it. Given that wisdom, I think it is
important that today we take the next step and repeal the requirement
altogether.
Now the bill of the gentleman from California [Mr. Thomas] will do
away with the Medicare data bank, his bill will save employers across
the Nation and the Federal Government time and money; as a corrections
bill it is one of
[[Page H2046]]
the best that I have seen, and I want to commend the gentleman for his
hard work and urge all of my colleagues to support H.R. 2685.
Mr. THOMAS. Mr. Speaker, I yield such time as he may consume to the
gentleman from New York [Mr. Houghton], a member of the House
subcommittee of the Committee on Ways and Means.
(Mr. HOUGHTON asked and was given permission to revise and extend his
remarks.)
Mr. HOUGHTON. Mr. Speaker, I am really at a loss of words because so
much of what I wanted to say has already been stated. Maybe I can
approach this from somebody who has been in business for a long time
and understands what this Congress is trying to do is to extract the
Government from onerous administrative tasks, which is hardly in
keeping with what we are trying to do to relieve people and businesses
to be able to create more jobs.
I have been around business a long time, and I know what data
collection is; it is important. But when we take a look at this
particular issue, clearly the data collected is highly expensive. The
GAO has estimated that to create a data bank like this, it would be
over $100 million. That is certainly not the intent of Congress, it is
not something which is good for business, it is not something which is
really good for the employees, and when we take a look at a variety of
different businesses that have been contacted, they all agree that this
is not necessary, that the administrative burden is onerous, it opens
the door to tax retirees on values received, and so why report this?
As a matter of fact, I think we all agree with this. As a matter of
fact, I do not think that there is any argument when we are talking
about this issue, H.R. 2685. It is a good issue; we all agree it is a
bipartisan approach. Where we get off the tracks is when we start
getting political and we start messing around in this whole field of
health reform.
We all are citizens of this country, we all want to do the right
thing. It is not a Republican or a Democratic issue. It is something
which we all ought to be concerned about. But today the narrow issue
really is this data bank. I agree with the proposition, I think it
makes a great deal of sense, it will reduce enormous administrative
overburden, and it will save the Federal Government and the taxpayers
of this country over $100 million.
Therefore, I support with the greatest strength I can H.R. 2685. We
are not talking about health insurance reform, we are not talking about
nexuses, we are not talking about inoculations, we are not talking
about strategic plans. We are talking about this particular data bank
issue, and I think it is a good one, and I support the resolution.
Mr. THOMAS. Mr. Speaker, I reserve the balance of my time.
Mr. STARK. Mr. Speaker, I yield myself such time as I may consume.
The gentleman from New York touched on an issue which I think it
important. It is true that we will save employers a piddly little
amount of money by doing away with this data. What the employer has to
do is keep track of an employee's insurance other than Medicare. But if
my colleagues want to talk about a cost to employers and a data bank
that will choke the horse of business, talk about the data bank that
the Republicans are requiring business to keep if they pass these silly
MSA's. Under a medical savings account a business would be required in
a data bank to keep track of every medical expenditure, it would be
required----
point of order
Mr. THOMAS. Mr. Speaker, I have a point of order.
The SPEAKER pro tempore (Mr. Camp). The gentleman is recognized for a
point of order.
Mr. THOMAS. Notwithstanding his elegant eloquence, I believe the
gentleman from California [Mr. Stark] has once again strayed from the
germaneness under the rules of the House.
Mr. STARK. If I may be heard? I am talking about data base
requirements by an employer, an issue raised by the previous speaker,
and I believe it is quite germane as it deals with the requirements
that employers may be faced with in keeping medical data banks as
required by the Federal Government.
Mr. THOMAS. May I be heard on the point of order Mr. Speaker?
I thought the Speaker had already ruled that a discussion of data
banks in general as a concept for collecting data is not necessarily
germane to a specific data bank which is the subject of this bill.
The SPEAKER pro tempore. The gentleman is correct. The Chair will
state again that on November 14, 1995, the Chair sustained a similar
point of order where a Member was unable to maintain a constant nexus
between the subject of the bill and the subject of health care
generally. The Chair has at least three time today, and does again,
sustain that point of order.
Mr. STARK. Mr. Speaker, I will confine my remarks to employers
collecting data for a data bank that relates to Government insurance
and private insurance, which I believe is specifically what the bill
and I am suggesting; that while we are eliminating this, we are on the
other hand creating an even bigger data bank, and perhaps we should
prohibit data banks for things like MSA's which, by the way, exist
without any new legislation.
MSA's are there today. It is, if we require the employer to keep
track of who collects the money for an IRS exemption, he will then have
to keep track of each specific payment to a doctor, and it has been
estimated that it will cost the Government $4 billion to have these
MSA's. Not only will it cost the employers, the gentleman from New York
is concerned about more money, it is going to add $4 billion in costs.
So, as the Republicans have done, on the one hand they say let us
save a nickel here, but let us spend a million dollars if it helps our
rich friends in business, and this is a perfect example of, I think,
being penny-wise and pound-foolish dealing, Mr. Speaker, with a data
bank which is minuscule, which requires almost no recordkeeping by
business, while on the other hand ignoring those data banks that are
being proposed to be imposed on business and private citizens, which
increase the number of insured, increase the deficit and do no good to
anyone.
This, unfortunately, is the litany and the inheritance of the
Republican leadership as they have shown this----
Mr. HOUGHTON. Mr. Speaker, will the gentleman yield?
Mr. STARK. I yield to the gentleman from New York.
Mr. HOUGHTON. Mr. Speaker, I would just like to ask the gentleman,
does he support or does he not support H.R. 2685?
Mr. STARK. I am relatively indifferent, but I can find nothing to
oppose it. If it came to a vote, I would vote for it.
Mr. THOMAS. Mr. Speaker, I yield myself 10 minutes.
(Mr. THOMAS asked and was given permission to revise and extend his
remarks.)
Mr. THOMAS. Mr. Speaker, I want to begin a discussion of the repeal
of this data bank with an underscoring of a point that the gentleman
from California made, and that is that this measure was insisted upon
by the Senate. This is not a work product that originated in the House.
It was contained in the budget legislation that was passed in 1993
under the majority.
I want to go back to a quote, Mr. Speaker, that I used at the
beginning to frame the debate about the repeal of this proposed data
bank. This data bank was never put into effect. It was proposed. We are
now proposing to make sure it never goes into effect.
In testimony before the Committee on Ways and Means by Sarah Jagger
on February 23, 1995, representing a GAO study, she said that this
proposed data bank would create an avalanche of unnecessary paperwork
for both the Health Care Financing Administration and employers, and
will likely achieve little or no savings while costing millions. That
statement was made in February of 1995.
The reason we have this legislation before us today is because the
need to save not only employers, but the Health Care Financing Agency,
money is even more critical today than it was at the time that we took
the testimony, because when we took that testimony in February of 1995,
we had a trustees' report, those individuals who are charged with the
responsibility of overseeing the Medicare trust fund reporting to us
that the Medicare trust fund was sound through the year 2002. What we
have now discovered is that
[[Page H2047]]
based upon real data, not projections, but real data, it is no longer
protected until 2002. This was what was described to us as the
prospective state of the Medicare trust fund at the time this testimony
was delivered, that notwithstanding the continual drop in the trust
fund, the Chairman of the Board of Trustees, the Secretary of the
Treasury, Mr. Rubin, signed a document saying that there is going to be
a reversal of this trend, that the Medicare trust fund will have more
money in it at the end of 1995 than it did in 1994. We were concerned
about saving money in February of 1995, but this was the projection
given to us by the Clinton appointees who are the trustees of the
Medicare trust fund.
This is now March of 1996, and the projections, the, if you will,
more rosy scenario, simply did not obtain, and the reason this bill is
before us today to repeal the proposed data bank and save not just
employers, but the Federal Government, millions of dollars is because
this is actually what happened; not projected, actually what happened.
We actually went minus in the trust fund account for this fiscal year.
That is the first time this has occurred since 1972.
In 1972 the Democrats were in the majority. They promptly raised the
payroll tax. That was a response they used nine times in response to a
shortage of funds. Rather than rethinking, reconceptualizing,
protecting, preserving, and strengthening Medicare they simply raised
the payroll tax.
{time} 1515
This is what they said was going to happen. This is what actually
happened. So we have begun an examination of legislation that we could
bring to the floor which would guarantee that there would be no more
hemorrhaging in the Medicare Trust Fund than was absolutely necessary.
That is the purpose and the substance of bringing this bill to the
floor today.
Perhaps even more chilling was the testimony not of the Secretary of
the Treasury in his function as the Chairman of the trustees, but the
Secretary of Health and Human Services. Dr. Shalala indicated, and
numbers have now been produced, that at the same time the trust fund
was a minus $36 million at the end of fiscal year 1995, in the first 4
months of that year there was $3.8 billion surplus. That is, over a 12-
month period, they went from a $3.8 billion surplus to a $36 million
deficit. As I said, this is the first time it has happened since 1972.
So my inquiry would be, of course, if this is what we look like in
the first 4 months of fiscal year 1995, what do we look like in the
first 4 months of fiscal year 1996, the year we are currently in? The
information that now has been reported, not projections, not rosy
projections to make it look good, but actual figures for fiscal year
1996, the first 4 months, are at a plus $133 million. Remember, when
the first 4 months were at $3.8 billion we wound up with a $36 million
deficit, the first time since 1972 that we had a minus number. If we
have only brought in $133 million in the first 4 months of fiscal year
1996, what is it going to look like in hemorrhaging red ink in the
trust fund without making the kinds of changes we are contemplating?
A number of people have complained that repealing this proposed data
bank certainly seems like small potatoes. It certainly is a first step.
We have to make sure, first of all, that the Government does not do
stupid things. This proposal that was passed by the former Democratic
Congress in 1993 is now universally agreed to be a stupid thing.
What we need to do is sit down and talk about additional changes that
need to be made in the system. Republicans have been more than willing
to do that on a bipartisan basis. In sitting down with a number of very
responsible Democrats, normally known as the self-named blue-dog
Democrats, we have moved forward a proposal, which I am hopeful we will
be able to announce, achieves a bipartisan majority in making sure that
we preserve, protect, and strengthen Medicare.
But we ought to take every opportunity. We ought not to pass up any
opportunity for making changes in the system that will guarantee that
not only employers but the Federal Government does not waste money.
This is one of those efforts. We chose corrections day to do it,
because there was no known opposition at all. This would be an
expedited way to deal with this particular question. I find it
interesting that notwithstanding all of the discussion that occurred on
the side of the minority, no one is in evidence who opposes this
legislation.
Our goal is to work in a bipartisan way to produce legislation that
will make positive change, will create a new Medicare which will
preserve, protect, and strengthen seniors in a prospective fashion,
once we have cleaned up the errors that are left over from previous
Democratic control.
I would urge an ``aye'' vote on this particular measure in front of
corrections day.
Mr. POMEROY. Mr. Speaker, I rise to offer my strong support for
repeal of the Medicare and Medicaid coverage data bank. This provision
of law imposed an unfair and unreasonable burden on the businesses of
North Dakota, and I believe it must be eliminated.
The data bank program was created to help prevent Medicare and
Medicaid from paying claims that are the responsibility of an employer-
based private insurer. Despite this laudable goal of saving Government
funds, there have been fundamental flaws with this planned program from
the beginning. First, under the program employers would be required to
report information to the Federal Government which they did not
routinely collect. Second, employers would be forced to report data on
100 percent of their work force even though only a tiny percentage of
workers would be individuals whose claims might have been eligible for
payment by Medicare or Medicaid. This is a classic example of the
treatment being worse than the disease.
As can be seen, the data bank program imposes a reporting burden on
employers which is far out of proportion to the Government's need for
information. Such unnecessary burdens are particularly harmful to the
many small businesses which dominate the North Dakota economy. This
program is precisely the sort of inefficient approach which North
Dakotans are demanding be eliminated from the Federal Government.
The reports from North Dakota businesses as to the anticipated
burdens of the data bank program were verified in a thorough study by
the General Accounting Office [GAO]. In a report issued on May 6, 1994,
the GAO concluded that the data bank would create burdensome and
unnecessary paperwork for both employers and the Federal Government and
would achieve little or no cost savings while costing millions of
dollars in administrative expense.
Mr. Speaker, at a time when many businesses too often labor under the
burden of complex and sometimes unnecessary Federal regulation, the
Federal Government should not add to this regulatory burden without a
concrete benefit clearly in sight. While the data bank program was well
intentioned, it has proven unworkable. The anticipated benefit is
overwhelmed by the cost of compliance, and, consequently, the program
should be eliminated. Elimination is also warranted by the harmful
effect this program would have on the availability of health insurance
to North Dakota's working families. When increasing numbers of families
are finding themselves without health insurance, the Federal Government
must not make it more expensive and difficult for employers to provide
this insurance for their workers. The substantial administrative
expense associated with the data bank program would have had precisely
this counterproductive effect.
I urge my colleagues to join me in voting for repeal of this well
intentioned but utterly unworkable program.
Mrs. FOWLER. Mr. Speaker, the Medicare/Medicaid data bank was
established by the Omnibus Budget Reconciliation Act of 1993 with the
intent of yielding savings to the Medicare and Medicaid Programs. Like
so many big-government answers, however, it turned out that the data
bank was more of a problem than a solution--impractical, inconvenient,
and expensive. Had the data bank been implemented by the Health Care
Financing Administration, it would have increased the administrative
and paperwork burden on businesses; discouraged employers from
providing health coverage to their employees; and created a
bureaucratic nightmare for HCFA.
Fortunately, the enforcement of the data bank reporting requirements
has been delayed, and now we have a chance to repeal it once and for
all.
At first glance, it appears that the data bank law asks employers to
provide routine information that is readily available. In truth,
however, the reporting requirements ask employers to collect data which
they could have never imagined compiling, such as the names and Social
Security numbers of their employees' spouses and children.
In May 1994, the Government Accounting Office issued a report showing
that the data
[[Page H2048]]
bank would yield little or no savings to Medicare and Medicaid.
Additionally, the Health Care Financing Administration has no interest
in administering the data bank. In fact, the Clinton administration
estimates that the data bank would cost $25 to 30 million to operate
each year.
The data bank sets a new standard for bad laws: It is bad for
business, bad for workers; and even bad for bureaucrats. And it
wouldn't accomplish what it was intended to do.
I want to thank Chairman Thomas for bringing this measure to the
House floor. In the 103d Congress, I introduced H.R. 4095, which would
have repealed the data bank, and I reintroduced the same bill at the
beginning of the 104th Congress. Recently, repeal of the data bank was
also included in the Medicare Preservation Act which the President
vetoed.
There are many of us who have been very disappointed by the
President's unwillingness to deal with Medicare reform in a responsible
manner. His veto of the Medicare Preservation Act not only threatens
the long-term viability of the Medicare Program, but also means that
employers still have to worry that HCFA might enforce the reporting
requirements of the data bank.
This bill eliminates that concern and I hope that my colleagues will
join me in support of H.R. 2685
The SPEAKER pro tempore (Mr. Camp). Pursuant to the rule, the
previous question is ordered.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question as taken; and (three-fifths having voted in favor
thereof) the bill was passed.
A motion to reconsider was laid on the table.
____________________