[Congressional Record Volume 142, Number 77 (Thursday, May 30, 1996)]
[House]
[Pages H5745-H5748]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            FEDERAL SPENDING

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Georgia [Mr. Kingston] is recognized for 5 minutes.
  Mr. KINGSTON. Mr. Speaker, let me start off by saying I have got 
great news for Ethel in San Rafael, California and Vern in California 
also. The Republican plan increases their Medicare from $190 billion to 
$304 billion. Good news.
  Ms. WOOLSEY. Will the gentleman yield?
  Mr. KINGSTON. Mr. Speaker, I will be glad to send them the 
information since they are not getting it from that side of the aisle. 
I will be happy to. Let me yield to the gentlewoman for 20 seconds. But 
let the Record show Democrats earlier would not yield to me for even 10 
seconds. But I got some other stuff I want to talk about.
  Ms. WOOLSEY. Mr. Speaker, I would have yielded for 10 seconds, 
believe me.
  I would like to point out that Medicare is not growing to cover the 
cost of inflation, nor the cost of the need for the services and the 
people who will be needing those services. One thing is increasing an 
amount, the other thing is to increase the amount to cover those who 
will be using the benefit.
  Mr. KINGSTON. Reclaiming the time, I appreciate that point. Our 
budget increases Medicare from $5,000 to $7,000 per person in 
anticipation of new enrollees, so that includes new enrollees. Again, I 
will be happy to send that information to your constituents and work 
with you on a bipartisan basis.
  Let me also, though, address the good old days of Democrat leadership 
because that is one of the things I really wanted to talk about since 
the theme on the Democrat side seems to be let us go back to Democrat 
leadership. What happened when President Clinton, the Democrats 
controlled the Senate, the House and the White House? The highest tax 
increase in the history of America, $265 billion. Highest spending, 
$300 billion increase in spending. A $16 billion stimulus package that 
President Clinton and the Democrats in the Senate and the Democrats in 
the House passed, which included, among other important things, is 
cataloguing fish.
  They did not propose a balanced budget when the Democrats controlled 
the House, the Senate and the White House. The Republicans on the other 
hand, have passed a balanced budget out of this House for the first 
time in 26 years. The balanced budget amendment did not get out of the 
House under Democrat leadership; did pass under Republican leadership.
  On welfare reform, the President of the United States in 1992 
promised to end welfare reform as we know it, had a Democrat House, a 
Democrat Senate, and did not introduce a welfare bill. We have passed 
two out of this body and in the Senate, one passing on a bipartisan 
vote of 87-12. It was vetoed not once but twice by the President.
  On health care, the President of the United States, when he had the 
two Chambers, tried to pass a nationalized health care plan and 
increased the bureaucracy by 59 different agencies. It did not move 
under the Republican House and the Republican Senate. We have health 
care reform that is making health care more affordable and more 
accessible. It is now in conference. It looks good.
  New bureaucracy, endless growth of the Government under President 
Clinton , including AmeriCorps, which is a volunteer program that pays 
volunteers $26,000 per volunteer. Let me repeat that: $26,000 per 
volunteer. We are trying to downsize the bureaucracy.
  Student loans, very little happened under student loans under 
President Clinton. A lot of defaults, of course, but implemented the 
first stage of government takeover of the student loan program. We, on 
the other hand, have a budget that has increased student loans from $24 
billion to $36 billion. Be happy to share that with any Democrat who 
does not have that information.

  When the Democrats controlled the Senate and the House and the White 
House, there were no major reforms of Congress. Under the Republican 
Congress, we passed Congressional Accountability Act, a gift ban. We 
have cut the staff by one-third. We have required a two-thirds vote for 
an increase in taxes. We are considering campaign reform as we speak.
  For the senior citizens that the Democrats used to love to say that 
they are great champions of, under President Clinton and the Democrat 
House and the Democrat Senate, there was an increase on Social Security 
taxes, taxes were increased on Social Security. Under the Republican 
House, we have decreased those taxes. Now, that of course was vetoed by 
the President.
  We have also passed an earnings limitation so that seniors who want 
to can stay in the workplace longer. Even little things, I am not going 
to say this is little at all, but I mean, things that are less visible, 
we have done many, many changes on. I will be happy to share that.
  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from New Jersey [Mr. Pallone] is recognized for 
one-half the time remaining before midnight as the designee of the 
minority leader.
  The Chair recognizes the gentleman from New Jersey.
  Mr. PALLONE. Mr. Speaker, I just wanted to begin this special order 
tonight by pointing out that this evening, when we had the Democratic 
motion to instruct on the budget, that a major point that was being 
made in that motion to instruct is that the budget resolution that was 
adopted here in the House that is put forward by the Republican 
leadership basically denies basic protection on health care for 
seniors.
  Essentially what we have in this budget resolution are major attacks 
on the Medicare Program, and also on the Medicaid Program. As a result, 
in the motion to instruct that was put forward by the Democrats this 
evening,

[[Page H5746]]

we were trying to seek to retain current protections under the law 
against excessive Medicare charges by doctors and hospitals to preserve 
Federal nursing home standards and also to make sure that we do not 
have a recurrence of the spousal impoverishment and liens on homes that 
occurred before protections were put into place for the Medicaid 
Program, again to protect seniors.
  Part of this motion to instruct was for us as Democrats to make the 
point that this Republican budget, which we will be considering again 
probably in conference within the next couple of weeks, essentially 
takes us down the same path that we were on last year with regard to 
fiscal priorities, especially with regard to our Nation's seniors. May 
is Older Americans Month, and I want to emphasize that this Republican 
budget truly reflects the hurt, if you will, that the Republican 
leadership seeks to implement on seniors, particularly on the Medicare 
and Medicaid Programs.
  The Republican Medicare plan will result in seniors paying more out 
of their own pockets for substandard care while cutting over $160 
billion to pay for tax breaks for the wealthy. More important than 
these steep cuts are the extreme structural change that the Republican 
leadership is trying to impose on seniors. Their plan eliminates the 
choice of doctors and hospitals that seniors now enjoy by basically 
forcing them into managed care.

  This Republican plan will allow doctors to charge seniors extra money 
beyond the expenses that Medicare will cover. This means that seniors 
will have to pay doctors a lot more money out of their own pocket. To 
compound all of this, the cuts that the Republicans are imposing will 
force many hospitals to close. The funding that hospitals, home health 
care service, skilled nursing facilities receive will be sharply 
reduced. The bottom line is that with that reduced resource, many 
seniors will suffer.
  I have to say once again that I believe very strongly that Medicare 
should not even be discussed in the context of the budget resolution. 
If we are looking to improve Medicare, we should increase preventive 
services and cut the waste, fraud and abuse in the Medicare Program. 
These are the types of things that will ensure Medicare's future while 
providing quality health care for our Nation's seniors. Instead, the 
Republican leadership is essentially going down a path of destroying 
Medicare and also Medicaid.
  I wanted to just point out again, and I know I have a number of 
speakers here tonight who want to join in this special order, and I 
would like to yield some time to them. But essentially we went through 
the same process in 1995 last year with the Republican leadership in 
their budget trying to essentially change both the Medicare and the 
Medicaid Programs in very negative ways.
  As Democrats, we pointed out that last year, essentially what we 
tried to do was to prevent the Republicans from doubling Medicare part 
B premiums, eliminating doctor choice, cutting Medicare premium 
assistance for low-income seniors, repealing Federal nursing home 
quality standards, putting homes and family farms of elderly couples at 
risk for nursing home care. And also the Republicans were trying to 
force adult children to be financially liable for their parents' 
nursing home bills.
   Mr. Speaker, we were very successful as Democrats in essentially 
putting to rest these changes that the Republicans were trying to make 
last year in the Medicare program. We have the same phenomenon again 
this year. The budget that was already adopted here, the Republican 
leadership that was adopted already on the floor and which will come up 
again in a few weeks in conference before it finally is adopted by both 
the House and the Senate Republican leadership, still plans to 
eliminate doctor and hospital choice by forcing seniors into Medicare 
managed care plans. It also allows doctors to charge extra out-of-
pocket costs to seniors who remain in medicare fee-for-service, 
severely cuts Medicare and Medicaid hospital funding, forcing many 
hospitals to close their doors on seniors, eliminates coverage 
guarantees for over 4 million elderly Americans who need nursing home 
care, and also further erodes Medicare's solvency by creating wealthy 
healthy plans, leaving many seniors with higher costs and less care.
  We have the same thing again, which is Medicare cuts to pay for tax 
care to pay for tax breaks for wealthy Americans, and a continued 
decline in the quality of service and the ability of our senior 
citizens to obtain quality Medicare programs and forcing them to pay 
more out of their own pockets.
  So the record, the Republican leadership record is the same. It is 
just the same old plan that we dealt with last year that we are going 
to have rehashed again here in the House in 1996.
  With that, I would like to introduce and yield some time now to the 
gentleman from Ohio [Mr. Brown].
  Mr. BROWN of Ohio. Thank you, Mr. Pallone, for your work in opposing 
these extreme Gingrich Medicare and Medicaid plans.
  What is amazing, and I want to take one small part out of what you 
said. The Gingrich plan and what they are trying to do in this body 
today is not much different from when they shut the government down 
last year. Medicare cuts, student loan cuts, cuts in the environment, 
all to pay for tax breaks for the richest people in society.
  One particular issue that you touched on is what they want to do to 
nursing home protections. Last year we thought we had won that battle. 
We thought that they would not try that again. Again, this year in 
their budget and in our committee, in the Committee on Commerce, and 
the Health Subcommittee when they are talking about these issues, the 
Gingrich plan again says let us repeal all the protections for nursing 
homes that this Congress, with President Reagan, passed 10 years ago.
  I though in this society there was a consensus around making sure 
that there were protections against oversedation, protections against 
restraints or senior citizens in nursing homes.

                              {time}  2315

  I thought there was a consensus in the society that they in fact 
would be protected if those laws would be in place to make nursing 
homes safer because clearly those laws passed by the Democratic 
Congress with the Republican President in the mid-1980's made sense and 
would stay in place.
  Yet the Gingrich extremists, this Congress, has tried to pull that 
consensus apart when a great majority, probably 90 percent of the 
public, believes, yes, we should have those protections in nursing 
homes. Yet this Gingrich extremist group says, ``Let's not; let's 
repeal it, turn it over to the States.'' That was the problem we had in 
the beginning where State governments simply were not providing for 
safe nursing homes with the kinds of regulation that is necessary to 
protect those senior citizens in nursing homes.
  And not only are they making cuts in Medicare and Medicaid to pay for 
tax breaks for the richest people in society, at the same time they are 
stripping away those protections for the safety of our parents and our 
grandparents in nursing homes.
  Mr. Speaker, it just simply does not make sense, and they are trying 
to explode a consensus, these Gingrich extremists are trying to explode 
this consensus that we have built in this country on this issue, on 
clean air laws, on safe drinking water laws, on pure food laws, on 
worker safety laws. They are trying to explode this consensus that 
society in this great country has built, and I simply do not understand 
it.
  Mr. PALLONE. Well, I think, if the gentleman will yield back, the 
problem is that they are trying to squeeze all of this money out of the 
budget through the Medicare and the Medicaid programs, and the 
gentleman from Ohio [Mr. Brown] makes the point that essentially what 
is happening here is they are turning over, if you will, the Medicaid 
program in a block grant to the States and letting the States 
essentially do what they want, whether that means no nursing home 
standards or whatever, in order to try to save money, to squeeze money 
out of Medicaid again primarily to pay for these tax breaks for the 
wealthy. That is what motivates this. It is all budget driven.
  And I want to thank the gentleman for his statements, and I would 
like to yield now to the gentlewoman from North Carolina [Mrs. 
Clayton].
  Mrs. CLAYTON. Thank you for yielding, and I also want to thank you 
for

[[Page H5747]]

your leadership in keeping us focused on what the implications of these 
cuts are, and I would just like to make my brief remarks on emphasis of 
rural communities.
  I come from North Carolina, and my district, North Carolina, 
including my district, is rural and represents a rural America which 
indeed suffers already from other economic indicators. We are 
communities that have less of infrastructure. We are communities of 
lower wages. We are communities having less of conveniences already.
  Now, when you combine that with having these indiscriminate cuts of 
reducing in the amount that senior citizens can get and hospitals can 
get, that is going to further impact those poorest, must vulnerable of 
our society, and that means rural hospitals, which are already 
operating at the margin because they have more than 80 percent of all 
of their pay coming from either Medicare or Medicaid. So they are 
already over-dependent on Medicare and Medicaid.
  That would mean more closing of hospitals in rural areas, yet this 
Congress's particular majority say they believe in rural America. They 
say that, but people will see indeed what they do.
  What they want is a cheaper health service, not a better health 
service, and I think we should make the point that Democrats would like 
to see that senior citizens have better health care. We would like to 
see a better health care plan, not necessarily a cheaper health care 
plan. Cheaper is not always less costly, because in the long run, when 
the society has less health care, that would mean there will be less 
providers. Already we are suffering from a disproportion of health 
providers in hospitals in rural areas.
  So cheaper does not mean better. It means always that you get less 
for the quality of services for the money that you offer.
  So we do not want to deny senior citizens quality health care under 
the disguise of having a cheaper plan. What we want is a better health 
plan that does not cost as much.
  And you are correct. What we should focus on is reducing--reducing 
the preventive--I mean increasing preventative programs that will give 
us better quality of health. Then those of us in rural areas can make a 
better life for ourselves.
  So I just want to add to the discussion that those of us who live in 
rural America will be hurt far greater than those of us who live in the 
rest of America. Already we are disproportionately suffering from the 
lack of services, and now to put this greater cut on our rural 
hospitals, that means that one-fourth of the hospitals in rural America 
will be finding themselves threatened with closure, and I think that is 
grossly unfair.
  Rural Americans also suffer with high percentage of people who are 
lower income, and 63 percent of those who are senior citizens in rural 
areas happen to live in poverty. So you know what the cuts in Medicare 
and Medicaid will do to that population, and I yield back the time and 
thank the gentleman for his leadership.
  Mr. PALLONE. Mr. Speaker, I think the gentlewoman makes a very good 
point, and I think a lot of people do not realize that whether it is 
rural areas, or suburban areas, or urban areas, my district is mostly 
suburban, but the majority of the hospitals are more than 50 percent 
Medicare-Medicaid dependent in my area, and so when you talk about cuts 
in Medicare and Medicaid, even in a suburban district like that I 
represent, you are talking about most of the income that these 
hospitals have. They will not be able to continue to operate with the 
level of cuts that the Republicans have proposed.
  And they are trying to say that they are doing this in order to save 
Medicare. In reality what they are really doing is using Medicare as 
the focal point of their budget in order to achieve, you know, tax 
breaks, and to deal with their budget, they are cutting, making these 
massive cuts in Medicare and Medicaid, and the result is that the 
hospitals in many areas will close, not only in rural areas, but even 
in some suburban areas.
  Mrs. CLAYTON. I think the American people will judge them by what 
they do. They say they are for America, but what they really are for is 
for the richest of America, and they do not mind who suffers in the 
process, whether senior citizens or whatever.
  Mr. PALLONE. Exactly. Thank you.
  I like to yield now to the gentleman from Michigan [Mr. Bonior], our 
minority whip.
  Mr. BONIOR. I thank my friend for taking this time and for laying out 
for us, I think rather clearly, this evening how the Republican agenda 
with respect to Medicare--and it really has not changed. You are 
absolutely right. Although we were able to beat back some of these 
Draconian measures in terms of cuts and increased charges for our 
seniors in order to pay for the huge tax breaks that they want to 
provide for the wealthiest in this country, we will beat that back, get 
the President to veto that particular provision. They have come back 
again this year, and they want to do it all over again. It is like deja 
vu all over again.
  And the gentlewoman from North Carolina is absolutely correct in 
terms of what this is going to do, what their plan is going to do to 
hospitals, and it is not just rural hospitals, but she is absolutely 
correct. It is going to really hurt rural hospitals. We are talking 
roughly about $5 million out of hospitals, and that means many 
hospitals will be closing in this country, and the services that they 
provide for those who remain open will be diminished in terms of what 
they provide today.
  But in metropolitan areas in southeastern Michigan where I come from, 
the Republican proposal last year would have cost those hospitals $2.2 
billion over the 7 years of their budget plan. Now, what does that 
mean? That means 5,000 people with good-paying jobs would have to be 
laid off in those hospitals. That means poor service for the people who 
are in those hospitals.
  And on top of all of that we learn that the Republican proposal to 
cut Medicare in order to give tax breaks to the wealthiest in our 
country today, the extremist Gingrich idea here would also do something 
that is beyond me. That is, it would allow people to be billed by their 
doctors above what Medicare allows, and this extra billing is 
disastrous for our seniors. Sixty percent of our seniors today in this 
country have incomes of $10,000 a year or less. That includes their 
Social Security and any annuity or retirement they may have; 60 
percent, $10,000 or less. They cannot afford to go to a doctor, have 
Medicare pick up x amount, and then have the doctor send them a bill, 
and these bills start piling up on their bureau drawers, and they look 
at them every day, and they have this terrible feeling they are not 
meeting their obligations, and these bills are there staring them in 
the face, hundreds of dollars, thousands of dollars.
  This billing practice that they want to institute is not in the best 
interests of our elderly people in this country. They cannot afford it. 
Is not fair. And you know this is all part of their plan to 
put together a pot of money in order to provide tax breaks for the 
wealthiest individuals in our society today.

  So I thank my friend from New Jersey [Mr. Pallone] for laying these 
facts out for us today, laying out the fact that what they really want 
to do is break this system, and they want to do it by moving people 
into managed care so those people who are left in fee for services are 
going to have humongous rates charged to them, and they want to do it 
by providing medical savings accounts which go to the healthy and the 
wealthy in this country, and not anyone else, and basically take away 
from the basic structure of Medicare.
  They really want to kill Medicare. We know that. I think the general 
public understands that. They are not interested in reforming it. They 
want to change it and change it permanently, and you really basically 
get rid of it.
  And Medicare has been a very good system. It has worked for seniors 
in this country for many, many years. Before we had Medicare in 1965, 
literally hundreds of thousands of seniors were indigent in this 
country. A large percentage of them were indigent because they could 
not afford health care, they have to rely on their families. This has 
helped bring literally tens of millions of seniors out of poverty and 
helped them live with dignity in their later years.
  We are here to protect that program. We, as you point out correctly, 
understand that there needs to be some streamlining, we need to make 
some

[[Page H5748]]

savings, we need to get rid of the waste, the fraud and the abuse in 
the system. And we are committed to do that. But we are not committed 
to destroy a program that has provided for our seniors in this country.
  And I thank my colleague for his determination, for his leadership on 
this issue and for raising this issue tonight for the American people 
to focus in on because in fact we are in another battle, and it is a 
battle to save Medicare for our elderly in this country.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Michigan 
and just point out again, you know, I know that our colleagues on the 
other side always say, well, people will have choice, they do not have 
to go into managed care. But the reality is the way the system is set 
up by the Republican leadership, people are forced into managed care. 
You have a rate differential, which means basically that doctors will 
get reimbursed more or less depending on which system seniors opt for, 
and then you have this balanced billing. So essentially what happens is 
seniors find that since they have to spend a lot more money out of 
pocket to pay the doctor, if they stay in the traditional system where 
they can choose their own doctor, they are literally forced into the 
managed care system because under that system they do not have to pay 
the extra money out of pocket to their doctor.
  So when the Republicans say, oh, you have a choice, the reality is 
you do not have a choice. You are forced into managed care. Otherwise 
you have to stay in a system where the cost and how much you have to 
pay out of pocket just gets to be more and more. And so in reality you 
do not have a choice. You lose your choice of doctor and also maybe 
your choice of hospital in a lot of cases, and I think that is 
important to point out.
  I yield now to the gentlewoman from Connecticut, who has done so much 
on this Medicare issue and made the point so well on it.
  Ms. DeLAURO. It is a pleasure to join my colleagues here tonight, and 
I just like to pick up a comment that our colleague from Michigan 
pointed out, and that is, if you need to put the Medicare debate in a 
context, we live in a great country, we really do, and in 1965 we 
passed a Medicare system. As a matter of fact as an aside, it was the 
current Republican candidate for President, Bob Dole, who said that he 
was proud of his vote back then and he voted against Medicare because 
he did not believe that it was a system that worked. And we ought to 
keep that in mind. This was not a comment that he did not believe it 
would work in 1965. In 1996, when he was running for President of the 
United States, he does not believe that this is a system that works. We 
ought to keep that squarely in mind.
  But the fact is that it was passed, and it was a stroke of genius in 
terms of health care for seniors in this country.

                              {time}  2330

  Before Medicare, less than 50 percent of seniors in this Nation had 
health care coverage in any way. Today, 99 percent of seniors are 
covered. They have health care. They do not have to worry that they are 
going to be wiped out because of an illness that they did not create 
but they were unfortunate enough to get.
  I think we need to talk about this debate on Medicare and Medicaid in 
the context of what this system has meant to people in this country. As 
my colleagues have pointed out, last year in the Republican budget they 
intended to make a $270 billion cut in Medicaid to pay for tax breaks, 
$245 billion in tax breaks for the wealthiest in this country.
  What happened around the Nation, the hue and cry of seniors, of their 
families, of people who believed that this was the wrong thing to do, 
stopped them from doing the kinds of things that my colleague, the 
gentleman from New Jersey, has pointed out in his chart. What they 
wanted to do was to double the premiums, to increase the copayments, 
increase the deductibles, do away with choice, make it more difficult 
for hospitals, make it more difficult for rural areas.
  Quite frankly, we thought we had beat back the barbarians. But 
instead, what we see is in the 1997 budget the very same set of 
premises, the very same policy being brought forward again. This is a 
new budget, but it is the same set of policies with regard to Medicare 
and Medicaid and the same sweeping and dangerous cuts.
  To quote the gentleman from Georgia, Mr. Gingrich, he said ``We can't 
do it all at once.'' The goal for Mr. Gingrich, he would like to see 
Medicare wither on the vine, but ``we can't do it all at once. We need 
to do it in pieces.'' So we tried in 1995 and we got pushed back, so we 
are going to try again in 1996, and God help us in 1997, because it 
will come back again.
  The Republicans got a little trickier this time in this budget. They 
learned a lesson: Don't let anything sit around for too long so that 
the American public has some time to notice what is going on and to 
learn about it, because if they learn about it and they know about it, 
they are very smart and they will rise up and they will say that we are 
not going to do this. Sixty percent of the public said to the President 
of the United States that they wanted him to veto that budget because 
it contained these kinds of Medicare cuts.

  This new budget, and I put ``new'' in quotes, moved through this 
House in a week, moved through this House in 1 week because they knew 
that if they let it stay around long enough, we would see the exact 
same set of premises, the exact same policy with regard to Medicare and 
Medicaid that they tried to impose on the American public in the last 
budget, last year. It is $168 billion in Medicaid and Medicare cuts 
this time around. It is done in 6 years versus 7 years. It would have 
sliced 19 percent last year from Medicare. This year it is 17 percent, 
a 2 percent difference. The American public should not be fooled. It is 
the exact some policy.
  Let us contrast the cut with the amount of the tax break for the 
wealthy. It is $168 billion in a tax cut in Medicare and it is $176 to 
$180 billion in a tax break that will benefit the wealthiest in this 
country. It is the same exact equation that was set up in the last 
budget. The public should not be fooled.
  If we move to Medicaid, or as my colleagues has pointed out, in these 
areas we have the same things that exist. The restrictions that are now 
on doctors and hospitals not to overcharge people beyond what Medicare 
will take care of will be removed: increased bills, out-of-pocket costs 
for seniors; nursing home standards not enforced. And we know what that 
means in the quality of life and the quality of care for those we love 
who go into nursing homes. We know also what they want to do to spouses 
and children in being able to attack their assets.
  The long and the short of it is that we are going to make this fight 
day in and day out in the next several weeks, in the next several 
months, because the public should not be fooled by the same set of 
policies that would foist upon American seniors a second-rate health 
care system. It is wrong, it is unfair, it is not what this Nation is 
about. It is not what our values are. It is not what our priorities 
are. We are going to make the same fight and the same cases that we did 
over the last several months. This is not going to rest until we turn 
this policy around and do what is right and do what is best for 
America's seniors and the American people.

                          ____________________