[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.
____________________