[Congressional Record Volume 142, Number 84 (Monday, June 10, 1996)]
[House]
[Pages H6098-H6104]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           IMPACT OF REPUBLICAN CUTS ON MEDICARE AND MEDICAID

  The SPEAKER pro tempore. Under the Speaker's announced policy on May 
12, 1995, the gentleman from New Jersey [Mr. Pallone] is recognized for 
60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, on previous occasions during these special 
orders I have talked about the impact of the Republican cuts in 
Medicare and the fact that the Republican leadership proposals on 
Medicare would cut the Medicare Program so much that most of the money, 
or a good percentage of the money that would be cut, would be used for 
tax breaks for wealthy Americans and also that the changes in the 
Medicare Program that have been proposed by the Republican leadership 
would negatively impact the Medicare Program by essentially depriving 
many senior citizens of their choice of doctor, pushing them into 
managed care programs; if they did not go into managed care of HMO 
programs, they would actually experience rather large

[[Page H6099]]

increases in out-of-pocket expenses because the protections that exist 
under current law whereby a doctor can charge only 15 percent more than 
what Medicare pays would basically be repealed.
  I have been very critical of the various components of the Medicare 
Program that the Republicans have proposed. Well, tonight I wanted to 
repeat some of that, but perhaps even more so, go into some of the 
changes that are being proposed for the Medicaid Program because 
tomorrow we are likely to take up on the House floor the Republican 
budget bill, the conference bill that comes back from both the House 
and the Senate, and that includes major provisions and incorporates the 
changes, if you will, in the Medicare and the Medicare programs that 
the Republican leadership has proposed.
  In addition, starting tomorrow and after tomorrow, once that budget 
is adopted, as I expect it will be by the Republicans or by the 
Republican majority, we will start seeing individual committees take up 
different components of that budget proposal, including the Medicare 
and the Medicaid components, and actually come forward, the committees 
will come forward, with legislation that provides a lot more details 
about exactly how the Republicans and the leadership plan to make 
changes in Medicare and Medicaid. Specifically, tomorrow my committee, 
the Committee on Commerce, which has a Subcommittee on Health and the 
Environment, will actually have a hearing on the Medicaid changes that 
would likely be brought up and voted on in the committee some time 
later this week.

  The problem that I have with the Medicaid Program in some ways is 
very similar to the problem that I have with the Republican Medicare 
proposal. The cuts are too deep, they negatively impact the program 
because the money is taken away from the program and used for other 
purposes, primarily tax breaks for wealthy Americans, but in the case 
of the Medicaid Program, unlike the Medicare program, the Medicaid 
Program is essentially repealed outright because its entitlement 
status, the guarantee that Medicaid recipients have now that they will 
receive certain health care coverage or even health care coverage, is 
basically taken away, and the program is what we call block-granted to 
individual States. The States get a certain amount of money. They can 
decide pretty much on their own how they decide to disburse that money. 
If they decide that certain categories of people should no longer be 
eligible for Medicaid, it is pretty much up to them to make that 
decision, and even those who continue to be covered by Medicaid in many 
cases will find that the scope of their coverage or services that are 
rendered available to them are significantly less or significantly 
poorer quality.
  Now, many people think of the Medicaid Program as a program for poor 
people, and that is essentially true, and the Medicare Program, of 
course, is for all seniors regardless of their income status. Medicaid, 
on the other hand, is for people of any age who fall below a certain 
income. But in this country, in these United States, most of the 
Medicaid Program money, most of the money that the Federal Government 
and the State governments contribute to Medicaid, actually pays for 
senior citizens who are staying in nursing homes. So Medicaid is, 
although it is not exclusively for senior citizens by far, the majority 
of the money goes to pay for senior citizens services, and it is just 
as important to the seniors of this country, almost as important, I 
should say, as Medicare itself.
  I want to keep stressing that, that Medicaid is primarily a program, 
or at least financially a program, that pays for seniors' health care, 
primarily again in nursing homes.
  Mr. Speaker, I wanted to talk about some of the reasons more 
specifically why I oppose this Republican Medicaid Program and the 
changes that are being proposed by the Republican leadership. The 
budget that we will be voting on most likely tomorrow would reduce 
Federal spending on Medicaid over the next 6 years by $72 billion. This 
means that compared with what the Congressional Budget Office, or the 
CBO, estimates is necessary to maintain the program's current level of 
coverage, the Federal Government would be spending $72 billion less, a 
cut in Federal Medicaid spending would be 16 percent below the amount 
CBO estimates is necessary or needed to maintain the program at its 
current level.
  So once again you are going to be hearing from the other side of the 
aisle, and they are going to be saying, well, we are actually 
increasing the amount of money that we spend on Medicaid in the same 
way that we are increasing the absolute amount of money that we are 
spending on Medicare. But if you look at inflation and the actual cost 
to take care of the people that are in the Medicaid Program now, just 
as in Medicare, and project how many people would be in those programs 
over the next 5 or 6 years, you realize very quickly that the amount of 
money that is going to be made available will not cover the needs of 
those Americans who would normally be eligible for Medicaid or 
Medicare.
  In addition, Medicaid, unlike Medicare, is 50 percent paid by the 
States. So what the Federal Government does in how it relates to what 
the States pay is also significant, and under the Republican budget, 
which we will be voting on most likely tomorrow, the States would be 
allowed to decrease their spending, and State Medicaid spending would 
fall by $178 billion over the next 6 years, more than twice as much as 
the Federal spending would be cut.

                              {time}  1845

  So we could say that the total cut in Medicaid spending, both Federal 
and State, would be $250 billion, or 18 percent.
  There is no way, Mr. Speaker, this program can continue to cover this 
same number of people and provide the same level of services with that 
level of cut. It is unprecedented. Of course, it is not intended to 
cover the same amount of people. The anticipation has to be that a lot 
of people will simply not be eligible for Medicaid anymore.
  As I said, the Republican bill would repeal the Medicaid Program and 
replace it with a block grant to the States. More specifically, the 
Republican bill repeals the individual Medicaid entitlement effective 
October 1 of this year.
  What does that mean when we talk about entitlements? Entitlements 
historically have been if you are eligible because of income or other 
criteria for a program, you are guaranteed that you would have that 
health care coverage. Essentially what this Republican bill does is 
take away the entitlement status of Medicaid, so no one is actually 
guaranteed that they are going to have health insurance. Basically, 
States would be entitled to fix the amounts of Federal dollars and 
could vary the benefits they offer from person to person and area to 
area.
  I want to stress again, and I do not think I can stress enough, that 
we are primarily here, in terms of dollars, talking about nursing home 
coverage for senior citizens. The Republican bill puts the elderly, 
especially the frail elderly in nursing homes, and their families at 
risk of paying large amounts of out-of-pocket expenses for needed care 
and of losing much of their current coverage altogether.
  The Republican bill repeals the current entitlement that low-income 
Americans have needed nursing home care, again effective October 1. 
Again, if you were below a certain income now, you are guaranteed 
nursing home coverage. You will not be under this bill. The bill 
repeals the current requirement that nursing home services and other 
benefits be sufficient in scope, allowing States to limit coverage to, 
say, 14 days per month, or 2 months per year. Elderly nursing home 
patients and their families would have to pay for the care received 
during those periods the States chose to cover. Not only can the States 
decide not to cover certain people for nursing home care, but they can 
decide they will only cover them for 14 days, half a month, or a 
certain number of months per year, and basically say you have to pay; 
and since these people do not have the money to pay themselves, their 
families, their children, their grandchildren, would have to pay those 
expenses in the nursing home.
  The Republican bill also repeals the current law requiring that 
States pay nursing homes reasonable and adequate rates for the services 
they provide to

[[Page H6100]]

Medicaid patients, and it prohibits nursing homes from suing States in 
Federal court to enforce the reasonable and adequate payment standard.
  Oftentimes what happens now is that States will decide that in order 
to save money, they will reduce the reimbursement rate that goes from 
Medicaid to the nursing homes. A lot of times in the past the nursing 
homes could get together and say, look, that is not enough money to pay 
for care. We would have to cut back on the amount of nurses that are 
available. We would have tot cut back on various services. They sue in 
the Federal court and they say, ``This is not enough to pay for the 
proper services that we offer,'' and many times they win. Sometimes 
that do not. They would not be able to bring suit anymore, and there 
would not be a requirement anymore that the States set a rate at what 
is reasonable to actually cover the costs of the nursing home care.

  The Republican bill also repeals the current law prohibition against 
the imposition of cost-sharing requirements on Medicaid nursing home 
patients. So, as a result, I will give an example, States could require 
each beneficiary to contribute $25 per day, say, toward the cost of 
nursing home care. Since most of the beneficiary's income is already 
applied towards the cost of care, because we are talking about low-
income people, the burden of this additional cost-sharing would, as a 
practical matter, fall on the individual's family.
  Mr. Speaker, what we are seeing here is a major shift historically. 
When seniors were not able to afford nursing home care, the State and 
the Federal Government contributed and paid for that care. What we are 
going to see increasingly is that the burden will fall more and more on 
the children and the grandchildren. I think some people say that is 
fine, let the children or the grandchildren pay; but when we think 
about the fact that those children may have the educational expenses 
for their children or may have other costs that they incur in order to 
pay for their children or their regular lives, it is very difficult for 
many of them to now have to shell money out of pocket to pay for 
nursing home care for their parents or their grandparents.
  Mr. Speaker, I wanted to talk a little bit about what this Republican 
Medicaid plan does for children. The bill basically strips over 18 
million poor children of the health insurance coverage which they are 
guaranteed under current law, children with disabilities or health 
conditions that are expensive to treat, and their families are at a 
particular risk of losing coverage.
  The bill repeals the current entitlement to a basic benefit package 
for every American child under 13 living in a family in poverty. This 
repeal, which will essentially terminate health insurance coverage for 
over 18 million children, would become effective October 1. The bill 
also repeals the current requirement that States provide basic health 
care coverage to children age 13 up to 18, living in poverty, and under 
the Republican bill, coverage to these children would be at the option 
of each State.
  Finally, the Republican bill repeals the current law requirement that 
physician, hospital, and other so-called guaranteed benefits be 
sufficient in scope for children. As a result, States would be allowed 
to limit children to, say, one physician visit per month or 5 hospital 
days per year. Just as with the seniors in the nursing homes, the 
children, the coverage for children, could be limited by just taking 
out whole categories of children who would not have health insurance, 
and would then be among the ranks of the uninsured, or basically by 
limiting the kinds of services that the children would receive under 
the program.
  I see that my colleague, the gentleman from New York [Mr. Hinchey], 
is here. I yield to him to talk about Medicaid or Medicare, which I 
know is very important to him and his district.
  Mr. HINCHEY. Mr. Speaker, I thank the gentleman for blocking out this 
time and giving me an opportunity to join him in this discussion.
  I know that the gentleman is very concerned, as I am and I think many 
of the people in this House are, about the future of both Medicare and 
Medicaid. Last week we saw once again the trustees, the 
Medicare trustees, issue their annual report. It is a report, of 
course, that they issue every year. When they issued their report last 
year, the Medicare trustees reported that legislation that would reduce 
costs by only $89 billion over a 7-year period would be sufficient to 
maintain Medicare's financial security. So it is not an awfully 
difficult job to do. A relatively small amount of money over that 7-
year period will ensure the future stability of Medicare for at least 
another decade beyond that.

  Most of this legislation, which would extend Medicare's viability 
another decade, required only the continuation of existing Medicare 
laws that were scheduled to expire. So, simply by taking laws that are 
about to expire and extending them into the future, that alone will 
provide us with most of the funds that we need to ensure the strength 
and viability of Medicare for at least another 10 years. Many of us, 
including you and I, cosponsored legislation that would continue those 
laws and would meet that $89 billion goal.
  Relatively small shifts in reimbursement levels and technical changes 
can produce substantial savings without requiring any dramatic overhaul 
of the Medicare Program. Our colleagues on the other side of the aisle 
here, whose real intention is to destroy Medicare, are proposing to cut 
much greater funds out of the program. Their proposal last year, of 
course, was for $270 billion out of Medicare. They have dropped that 
back a little bit this year. It is something in the neighborhood of 
$220 to $240 billion that they would cut out of Medicare this year in 
their budget proposal over a 7-year period.
  We know that there have been many times in the past, and Medicare has 
been around now for 30 years, there have been many times when the 
trustees have reported that Medicare would run out of funds, in some 
cases in as short a time as only 2 years. There were a couple of 
periods back in the decade of the 1980s, for example, when the trustees 
came in with their report and said unless the Congress takes some 
action of some kind to strengthen the fund, the fund will be exhausted 
in 2 years. Of course, Congress took that action, and the fund was 
extended for years into the future.
  Now the trustees, in their most recent report, have said that the 
fund is secure for another 5 years. There is nothing that has to be 
done for another 5 years and it will be secure, but sometime within 
that 5-year period the Congress will have to act.
  That has always been the case. Medicare was created on a pay-as-you-
go basis back in 1965. It was not as though Lyndon Johnson, who was 
President then, found a big pot of money someplace and said, well, this 
is going to be the Medicare trust fund. We have just discovered this 
fund and we are going to turn it into the Medicare trust fund. Nothing 
like that, of course, happened. What they did was set up the Medicare 
program and established its funding on a pay-as-you-go basis, year 
after year after year, assuming that the program would be effective, 
that the American people would support it, and so therefore the 
Congress would continue to support it with the necessary funds.
  Now the majority party here has come and has reacted to this recent 
revelation, this recent report from the trustees that stipulates that 
Medicare is fine for 5 years, and they are trying to instill panic in 
the general population, particularly those people who are receiving 
Medicare, elderly people. They are vulnerable to this. They are worried 
about their health care. So when someone in the House of 
Representatives stands up here on the floor and stamps their feet and 
makes a big to-do, pretending that Medicare is about to go bankrupt, 
when in fact it is stronger today than it has been many times in the 
past, senior citizens become concerned, because it is the health 
insurance that they need to get the health care they need to sustain 
their health and to sustain their lives. Their children become 
concerned, too, because without Medicare they know that they would have 
to sustain substantial costs which in many cases for working people 
would be far beyond their ability to sustain.
   Mr. Speaker, it is really, I think, scandalous the way some people 
here have tried to turn this routine report from the Medicare trustees 
that comes out every year, how they have tried to turn it into a 
political football, and they are trying to exploit this report

[[Page H6101]]

by pretending it is something that it is not. It is not a call for 
alarm, certainly not panic. It is simply the requirement, annual 
requirement that the law stipulates that the trustees must do, and that 
is to report to Congress and to the United States every year on the 
condition of the fund. The fund, with 5 years, is obviously a lot 
stronger than it was back in the 1980s, when a number of times, at 
least twice, there were only 2 years left in the fund.
  Congress has responded throughout this 3-year period. In the last 13 
years, for example, Congress has adjusted the Medicare fund nine times 
to respond to recommendations that were contained in the annual report 
of the Medicare trustees. So this report this year is nothing 
extraordinary, it is nothing new. It is the routine, annual reporting 
of the trustees to the Congress, and it is our responsibility to 
respond to that either this year or next year.
  The proper response is, as I indicated when I first started speaking 
a few moments ago, the proper response is to look at the existing law, 
take some of those things that are about to expire, extend them on into 
the future so that they will produce the needed revenues, and the mere 
$89 billion over 7 years, a far cry from the $270 billion that our 
friends on the other side of the aisle are trying to chop out of the 
program, simply by extending provisions in the existing law you can 
obtain the $89 billion over 7 years and ensure the strength and 
solvency of the fund for at least another decade, which is the kind of 
thing that the Congress has done over and over and over again 
throughout the 30-year history of Medicare.
  But it comes as no surprise to you nor to me that these folks are 
trying to exploit this report, to turn it into a source of panic and 
concern, when really there is no need for concern, let alone panic. It 
comes as no surprise to us because we know that the majority leader of 
the Senate, who is now about to retire, was bragging here on an October 
day last year when he was addressing a very conservative group of 
people here, when he was trying to appeal to them as a candidate for 
the Republican nomination for President, he was trying to appeal to 
them by saying to this very right-wing group, ``If you want someone who 
is really conservative, then I think I am the guy you want, because I 
have been against Medicare from the very beginning.'' He bragged about 
being one of only 12 people to vote against Medicare when it was first 
proposed on the floor of this House. he was a Member of the House in 
those days, in 1965.
  He bragged about being only one of 12 people to oppose the Medicare 
legislation, and he seemingly makes no bones about it, frankly. He was 
proud of the fact that he was against it then. He said he has been 
against it ever since, and he is against it today. Why, he explained? 
Because, and this is the real kind of silly part of his argument, he 
said, ``Because I knew it would not work then and I know it does not 
work now.''
  The fact of the matter is that millions of American seniors have 
benefited from the Medicare program. It has provided them with 
excellent health care; not that it is perfect by any means. There are 
things we have to do and will do to improve the program. But the fact 
of the matter is that Medicare has served the senior citizens, 65-year-
or-older population in this country, very well now for more than 30 
years. And of course we know that the Speaker of our own House, 
coincidentally that same week in October of last year, speaking to a 
group of insurance executives at the time, said this to them.
  He said, ``We are not going to attack Medicare directly. No, no. We 
are not going to do that. That would be politically unwise,'' he said. 
``What we are going to do is attack it circuitously, by going around 
the back, withdrawing the funds from the program''; hence their 
proposal for a $270 billion reduction, ``withdraw the funds from the 
program and let Medicare wither on the vine.''

                              {time}  1900

  That was his approach to these insurance executives, who of course 
many of them would like to see Medicare be destroyed, because that 
would give them some opportunity to perhaps sell some health care 
insurance to some people who do not need it now because of the fact 
that they have Medicare.
  So it comes as no surprise to us, it ought to come as no surprise to 
the American people that there are certain people in this House as well 
as in the other body that are trying to exploit this routine report 
from the Medicare trustees, turn it into something it is not, pretend 
that it is cause for concern and try to exploit it for political 
reasons, which I think is frankly unconscionable. Nevertheless, that is 
what they are trying to do, when in fact this is a routine report.
  It is simply the trustees fulfilling their obligations to report to 
the Congress and to the American people, and this Congress or the next 
one, which will be elected in November, will do exactly what Congresses 
have done in each and every case in the past. They will do the 
responsible thing. They will extend these programs out. They will take 
the appropriate action to ensure that this Medicare program, which has 
served the country and particularly our elderly population so well now 
for so long, will continue to do precisely that.
  So I wanted to come over and join you in this discussion because I 
think that these are matters that are important and ought to be said. 
In fact, I think that they ought to be said as often as possible.
  Mr. PALLONE. I appreciate the gentleman coming down and saying the 
things that he said. It is so true. I think it is really an ideological 
phenomenon that basically the Republican leadership does not favor 
Medicare or Medicaid, and that is essentially because I think that they 
believe that whether it is for seniors or it is for low-income people, 
there really should not be a government-funded or run health care 
program.
  The bottom line is that these programs were established because we 
knew that the majority of seniors were not able to get health 
insurance. When Medicare was established in 1965, the majority of 
seniors did not have health insurance coverage. Certainly people who 
are eligible now for Medicaid who are very low income, there is no way 
for them to get health insurance coverage unless the Government 
provides a program like Medicaid.
  But what the gentleman was saying about how the Republican leadership 
is trying to use this Medicare trustees' report as a way to justify 
their radical changes, if you will, that they are suggesting for 
Medicare, is so true.
  I just have some statistics here that show that right now the 
Medicare trust fund actually has a $125 billion balance and there is no 
danger that claims will not be paid. I have people coming up to me 
because they hear what the Republicans say, and they say, ``Is my 
Medicare going to be paid this year?''
  As the gentleman points out, even though the trustees' report 
indicated that it would only be solvent for another 5 years, that is 
actually better than many previous trustees' reports which were only 
for 2 years. Also, when the gentleman was talking about the actions by 
the House, the Democrats in 1995 and 1996 actually proposed on the 
floor amendments to the budgets that would have corrected the problem.
  We had a vote on a proposal of the gentleman from Florida [Mr. 
Gibbons], the ranking member on the Committee on Ways and Means, the 
Democratic ranking member, last year during the budget debate to cut, 
I guess, $90 billion out of Medicare. That is exactly what the 
trustees' report said was necessary in order to keep the program 
solvent for the next decade. The President's budget was offered on the 
floor this year that would have achieved the same goal, and the 
Republicans voted against it.

  Basically what they are trying to do is, they are trying to increase 
the cuts significantly more, as the gentleman said, than what is 
necessary to keep the program solvent. I have maintained that is 
primarily in order to pay for these tax breaks that go primarily to 
very wealthy Americans.
  So I think it is only fair, as the gentleman is doing, to point out 
where this debate really is. What we are seeing are efforts on the part 
of Speaker Gingrich and the Republican leadership to make real changes 
in the Medicare program and also in Medicaid, as I was talking earlier 
that are essentially going to have a negative impact on these programs 
and ultimately force

[[Page H6102]]

them to disappear or, as I guess the Speaker said, wither on this vine. 
I think that was his quote, that Medicare should wither on the vine.
  Mr. HINCHEY. It is clear that that is his intention. I think you are 
right for pointing out that there are certain ideological differences. 
There are things relating to public policy that separate the Democratic 
Party from the Republican Party, not every member of the Republican 
Party, because there are people in the Republican Party who very much 
appreciate Medicare, who like it, regard it as something very positive 
and want to support and sustain it.
  It happens, however, that the leadership in this House feels quite 
differently and the leadership in the Senate feels quite differently. 
They are very strongly opposed to it. They have said so themselves. 
They make no bones about it. They are not reticent about their 
opposition to it. They have been quite clear in the things that they 
have said. They are opposed to the continuation of Medicare, as they 
are opposed to the continuation of Medicaid, and they are trying to 
destroy these programs by taking the lifeblood from them, the funding 
that is necessary to keep them going.
  Something else that the gentleman said really stuck me, also. I was 
at a housing unit over in Binghamton, which is a city in my district, 
over the weekend. It is a very lovely place. It is well run, it is well 
kept. It is 16 years old, was funded by the Federal Government. It was 
built 16 years ago but it is maintained so well that one would think it 
was only 4 or 5 years old. it is in very good condition.
  This is a building that houses senior citizens and people with 
multiple disabilities. If it were not for buildings like this, these 
people frankly in many cases would have no place to go. So here they 
have an opportunity to live independently and live in a secure 
environment and one that is quite pleasant. In fact, in the back yard 
there was a lovely landscaping operation and a garden where people had 
planted some vegetables, tomatoes, and things like that, to harvest in 
the summer harvest.
  They were deeply concerned when I talked to them about Medicare. They 
had heard some of the things that were reported here. They had heard 
about the Medicare trustees' report, they had heard about the kind of 
twists on that report that had been placed upon it by certain Members 
of this House on the other side of the aisle, and they were deeply 
concerned.
  They were wondering if they were going to continue to have their 
health insurance, if it was going to continue to be viable. I had to 
assure them that, yes, of course it was, that this report was not 
anything unusual, it was simply the routine report put out by the 
trustees.

  But there are people here in Washington who do not like Medicare. 
They have never like it, as Bob Dole has said quite clearly. He was 
against it from the very beginning back in 1965. He did not like it 
then, he does not like it now. That is his right, of course, not to 
like it. He is certainly entitled to his opinion.
  We think he is wrong. We believe earnestly that he is wrong. We 
recognize that Medicare has served this country very well, particularly 
our elderly population and the families of older people as well. But 
they do not like it and they are opposed to it. They would like to see 
it ended, and they are trying to destroy it by these continuing efforts 
to cut the funds out of the program so that, in the words of Speaker 
Gingrich, it would just wither on the vine.
  Mr. PALLONE. I am somewhat familiar with the gentleman's district, 
not so much with Binghamton but with Endicott, which is also in your 
district, I believe.
  Mr. HINCHEY. Yes, it is.
  Mr. PALLONE. Because my father-in-law and mother-in-law both grew up, 
until they went off to college, lived in Endicott, and I have been up 
there a few times. It in many ways very similar to a lot of areas in my 
district where there is an aging population in many ways. You have a 
lot of the senior citizens, maybe a little out of proportion to some 
other areas of the State or other States.
  The problem that I see with all this, not only with Medicare and 
Medicaid, with the Republican proposals, is that if you cut people off 
the rolls or if you cut back the services that are covered by Medicare 
and Medicaid you cause, which is what they are doing basically, a lot 
more out-of-pocket expenses. What I see is the burden shifting 
increasingly to the children and the grandchildren of these senior 
citizens. Because many of them are not going to be able to afford the 
additional costs out of pocket.
  Some people have said to me, ``Oh, that's okay, let the children and 
the grandchildren pay for it.'' First of all, you have the phenomenon 
that some will not. But beyond that, how far can they go? A lot of 
younger people have their own children to raise and they are not 
expecting that they are going to have to shell out large amounts of 
money to pay for nursing home care for their parents or their 
grandparents or these other doctor and physician services.
  What we are talking about here is not just something that relates to 
senior citizens but relates to the population as a whole because of the 
cost shifts that would occur. I do not know that we have been able to 
get that out a lot, but I think that it is a phenomenon that we need to 
speak out about.
  Mr. HINCHEY. The gentleman is absolutely right, of course. It is 
critically important. I know the families in my district, and I know 
that my district is not unusual, this is true of families across the 
country, are struggling today because of the fact that incomes have 
been stagnating, in some cases even declining. From 1989 to 1992, 
average incomes in this country for working people actually went down. 
That is an extraordinary fact. So working people are having a difficult 
time as it is just trying to maintain their standard of living. In many 
cases it is slipping a bit. They are trying to put some money aside for 
the education of their children, perhaps for their retirement, in the 
case of young people trying to put some money aside for the purchase of 
a first home or perhaps to start a business, something of that 
nature. and if they had to suddenly be forced to bear the additional 
costs of tending for the health care needs of their parents and 
grandparents absent Medicare and Medicaid, I think for many people that 
I know, certainly in my family and many of my friends and the people 
that I know and the people that I represent across my district, it 
would be an absolute impossibility. They just could not do it.

  This is a situation that although it affects our elderly population, 
our senior citizens, most directly because it is their health care, 
after all, but by extension it affects in a very direct and very solid 
way everybody in the country. Everyone in this country would be 
affected if we were to lose the Medicare Program. I think that that is 
why this program is supported so overwhelmingly. Every indication, 
polls and other samplings of public opinion indicate that the American 
people support Medicare, they understand its value, how it has helped 
their parents and grandparents, what it means to them and their 
economic circumstances, and they support its continuation. They want it 
improved as you and I want it improved. There are problems with 
Medicare in the area of fraud and abuse that need to be improved and I 
am happy that the administration has taken some very solid steps 
recently updating the computer operation so that cross-checking of 
bills can be done much more quickly and much more accurately. There 
have been instances of double billing in Medicare from some doctors. 
Most doctors, of course, would not do that. But in any population of 
any group of people, you are going to find some who will try to exploit 
the system. And so we have had examples of double billing from some 
physicians in Medicare, and these changes in the administration of 
Medicare that are being brought on line by the Clinton administration, 
updating the computers, making them more powerful, giving them the 
ability to cross-check and cross-reference bills, will sharply reduce 
the incidence of fraud and abuse in the Medicare system, and we need to 
continue to do that.
  It is estimated that as much as $1 billion a year is found in fraud 
and abuse in Medicare. I think if we continue to work on that, we can 
get that down to a very small number. I do not think that we are ever 
going to eliminate it completely, but I think we can get it

[[Page H6103]]

down to a very small number and that will be additional funds, of 
course, which will be available to improve the quality of the program 
and the quality of health care that is available to the people who 
depend upon it.
  Mr. PALLONE. One of the things that I was going to get to tonight, 
and obviously there is so much to be said about Medicare and Medicaid 
that we could talk forever, but one of the things that Democrats have 
been critical of in the Republican changes to the Medicaid program is a 
provision that actually repeals statutory safeguards that have 
protected against some fraud and abuse. I think people have the notion 
that the reform proposals that have come forward on the floor here over 
the last year would somehow curb fraud and abuse, but in many cases 
they repeal existing statutory protections against fraud and abuse.
  For example, in the Medicaid program over the past 10 years the 
largest single abuse of Federal Medicaid funds has been the use by some 
States of what is called illusory financing schemes. This is where they 
have these fictitious payments to disproportionate share hospitals and 
then the State substitutes Federal for State dollars effectively 
reducing the State's share of program costs.
  In 1991 and again in 1993 Congress enacted legislation designed to 
curb these abuses where they set up these fictitious funds and the 
Republican bill expressly repeals these statutory safeguards 
essentially reopening the door to abuse of the Federal Treasury by 
States if they want to lower their own Medicaid spending without 
reducing the amount of Federal Medicaid funds that they would fall down 
on.

                              {time}  1915

  So again, one would think when we are getting a reform proposal that 
we would be cutting back on the fraud and abuse, but in effect what 
this does, in block granting the money, it actually takes away some of 
the safeguards that have been used by the Federal Government to prevent 
the States from basically coming up with these illusory finance 
schemes.
  We might say what State would do that, but, of course, States do that 
because they are trying to save money and cut back on the amount of 
State dollars and use the Federal funds in ways they are not supposed 
to.
  Mr. HINCHEY. Absolutely. I served in the State legislature, and I 
know State legislatures and governors are not embarrassed about trying 
to use Federal funds in creative ways to solve their own budgetary 
problems.
  In New York, for example, where the State still does not have a 
budget in place, it is months overdue, if they had the opportunity to 
manipulate Federal funds in a way that would allow them to produce a 
budget easily, without them having to do some difficult things within 
the context of their own responsibility, I believe they would do it and 
they would not care about the loss of the Federal program. They would 
just sort of gloss over that.
  So there is a lot of irony here, unquestionably. Not only do our 
friends on the other side of the aisle over here want to cut Medicare 
by $270 billion so they can pay for a $245 billion tax cut, most of the 
proceeds of which would go to upper-income people, but, as the 
gentleman pointed out, they are slashing away, and the bill is still 
before the House, the one that calls for a $270 billion cut, they are 
slashing away at the existing provisions which attack fraud and abuse.
  What they would do in that bill is this: They would raise the 
standards of proof so it would be more difficult for investigators and 
law enforcement people to prove fraud in the system. So if there were 
people out there ripping the system off, under their proposal it would 
be tougher to catch them. So the white collar crooks ripping off the 
Medicare system would get away with murder based on their proposal 
because they would make it much more difficult for the authorities to 
catch up with them.
  And, in addition to that, they go further. When and if they were ever 
caught under their proposal, they reduce the penalties. So anyone 
caught abusing the system through fraud or other ways, not only would 
it be tougher to catch them under their proposal but if they were ever 
caught the penalties for stealing from the system would be 
substantially reduced.

  It is an incredible irony and I think it indicates quite clearly how 
dedicated they are to the destruction of the Medicare Program. They 
want to take the money out of it and use if for unnecessary tax cuts. 
And, for the most part, people are sensible enough not to want them 
because they understand that that money ought to be used to keep this 
program strong, and if there is any extra money lying around here in 
Washington it ought to be used to balance the budget.
  Not only do they want to do that, but out of one side of their mouth 
they talk about the budget deficit and out of the other side they talk 
about big tax cuts. It is quite extraordinary, frankly.
  Mr. PALLONE. I agree. And the other thing that has really been, I 
think, not exposed enough is this whole way in which they go about 
adding more out-of-pocket expenses under Medicare. Last year when we 
had the Medicare proposal, they were actually increasing the costs of 
the part B premium, the amount that seniors pay under Medicare for 
their physician's care. Those premiums were skyrocketing over the next 
5 or 6 years, and we managed to basically scuttle that because the 
President said he would not sign it. I guess he actually vetoed the 
bill.
  But now what they are trying to do in this bill that is going to come 
to the floor tomorrow is essentially say that if an individual refuses 
to join an HMO or a managed care system, and they want to stay in the 
traditional Medicare Program where they choose their own doctor or 
their own health provider, then they no longer have the guarantee that 
the doctor or provider cannot charge them 15 percent beyond what 
Medicare pays. There is actually no limit.
  So when I hear my colleagues on the other side say, well, you are 
given all the choice you want here; you can stay in traditional 
Medicare or go to an HMO, or you can have all the choices you want, 
what kind of choice do you have if you stay in the traditional Medicare 
program and then the doctor can charge you an unlimited amount of 
copayment? You are not going to be able to stay with this very long 
unless you have unlimited resources, which obviously most seniors do 
not.
  I have been trying to explain that as much as possible to my own 
constituents because I think they cannot imagine a situation where the 
doctors can charge an unlimited amount beyond what Medicare bills. But 
that is only forbidden now because of the statutory restrictions on it.

  Mr. HINCHEY. Right. There are statutory restrictions which were put 
into place not too long ago, as a matter of fact, were they not? I 
think a decade or so ago.
  Mr. PALLONE. That is right.
  Mr. HINCHEY. They were put into place because it had become clear 
that overbilling had become rampant in the system, and this was 
something that was done to ensure fairness and to prevent overbilling.
  I think the point that the gentleman has just raised is important, 
and it reminded me of something that I have here. The Physician's 
Payment Review Commission, which is a nonpartisan panel of experts that 
advises Congress on Medicare policy, had the following to say. They 
said, and I quote, this change that our friends, the Republicans want 
to make here, which would allow unscrupulous physicians to overbill 
Medicare patients by large amounts, they say, and I quote, ``could 
leave beneficiaries exposed to substantial out-of-pocket liability in 
the range of 40 percent of the bill.''
  So the effect of their proposal, which will be, I think, here before 
us tomorrow or later this week, is it tomorrow?
  Mr. PALLONE. Probably tomorrow, but I guess we do not know for sure.
  Mr. HINCHEY. Yes. Could be tomorrow or could be Wednesday. In any 
case, what they want to do is take the limit off the billing ceilings 
for health care, and that would expose Medicare beneficiaries, the 
people who are reliant upon Medicare, to pay out of their pockets an 
additional 40 percent.
  Now, again, what they are trying to do here is transparent. It is so 
easy to see through their motivation. They are trying to destroy 
confidence in the program. They think that if somehow they could get 
this bill passed, I do not know how they think they could get it

[[Page H6104]]

passed, I mean the President would obviously veto if it ever gets to 
him, the Senate probably has more sense than to ever take it up, but 
what they want to do is to establish a new law which would require 
Medicare beneficiaries to pay, on tap of their copayments and on top of 
other insurance that they might have now, under their proposal, an 
additional 40 percent out-of-pocket for routine health care procedures.

  Now, that is guaranteed to undermine the public's confidence in the 
Medicare system and it is precisely what they want to do. It is clearly 
their motivation. It is so transparent that anyone, no matter how 
myopic they might be, can see through it.
  So over and over again they want to destroy this Medicare program in 
one way or another by cutting the funding out of it, by pretending the 
Medicare trustees report is something it is not, trying to elicit fear 
on the part of people who are depending upon Medicare, and now by 
attempting to pass a bill which would provide that doctors can charge 
almost as much as they want and elderly people would have to pay 40 
percent out-of-pocket.
  It is really, I think, scandalous.
  Mr. PALLONE. I am glad you mentioned this. I was actually assuming, 
which I see from the document I have, which is similar to yours from 
this Physician's Payment Review Commission, I was assuming that that 40 
percent included the copayment, but that is actually beyond the 
copayment.
  Mr. HINCHEY. Yes.
  Mr. PALLONE. So you could have a 20 percent copayment and then have 
this 40 percent out-of-pocket beyond the traditional copayment, which 
is incredible when you think about it. Who is going to be able to 
afford that? I mean, very, very few.
  Mr. HINCHEY. Oh, yes. That is exactly right. On top of everything 
else it is as much as an additional 40 percent. So if their bill ever 
became law, what we would have in the case of a senior citizen who 
required some surgery of some kind, say for example, that in an 
addition to the payments that would be made through Medicare and 
whatever additional insurance they might have, they would then be faced 
with the need to pay thousands of additional dollars out of their own 
pocket. And that is just absurd.
  Mr. PALLONE. The other thing that I was thinking about when the 
gentleman was talking about this extra out-of-pocket expense is the 
fact that the majority of seniors now are covered by medigap. So they 
are already buying a supplemental insurance policy, in many cases 
called medigap, that covers services and out-of-pocket expenses in some 
cases as well.
  I know that I saw an article in the New York Times just a few weeks 
ago that talked about how costs for Medigap supplemental insurance were 
going up in our States, the New York metropolitan area, New York, New 
Jersey, and Connecticut, something like 14 percent over the next year. 
So when one thinks about all these extra out-of-pocket costs for the 
seniors that would result, I would assume also that those Medigap 
premiums would soar as well, because as fewer services were covered, we 
would see even a higher cost for Medigap.

  How far can these people go? How far can the seniors go?
  Mr. HINCHEY. Well, there seems to be no limit on the temerity of some 
of the majority party in this House and their ability to attack 
Medicare and Medicaid.
  I know you have talked about Medicaid earlier. In my State, and I 
assume it is probably similar in New Jersey, 80 percent of the funding 
in the Medicaid program in New York goes to pay for the expenses of 
senior citizens and people with multiple disabilities in nursing homes 
or similar settings.
  Mr. PALLONE. Exactly.
  Mr. HINCHEY. Obviously, what would happen to the families of those 
people if Medicare were changed in the way that they are proposing to 
change it, to block grant it, reduce the amounts of money that is 
available, send what is left in the form of block grants to the States, 
the States then would have to add on administrative costs or take out 
of that administrative costs because now they will have to run the 
program and be responsible for parts of it. They would have to hire 
people to do that. They would have to have office space and most of the 
things that would be associated with making additional costs, which 
would take money out of the Medicaid program.
  As the gentleman mentioned earlier, there is always the temptation 
for State governments, when they have access to Federal funds, to use 
them in what might be called creative ways and to spend that money out 
of the Medicaid system to help balance a budget or to do something else 
for some other kind of expenditure in some way.
  The result of all of that would be far less money available for 
Medicaid recipients, elderly people in nursing homes, people with 
multiple disabilities in nursing homes. I ask myself, what would the 
families of those people do? How would they cope with that? How would 
they manage under those circumstances?
  I can tell the gentleman in the case of many of the people I know, 
the families of people who have elderly parents in nursing homes or who 
have someone in their family who is severely handicapped with a severe 
physical disability as a result of an automobile accident, perhaps, or 
as a result of a condition at birth in some instances, they simply 
would not be able to deal with it. They do not have the financial 
resources.
  So people would end up being taken and put into closets somewhere. We 
have all heard the horror stories that existed prior to the 
establishment of Medicare and Medicaid; how people, left to their own 
devices, without the resources to handle these situations in competent 
ways, what they had to resort to. And I know that we would be in many 
instances put back into those same circumstances. We have to prevent 
that and the way we can prevent it is by keeping these programs alive 
and preventing the opponents of Medicare and Medicaid from having their 
way, preventing them from destroying these programs, which is precisely 
what they want to do.
  Mr. PALLONE. I appreciate what the gentleman is saying, and I think 
that over the next few weeks we will be pointing out more and more 
about how Medicare and Medicaid are negatively impacted by these 
Republican proposals.

                              {time}  1930

  In many ways, even though we have not talked as much, we have talked 
about it, but there has not been as much discussion on the floor about 
Medicaid. In many cases the changes proposed on Medicaid are even more 
drastic, but I think fewer people will be covered. The impact on senior 
citizens is just as great, as the gentleman said, because so many 
senior citizens in nursing homes or other institutions will no longer 
be covered or will not have adequate coverage and will see increasing 
out-of-pocket expenses.
  The same things we talked about for Medicare in terms of the 
overcharges, that is also in the Medicaid legislation that the 
Republicans have proposed. Those overcharges will not be paid by the 
seniors but will be paid by the family in many cases.
  I thank the gentleman for coming down and joining me in discussing 
this. I know that over the next few weeks we are going to be talking 
about it more and more, and even though the budget comes before the 
House tomorrow, a lot of the details will be worked out in the various 
committees leading up to reconciliation, as we call it, later this 
year. So we are going to have to continue to fight this battle to 
preserve Medicare and Medicaid.
  Mr. HINCHEY. I thank the gentleman. This is one of the most critical 
subjects we have before this Congress, and the more light we can shed 
on those proposals, the better off the American people will be. They 
will be able to make competent decisions based on factual information 
rather than pretend on hysterical statements that we have seen coming 
out of some of the people in the House over the last couple of days.
  Mr. PALLONE. I thank the gentleman.

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