[Congressional Record Volume 142, Number 123 (Tuesday, September 10, 1996)]
[House]
[Pages H10115-H10118]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                COUNTY HEALTH ORGANIZATION EXEMPTION ACT

  The Clerk called the bill (H.R. 3056) to permit a county-operated 
health insuring organization to qualify as an organization exempt from 
certain requirements otherwise applicable to health insuring 
organizations under the Medicaid program notwithstanding that the 
organization enrolls Medicaid beneficiaries residing in another county.
  The Clerk read the bill, as follows:

                               H.R. 3056

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. PERMITTING COUNTY-OPERATED HEALTH INSURING 
                   ORGANIZATIONS TO ENROLL MEDICAID BENEFICIARIES 
                   RESIDING IN ANOTHER COUNTY UNDER MEDICAID 
                   WAIVER FOR CERTAIN COUNTY-OPERATED HEALTH 
                   INSURING ORGANIZATIONS.

       (a) In General.--Section 9517(c)(3)(B)(ii) of the 
     Consolidated Omnibus Budget Reconciliation Act of 1985 (42 
     U.S.C. 1396b note), as added by section 4734 of the Omnibus 
     Budget Reconciliation Act of 1990, is amended by inserting 
     ``or counties'' after ``county''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to quarters beginning on or after October 1, 
     1996.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California [Mr. Moorhead] and the gentleman from New Mexico [Mr. 
Richardson] each will control 30 minutes.
  The Chair recognizes the gentleman from California [Mr. Moorhead].
  Mr. MOORHEAD. Madam Speaker, I yield myself such time as I may 
consume.
  (Mr. MOORHEAD asked and was given permission to revise and extend his 
remarks.)
  Mr. MOORHEAD. Madam Speaker, I rise in support of H.R. 3056.
  This bill would allow a Health Insurance Organization to serve 
Medicaid beneficiaries residing in one or more counties. Current law, 
as interpreted

[[Page H10116]]

by the Health Care Financing Administration, limits such coverage 
solely to the county in which an organization operates.
  This bill redefines an eligible organization to be one that ``enrolls 
all Medicaid beneficiaries residing in the county or counties in which 
it operates.''
  This will enable eligible health insurance organizations, including 
the Solano partnership health plan--which operates in Solano County, 
CA--to extend coverage to Medicaid recipients residing in counties 
other than that county in which their operations are based.
  In the case of the Solano plan, coverage will be extended to 12,000 
Medi-Cal recipients residing in Napa County. Since coverage costs for 
these organizations are lower than the average monthly payment for 
beneficiaries, the Congressional Budget Office estimates that this bill 
will save the Federal Government up to half a million dollars a year.
  This bill is supported by Governor Wilson, the California Department 
of Health Services, and the Solano and Napa County Boards of 
Supervisors.
  I especially want to commend the gentleman from California [Mr. 
Riggs] for bringing this issue to the attention of the committee.
  I urge the Members of the House to approve this bill.
  Madam Speaker, I yield such time as he may consume to the gentleman 
from California [Mr. Riggs].
  (Mr. RIGGS asked and was given permission to revise and extend his 
remarks.)
  Mr. RIGGS. Madam Speaker, I thank the gentleman for yielding time to 
me and for his leadership on the Committee on Commerce, and as my very 
good friend and colleague, the gentleman from California, and the dean 
of our delegation, and let me just say I hope we will have future 
opportunities in the next few weeks as we wrap up our legislative work, 
but I want to salute Carlos Moorhead for his distinguished service in 
the Congress and tell him the he will be sorely missed in our ranks, 
and particularly as the dean of the California Republican congressional 
delegation.
  Madam Speaker, I rise today in support of my legislation, H.R. 3056, 
a very simple bill that I introduced that makes a technical change to 
current Medicaid law as it applies to California and my congressional 
district. I want to thank the gentlewoman from Nevada, Barbara 
Vucanovich, who is the chairwoman of the Speaker's Corrections Day 
advisory group, the gentleman from Virginia, Tom Bliley, the chairman 
of the House Committee on Commerce, the gentleman from Florida, Michael 
Bilirakis, from the Committee on Commerce, the gentleman from Florida, 
Mr. Barr, of the Committee on Commerce, the gentleman from California, 
Mr. Waxman, and the gentleman from Michigan, Mr. Dingell, on the 
minority side, for their help on this legislation.
  This is a very commonsense bill that would simply allow county health 
systems that are currently prohibited from providing Medicaid services 
to eligible recipients in other counties to do so. That is to say, it 
changes the law by making a technical modification to Medicaid HMO 
amendments included in the Omnibus Budget Reconciliation Act of 1985, 
as amended by the Omnibus Budget Reconciliation Act of 1990, by 
specifically inserting the phrase ``or counties'' after the word 
``county'' in one place to clarify the intent of the law.
  What this technical amendment does, of course, is allow a Medicaid 
HMO, in this case the Solano Partnership Health Plan, a nonprofit 
Medicaid HMO, to be able to expand out of its home county, its county 
of origin, if you will, Solano County, to a neighboring and adjacent 
county, Napa County, and in the process serve an additional 12,000 
Medicaid recipients in my district.
  This legislation, making technical amendments to the law, will 
provide those 12,000 Medicaid recipients with greater access and 
greater quality of medical and physician services. It will decrease the 
reliance on hospital emergency facilities for primary health care for 
Medicaid beneficiaries. The Congressional Budget Office has scored this 
legislation and found that it will actually save the taxpayers $500,000 
annually.

  The bill contains no private sector or intergovernmental mandates of 
any kind. This bill is health care reform at its finest. It offers the 
neediest of patients greater access to health care, decreases the 
administrative burden on providers, and allows for more efficient 
program management, which results in savings and cost containment.
  Let me suggest to my colleagues that this is the wave or the trend of 
the future in Medicaid health care services to the truly indigent and 
desperately poor in our society, a very important part of the American 
safety net.
  I happened, flying back yesterday to Washington from my California 
district, to read an article in USA Today, the headline of which is 
``Medicaid Outcome Will Affect All.'' The subheadline is ``The Clinton 
Administration, Congress, and the Nation's Governors have failed to 
reach consensus on future of Medicaid. With caseloads rising, the 
States have had to step up.''
  The article starts out by saying, ``President Clinton and Congress 
succeeded in revamping the Nation's antiquated welfare system'' when we 
passed through this Congress a bipartisan welfare reform bill that the 
President signed into law just last month. And it goes on to say, 
``President Clinton and Congress succeeded in revamping the Nation's 
antiquated welfare system this year only by failing a more difficult 
test. Left in the wake of welfare reform is Medicaid, the health 
insurance program for the poor, which dwarfs welfare in both caseload 
and cost.''
  Clearly, Medicaid in recent years, Medicaid expenditures, have been 
growing at an unsustainable rate. Because this is a 50-50 cost-shared 
program between Federal taxpayers and State taxpayers, State taxpayers 
and State government has been asked to pick up an ever-increasing 
portion of Medicaid health care cost in America. The program cries out 
for reform.
  As I mentioned, I believe that the wave of the future in the Medicaid 
services and in trying to control Medicaid costs is managed care plans 
such as the Solano partnership health plan.
  Presently today in America, nearly one-third of all Medicaid 
recipients are in managed care plans. Those States that have 
aggressively, those States that have aggressively experimented and 
expanded Medicaid managed care programs have realized a significant 
cost savings.

                              {time}  1415

  Michigan, for example, has put 80 percent of its Medicaid recipients 
into managed care and cut inflation, the growth of health care cost, 
from 11 percent to 1 percent in 1 year. To quote health policy adviser 
Vernon Smith for the Engler administration in Michigan, ``These are 
real savings.'' So again, Madam Speaker, I believe it is unfortunate we 
have not been successful in enacting more ambitious or more broad-based 
Medicaid reform in this session of Congress, but I submit that this 
legislation is perhaps the only meaningful Medicaid reform that we will 
be able to enact in the 104th Congress.
  Again I want to thank the gentleman for being so gracious in yielding 
me the time today. I want to reiterate, as he said, that this 
legislation is supported by Governor Pete Wilson, the California State 
Department of Health Services, and many other organizations in 
California. This bill is health care reform at its finest. As I 
mentioned before, this is going to expand access to and quality of 
health care for 12,000 Medicaid recipients in my district. I urge my 
colleagues to vote in favor of this legislation.
  Mr. RICHARDSON. Madam Speaker, I yield myself such time as I may 
consume.
  (Mr. RICHARDSON asked and was given permission to revise and extend 
his remarks.)
  Mr. RICHARDSON. Madam Speaker, we have no objection to the policy 
change in H.R. 3056. The bill was marked up in our Committee on 
Commerce in July with no controversy. As I think the gentleman from 
California [Mr. Moorhead] described the bill, what we are doing here is 
allowing the Solano Partnership Health Plan, which currently operates 
in Solano County, CA to enroll Medicaid beneficiaries residing in 
neighboring Napa County.
  What we do question, Madam Speaker, is why is the Republican 
leadership choosing to move this bill on the Corrections Calendar? This 
should be on suspension. A correction implies that

[[Page H10117]]

some mistake was made. What I understand we are doing in this bill is 
to expand a special exemption for Medicaid requirements that California 
obtained for three of its HMO's in 1990.
  This is a policy change. I would think that it should be part of the 
Suspension Calendar. Now we have it in corrections. That provisions in 
the 1990 reconciliation bill intentionally limited this Solano Managed 
Care Organization and two others in California to providing services 
only to residents of the respective counties in which they operated 
because at the time this was an experiment.
  Madam Speaker, there is no reason today that this legislation could 
not have been handled with less attention and less fanfare on the 
regular Suspension Calendar. So why the special attention? Our 
colleague, the gentleman from California [Mr. Riggs], is a good Member. 
He is my friend. We serve on some committees together. But why are we 
hiding this useful but largely insignificant piece of legislation on 
the Corrections Day Calendar?
  We are left wondering on this side whether it is simply a reason to 
make my good friend look good, which he many times, I am sure, 
deserves, but we are acting here in good faith. So I am going to remain 
perplexed and ask some of my colleagues to explain why we are doing it 
this way. I think we have to very careful about how we use corrections 
day.
  Again, I do not object to the policy in this bill. We should be 
handling this bill together with the other 14 small, noncontroversial 
bills taken up under suspension of the rules. I have been here 14 
years. I have never had a corrections bill.
  Madam Speaker, I support passage of this legislation, but I would 
urge our friends in the Republican leadership to confine the use of 
corrections day to corrections, not use it for expansion of special 
exemptions in current law to benefit specific constituents of specific 
Members.

  Madam Speaker, I reserve the balance of my time.
  Mr. MOORHEAD. Madam Speaker, I yield myself such time as I may 
consume. I would just make one comment, that in the meeting of the 
Committee on Commerce, the gentleman from California [Mr. Waxman], who 
was the chairman of the subcommittee during the last Congress and is 
the ranking member of it this time, said he hoped he would see the bill 
on the Corrections Day Calendar. So the Republican leadership was 
basically following his advice.
  Madam Speaker, I yield such time as he may consume to the gentleman 
from Maryland [Mr. Ehrlich].
  Mr. EHRLICH. Madam Speaker, I regret my colleague is perplexed. Maybe 
I can help him out as a representative of the Speaker's Corrections Day 
Committee, which is a bipartisan organization, as my colleague well 
knows.
  This is the classic example why corrections day was put together by 
the Speaker and this leadership. H.R. 3056 is very narrow in scope. It 
is certainly bipartisan in nature. Not only is the gentleman from 
California [Mr. Waxman] a member of the Committee on Commerce, but he 
is a member of the bipartisan group which constitutes in fact the 
corrections day advisory group.
  This bill is a technical, commonsense bill that actually saves the 
taxpayers money. It is what corrections day and the entire process of 
corrections day is all about. It proves to the American people that 
this House is capable of doing things expeditiously and fairly when 
called upon.
  Mr. RICHARDSON. Madam Speaker, I yield myself such time as I may 
consume.
  Let me continue this dialog, because the reason I am here 
representing the Committee on Commerce is because former Chairman 
Waxman, former Chairman Dingell, object to this procedure. I was asked 
by the committee to represent the views of the minority members of the 
Committee on Commerce--Chairman Henry Waxman is the ranking minority 
member; the gentleman from Michigan, John Dingell, is the ranking 
minority member of the full committee--and their concern with this 
procedure.
  If I could ask my colleague, are we not talking about this 
legislation being a specific policy change in effect for certain 
beneficiaries in a State? Is that not correct? Are we not talking about 
a policy change?
  Mr. EHRLICH. Madam Speaker, will the gentleman yield?
  Mr. RICHARDSON. I yield to the gentleman from Maryland.
  Mr. EHRLICH. The answer is certainly yes, but that is not exclusive 
of the jurisdiction maintained by the corrections committee. I missed 
the point the gentleman is making. I can reiterate the fact that 
whenever a corrections day bill is reported out of the Corrections Day 
Committee to the standing subcommittee of the House, it is done in a 
bipartisan way. Certainly this bill was done in a likewise manner, in a 
bipartisan way. I remain concerned on this side as to why the gentleman 
is perplexed.
  Mr. RICHARDSON. Madam Speaker, let me be perfectly candid. A 
corrections day implies a mistake. This is not a mistake. This is 
policy change.
  Would the gentleman explain to me where the mistake occurred? If we 
pass a piece of legislation, it is to advance a policy. The implication 
is, and the gentleman knows, that a Corrections Day Calendar is to 
correct a mistake. Where is a mistake in this legislation?
  Mr. EHRLICH. If the gentleman will yield further, I believe the 
gentleman is actually mistaken with respect to his interpretation of 
the Corrections Day Committee and the Corrections Day Calendar. It is 
simply not limited to mistakes. It certainly can include mistakes, but 
it also concerns Federal regulations that may in fact have not been 
mistakes when they were originally promulgated but no longer make sense 
given the passage of time or the change of circumstances concerning any 
particular Federal agency. So the answer to the gentleman's inquiry is 
that certainly mistakes can be taken care of on the Corrections Day 
Calendar but the Corrections Day Calendar is not limited to, quote-
unquote, ``mistakes.''
  Mr. RICHARDSON. Madam Speaker, I remain very perplexed. The gentleman 
keeps talking about bipartisanship. Policywise, bipartisanshipwise, we 
are gong to support the gentleman from California [Mr. Riggs], but 
procedurally I am here to object to the use of this procedure in the 
Corrections Day Calendar.
  I wish my colleague would stop saying about a bipartisan agreement on 
the process. We are going to support this bill, but I just think that 
this is highly unusual. There are several suspensions. Would the 
gentleman answer this question; I do not know if he is on the rules, 
and maybe it is unfair to ask him: Why is this bill not on the 
Suspension Calendar? On the 14 bills that we will be doing later today, 
why is this on corrections and not on suspension?
  Mr. EHRLICH. If the gentleman will yield further, those decisions are 
made at a higher level than where I sit, as the gentleman well knows. 
But, quite frankly, in view of my membership on the Corrections Day 
committee and my personal knowledge as to the way the Corrections Day 
advisory committee operates, we certainly have not had this problem, 
and this committee has now been operating for well over a year.
  Mr. RICHARDSON. I thank the gentleman. I just want to raise this. We 
support what the gentleman from California [Mr. Riggs] is trying to do. 
This is again a major policy change. As the committee of jurisdiction, 
we will not object. We just would like to be consulted when these 
procedures take place. I would not be sitting here or standing here. 
Chairmen Waxman and Dingell are not here. I was asked on their behalf 
to please voice these objections. This is why I am here.
  Mr. MOORHEAD. Madam Speaker, will the gentleman yield?
  Mr. RICHARDSON. I yield to the gentleman from California.
  Mr. MOORHEAD. Madam Speaker, I obviously do not have any choice one 
way or the other in the operation of the House, but this is a good 
measure. It is something that will do good for the country. I 
appreciate very much the gentleman from New Mexico's support for what 
we are trying to do even though he does not like the way it is being 
done. I ask for an aye vote on the bill.
  Mr. RICHARDSON. The gentleman as usual is very persuasive, and he is 
a very fine Member. I just want to make my point.
  Madam Speaker, I yield back the balance of my time.

[[Page H10118]]

  Mr. MOORHEAD. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Ms. Greene of Utah). Pursuant to the rule, 
the previous question is ordered.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and (three-fifths having voted in favor 
thereof) the bill was passed.
  A motion to reconsider was laid on the table.

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