[Congressional Record Volume 143, Number 93 (Friday, June 27, 1997)]
[Extensions of Remarks]
[Page E1361]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      BALANCED BUDGET ACT OF 1997

                                 ______
                                 

                               speech of

                         HON. WILLIAM J. COYNE

                            of pennsylvania

                    in the house of representatives

                        Thursday, June 26, 1997

  Mr. COYNE. Mr. Speaker, I rise today in opposition to the portion of 
the 1997 reconciliation bill that we are considering today. I oppose 
this bill because there a number of provisions contained in it that are 
so objectionable that I cannot support this legislation in its current 
form. Let me outline my objections to this bill.
  Until this morning, the House welfare legislation would have allowed 
States to pay welfare recipients less than the minimum wage for 
publicly sponsored work programs. This isn't right. Work is work. 
Everybody should earn a living wage. States should not be permitted to 
treat individuals on welfare differently from other workers. Afraid of 
the political repercussions of such a patently unfair policy, the 
majority has modified its legislation in the Rules Committee. While I 
am pleased that the House leadership has conceded that welfare workers 
ought to be paid at least the minimum wage, I think that the changes 
that were made to this legislation do not go far enough. Welfare 
workers still will not be ensured of adequate protection from sexual 
harassment, discrimination, or health and safety violations in the 
workplace. Welfare workers also will not be assured that they will 
receive the same benefits and working conditions as other workers doing 
the same type of work for the same employer.
  The House bill would allow States to privatize their Medicaid and 
food stamps eligibility processes. I believe that making eligibility 
determinations is an inherently governmental function that should not 
be privatized, and that the privatization of eligibility determinations 
could lead to many unfair and inappropriate eligibility determinations.
  The welfare portion of the House bill also overturns an appeals court 
ruling mandating that States use alternative base periods for 
determining unemployment compensation eligibility. By overturning the 
court's ruling, the bill denies many low-wage, intermittent workers 
access to unemployment insurance benefits at the times when they need 
them most. It seems to me that states should use workers' most recent 
earnings history to determine eligibility for unemployment compensation 
benefits.
  Finally, the welfare portion of the reconciliation bill breaks both 
the spirit and the letter of the budget agreement in its treatment of 
legal immigrants. The budget agreement stipulated that legal immigrants 
in the United States by August 22, 1996, but who become disabled after 
that date would be eligible. Under the House bill, only legal 
immigrants who were on the SSI rolls as of August 22, 1996 would 
continue to be eligible for SSI payments.

  In addition to the welfare provisions of this legislation, I object 
to a number of the bill's Medicare provisions as well. The Medicare 
portion of the reconciliation legislation includes a provision 
authorizing a demonstration project of 500,000 medical savings account 
[MSA's]. At a time when we are fighting to preserve the Medicare 
program, we should not be giving hand-outs to the healthiest and 
wealthiest Medicare beneficiaries--especially when these hand-outs cost 
the Medicare program money.
  The Medicare portion of the legislation falls short with regard to 
managed care consumer protection provisions as well. It does not 
include some critically important managed care consumer protection 
provisions, like the ability of beneficiaries to obtain expedited 
appeals of denied claims in urgent situations. The bill also allows the 
Secretary of Health and Human Services to waive the 50-50 rule for 
managed care plans. This rule traditionally ensured that managed care 
plans provided quality care to Medicare beneficiaries. It is not 
certain that other, more comprehensive, measures of quality will be 
established before the 50-50 rule is waived. In short, this legislation 
does not ensure that Medicare's managed care beneficiaries will receive 
the highest quality of medical care.
  In addition, the bill does not allow graduate medical education [GME] 
and disproportionate share hospital [DSH] payments to go directly to 
the institutions that train medical residents and take care of Medicare 
beneficiaries. Instead, these payments will continue to go to managed 
care companies, middlemen who do not perform these critically important 
functions, but whom many people believe often fail to pass the full GME 
and DSH payments on to the hospitals. It is only fair that these 
payments go to those institutions that incur the costs of GME and DSH. 
The GME and DSH provisions of this bill desperately need to be changed.
  The bill also includes some unwarranted weakening of our medical 
malpractice laws. The malpractice provisions in the legislation way 
weaken the ability of our legal system to deter medical malpractice.
  Finally, the bill does not include some important protections against 
waste, fraud and abuse in the Medicare program that were offered by the 
Democrats on the House Ways and Means Committee when this bill was 
marked up. It has been estimated that waste, fraud and abuse cost the 
Medicare program about $23 billion last year alone. The Republican 
majority refused to incorporate several provisions that would have 
helped the Medicare program to avoid rampant waste, fraud and abuse. 
This bill should be changed to include those provisions.
  I am also opposed to several of the Medicaid provisions contained in 
this legislation. Specifically, I am very concerned that the level of 
disproportionate share hospital payments that go to hospitals who treat 
large numbers of the poor will render these facilities unable to 
continue providing services to this vulnerable population.
  Further, I am opposed to repeal of the Boren amendment, which 
requires states to pay hospitals and nursing homes a reasonable and 
adequate rate for treating and taking care of Medicaid recipients. It 
is only fair that health care institutions charged with caring for 
Medicaid recipients be assured that they receive adequate compensation 
for doing so. I believe that repeal of the Boren amendment could have 
disastrous consequences for many hospitals and nursing homes that care 
for the poor.
  Mr. Speaker, these are the main reasons that I have decided to oppose 
this legislation. I urge my colleagues to work with me to produce a 
reconciliation bill that we can all support--one that provides for the 
neediest, most vulnerable members of our society in a fiscally 
responsible fashion.