[Congressional Record Volume 144, Number 143 (Sunday, October 11, 1998)]
[House]
[Pages H10546-H10553]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1830
                  MANAGED CARE REFORM AND OTHER TOPICS

  The SPEAKER pro tempore (Mr. Mica). Under the Speaker's announced 
policy of January 7, 1997, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes.

[[Page H10547]]

  Mr. PALLONE. Mr. Speaker, I wanted to start out this evening by 
pointing out that the problem that I as a Democrat and I think most of 
the Democrats have with what has been happening here the last 2 years 
is not necessarily that we are not willing to debate with the 
Republicans on these issues because in many ways I think that what 
happened today in the discussion that we have had today on both sides 
of the aisle has been rather interesting. The problem is that on most 
of the Democratic initiatives which I think are the initiatives that 
the average citizen is concerned about, we have not had the opportunity 
to bring them up. We have talked as Democrats about how we want to 
bring up before the Congress adjourns education concerns, money to 
modernize our schools, to hire additional teachers, 100,000 new 
teachers. We are going to talk this evening in the next hour quite a 
bit about HMO reform. We have talked about the need to address Social 
Security because we know that eventually down the road there is not 
going to be enough money in the Social Security trust fund. But what we 
have found is that the Republican leadership does not allow these 
things to come up. They do not even allow, and the very debate that we 
have had tonight in the context of these special orders is not a debate 
that we are allowed to have on legislative issues because the 
legislation that deals with these education or HMO, health care 
concerns or Social Security concerns, we do not get an opportunity to 
deal with it. The Republicans control the House. The Republicans decide 
what comes to the floor. And they have basically stalled and not 
allowed most of these concerns that the American public has to even be 
considered. That is why we are here tonight on Sunday to debate this, 
why we are demanding that these issues be addressed before we go home, 
and all we keep hearing from the other side of the aisle is that they 
want to get out of here quickly, they think they have completed their 
business. Well, they have not completed their business. We would like 
to point that out.
  I yield to the gentlewoman from Connecticut who started the special 
orders earlier this afternoon and who has been our leader on so many of 
these issues.
  Ms. DeLAURO. I thank the gentleman from New Jersey. I just wanted to 
make a couple of points before we start our hour's time here. The 
gentleman who led the previous discussion here this evening is the 
third-ranking leader in the House of Representatives, the majority 
whip. I think it was interesting to note that he commented about the 
government shutdown 2 years ago. What is quite extraordinary to note is 
that the government was shut down twice, unheard of in the history of 
the United States, by the Republican majority because, as my colleague 
from New Jersey has rightly said, and sometimes people do not 
understand this, when the party is in power and they have the majority, 
they control what happens here. You can say anything that you want 
about the Democrats were in the majority and you could agree or 
disagree on what they have, but the fact of the matter is that the 
Republicans control both the House and the Senate. But an interesting 
point, because he talked about how terrible a government shutdown would 
be and that is not what they were looking for and that it was the 
President looking for a government shutdown. Well, I was so stunned by 
a comment that the majority whip made when the government was shut down 
2 years ago that quite honestly I had it blown up and I have it in my 
office because I could not believe anyone who held such an honor and 
held a position in this body would say such a thing. It was in a Texas 
newspaper and I am happy to provide it to anyone who would like to see 
it. I am not making this up. He said that when he heard that the 
government was reopened, that it was the worst moment, and I am 
paraphrasing, the worst moment of his life. He was grilling steaks on 
his balcony with some other Republican members, and he said, ``We 
should have kept the government closed for as long as it was 
necessary.''
  Now, he has the luxury of saying that because he was earning a salary 
while the government was closed and people who were furloughed or laid 
off had no idea whether or not they were going to get their salaries, 
and the hundreds and hundreds of services that are supplied by this 
United States Government were shut down. So that he truly is someone 
who, in fact, was pleased that the government was shut down in the 
past, and I hasten to view that he would not mind if that happened 
again. That is where they are going.
  I might also make just one more point. We are talking about how this 
Republican majority, how they legislate and the reasons for what they 
do and how that is tied in to special interest money. There is a big 
argument, if you will, a feud, GOP Feuding About Lobbyists. The point 
here, and it is in the papers here, again the majority whip is locked 
in a feud with the chairman of the Republican Conference because what 
they want to do is to dump the choice of president of something called 
the Electronic Industries Alliance. The long and the short of it, the 
person that is scheduled to become the president of this organization 
is a former Member of the House, Representative Dave McCurdy, who is a 
Democrat from Oklahoma. Essentially what they want to do, and this is 
by their own admission here, this is a quote, they want to send a 
message to this EIA that Republicans will not deal with trade 
associations and lobbying groups run by Democrats. Now, this is a quote 
by John Linder who is the head of their Republican Congressional 
Campaign Committee who says, quote, we think they, ``they'' being the 
trade associations, et cetera, ought to look back and see who won the 
last couple of elections. And Mr. Linder confirmed that Republican 
leaders held intellectual property legislation, that means that our 
patents, all of our inventions, that laws restricting foreign 
governments, speaking of foreign governments, Chinese, everywhere where 
they are stealing our intellectual property around the world. What he 
is saying is that they held the legislation hostage that would have 
restricted foreign governments from stealing our intellectual property. 
He confirmed, ``Republican leaders held intellectual property 
legislation favored by these EIA members hostage, quote, to send a 
message, that if you don't play by the Republican rules and don't do 
business with the Democrats, we are not going to pass legislation and 
you are not going to be able to get anything done up here.'' That is 
the way this Republican majority is dealing, fast and loose, fast and 
loose with the lives of the people in this country. It is on 
intellectual properties, it is on tobacco, 3,000 of our kids start to 
smoke every single day, a thousand of whom die. And they refused to 
pass tobacco legislation in this body. They are the single biggest 
recipients of tobacco dollars in the country. So who are they kidding 
when they talk about what they want to do for the American public? It 
was Mr. DeLay, it was Mr. Gingrich who said, ``There isn't enough 
money in our system. That's why we cannot pass campaign finance 
reform.'' And it was the Republican leadership of this House who said 
take Social Security dollars and squander them away.

  Mr. PALLONE. ``And let Medicare wither on the vine.''
  Ms. DeLAURO. That is right.
  Mr. PALLONE. That was Speaker Newt Gingrich's quote.
  Ms. DeLAURO. I believe it was Mr. Armey, the second-ranking member, 
who said Social Security is not a system that ought to be in existence 
or that we ought to have a part of. We need to remember some of those 
things.
  In terms of public education, what we were talking about before, they 
would just as soon see public education come crumbling down and take 
public education and take those dollars and put them in the hands of 
the very few and the very rich and take away our birthright to 
education in this country.
  Mr. PALLONE. I want to introduce the gentlewoman from California, but 
I just wanted to follow up on one of the things that the gentlewoman 
from Connecticut said. I am glad that she brought up this issue of Mr. 
DeLay, his remarks that he made when the government had been shut down 
by the Republicans and he regretted the fact that it was not shut down 
longer. There is a basic difference of philosophy here, or ideology, 
and, that is, that this Republican leadership does not believe in the 
government essentially, and they believe that it is better if the 
government does nothing. I have had

[[Page H10548]]

many Republicans on the other side of the aisle the last couple of days 
say, ``Well, it doesn't matter if we're labeled as the do-nothing 
Congress because a do-nothing Congress is better.'' Many of them 
actually believe that. They do not look at the concerns that we have 
for the health and the safety and the protection of the average 
American as something that is actually positive. Remember that the 
issues that we feel that they should be raising, managed care reform, 
as far as many of them are concerned, there is no need for managed care 
reform because they do not have a problem with the insurance industry 
basically running roughshod over the American people and not providing 
medically necessary procedures and operations and length of stay in the 
hospital that a person needs to provide for adequate health care.
  As far as education issues, I think the gentlewoman is right when she 
says that for many of them they would just as soon not have public 
education. So when we talk about modernizing school or class size, that 
is not their concern. They want more students to go to private schools. 
They are not concerned about public education. When we talk about 
Social Security, we have heard some of these same leaders say that 
Social Security was a bad thing from the beginning, so they are not 
concerned about whether or not we bring up efforts to try to shore up 
Social Security. She mentioned teen smoking. The same thing. Let the 
tobacco interests sell whatever they want to whomever. That is laissez 
faire. They believe that. They are not going to have us play some role 
in trying to protect young people or teenagers from smoking. And on 
down the line. Minimum wage. They do not want to raise the minimum 
wage. We have had to fight that so many times. Every time it has been 
raised here, it has been a battle by the Democrats to try to raise 
minimum wage. As far as they are concerned, there is no need to deal 
with that. For them to talk about how they really care about these 
issues, they do not care about these issues, they want to go home and 
they are proud of the fact, many of them, not all, but many of them 
that this is a do-nothing Congress. I yield to the gentlewoman from 
California.
  Ms. WOOLSEY. I thank the gentleman from New Jersey and I thank the 
gentlewoman from Connecticut for this day of standing up for the rights 
of the minority party. I was listening to the majority whip yammer 
along about the fact that blaming everybody else for this being a do-
nothing Congress. Of course if he had anything to say about what they 
had achieved, they would have stood there and told us what they had 
done. Instead, they talked and talked and talked about why nothing had 
happened and pointed fingers and blamed others. If they had managed 
this Congress any better than the Soviets managed Chernobyl, they would 
have something to say. If they had been working on the American 
public's needs instead of trying to raid Social Security, trying to cut 
taxes so the wealthy could benefit, trying to give education tax breaks 
for private schools, cheating the public education funding and 
threatening our national resources with anti-environmental riders, 
maybe they would have achieved enough that they could have stood up 
there earlier and said, ``But this is what we did.'' But instead they 
had to say, ``Oh, it's everybody else's fault, not ours.'' I will quote 
the Vice President in his saying, ``The right hand does not know what 
the far right hand is doing,'' if they had their ranks together. They 
are the majority. And at what cost have they left this country without 
really anything except renaming National Airport to the Ronald Reagan 
Airport. They have not produced a managed care bill. There has been no 
bill to train and hire more teachers so we can reduce class size. They 
have no bill to modernize our schools, no safeguards for our Social 
Security, nothing to reduce teen smoking, no increase in minimum wage 
for working families, and the campaign finance bill that passed the 
House over their dead bodies, if Members can remember what Majority 
Whip DeLay said and what the Speaker said about campaign finance 
reform. And then when we did pass it, it could not get through the 
Republicans in the other body. They forget. They forget that children, 
25 percent of our population are 100 percent of our future. Because of 
that, they are setting a record, a record that has not been broken for 
generations, for the least amount of days worked, the least number of 
bills enacted and the first time since the budget process was created, 
they have failed to pass a budget. This is not management. This is 
disaster. That is why they are complaining over there and trying to 
blame somebody else. But our families deserve better. It is time for a 
change.
  Let me tell you how this has affected our children. 71,682,000 of our 
population in the United States are children. 10,000,743 more American 
children have no health insurance, that is up over 10 million from the 
start of this Congress. This number has continued to rise during the 
105th Congress. It continues. Five thousand schools in the United 
States are in desperate need of repair and many are unfit learning 
environments.

                              {time}  1945

  Zero, none, of the 100,000 teachers needed to reduce class size and 
improve education quality have been approved; 14,113,000 children are 
living in poverty. This is in the richest Nation in the world. Despite 
a very strong economy, children continue to represent 40 percent of the 
impoverished while compromising only 20 percent of the Nation's 
population, and yet we have to remember 100 percent of the Nation's 
future. Seventy-three percent more children have taken up a daily 
smoking habit. Each day 3,000 kids become habitual smokers. Of these 
1,000 will die of smoking-related illnesses.
  It is time that we turn the debate to the needs of our children, our 
seniors, our environment. Enough about politically inspired 
investigations, and excessive partisanship and wasteful spending on 
duplicative and wasteful Republican committee investigations that have 
ended in dead ends, costing millions of American dollars. Instead, we 
have to do something about managed care reform. We have to have 
campaign finance reform. We have to have bills that will reduce teen 
smoking. We have to have bills that will enhance environmental 
protections. And we must raise the minimum wage. Then our children will 
be considered our number one priority. But most of all, making them our 
number one priority, we must invest in their education. We cannot leave 
here without an agreement for 100,000 more teachers and new and 
improved classrooms.
  Twenty-five percent of our population are our children. One hundred 
percent of our future are those same children.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman, and I 
wanted to point out tonight, if we could just spend a little time on 
the issue of HMO reform, because all three of us went over to the 
Senate; I believe it was a couple days ago now when the democratic 
majority leader Mr. Daschle tried for the last time, and he has tried 
many times, to bring up the issue of HMO reform or the Democratic, 
really bipartisan, proposal that we call the Patients Bill of Rights. 
And many of us in the House, the three of us included, went over to the 
Senate and basically stood in the back of the room to show our support 
for the effort to bring up HMO reform, and, as you know, it was a 
defeated. We had a couple of Republicans that joined all the Democrats, 
but not enough because we do not have the majority to bring it up and 
to discuss it.
  Again, we were only asking that the Senate take up the issue on the 
floor. The issue of whether they passed something, the Patients' Bill 
of Rights or any kind of managed care reform, never came up. Again, we 
are just asking that they consider these things as part of the debate, 
and that was denied, and that unfortunately probably means the death 
knell of that issue in the Congress for this year.
  What I wanted to point out very emphatically, if I could, is that 
what the Democrats and some Republicans, this is not just a Democratic 
issue, but it is something opposed by the Republican leadership; what 
the Democrats are asking for are very simple common sense protections.
  Most people, when I discuss this with them, unless they have had a 
problem with their HMO, you know, because maybe they have been healthy 
and

[[Page H10549]]

have not had to deal with this, they think that these things are 
already there. They are surprised to learn that these protections do 
not already exist, and just to give you an idea, I just listed some of 
the main ones here that we would like to have provided for all 
patients, all Americans, is guaranteed access to needed health care 
specialists; if you need a specialist, that you should be able to get 
one; access to emergency room services. Many people go to the emergency 
room and are either turned away or find out later that their health 
insurance will not cover the emergency room care. Continuity of care 
protections, access to timely internal and external appeal; if the HMO 
or insurance company denies you a particular procedure, then you should 
be able to appeal that and have it overturned. Limits on financial 
incentives to doctors. Unfortunately, and many people are surprised to 
learn, that doctors in many managed care organizations are actually 
encouraged and given extra money if they limit the number of people 
that are provided care, assuring doctors and patients can openly 
discuss treatment options. Can you imagine? I do not think there is 
anybody probably who thinks that there is anything out there that would 
deny doctors and patients the right to openly discuss treatment 
options. We live in a free society, we value the first amendment, and 
yet many of the HMOs tell their physicians that they cannot talk about 
treatment options that are not covered by the health insurance. It is 
called the gag rule, which is un-American. Assuring that women have 
direct access to OB/GYN; I know that Congresswoman DeLauro has been 
very much involved with that and some of the other issues that women 
have been denied by their insurance companies, various types of care, 
and lastly an enforcement mechanism that insures recourse for patients 
who are maimed or die because of health plan actions. Many people do 
not know that if their HMO denies them a particular type of care and 
they are seriously insured or die from it, that they cannot sue the 
HMO. Well, they should be able to.
  We are just pointing these things out because we think that every 
American should be guaranteed these basic protections. But if we do not 
enact them into law, if we just proceed with this do-nothing Congress 
that says that the government does not have to do anything, you know 
laissez-faire, or whatever the term is, then we have a situation where 
these insurance companies simply deny care, decide what is medically 
necessary, and you have no recourse, and that is what we are trying to 
prevent.
  Mr. Speaker, I yield to the gentlewoman again.
  Ms. WOOLSEY. Well, you said that maybe some of our colleagues have 
never experienced the shortcomings of managed care because they are 
healthy. Well, oops, maybe it is because they can afford other 
coverage. It might have something to do with people being wealthy, and 
I think we have to remember that, and we have to continually remember 
that if an appeal process does not have real teeth, it is not an appeal 
process.
  There is some very good managed care providers in my district, the 
Sixth Congressional District in California. I mean they are models for 
the Nation. But I tell you we can be assured that even these good 
managed care providers are going to have to give up some of their 
quality, some of their standards if we do not have real reform because 
they will have to compete, and they will be competing against providers 
that do not do as well, do not do as much, do not have protections, and 
everybody is going to lose because we will be slipping sliding to the 
lowest rung of the ladder; there is no question about it.
  We have to have real managed care reform, and the doctors in my 
district want it. They want to be part of making the decision about 
health care with their patient. They do not want to have to be 
listening to what a clerk in an insurance company is telling them that 
they can to or not do for their patient. The patient and the doctor 
want to make those decisions, and the insurance company is responsible 
for paying for it.

  Mr. PALLONE. I want to thank the gentlewoman and yield to the 
gentlewoman from Connecticut.
  Ms. DeLAURO. I think that this is such an appropriate discussion, and 
it is such an issue that is on the minds of the American people, and 
that is what is being flaunted here. It is not us. It is about what the 
American people have talked about in terms of the whole managed care 
system which they find is out of control.
  There was a recent Times CNN poll that found that 76 percent of 
Americans support managed care reform. Only 41 percent said that they 
were very confident that their health care plan would pay for their 
treatment if they really got sick. And now you have another, and most 
people, and I think everybody saw it, As Good As It Gets, the movie 
where there is the great applause line when Helen Hunt expresses her 
frustration with the HMOs and managed care because people feel that 
that is out of control, that they, in fact, have no way of being able 
to handle this system.
  More recently we have found that the HMOs are pulling out of Medicare 
and leaving seniors on their own. It has happened in my State of 
Connecticut where we have 12,000 people now who are, you know, trying 
to scramble around for what they are going to do for their health care. 
Now, it is not only happening in Connecticut, it is happening all over 
the country. So, the fact is that the public truly knows that the 
managed care system is out of control.
  Now we tried to address that, as both my colleagues have pointed out, 
with a very simple set of guidelines, if you will, in which my 
colleague from New Jersey mentioned about emergency room care, and 
speciality care and continuity of care if your employer changes plans, 
and employers change plans every year now.
  Just interesting to note that that was a bipartisan piece of 
legislation. There are lots of folks said if we can put the bickering 
aside and do something on behalf of the American public, let us set the 
record straight. It is a bipartisan piece of legislation. Dingell, 
Ganske, a number of other folks including the gentleman from New Jersey 
who worked very hard on this issue that could have passed this House in 
a heartbeat. But go back to the notion that who was in charge? Who has 
the jurisdiction to bring up the legislation? Who has the jurisdiction 
to hold hearings?
  Three days of hearings on the issue of managed care reform; contrast, 
63 days of hearings on politically-motivated investigations. More to 
the point: 2 days of hearings on renaming National Airport the Ronald 
Reagan Airport.
  Now for 3 days, only 3 days for our health care system, they finally 
passed; they brought up after months and months, they passed this sham 
bill, sham bill, and I just want to mention it because they will come 
up and claim that they passed a HMO bill, but let me just say that it 
makes things worse, the bill that they passed. It does not guarantee 
coverage of emergency care, it does not guarantee privacy of medical 
records. That is your medical records which today is such a problem 
with regard to employment or with regard to insurance coverage can be 
given away to anyone without your knowledge. It would not guarantee 
access to specialists, it does not guarantee the continuity of care if 
your doctor is arbitrarily dropped from the plan, does not hold health 
plans accountable for their decisions when things go wrong. And above 
all, above all, it will not give the power to decide what is medically 
necessary to your doctor.
  That is the fundamental reason people want to see health, managed 
care reform because of they want doctors to make the decisions along 
with them, with themselves.
  Again, this is thwarting the will of the public, it is thwarting the 
will of the majority in both the House and in the Senate, and they 
recently, just 2 days ago, defeated managed care. That is not the way 
that this place should be operating. We are here to represent people's 
interests. We are not for political reasons to thwart the will of the 
people particularly on their health care and their health and their 
safety.
  Mr. PALLONE. The gentlewoman points out, makes a very good point I 
should say, with regard to the HMO reform, and that is that, as we 
know, back in August, there was so much heat, if you will, on the 
Republicans to deal with the issue of managed care reform, so many 
constituents who were

[[Page H10550]]

clamoring that they take up the issue that they finally did just on one 
day with a very brief debate on the House floor allow the issue to come 
up. But what they did as a result of that was to pass a bill that was 
actually worse than the status quo.
  I have not been dwelling that much on that, although I think we 
should talk about it a little bit because when it went over to the 
Senate, they would not even take that sham bill up. So we are faced in 
a situation now where they will not even bring it up again because they 
think that, you know, circumstances have changed and the public is not 
paying as much attention to that, which I think is garbage. There is no 
question that the public is still very much concerned about it.
  But if we can just take a minute to elaborate a little more on this 
sham bill that they brought up, and I think you pointed out this issue 
of medical necessity which is really the heart of this debate because 
when we say that a person is not getting care, it is usually because 
they are not allowed to have a certain operation or they are told they 
cannot stay in the hospital more than 2 days for a certain procedure, 
and so the decision about what is medically necessary in that case, 
just to have the operation or to stay the extra few days, is 
essentially made by the insurance company.

                              {time}  1900

  What the Democratic or bipartisan, if you will, Patients' Bill of 
Rights says is that medical necessity will be based on generally 
accepted principles of professional medical practice.
  So it goes back to what the physicians and the physician groups say 
is necessary, as opposed to what the insurance companies say. They do 
not change that in their bill. They simply say it is up to the 
insurance company to decide what is medically necessary.
  This kind of trickery goes on for just about everything in their 
bill. Emergency room care is another example. You can theoretically go 
to any emergency room under the Republican bill, but there is no 
guarantee that the insurance company is going to pay for it.
  We use this example of severe pain, because under the Democratic 
bill, we use a lay person's standard, a prudent layperson. Obviously 
the prudent or typical citizen, if you will, if they get severe pain in 
their chest, figures they had better go to the emergency room because 
they may be having a heart attack.
  Under the Republican bill there is no guarantee that severe pain is a 
basis for your getting emergency room care. You could go to the 
emergency room with what you think is a heart attack because you have 
severe pain, and, if it turns out you do not have a heart attack, they 
do not pay the emergency room.
  Ms. DeLAURO. If you survive, they do not pay. Only if you die.
  Mr. PALLONE. I just want to mention one more example. We laugh, but 
it is not funny; but it is ridiculous when you think about it. I talked 
about the gag rule before where they do not allow or many of the HMOs 
do not allow the physicians to talk about procedures that are not 
covered by the insurance plan. In the GOP bill, a health plan would 
still be allowed to restrict communications between doctors and 
patients, because their bill only prohibits gagging doctors who 
contract directly with the HMO plan. What they do not tell you is that 
most doctors subcontract with health plans and their bill does not 
prohibit plans from gagging doctors who subcontract with plans.
  So here again we have got all these little quirks in their 
legislation, little exceptions and things that turn out to be big 
exceptions that still impact the majority of the people.
  There are similar things with the financial incentives, where most 
insurance companies can still create financial incentives for doctors 
who do not provide care.
  So, again, I have not stressed this too much, because I would have at 
least appreciated if the Senate would bring up any managed care reform 
bill and let us debate the issue the way we have tonight in this 
special order. But we did not even get that. So there is almost no 
point in talking about what should or should not be in the bill, 
because they will not let us bring the bill up.
  I yield to the gentlewoman from California.
  Ms. WOOLSEY. We should not be surprised, because a year ago, November 
1997, let me read to you from the New York Times.

       Business and insurance lobbyists who helped kill President 
     Clinton's health plan in 1994 are mobilizing a new campaign 
     to block more modest proposals that would set Federal 
     standards for quality of care. Republican leaders of Congress 
     are urging the lobbyists to step up their activities against 
     an array of managed care reform bills, backed by consumer 
     advocates as a way to protect patients in a turbulent medical 
     market.

  That was the first. Then the times reported on October 22, 1997 that 
Melody Harnad, a Federal Affairs Counsel at the Health Insurance 
Association of America, summarized the situation in a confidential memo 
to her supervisor, the vice president of the association, and she said,

       The message we are getting from the House and Senate GOP 
     leadership is that we are in a war and need to start fighting 
     like we are in a war. Republican leadership is now engaged on 
     this issue and is issuing strong directives to all players in 
     the insurance and employer community to get activated.

  Well, I would like to say that there was a lot of fear in 1993 when I 
was first sworn into the House of Representatives, a fear of a single 
payer national health care system.
  Well, I think we are going to get there sooner than we ever thought, 
because, with attitudes like this, the public has to be fearful that 
they will have health care in their future, a national health care 
system could protect them and will.
  Ms. DeLAURO. If the gentlewoman will yield for one second, because I 
think it is interesting, and this is a quote, because we started 
talking earlier about how special interest money plays into this 
effort. It happened, as we pointed out, with tobacco, and there was a 
$40 million ad campaign by the tobacco companies to defeat tobacco 
legislation, and they succeeded. They succeeded.
  Now, this is what Senator Lott said, that the Senate Republicans need 
a lot of help from their friends on the outside. ``Get off your butts; 
get off your wallets.''
  Then we see another $40 million ad campaign by the group of votes 
here.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. Members must not make personal references to 
members of the Senate.
  Ms. DeLAURO. Mr. Speaker, then the leader of the other body, that was 
his quote, so that in fact what you understand here is that they wanted 
their folks to get up, get their money out there, and defeat managed 
care reform. Another $40 million ad campaign to defeat managed care 
reform, one of the single biggest issues that the American public is 
trying to grapple with today. It just reinforces the point of how this 
Republican-controlled Congress is dealing with legislation that faces 
people.
  Ms. WOOLSEY. Taking my time back, it worked. Did it not work? We do 
not have managed care health reform in this Congress.
  Now we have to change it. The people of this country have to know 
what is happening, and I thank both of you for making this possible so 
we can speak to the issues and the people who are listening can hear 
the issues, and we can be moving forward. We need a Congress that cares 
about health care, our seniors, our children and our environment, and 
this Congress and its majority does not.
  Mr. PALLONE. I want to thank the gentlewoman. Let me talk a little 
bit more about health care, if I can, and then maybe we could also 
bring up this whole debate over Social Security, if you would like, 
because I think that is another one of the major points that I feel 
needs to be addressed and that the Republicans have gone on off on a 
totally different course.
  I was so glad when you mentioned about the President's health care 
plan a few years ago, because, if we remember, at the time the 
President brought up his proposal for universal health care, it was a 
different proposal. It was not a single payer system, it was a 
different approach. But, nonetheless, he was responding to the fact 
that so many Americans, and more Americans every day, did not have 
health insurance.
  Many of the issues that we have brought up are sort of aspects of 
that. We talk about managed care reform, we talk about portability, we 
talk

[[Page H10551]]

about preexisting conditions, about people being denied care. But, most 
important, the President was addressing the fact that more and more 
Americans do not have health insurance.
  What we have found since the President's plan was defeated by the 
special interest lobbyists and their multimillion dollar campaign was 
the number of people that have no health insurance has gone up. There 
was a report that came out just a few weeks ago that had an all-time 
high, it was over 40 million Americans, 42 or 43 million Americans have 
no health insurance. So we know the concern he had then was a 
legitimate concern, and, in fact, the situation is getting much worse.
  Now, we have tried sort of dragging and kicking to get this 
Republican Congress over the last few years to address some of these 
concerns. We did manage to get a kids health initiative passed last 
year. But what we found, in fact, we had a hearing just a couple of 
weeks ago in the Committee on Commerce on the kids health initiative, 
because that initiative came out of the Committee on Commerce and was 
also another focus of our Democratic Health Care Task Force, is that 
although we were now on the way to ensuring about 5 million more young 
children, that the number of uninsured children is rising at a much 
more dramatic rate than it was when we were trying to address this kids 
health initiative. So as fast as we are with this new program trying to 
ensure more kids, the number of children uninsured is growing even 
larger.
  The main reason for that is because so many people who are working, 
and we are not talking about people who are on welfare or eligible for 
Medicaid, we are talking about families that are working, who cannot 
get health insurance for their kids because more and more employers are 
not providing for health insurance, are not given the opportunity for 
health insurance on the job.
  I have always felt what we needed to do was somehow encourage more 
employers to provide health insurance. I do not know how you do that, 
whether it is a mandate or through some tax incentives or whatever, but 
the HMO reform, as important as it is, only helps those who already 
have insurance. The numbers who do not have insurance continues to 
grow.
  This Republican Congress, it just ignores this whole health insurance 
debate, and essentially, as Ms. DeLauro said, is basically just in the 
pockets of the insurance industry, and they do not want any of these 
reforms to take place. They just do not want to hear it, every aspect 
of this health insurance debate.
  We are at the end of this session. We are not going to be able to 
address most of these things. But we cannot let them go home, we cannot 
let them go home without addressing some of these concerns, whether it 
is HMO reform or the education initiatives or some of the other 
concerns that we have brought up here.
  As I said before, with all the things I think should have been done 
in this Congress, if I was able to say that I only stayed here a few 
more days and was at least able to get the school modernization program 
passed, I would be happy and say okay, ``let's go home.'' But, right 
now, they are not willing to address any of these things, and we just 
have to keep pointing it out over and over again.
  Ms. DeLAURO. I think the gentleman is right. Also, just because of 
what they will say on the other side of the aisle, I would just say 
this: There are reasonable people, as I said, because the managed care 
reform bill was a bipartisan piece of legislation. It was the 
leadership who will not bring it to the floor. I think that is 
critical, because this is not bickering back and forth. We could have 
done this. We had enough votes.
  Mr. PALLONE. If I could just take my time back a second, you remember 
that we have our Democratic Health Care Task Force, but the Republicans 
had set one up also, and they had come forward at some point in the 
summer, early in the summer, with a patient protection bill that was 
very similar to the Patients' Bill of Rights. Some of the people on 
there had actually endorsed the concept of our Patients' Bill of 
rights. But when Speaker Gingrich got a copy of that thing, he 
immediately said, ``No way. We are not going ahead with this.'' He 
obviously showed it to the insurance industry and they said, ``No way, 
this is much too protective of the interests of the patients,'' and he 
told them literally, ``Go back to the drawing board.''
  They went back, two or three more weeks, and they came out with this 
awful bill that they eventually brought up in one day.
  Ms. DeLAURO. That is precisely the point. Let us listen to the 
public. We reflect their interests here. We put a piece of legislation 
together. Let us get it passed.
  The other thing they would say is that this was going to drive the 
cost of health insurance sky high and make it unable for people to pay 
for.
  Wrong. The CBO analysis, Congressional Budget Office analysis of the 
Patients' Bill of Rights of 1998, was it would have only a minimal 
effect on premiums, with most individuals paying only about $2 more per 
month for all of the protections that have been cited in the past. So 
they should not have said that.
  Mr. PALLONE. If you remember, we had many of the Members of the Texas 
delegation, and these are not ideological liberals by any means, 
Democrats, many of them of conservative ideology, who had the 
experience in Texas where Texas passed a Patient Protection Act, and it 
was very similar to what we want at the Federal level. The results are 
already in and show that the cost is practically nothing. I think it 
was like 34 cents a month or something like that.
  One of the reasons that the cost was so minimal, and this was brought 
out by one of our task force hearings where we had someone testify from 
some of the Texas organizations that were involved, was because it led 
to prevention. In other words, it was sort of like what Congresswoman 
Woolsey was saying: Once the HMOs have this sort of floor that they 
have to provide these basic protections, they are very careful to make 
sure that the level of health care that is provided is of good quality, 
and you have preventative measures taking place so that you do not get 
lawsuits, you do not get all these problems that result from the 
current system, because they know they are being watched, and it 
actually cuts the costs down considerably.
  Ms. WOOLSEY. One thing I would like to call to everybody's attention 
is that these 10 million children that are not covered, more than 80 
percent of them live in families with at least one working parent.

                              {time}  1915

  That is a huge number. We are not talking about welfare recipients, 
we are talking about the working poor who work every day as hard as 
everybody else, or harder, at maybe more than one job, and they cannot 
afford health care for their children. One of the reasons that 
businesses do not provide it is that health care costs are going up 
again.
  One of the reasons we supported HMOs in the first place, and HMOs 
were going to be the savior for health care, is because the cost of 
health care leveled as the number of HMOs grew in this Nation. Now we 
have passed that nexus. Health care costs are going up in rapid, rapid 
numbers, and the quality of the HMO is going down, so we have to put 
that floor. That is what HMO reform would do, managed care reform. I 
thank the gentleman.
  Mr. PALLONE. Mr. Speaker, I know we only have about 10 or 15 minutes 
left, but if we could just spend a little time talking about the Social 
Security issue and what the Republicans tried to do a few weeks ago 
with regard to these tax breaks for the wealthy versus Social Security, 
because this was very disturbing to me.
  We passed the Balanced Budget Act last year. For the first time in a 
long time, this year there was a bit of a surplus in the budget. 
However, when we look at the budget, we realize very clearly that that 
surplus is totally the result of money that has been set aside in the 
Social Security trust fund, because at some time down the road that 
trust fund money is going to be needed to pay out benefits to senior 
citizens. We know that at some point, even more money is going to have 
to be available than what is set aside in the trust fund years down the 
road.
  But they had the audacity a few weeks ago to suggest and to actually

[[Page H10552]]

pass on the House floor a bill that would take money from the surplus 
for tax breaks, a lot of which, from what I can see, would just help 
wealthy corporations. But regardless of who it helps, they would be 
taking this money out of the Social Security Trust Fund. They actually 
had to change the House rules or get around the House rules because the 
money was coming directly from the Social Security Trust Fund.
  When I talk to the senior citizens in my district, I do not even have 
to explain this to them. They know it right off the bat. They 
understand. They become very upset, because if we start skimming this 
trust fund, we are going to aggravate the problem that we already have 
in not having enough money to pay out benefits in the future.
  Then what is going to happen is the pressure is going to be on to 
reduce benefits, either by raising the age or eliminating the COLA or 
somehow changing the Social Security program. That gets back to what 
the gentlewoman from Connecticut (Ms. DeLauro) was saying again; this 
Republican leadership does not care about Social Security anyway, so 
that probably fits into their scheme.
  I am thankful at least, in this case, that the Senate did not take up 
this terrible bill. It just goes again to show the kinds of things we 
have had to deal with and the kinds of things we have wasted our time 
with in this Republican Congress.
  Ms. DeLAURO. When we voted, I know the gentleman from New Jersey (Mr. 
Pallone) did and the gentlewoman from California (Ms. Woolsey) and I 
did, we voted for tax cuts. We all support tax cuts. We voted for the 
tax cuts, and we said that they would go into effect when there was a 
law in place that would make sure that the Social Security system was 
solvent. Because in fact with this opportunity for a surplus, the 
Social Security Trust Fund surplus allows us to have the surplus, so in 
fact you are using the surplus and then shortchanging Social Security.
  We vetoed four tax cuts. I support tax cuts. Men and women are 
working hard today. Families are literally throwing every hour that 
they have into the workplace, and they are barely staying even. We need 
to do that.
  However, the point was, let the tax cuts go into effect when we are 
sure that Social Security is solvent, so the beneficiaries today will 
keep getting their benefits, and, if you will, my generation, the 
gentleman's kids' generation, will have the opportunity.
  I want to just tell the gentleman why, because this is critical. 
Social Security is 60 years old. It has been one of the major success 
stories of this country. We have men and women who are working hard all 
their lives, and now for their financial security and their retirement 
years they rely on Social Security. Today two-thirds of America's 
seniors rely on Social Security for over one-half of their income.
  That is staggering, and is why we cannot be political with Social 
Security. Social Security, we cannot play fast and loose with it. It 
has to be a thoughtful and reflective process. We have the opportunity 
immediately to take a look at this potential surplus in order to be 
able to make it solvent over the next 75 years. This is going to be the 
critical issue in the next session of the Congress.
  There are going to be a number of issues that are going to come up, 
such as privatizing Social Security, which is something that I lean 
against, because the other piece, which is important to note, Social 
Security provides for a guaranteed annual income for these two-thirds 
of seniors who rely on Social Security for over half of their income. 
There is a guaranteed annual income.
  The privatizing solutions remove that guaranteed annual income, so we 
need to be very, very careful with it. That is what we were saying by 
that vote a couple of weeks ago in this body: Let us not raid Social 
Security, let us make sure it is safe for the next 75 years. Then, yes, 
let us move to tax cuts, targeted tax cuts for working families today 
in this country.
  Mr. PALLONE. Again, the biggest concern I have is that so much time 
was wasted on this debate. The Republicans basically knew this was 
going nowhere, so what happens? We are back here again today. They have 
not accomplished anything in terms of trying to achieve any of these 
goals relative to education, HMOs, or Social Security.
  The issue is how to deal with Social Security in the long run and try 
to shore up Social Security for the future. Instead, they waste all 
this time again, forcing us into a situation where we are going to be 
back in session here tomorrow. There is no budget, there is so little 
time, and basically they are saying, look, do not worry about it. Go 
home. A do-nothing Congress is fine with us. We take pride in it.
  It is just very upsetting. I think the only thing we can do is keep 
doing what we are doing now, keep demanding something be done. Mainly, 
I think the education initiative is something we can try to achieve 
over the next few years.
  I yield to the gentlewoman from California (Ms. Woolsey).
  Ms. WOOLSEY. Mr. Speaker, I, for one, am embarrassed at how little 
this Congress has produced. I would think the leadership of this 
Congress, of this House, would be red in the face when they look at 
themselves in the mirror.

  I, too, voted for Social Security first and tax cuts afterward. But I 
want to tell the Members, I represent if not the, one of the best-
educated districts in the Nation. They know about this stuff. They have 
been saying to me since the day I was elected in 1992, when is the 
Congress going to pay back what this country owes our Social Security 
Trust Fund? I have said, it is going to be paid back. We are on our way 
to a surplus. It will happen then.
  I am telling the Members, it had better happen, because if we do not, 
not only are we putting the Generation Xers and the baby boomers at 
risk, we are putting our national debt at risk, because a great 
percentage of that national debt is what we owe back to the Social 
Security trust.
  It is a win-win. It is a two-fer, if we take care of Social Security. 
We need to get Social Security off-budget. Social Security deserves to 
stand on its own. It must be secure. I will not fool around with 
privatizing Social Security, but I certainly would encourage people to 
have a base, and we have to find a way to encourage people to invest 
more. We cannot just depend on Social Security for our retirement, 
because that is not enough. It is not intended for that. It is intended 
for a safety net. So, Social Security first; tax cuts, yes, 
particularly for middle-income working families, next.
  Mr. PALLONE. My fear is that in the same way, and I do not know when 
it was, I think it was in the seventies or maybe eighties before any of 
us were here in Congress, that the Congress actually passed a law 
raising the payroll tax on Social Security to make sure that there were 
enough benefits. That is my fear.
  In other words, what is going to happen here is if this money from 
this trust fund keeps getting siphoned off for these tax breaks or 
whatever it happens to be, then 10 or 20 years from now, the next 
Congress or future Congresses will be faced with actually having to 
raise taxes in order to pay for the benefits.
  What we are doing now, or what the Republicans are doing now, is 
taking that money away, or they are not succeeding, but they are trying 
to take it away for tax breaks, and they are going to make future 
generations possibly pay more taxes to make sure that money is there. 
That is the possibility we could have down the road.
  Mr. Speaker, I yield to the gentlewoman from Connecticut.
  Ms. DeLAURO. Mr. Speaker, I just want to say, and it kind of sums it 
up for me about this Congress, it is really the political equivalent of 
the Maytag repairman. The Maytag repairman's phone never rang because 
nobody ever needed his help.
  Our phones are ringing off the hook here, but we have a Republican 
Congress that refuses to pick up the line. All the Democrats are saying 
on these issues is, let us answer the call from the American public.
  First and foremost, we have talked about HMO reform, we have talked 
about saving Social Security, but what we are asking for in these next 
several days while we are here is education reform. Let us reduce the 
size of classrooms, 100,000 teachers in grades 1 through 3, and let us 
in fact modernize our classrooms, provide those tax credits to local 
government, so that they

[[Page H10553]]

can float the bonds to build the schools, and it will bring down their 
own property taxes, if you will. Let us do that for the good of our 
children. That is what we are claiming to want to do in the next 
several days.
  We can talk all we want about what has not been done. We have a few 
more days. This we can get done. I think we have an obligation to go 
for it.
  Mr. PALLONE. Mr. Speaker, I agree with the gentlewoman. I regret to 
say that HMO reform is dead, and that there is no opportunity here to 
really deal with the Social Security issue anymore, because they have 
run the clock.
  But at least over the next few days if we can get the budget to 
include these two education initiatives, the modernization of the 
schools and the 100,000 additional teachers, then at least we can say 
that we have accomplished something before this do-nothing Congress 
goes home. We are just going to be out there every day saying that. We 
are not leaving. We are not leaving this place until we get some 
response from the other side of the aisle on these two issues.
  Again, I started off today by saying that when I was back in New 
Jersey in my district and I was at an event, this is what the people 
were talking about. I had a lot of educators there, I had a lot of 
elected officials on the local level, and as the gentlewoman from 
Connecticut (Ms. DeLauro) was saying, they were saying they need to 
modernize their schools, and they cannot do it. They cannot get the 
bonding. The cost of the interest rate on the bonding is so excessive 
that they either cannot do it, or the taxpayers are upset because of 
the amount of money that is involved.
  We need to address these issues. I know the gentlewoman has the dozen 
education initiatives that they failed to do. I wish the gentlewoman 
would go over that.
  Mr. Speaker, I yield to the gentlewoman from Connecticut (Ms. 
DeLauro).
  Ms. DeLAURO. Mr. Speaker, I would be happy to. This is the dirty 
dozen that the Congressional Republicans wanted to do to our public 
schools: eliminate the Department of Education; divert billions of 
dollars in public school funds for private school vouchers; cut school 
lunches for poor children; block-granting critical education programs, 
and when we block-grant those programs, we eliminate programs, and 
there is no accountability by the Governors as to where that money is 
being spent; ending equal opportunity in higher education; tax cuts for 
wealthy taxpayers who send their children to private schools; 
eliminating summer jobs; eliminating school-to-work; ending school 
interest subsidies for student loans; eliminating safe and drug free 
schools. That is the litany, that is the legacy of this Republican 
Congress.
  Mr. PALLONE. Hopefully, we can get something done before we adjourn.

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