[Congressional Record Volume 145, Number 47 (Wednesday, March 24, 1999)]
[Senate]
[Pages S3260-S3262]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               FEDERAL PRISONER HEALTH CARE COPAYMENT ACT

 Mr. KYL. Mr. President, I rise to introduce the Federal 
Prisoner Health Care Copayment Act, which would require federal 
prisoners to pay a nominal fee when they initiate certain visits for 
medical attention. Fees collected from prisoners subject to an order of 
restitution shall be paid to victims in accordance with the order. 
Seventy-five percent of all other fees would be deposited in the 
Federal Crime Victims' Fund and the remainder would go to the Federal 
Bureau of Prisons (BOP) and the U.S. Marshals Service for 
administrative expenses incurred in carrying out this Act.
  Each time a prisoner pays to heal himself, he will be paying to heal 
a victim.
  Most working, law-abiding Americans are required to pay a copayment 
fee when they seek medical attention. It is time to impose this 
requirement on federal prisoners.
  The Department of Justice supports the Federal inmate user fee 
concept, and worked with us on crafting the language contained in this 
Act.
  To date, well over half of the states--including our home states of 
Arizona and South Dakota--have implemented state-wide prisoner health 
care copayment programs. Additionally, the following states have 
enacted this reform: Alabama, California, Colorado, Connecticut, 
Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, 
Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, 
Nevada, New Hampshire, New Jersey, North Carolina, Ohio, Oklahoma, 
Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, West 
Virginia, and Wisconsin. Additional states are considering implementing 
copayment programs.
  Copayment programs have an outstanding record of success on the state 
level.
  Tennessee, which began requiring $3 copayments in January 1996, 
reported in late 1997 that the number of infirmary visits per inmate 
had been cut almost in half. In August 1998, prison officials in Ohio 
evaluated the nascent state copayment law, finding that the number of 
prisoners seeing a doctor has dropped 55 percent and that between March 
and August the copayment fee generated $89,500. In Arizona, there has 
been a reduction of about 30 percent in the number of requests for 
health care services.
  Copayment programs reduce the overutilization of health care services 
without denying necessary care to the indigent. By discouraging the 
overuse of health care, the Prisoner Health Care Copayment Act should 
(1) help prisoners in true need of attention to receive better care, 
(2) benefit taxpayers through a reduction in the expense of operating a 
prison health care system, and (3) reduce the burden on corrections 
officers to escort prisoners feigning illness to health care facilities 
is reduced.
  The Act prohibits the refusal of treatment for financial reasons or 
for appropriate preventive care.
  Congress should follow the lead of the states and provide the federal 
Bureau of Prisons with the authority to charge federal inmates a 
nominal fee for elective health care visits. The federal system is 
particularly ripe for reform. According to the 1996 Corrections 
Yearbook, the system spends more per inmate on health care than 
virtually every state. Federal inmate health care totaled $354 million 
in fiscal year 1998, up from $138 million in fiscal year 1990. Average 
cost per inmate has increased over 36 percent during this period, from 
$2,483 to $3,363.

[[Page S3261]]

  Before I conclude, I would like to thank my colleague Senator Johnson 
for his support and assistance with this legislation. Additionally, I 
appreciate the assistance of the Arizona Department of Corrections, and 
the office staff of Sheriff Buchanan in helping me draft this reform.
  I look forward to continuing to work with the Department of Justice, 
the Bureau of Prisons, and colleagues on both sides of the aisle, to 
implement a fee-for-medical-service-program--a sensible and overdue 
reform--for federal prisoners.
 Mr. JOHNSON. Mr. President, I am pleased today to join Senator 
Kyl in introducing the Federal Prisoner Health Care Copayment Act. The 
Kyl-Johnson bill will require federal prisoners to pay a nominal fee 
when they initiate certain visits for medical attention. Fees collected 
from prisoners will either be paid as restitution to victims or be 
deposited into the Federal Crime Victims' Fund. My state of South 
Dakota is one of 34 states that have implemented state-wide prisoner 
health care copayment programs. The Department of Justice supports 
extending this prisoner health care copayment program to federal 
prisoners in an attempt to reduce unnecessary medical procedures and 
ensure that adequate health care services are available for prisoners 
who need them.
  My interest in the prisoner health care copayment issue came from 
discussions I had in South Dakota with a number of law enforcement 
officials and US Marshal Lyle Swenson about the equitable treatment 
between pre-sentencing federal prisoners housed in county jails and the 
county prisoners residing in those same facilities. Currently, county 
prisoners in South Dakota are subject to state and local laws allowing 
the collection of a health care copayment, while Marshals Service 
prisoners are not, thereby allowing federal prisoners to abuse health 
care resources at great cost to state and local law enforcement.
  I want to thank Senator Kyl for working with me on specific concerns 
raised by South Dakota law enforcement officials and the US Marshals 
Service that I wanted addressed in the bill. I sincerely appreciate 
Senator Kyl's willingness to incorporate my language into the Federal 
Prisoner Health Care Copayment Act that allows state and local 
facilities to collect health care copayment fees when housing pre-
sentencing federal prisoners.
  I also worked with Senator Kyl to include sufficient flexibility in 
the Kyl-Johnson bill for the Bureau of Prisons and local facilities 
contracting with the Marshals Service to maintain preventive-health 
priorities. The Kyl-Johnson bill prohibits the refusal of treatment for 
financial reasons or for appropriate preventive care. I am pleased this 
provision was included to pre-empt long term, and subsequently more 
costly, health problems among prisoners.
  The goal of the Kyl-Johnson Federal Prisoner Health Care Copayment 
Act is not about generating revenue for the federal, state, and local 
prison systems. Instead, current prisoner health care copayment 
programs in 34 states illustrate the success in reducing the number of 
frivolous health visits and strain on valuable health care resources. 
The Kyl-Johnson bill will ensure that adequate health care is available 
to those prisoners who need it, without straining the budgets of 
taxpayers.
                                 ______
                                 
      By Mr. ASHCROFT:
  S. 705. A bill to repeal section 8003 of Public Law 105-174; to the 
Committee on Commerce, Science, and Transportation.


                        home page tax repeal act

  Mr. ASHCROFT. Mr. President, Daniel Webster argued to the Supreme 
Court in McCulloch v. Maryland that the power to tax involves the power 
to destroy. Chief Justice Marshall was so taken with Webster's argument 
that he made it the central premise of his landmark opinion for the 
Court. Fully cognizant of the potential for abuse inherent in the power 
to tax, the framers carefully circumscribed this power. The 
Constitution limits the tax power to the Congress and requires revenue 
bills to originate in the House of Representatives, the body most 
responsive to the people. The notion that unelected bureaucrats could 
levy taxes absent any congressional authority would have been a 
complete anathema to the framers. It is a long way from ``no taxation 
without representation'' to taxation without notice, representation or 
even participation from the Congress.
  Unfortunately, the National Science Foundation appears to have 
forgotten that the power to tax belongs to the Congress and to Congress 
alone. Since 1992, the National Science Foundation has employed a 
private sector firm to registering second-level domain names, which are 
the unique identifiers that precede ``.com'' or ``.org.'' In 1995, the 
National Science Foundation amended its agreement with the firm to 
allow it to charge a $100 registration fee, and a $50 renewal fee. If 
those fees had been designed simply to allow the private firm to cover 
its costs and make a modest profit they would be unproblematic. 
However, that is not what happened here. The National Science 
Foundation, without any congressional authority, required the private 
firm to set aside 30 percent of the total fees collected and turn them 
over to the National Science Foundation's Intellectual Infrastructure 
Fund. In short, without any congressional authorization, the National 
Science Foundation levied a substantial tax (at greater than a 42-
percent rate) on a necessary item for doing business on the Internet.
  Allowing this agency action to go unremedied would set a terrible 
precedent. Why should any agency suffer through the vagaries of the 
appropriations process if it can just impose its own taxes? As long as 
the agency has a monopoly over a necessary permit or license, it can 
set just about any tax rate it pleases. The agency could then use these 
tax revenues to fund its activities without too much concern for the 
appropriators and authorizers in Congress.
  The potential for abuse in such unauthorized and unconstitutional 
taxes was not lost on the Federal District Court that heard a challenge 
to the National Science Foundation's actions. The Court correctly 
determined that the National Science Foundation's actions amounted to 
an unconstitutional tax. Remarkably, Congress, rather than taking the 
National Science Foundation to task for its arrogation of taxing 
authority, actually ratified the Foundation's actions in a provision in 
last year's supplemental appropriations bill. The message this sends to 
federal agencies is intolerable. It creates a perverse and 
unconstitutional incentive for agencies to impose unauthorized taxes 
with every reason to believe that a Congress that has never seen a 
revenue source it did not like will ratify its misbehavior.
  What is more, the National Science Foundation's actions and Congress' 
ratification of those actions are inconsistent with the spirit of the 
Internet Tax Moratorium Act we passed last year. At the same time that 
we are telling States and localities that they cannot impose 
discriminatory taxes on the Internet, Congress is ratifying a 42% tax 
on the registration of domain names. Congress must be consistent with 
respect to Internet taxation. We must act to repeal the ratification of 
this unconstitutional tax. The bill I introduce today, the Home Page 
Tax Repeal Act of 1999 does just that. It sends a clear message that 
Congress will not tolerate taxation of the Internet and will not allow 
federal bureaucrats to wield the power of taxation.
  Finally, let me be clear that my criticism of the National Science 
Foundation's actions in levying this tax should not be mistaken for 
criticism of the policies they have pursued or of the uses to which 
they have put the revenues. I am fully supportive of efforts to ensure 
that we study the growth of the Internet and that the infrastructure 
supporting the Internet keeps up with rapid growth of this incredible 
medium. Indeed, spending for these purposes is so clearly justified 
that I have every confidence that sufficient funds will be appropriated 
through the normal appropriations process. But that is the process that 
should be followed. Allowing an agency to short-circuit that process 
and impose unconstitutional taxes--even with the best of motives--is 
simply unacceptable. The power to tax is indeed the power to destroy. 
The power to tax is oppressive enough in the hands of elected officials 
who must face the voters. That same power in the hands of unelected 
bureaucrats is intolerable. On behalf of the people we represent, 
Congress should reclaim its

[[Page S3262]]

proper constitutional authority and reject--not ratify--this 
unconstitutional tax.
                                 ______
                                 
      By Ms. SNOWE (for herself, Mrs. Hutchison, Mrs. Murray, Ms. 
        Mikulski, Mrs. Boxer, Ms. Collins, Mr. Rockefeller, Mr. Reid, 
        Mr. Biden, Mr. Akaka, Mr. Kerry, Mr. Ashcroft, Mr. Dodd, Mr. 
        Durbin, Mr. Torricelli, Mr. Inouye, Mr. Lieberman, and Mr. 
        Sarbanes):
  S. 706. A bill to create a National Museum of Women's History 
Advisory Committee; to the Committee on Rules and Administration.

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