[Congressional Record Volume 145, Number 94 (Tuesday, June 29, 1999)]
[House]
[Pages H5060-H5066]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            SUPPORT THE DEMOCRATIC PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore (Mrs. Northup). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Madam Speaker, this evening I would like to talk about 
two significant health care issues that the Democrats have made a major 
thrust, if you will, of their agenda for this Congress. One is the 
Patients' Bill of Rights, which is our HMO reform, our patient 
protection reform; and the second one is the effort that was announced 
today by President Clinton at the White House to modernize and 
strengthen Medicare and, most importantly, to provide a prescription 
drug benefit for all Medicare recipients for the first time.
  As Members know, when Medicare began in the 1960s under President 
Johnson, there was not a prescription drug benefit. As part of the 
effort to modernize Medicare and strengthen Medicare, the President 
today went far towards coming up with a prescription drug benefit that 
I think is a wonderful way for this Congress to show that it really 
does care about our senior citizens.
  Let me start this evening by talking a little bit about the Patients' 
Bill of Rights. I have said over and over again on the floor of the 
House of Representatives, both this session and previous sessions, that 
the most important issue, the issue that I hear the most from my 
constituents about and the issue that I think our constituents feel we 
should address immediately, is reforming HMOs. Because so often 
Americans who have managed care, whose insurance policy is essentially 
a managed care or HMO type of policy, find that there is not adequate 
protection under the law for them to receive quality care when they 
need it.
  The horror stories have been recounted many times about Americans who 
need a particular operation and are told that the HMO will not pay for 
it or need a particular type of equipment and are told that the HMO 
does not cover that or who need to go to an emergency room and want to 
go to the closest one nearby to where they live or where they happen to 
be hurt and are told that they cannot go to that emergency room because 
that particular hospital does not come under the HMO plan. All we are 
seeking to do with the Patients' Bill of Rights is to provide 
sufficient protections, what I call common-sense protections under the 
law, under Federal law, that get rid of these horror stories.
  Essentially, the Patients' Bill of Rights has two focuses. One is to 
make sure that the decision of what kind of medical care you receive is 
made by the doctor and the patient, not by the insurance company; and 
the second focus is that there be an opportunity, if you are denied 
care by the HMO, that you have some sort of appeal, external appeal, as 
well as the right to bring suit in court to make sure that your 
grievance is heard and that that incorrect decision can be overturned 
if it should be. Those are the two focuses of our legislation.
  But there are a number of other things that come up in the context of 
the Patients' Bill of Rights. I would like to go into a little bit some 
of the objectives tonight. I say that there are four central objectives 
of the bill: Patients should have access to needed care, doctors should 
be free to practice medicine without improper interference from HMOs 
and insurance companies, the health plan's decision to deny care can be 
appealed by patients to an independent entity, and health plans are 
held accountable for their medical decisions that lead to harm.
  Let me get into some of the specifics, because I think that they are 
important. As I mentioned, patients today face numerous obstacles as 
they seek access to doctors and needed health care services in the 
context of managed care. These barriers to quality health care range 
from managed care companies' refusal to pay for emergency room services 
without prior authorization to restricting patients' access to 
specialists.
  These are the most important provisions that I am going to go through 
in the Patients' Bill of Rights that will provide patients with access 
to the care that they need when they need it.
  First, access to emergency room care. The Patients' Bill of Rights 
allows patients to go to any emergency room during a medical emergency 
without having to call a health plan first for permission. Emergency 
room physicians can stabilize patients and begin to plan for 
poststabilization care without fear that health plans will later deny 
coverage.
  Access to needed specialists. We hear many times about the fact that, 
under HMOs, patients have been told, ``Well, you can't go to a 
particular specialist.'' The Patients' Bill of Rights ensures that 
patients who suffer from a chronic condition or a disease that requires 
care by a specialist will have access to a qualified specialist. If the 
HMO network does not include specialists qualified to treat a 
condition, such as a pediatric cardiologist to treat a child's heart 
defect, it would have to allow the patient to see a qualified doctor 
outside its network at no extra cost. And the Patients' Bill of Rights 
also allows patients with serious ongoing conditions to choose a 
specialist to coordinate care or to see their doctor without having to 
ask their HMO for permission before every visit.
  Another important provision in our Patients' Bill of Rights is access 
to an OB/GYN. The Patients' Bill of Rights allows a woman to have 
direct access to OB/GYN care without having to get a referral from her 
HMO. Women also would have the option to designate their OB/GYN as 
their primary care physician.
  The other thing, because, as I mentioned earlier, one of the major 
concerns right now is access to prescription drugs, well, under the 
Patients' Bill of Rights, it requires that needed prescription drugs be 
available to patients. Currently, many HMOs refuse to pay for 
prescription drugs that are not on their preapproved list of 
medications. As a result, patients may not get the most effective 
medication needed to treat their condition. The Patients' Bill of 
Rights ensures that patients with drug coverage will be able to obtain 
needed medications even if they are not on the HMO's approved list.
  Now, before I go on and talk a little more about the Patients' Bill 
of Rights, let me stress that what the Democrats have faced in this 
Congress is the fact that the Republican leadership refuses to bring up 
the Patients' Bill of Rights. They refuse to have a hearing in 
committee, they refuse to mark it up in committee, they refuse to bring 
it to the floor of the House of Representatives. This has been going on 
now since the beginning of this session, and we faced the same problem 
in the previous session of Congress.

[[Page H5061]]

  So what do we do? Well, what we did last week is we started a 
petition process. There is such a thing as a discharge petition which 
Members can sign on the floor of the House of Representatives; and if a 
majority of Members of this House sign the discharge petition, then 
that forces the Republican leadership to bring the bill to the floor to 
have a debate, to have a vote, to have the American people see us have 
the opportunity to vote on this bill.
  What we started last week was this petition drive. As of Friday, we 
had 180 signatures to our discharge petition, all Democrats. We are 
hoping, though, that we can eventually get some Republicans to join us; 
and we went through the same process last year in an effort to get the 
Patients' Bill of Rights to the floor.

  I assure my colleagues that over the next few weeks we will do our 
best to get to that magic number of 218 which will bring the Patients' 
Bill of Rights to the floor, if we can get that number, and I think we 
can, because I think there is a huge groundswell, if you will, of 
public opinion that wants to see this legislation brought to the floor.
  Let me just say a few more things about the Patients' Bill of Rights, 
what the legislation does. I stressed in the beginning this notion that 
doctors need to be free to practice medicine. Accountants, insurance 
companies, insurance company bureaucrats, should not be making medical 
decisions and deciding what type of care you receive. Yet some managed 
care organizations interfere with doctors' medical decisions and even 
go so far as restrict open communication between patients and doctors.
  I think that most people are surprised to find out that if the HMO 
does not cover the particular type of procedure or operation that your 
doctor thinks you need, that the HMO can actually tell the doctor that 
he or she is not allowed to tell you what that procedure is. It is 
called a gag rule, because, essentially, the doctor is denied his or 
her freedom of speech, their first amendment rights. That is just the 
most egregious example, and one of the things that the Patients' Bill 
of Rights does is to prohibit insurers, HMOs, from gagging doctors. But 
even more important is the idea that the decision about what is 
medically necessary, what is defined under the insurance policy to be 
medically necessary, is defined by standards within that particular 
specialty of care. In other words, right now if you have an HMO and the 
HMO decides that a particular procedure or a length of stay in the 
hospital, for example, is not what they want to cover, they will simply 
say that what is medically necessary for you does not include that.

                              {time}  2030

  They will define what is medically necessary.
  What we do in the Patients' Bill of Rights is we say no, the decision 
about whether a particular cardiac procedure is medically necessary is 
defined, is made by the board of specialists for cardiology. The 
decision about whether a child should stay in the hospital, as my 
colleagues know, a certain number of days or the mother should stay in 
the hospital a certain number of days after the baby is born is not 
defined by the HMO, the insurance company, but defined by the 
specialist for pediatric care or for obstetrics, whatever happens to be 
that specialty defines what the level of care, what the treatment, what 
the equipment, what the number of days in the hospital should be.
  And that is very important because right now even if your HMO allows 
you to appeal the denial of care in a particular circumstance, that 
usually goes to a review board either within or outside the HMO that 
limits its review to whether or not the insurance policy is allowing 
you a procedure that they would normally allow. In other words, they 
allow what is medically necessary themselves, and all that the appeals 
process can do is to review whether they stood within the confines of 
their own definition of what is medically necessary.
  That is not the way it should be. It should be that those standards 
are defined by the doctors, by the specialist in that particular area 
and that that is what is reviewed when it goes to an external review 
board or when it goes to a court of law, and it is a very important 
part of all this.
  All we want to do is make the HMOs accountable for their actions. 
Some people have said to me, well, as my colleagues know, if you let an 
external review take place of whether or not someone should have been 
denied that particular procedure or if you let that person go to court 
and have the court decide, as my colleagues know, whether or not that 
denial of care was appropriate, you are going to have, as my colleagues 
know, endless lawsuits and the costs are going to go up and all this 
kind of thing. Well, none of that is true.
  I see my colleague from Texas has joined me tonight, and he has 
pointed over and over again how Texas has enacted a Patients' Bill of 
Rights, and none of those concerns about extraordinary costs or a lot 
of litigation have come true. But what we are really saying is that 
there has to be accountability, that the HMOs, just like anyone else 
has to be accountable for their actions, and, if you have an external 
review process that is independent, that does not have people from the 
HMO making those decisions, or if you allow someone to go to court to 
overturn a denial of care or to have someone recover because the care 
was not provided and they suffered damages, then in the long run the 
HMO will be more accountable. They will do the right thing from the 
beginning because they will be fearful that their decision, their wrong 
decision, will be overturned or that they have to pay damages in a 
court of law.
  So we are not really trying to do anything I think that most people 
do not already think should be the case, but, unfortunately, it is not 
the case. And I would point out that what we are seeing now on the 
Republican side, because I think they understand that this is a major 
issue and that they cannot keep denying us the opportunity to consider 
the Patients' Bill of Rights on the floor or in committee is that they 
have come up with their alternatives, what I call a piecemeal approach.
  They have introduced eight different bills to cover some aspects of 
the Patients' Bill of Rights, but those eight bills are woefully 
inadequate in terms of the kinds of protections that are needed, they 
do not look at this problem in a comprehensive way, and most 
importantly, the Republican bills that are put out there, these eight 
bills, do not define medical, what is medically necessary in a way that 
leaves it up to the physician and the patients to make that decision. 
They essentially leave it up to the HMO, and they do not have any kind 
of accountability because they do not have an external independent 
review process and they do not allow you to sue in a court of law.
  So we are going to go through this process, we are going to see the 
Republican leadership trying to say that they are going to do HMO 
reform, but hopefully our discharge petition will eventually force the 
Republican leadership to bring the Patients' Bill of Rights to the 
floor, and then we will have a full debate and a vote on the bill.
  I wanted to tonight also go into what happened today at the White 
House where the President unveiled his plan to modernize and expand 
Medicare and, of course, the prescription drug benefit that is so 
important as part of that.
  I think my colleague from Texas may have already discussed that to 
some extent tonight, but maybe what we can do, if I can yield to him, 
is we can talk somewhat about the Patients' Bill of Rights, and then we 
can go into the Medicare prescription drug benefit as well because I 
think it is so important, and I yield to the gentleman from Texas.
  Mr. GREEN of Texas. Madam Speaker, I thank my friend from New Jersey 
for one, requesting this special hour this evening, but also for the 
announcement yesterday that you are going to continue to serve with us 
in the House, we hope, and not make that jump over to the other Senate 
side, and because of your leadership both in our health task force but 
also on this issue. I think we can use that experience here on this 
side of the aisle. The air is so rarified over in the Senate anyway, 
you have to have oxygen over there.
  But, Madam Speaker, for months all we have heard is that we cannot 
pass a Patients' Bill of Rights because it will increase the cost and 
open employers to unfair lawsuits, both of which will supposedly force 
employers to drop insurance coverage from their employees. Essentially 
they are trying to kill

[[Page H5062]]

meaningful managed care reform with half truths and scare tactics.
  The insurance industry, managed care organizations, HMOs and 
oftentimes even some of the big businesses have repeatedly tried to 
scare the American people by saying the bill would dramatically raise 
premiums and force employers to drop health insurance for their 
employees. Obviously, that is not the furthest thing I would ever want 
to do and I know every Member of the House would not want to do that.
  Some of these special interest groups even suggest that the increase 
could go as high as a 40 percent increase in premiums, and once they 
are done spreading that inaccurate number, maybe we really ought to 
talk about what the bill may cost and even use some real life 
experience, what has happened in the State of Texas. But even on the 
Federal level our nonpartisan Congressional Budget Office after 
thoroughly analyzing each section of the Patients' Bill of Rights 
determined that the bill would cost beneficiaries only $2 a month; that 
is right, the cost of a happy meal at McDonalds. Patients and managed 
care could have what they really need as fairness and protection in 
accountability and for $2 a month. But the news is even better than 
they want to hear because in my home State of Texas, which passed a 
Patients Protections in 1997, the State of Texas Patient Bill of Rights 
included external appeals and accountability and liability sections, 
and you know the only premium increase that can be attributed is to the 
higher cost for prescription medication.
  There have been increases, but it has been the standard increase 
whether it is in Dallas or Houston, it has been in San Francisco or 
Denver or in Washington or New York, anywhere else in the country. 
There has been no noticeable increase in premiums in the State of Texas 
since 1997 because of the managed care reform bills. So even the 
Congressional Budget Office at $2 a month may be over exaggerating, but 
again maybe we can afford a happy meal to make sure we get the health 
care we need.
  In fact, in the State of Texas in the outside appeals 50 percent of 
those appeals are being found in the patients benefit; so in other 
words, 50 percent of the time if an HMO tells you that is not covered 
or we are not covering it, they are wrong, and that is what happened in 
the State of Texas. So again, for $2 a month or even less I would be 
more than happy to have an outside appeals process that is really an 
appeals process. Plus, there has been no mass exodus in the State of 
Texas for employers that drop health insurance in Texas. What Texas 
residents do have now is health care protections that they need and 
they deserve. Provisions included in the Patients' Bill of Rights in 
the State of Texas should be extended to all Americans and, most 
importantly, to the 8 million Texans who have insurance policies that 
come under federal law.
  Again, we have many policies in our country that come under State law 
or Federal law, and no matter if all 50 States pass their own patient 
protections or the Patients' Bill of Rights, we still have to pass it 
on the Federal level because of the Federal law and ERISA. These 
include eliminating gag clauses so that the physicians will be able to 
communicate freely with their patients. That should not cost a dime 
except letting the doctors talk to their patients. Open access to 
specialists for women, children in the chronically ills of patients who 
will not need to have a referral every time they see a physician. They 
have to go back to their primary care doctor, and we understand this. A 
woman, for example, may pick a primary care doctor that is not her OB/
GYN, and she should not have to go back to that primary care doctor 
every time she needs to go to her obstetrician. Same way a person who 
may be diagnosed with cancer. They should not have to go back to that 
primary care doctor every time they need a cancer treatment. They 
should be able to go to their oncologist that is on their list. 
External and binding appeals process that guarantees patients timely 
review of questionable decisions.
  Again, in the State of Texas 50 percent of the time the appeals have 
been found for the patient, and 50 percent for the insurance company, 
and that is great; 50 percent of the time they are wrong, and before 
this law passed in Texas, 100 percent of the time they were wrong. It 
is just that we have found out that half the time they were right. 
Coverage for emergency care so families will not be required to stop at 
a pay phone to get pre-authorization because they could go to the 
nearest emergency care unit that they have and medical necessity for 
those decisions.
  But also, and we heard it last week and we have heard testimony not 
only in our Committee on Commerce hearing we had, but also in our task 
force hearing we had last week: If you hold the medical decision maker 
accountable, if you hold that doctor or that provider accountable, then 
the person who is telling that doctor how to practice medicine ought to 
also be accountable, and in the State of Texas again; I hate to keep 
using Texas as an example, but that is where this has been tried and 
tested and proven.
  There have been no more than three lawsuits anybody knows of filed 
since 1997; one because the appeals process is working. Patients only 
want to have the health care that they pay for, and so if they get it 
and then plus if they are ruled against half the time, then they are 
probably not going to go hire them a lawyer because the facts are 
already out there, and they know what reason was made for not having 
the health care that they expected they should have.
  Instead they recognize the affordability and the value of the 
Patients' Bill of Rights. I am sorry to hear that our Republican 
leadership continues to push with sometimes half fixes and even 
loopholes. To be honest, I am not so sure I have been convinced that 
the leadership seriously wants to pass a managed care reform bill that 
truly protects patients with some of the things I have heard the last 
few weeks.
  Certainly their actions to date have not given us any reason that 
they will, but I do think they would have compassion to bring a bill up 
on the floor so we can debate it here on the floor just like we are 
doing tonight. If our ideas do not have the majority vote, then so be 
it. That is the democracy and the American system. But we need to have, 
the American families need to have, the protections, and we ought to 
debate it openly here on the floor of the House, and whether it takes, 
as my colleagues know, 1 hour or 10 hours we ought to have that time 
here for the most important health care bills that will come along 
maybe in our lifetime.
  Unfortunately that is not the case. Last year's floor consideration, 
as Members of the Committee on Commerce, we did not even have, were 
unable to consider the bill that came up here on the floor, was 
actually drafted in the Speaker's office, and we had one chance to mend 
it, one chance. And we all, we lacked five votes in coming up with a 
real strong Patients' Bill of Rights. Ours failed by 5 votes. What 
passed the House was not even seriously considered by the U.S. Senate 
because it actually weakened the law that had already been passed in a 
lot of our States.
  And so that is why tonight I am happy to be here with you again and 
in talking about how important a comprehensive Patients' Bill of 
Rights, and let us stop stonewalling, let us go ahead and get this bill 
out here on the floor. Sure, we can have all the committee hearings we 
want, but we really need to get a comprehensive bill here on the floor 
of the House. It is a fair bill, but it rules that we can debate our 
ideas, and that way we can vote out here in public for everyone.
  With that I would be glad the gentleman requested this time this 
evening, and again I know you wanted to talk about the President's plan 
today. And let me just say that a few minutes ago I spoke, and the 
President's plan may not go as far as I would like it to go, but it 
moves us down that road. In football terminology we may be on the one 
yard line now, he may move us to the 40 or 50. Of course, I would 
rather have a touchdown, but at least he moves us down the road on 
really prescription medication for our senior citizens.
  And so I am glad the President announced that today. Hopefully we 
will go from here and go forward with it.
  Mr. PALLONE. I want to thank the gentleman for his comments.

                              {time}  2045

  Madam Speaker, I just wanted to comment on some of the remarks that

[[Page H5063]]

my friend, the gentleman from Texas (Mr. Green), made because I think 
they are so significant.
  First of all, with regard to the Patients' Bill of Rights, the 
gentleman has set forth not only tonight but on many occasions, 
including last week when we had our Democratic Health Care Task Force 
hearing, on the fact that there is no question that under the Texas 
law, which is very similar to what we have, that some of the concerns 
that have been expressed about HMO reform legislation, like the 
Patients' Bill of Rights, have just not materialized. The fact that 
there have been almost no lawsuits, the fact that the cost increases 
have been really a few pennies, really, per month, and I think that is 
important because as much as we realize a lot of these criticisms are 
not justified, many of the insurance companies, many of the HMOs 
continue to make these criticisms and in many cases spend a lot of 
money trying to advertise potential problems that might exist with the 
Patients' Bill of Rights; and the Texas legislation, which has been in 
force now for about 2 years, shows rather dramatically that those 
criticisms are not legitimate.
  The problem, of course, is that this Texas law and the New Jersey 
law, which we have in my State, and all the State laws do not apply to 
the majority of the people who fall under a Federal preemption because 
their insurance is essentially Federal because their employer is self-
insured or some other things that might bring them under Federal 
preemption. So we do need the Federal law, and I think we will get the 
Federal law if we keep pressing.
  I did want to switch because I did not hear the gentleman this 
evening but I knew that he was talking about the announcement that the 
President made today, and I think that we are going to see that his 
proposal for Medicare reform and expansion, albeit modest, is something 
that the majority of the people will become very supportive of. And we 
hopefully will not have to press the Republican leadership to bring 
that up for the vote; but if we have to, we will.
  If I could just talk briefly about the prescription drug benefit, I 
guess the hallmark of it, from what I understand, is that it will pay 
for half the cost of prescription drugs up to a total cost annually of 
$5,000 when it is fully in force, which I guess is in the year 2008. 
But initially when it goes into force, it will at least cover up to 
$2,000 annually, and we are talking about a premium which I think is 
about $24 a month beginning in the year 2002.
  So if this went into place the first time in 2002, one would be 
paying $24 a month; and this would apply to anybody who wanted to. It 
is a voluntary system, a new part B benefit, that anybody who wants to 
could pay the $24 a month, and they would be guaranteed in that year up 
to $2,000 of prescription drugs that they might incur. A thousand of 
that, half of that, would be paid for by Medicare. Then that premium 
would eventually go up, I guess, to $44 a month when fully phased in at 
2008, but at that point it would cover up to $5,000 in costs.
  Now I say it is modest because I am sure some people will say, well, 
why is it not paying the whole cost? Why is it we only get 50 percent 
and we still have to put up the other 50 percent?
  I think we have to look at the realities of the situation. We know 
that everything costs money and that the Federal budget is not 
infinite. The President is basically saying that he is going to put 15 
percent of the surplus into Medicare, and this will be one of the 
benefits of that. When I think of most of the seniors that I know, they 
would be very glad to pay that $24 a month and to have half of their 
drug costs subsidized by Medicare.
  The other thing which I do not think was heralded so much today but I 
am sure will be brought out as this unfolds is for beneficiaries with 
low incomes, below 135 percent of poverty, which I guess is defined as 
$11,000 for a single person or $17,000 for a couple, they would not pay 
premiums or cost sharing. Those with incomes between 135 and 150 
percent of poverty would receive premium assistance as well, in the 
same way that we do with part B that covers the doctors' bills. I guess 
it is called the QMB. I have forgotten what QMB stands for, but these 
are people with low income who do not have to pay the premium. So 
between that and this $24 cost that anyone else wants to pay on a 
voluntary basis, I think it is a pretty good deal.
  I would like to see it go further, but I think it is a very good 
beginning and something that hopefully we can get bipartisan support 
for.
  I would yield to the gentleman from Texas (Mr. Green).
  Mr. GREEN of Texas. Mr. Speaker, earlier, in a 5-minute special 
order, I talked about a constituent of mine that pays $260 a month for 
her prescription medication. That comes out to a little over $3,000 a 
year, $260 a month.
  Basically, under the President's plan, and again we will all see how 
this applies to our own constituents but now she pays a little over 
$3,000 a year. Under the President's plan, she would pay $25 a month so 
that would be times 12. She would pay 200-and-something dollars. Let me 
see. I have to go back to my math but probably around $300 a year. And 
then she would get half of that so she would be paying $1,500 if her 
medication costs stay the same, $3,000. She would pay half under the 
President's plan and then the other half would be paid for by Medicare 
part B. So she would actually come out saving money.
  Again, that is like I said, she still has to come up with her amount. 
She is paying this $260 a month now, and at $25 it just seems like it 
would save her money. It is not as far as I want but, like I said, it 
moves us down the field a little bit.
  Again, I do not have all the numbers. We serve on the Committee on 
Commerce, not the Committee on Appropriation and the Committee on the 
Budget. We identify the problems. Then we have to figure out how to do 
it. If we cannot completely solve them, let us at least go part of the 
way to do it.
  The President's plan goes $3,000 for the first few years, and then it 
goes up to $5,000 after that. I have constituents that have been to my 
townhall meetings literally for years and said that a husband or wife, 
oftentimes the wife has minimum benefits on Social Security because the 
wife worked traditionally at a lower wage job. Her whole check, every 
month, goes to their prescription medication. Their fear is that what 
happens when one of them passes away?
  Now, sure, their prescription medication may be cut in half, but they 
are losing that income, and they are also going to lose some of their 
Social Security. So they cannot afford for one of them to pass away 
because of the high cost of their prescriptions.
  It is just a shame in our country. I have seniors who have told me 
their blood pressure medicine that they have to take once a day, I 
really cannot afford it because it is really so expensive so I take it 
every other day. That should not be for that senior to have to do it or 
decide I am not going to have dinner tonight or I am not going to have 
breakfast or go to lunch because I need to take my medication. Those 
choices should not have to be made in a country as wealthy and as great 
as ours and who has a tradition, at least since the 1930s, of taking 
care of our seniors, first by a Social Security system that literally 
was the first welfare bill because people paid into Social Security so 
when they are retired they get something back on it, and then in 1965 
with the Medicare bill and now in 1999 to expand it to include 
prescription medication.

  The other thing the President talked about in his Medicare proposal 
was to correct some of the inequities in the Balanced Budget Act of 
1997 where a lot of our hospitals and even our home health care 
providers, the cuts were so dramatic that they are not being able to 
provide some of the services. I know I get letters in my office from 
senior citizens but also hospitals. So by dedicating 15 percent of the 
budget surplus over and above the Social Security amount that we will 
need for Medicare, it shows that that will help us and not only with 
prescription medications.
  So I congratulate the President. Again, I hope that we will have the 
chance on the floor of the House to debate prescription medication 
provisions for our senior citizens. Again, it may not go as far as I 
want to, but again let us show some progress in the legislative side. 
Instead of just saying no, we are not recognizing the problem, let us 
show we recognize the problem and do the best we can with the resources 
we have to do it.

[[Page H5064]]

  Again, I thank the gentleman for taking this time tonight and also 
letting us talk a little bit about prescription medication because that 
is important to all of our constituents. Whether they live in Houston 
or Texas or New Jersey or California or whether they are Democrat or 
Republican, it is important for us to address that.
  Mr. PALLONE. Madam Speaker, I want to thank the gentleman from Texas 
(Mr. Green) for his remarks. I know that we just heard about the 
details of this proposal today, but I am sure that over the next few 
weeks or few months we will be going into the details a lot more and 
basically pointing out the good points of the program.
  I just wanted to mention, it is estimated that about 31 million 
Medicare beneficiaries would actually benefit from the coverage that 
the President outlined today. The reason there are so many is because 
so many older and disabled Americans rely so heavily on medication. In 
other words, somebody who is younger might say, well, will I even incur 
$25 worth of prescription drug costs per month? But for people who are 
over 65 or the disabled that are covered by Medicare, most of them 
incur prescription drug costs that are well over the $24 premium per 
month.
  As I said, about 31 million people would benefit if they took 
advantage and opted into this new part B prescription drug benefit that 
the President has outlined.
  The other thing I would say about it is that the way the President is 
structuring this Medicare prescription drug benefit, it ensures 
beneficiaries discounts similar to that offered by many employer-
sponsored plans estimated to be, on average, over 10 percent for each 
prescription purchased. That has nothing to do with the limit. In other 
words, it has built into the prescription drug program these kinds of 
discounts; and, of course, the Medicare subsidy to pay half the cost is 
beyond the discount that one would also get. So I think that is another 
very significant aspect to it.
  The other thing, there were a number of other things that the 
President mentioned today as part of the Medicare expansion that he 
unveiled, and I just wanted to mention a few of these because I think 
they are significant.
  Very significant is that his proposal eliminates all cost sharing for 
preventive benefits in Medicare and institutes a major health promotion 
education campaign. Let me just talk a little bit about that preventive 
aspect.
  One of the biggest criticisms that we have had over the years, not 
only of Medicare and Medicaid but just health care in general, is that 
we do not encourage prevention. Prescription drugs essentially are 
prevention. It used to be 30 years ago when Medicare was started that 
prescription drugs were not important because the emphasis on health 
care then was if one was in the hospital and if they had to have an 
operation they had the operation, and that was the way to cure them.
  Prescription drugs have become more available and more prevalent over 
the last 30 years since the 1960s when Medicare began because it was a 
preventive measure. One takes the prescription drugs to prevent getting 
further sick or having to be hospitalized or having the operation, but 
there are other preventive benefits in Medicare that are just as 
important.
  By eliminating existing copayments and deductibles for these kind of 
preventive services, I think the President goes far, combined with the 
prescription drug program, in stressing prevention as part of the 
Medicare program which is so important.
  He said today, just to give an idea of the kind of preventive 
services that would no longer have those copayments and deductibles, 
just to give some examples of the cancer screening, bone mass 
measurements, pelvic exams, prostate cancer screening, diabetes self- 
management benefits, mammograms, these are the kinds of preventive 
measures that I think should not have the copayment deductible because 
we want everybody to take advantage of them, a significant part of his 
proposal today.
  The other thing is he reiterated as part of his Medicare proposal 
today the Medicare buy-in for the near elderly. The plan includes the 
President's proposal to offer any American between the ages of 62 and 
65 the choice to buy into the Medicare program for approximately $300 
per month; displaced workers even at a lower age. Displaced workers 
between 55 and 62 who had involuntarily lost their jobs and insurance 
could buy in at a slightly higher premium, approximately $400 per 
month.
  So what we are seeing here is an effort by the President to expand 
Medicare to the near elderly at no additional cost because this would 
be the cost of having those people enter into the Medicare program. I 
think that is also significant.
  The last thing I wanted to mention on the President's Medicare 
proposal today, I think my colleague, the gentleman from Texas (Mr. 
Green) already touched on it, but I wanted to reiterate that his 
proposal extends the life of the trust fund, the Medicare Trust Fund, 
until at least 2027.
  A lot of my constituents come up to me and say, is Medicare going to 
be there in a few years? Well, the answer is that if the President's 
plan is adopted, it will be. It will be there at least until 2027. He 
does that by dedicating 15 percent of the surplus, which is $794 
billion over 15 years, to Medicare, to insure the financial health of 
the trust fund through at least the year 2027.

                              {time}  2100

  We will go into this more, Mr. Speaker, as we get a chance to look at 
his proposal in more detail over the next few weeks.


   On Turkish Intransigence and Concerns Regarding the Entities List 
                      Against Turkey and Pakistan.

  Mr. PALLONE. Mr. Speaker, what I would like to do now, if I could, 
and I will not take up the whole time, but I wanted to sort of change 
the subject and talk about two foreign policy areas which I am very 
concerned about.
  The first one involves U.S. relations with India, which I often speak 
about as a member of our bipartisan India Caucus. It references 
legislation that I am introducing today with regard to the so-called 
``entities list'' against both India and Pakistan.
  The legislation I am introducing, Mr. Speaker, is a concurrent 
resolution aimed at getting the administration to review its so-called 
``entities list'' with regard to India and Pakistan.
  The Bureau of Export Administration has created a blacklist of 
private and public entities in the two countries, subjecting them to a 
near complete prohibition on all exports, including paperclips and 
paper cups, without regard to their specific use or whether these items 
contribute in any way to nuclear weapons or missiles.
  In effect, the entities list imposes a trade embargo against nearly 
300 companies and agencies with little or no direct connection to 
nuclear weapons programs. In practice, this is an essentially punitive 
list. Besides punishing the Indian and Pakistani entities, the list 
also ends up hurting U.S. firms and U.S. research organizations that 
have ties with them.
  Mr. Speaker, the administration, I believe, has cast too wide a net 
in listing entities, including private companies and research 
institutions, that do not threaten U.S. security interests. There are a 
total of 196 entities from India and 92 from Pakistan on the list. This 
compares with a total of only 13 named entities from China and 13 from 
Russia.
  There are some truly absurd examples of entities that have been 
included in this list. For example, medical equipment cannot be 
supplied to a cancer unit that comes under the administrative 
jurisdiction of an atomic research center. The trade restrictions are 
actually more permissive with regard to military than civilian 
entities. It is indicative of policies that I think have lost touch 
with the spirit of the laws that they were meant to implement.
  Thus, I have introduced today my sense of the Congress resolution, 
similar to a provision approved in the other body, the Senate, as part 
of the fiscal year 2000 defense appropriation legislation.
  It states that export controls should be applied only to those Indian 
and Pakistani entities that make direct and material contributions to 
weapons of mass destruction and missile programs, and only those items 
that can contribute to such programs.
  The entities list was adopted, I think I mentioned, by the Bureau of 
Export

[[Page H5065]]

Administration last year in the wake of the imposition of unilateral 
U.S. sanctions pursuant to the Glenn Amendment to the Arms Export 
Control Act.
  The sanctions were invoked automatically, pursuant to the Glenn 
Amendment. However, the naming of the Indian entities on the list is 
not a mandatory Glenn Amendment sanction. I would say that the list 
goes way beyond the intent of Congress when it enacted the Glenn 
Amendment in an effort to prevent nuclear detonations by what were 
termed nonnuclear powers by the Nuclear Non-Proliferation Treaty. 
Furthermore, the entities list is not subject to suspension or waiver.
  Mr. Speaker, in the Omnibus Appropriations Act of the last fiscal 
year, there was a provision granting the President the authority to 
waive certain Glenn Amendment sanctions. This year both houses of 
Congress, both the House and Senate, are moving legislation to further 
waive or to suspend the sanctions, but the entities list would not be 
affected by these efforts. It is a discretionary measure imposed by the 
administration above and beyond what the Glenn Amendment provides for.
  Mr. Speaker, I have repeatedly made the point that I have concerns 
about this discretionary approach in general. Personally, I would like 
to see the sanctions permanently repealed. I would at least favor 
suspension of the sanctions for some period of time, 5 years is 
provided for in the Senate language, rather than continuing to use the 
sanctions in a carrot and stick strategy to force concessions.
  With the entities list, we have seen this discretionary approach 
taken to its logical extreme. Instead of controlling exports that have 
a direct bearing on nuclear or missile programs, the list is simply a 
broad technological embargo against non-weapons related private and 
commercial activities.
  Mr. Speaker, I made the point that this list is punitive, but the 
real question is, whom does it punish? The named entities can generally 
find alternative suppliers from other countries. The real victims are 
the American companies, their employees, and suppliers.
  Furthermore, the list is open-ended. The named entities from India 
and Pakistan are not accused of violating any law or commitment. There 
is nothing the entities can do to get delisted, since there was nothing 
really they did to get put on the list in the first place.
  I have come to this floor on many occasions in the last year to 
express my concern that the sanctions regime against India has severely 
damaged the burgeoning economic relations that have been opened up 
since India undertook historic market reforms in the early 1990s.
  The sanctions have forced the U.S. to oppose major projects funded by 
the World Bank and other international financial institutions. We have 
had to abandon nonhumanitarian aid, including technical assistance 
programs that were helping India establish the kind of viable financial 
institutions that it would allow for much-needed infrastructure and 
other development projects. The sanctions not only deprive the people 
of India of important opportunities, they also serve to cut the U.S. 
private sector out of one of the world's major emerging markets.
  I am glad to see Congress is working on a bilateral and bicameral 
basis to lift the sanctions. Mr. Speaker, these efforts would not 
affect the Administration's entities list. It is up to Congress, 
working with the American private sector entities that have been hurt 
by this counterproductive policy, to speak out and urge the 
administration to reconsider.
  I hope we can enact this legislation that I am introducing today, Mr. 
Speaker, and that the administration will respond in a meaningful way 
by removing entities from this list that simply do not belong there.
  Mr. Speaker, I also wanted to take a few minutes, about at the most 5 
minutes, to talk about something that I read about over the weekend in 
the New York Times that again indicated very strongly the Turkish 
government's intransigence with regard to the continued occupation of 
Cyprus.
  I have a number of Cypriot constituents. I know the Cypriot Americans 
as a community have been to many Members of Congress, both Democrats 
and Republicans, many times to express their concern over the lack of 
progress in resolving the continued Turkish occupation of Cyprus. This 
year, actually July 20 of this year, next month, will mark the 25th 
anniversary of this illegal Turkish invasion and occupation of Cyprus.

  The problem is that the Turkish side continues to refuse to come to 
the negotiating table with the intention of negotiating in good faith. 
Hundreds of attempts to solve this problem have been made, yet to date 
the islands is divided and remains one of the most militarized places 
on the face of the Earth.
  Mr. Speaker, to its credit, following the leading role it played in 
bringing NATO's role with Serbia to an end, the group of eight major 
industrialized nations, the G-8, agreed to press for a new round of 
negotiations recently on the Cyprus issue.
  The Secretary General of the U.N. endorsed the G-8's plan and 
subsequently announced he was prepared to invite the Greek and Turkish 
Cypriots to hold comprehensive peace negotiations. The Turkish side, 
however, did not waste a second in reaffirming its disrespect for the 
will of the international community.
  Turkish president Rauf Denktash, he is the President of the Turkish 
occupied part of Cyprus, quickly dismissed the U.N.'s proposal for a 
new round of peace talks as nonsense.
  After nearly 25 years of Turkish belligerence and intransigence over 
the Cyprus issue, this latest refusal to allow the peace process to 
move forward is hardly a surprise. I am certainly not surprised. But I 
nonetheless wanted to come down here to discuss this particular example 
on the House floor because, frankly, the U.S. Government is simply not 
doing enough to help bring Turkey to the negotiating table.
  In my view, pressure by Members of Congress who support a just 
resolution to the Cyprus problem must be turned up. The justification 
the Turkish leader provided to Reuters News Agency for rejecting a new 
round of peace negotiations is absolute garbage. Denktash told Reuters 
he would not attend any negotiations at which the democratically-
elected president of Cyprus, Mr. Clerides, represented the Cyprus 
government.
  According to Denktash and his patrons in Ankara, the Cypriot 
government does not have any official jurisdiction or authority over 
the portion of the island that has been illegally occupied by Turkish 
troops for almost 25 years.
  Adding to this absurdity, the Reuters report also noted that Denktash 
and Turkey claimed that ``decades of talks on an inter-communal basis 
have failed to acknowledge the existence, in effect, of two separate 
governments on the island.''
  Mr. Speaker, these ridiculous claims were made by Denktash for the 
sole purpose of killing a new round of negotiations before they have a 
chance to succeed. That is what he is up to. Clerides, President 
Clerides, is recognized internationally as the President of Cyprus, and 
Turkey is alone in its recognition of the so-called Turkish Republic of 
Northern Cyprus. No other country in the world recognizes the portion 
of Cyprus that the Turks have illegally occupied for 25 years as an 
independent state.
  The Turkish suggestion that peace negotiations must be between 
leaders of independent nations from the same island is way outside the 
realm of reality.
  Mr. Speaker, the international community recently reaffirmed its 
position on the Cyprus issue. In December of last year, the U.N. 
Security Council passed a number of resolutions on the Cyprus 
situation, including Resolution 1217 which reiterates all previous 
resolutions on the Cyprus problem.
  Those resolutions state that any solution to the Cyprus problem must 
be based on a State of Cyprus with a single sovereignty and 
international personality and a single citizenship, in a bi-communal 
and bi-zonal federation, with its independence and territorial 
integrity safeguarded.
  So on the one hand we have the international community taking steps 
to reaffirm its commitment to a peaceful and just settlement to the 
Cyprus problem, and on the other hand, the

[[Page H5066]]

Turks are only hardening their position and thumbing their nose at 
whatever the international community suggests.
  Their claim that a new basis for negotiations is needed because the 
negotiations over the last 2\1/2\ decades, which they have worked 
systematically to undermine, have failed to produce any results 
essentially says it all. Rejecting all reasonable and peaceful 
overtures and substituting unreasonable and unworkable conditions in 
their place is not an approach that will move the peace process 
forward.
  Sadly, that is precisely why they make the suggestions. If the Turks 
were truly interested in moving the peace process forward, they would 
come to the table and abandon their belligerent and unreasonable 
conditions for negotiations.
  They could also accept the standing offer from the Cypriot government 
to demilitarize the islands in an effort to reduce tensions, as well as 
the Cypriot government's offer to pay for the costs of the peacekeeping 
force following any such demilitarization.
  The fact of the matter is that the Turkish side could do any of a 
number of things to reduce tensions and put the peace process back on 
track if Ankara, where the real decisions about Cyprus are made, 
allowed it to happen. History has shown we should not expect that to 
happen any time soon, and that is why the U.S. has to do more to make 
it happen.
  Mr. Speaker, I just wanted to say that in my view, it is long past 
time to stop focusing public and private efforts on the Turkish 
Cypriots and intensify American efforts to move the peace process 
forward on the Turkish military, which has real and substantial 
influence on decision-making in the Turkish government.
  To that end I would reiterate what I and many other Members of 
Congress have said publicly and privately to the administration. The 
United States government must stop spinning its wheels and convey to 
Ankara in forceful and unequivocal terms that there will be direct 
consequences in U.S.-Turkish relations if Ankara does not prevail upon 
the Turks to come to the negotiating table in good faith.
  Almost 25 years have passed since Turkey invaded Cyprus. The recent 
comments by Denktash, who is now taking his orders from the very same 
Prime Minister in Ankara who presided over Turks 1974 invasion, suggest 
it might as well have been yesterday.
  Mr. Speaker, finally, I think it is clear that the people of Cyprus 
have waited far, far too long for their freedom. It is my unshakable 
belief that the U.S. should immediately take the appropriate course of 
action against the Turkish government to help the Cypriot people attain 
their independence and their freedom and the cause of a united Cyprus 
without further delay. I do think these international issues are 
important.

                          ____________________