[Congressional Record Volume 145, Number 156 (Monday, November 8, 1999)]
[Extensions of Remarks]
[Pages E2298-E2300]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    REPUBLICANS BLOCK DEMOCRATS FROM OFFERING MAJOR IMPROVEMENTS TO 
                                MEDICARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Monday, November 8, 1999

  Mr. STARK. Mr. Speaker, last Friday, the House passed an okay 
Medicare improvements bill.
  But it could have been much better; it could have helped seniors get 
a better price for pharmaceuticals; it could have helped low-income 
women fight cancer; it could have provided more help to providers hurt 
by excessive cuts in the 1997 Balanced Budget Act. But Republicans 
blocked any amendments to the bill--they did not want to be embrassed 
by having to vote against helping seniors with the high costs of drugs.
  Following is a letter which 119 Democrats (many more would have 
signed if we had had more time) sent to the Speaker, outlining our 
request for amendments to H.R. 3075.
  Mr. Speaker, the majority should be ashamed for a legislative gag 
rule that prevented us from improving this legislation.


[[Page E2299]]


                                    Congress of the United States,


                                     House of Representatives,

                                 Washington, DC, November 4, 1999.
     Hon. Dennis Hastert,
     Speaker of the U.S. House of Representatives, The Capital, 
         Washington, DC.
       Dear Mr. Speaker: We are writing to ask that you not bring 
     the Medicare Balanced Budget Act legislation (HR 3075 as 
     amended in negotiations with Commerce Committee Republicans) 
     to the floor under suspension of the rules, but instead 
     provide a rule permitting Democratic amendments and a motion 
     to recommit. Because Democrats were not included in the 
     negotiations between the Ways and Means and Commerce 
     Committee Republican members, it is particularly important 
     that we be offered the opportunity for floor amendments.
       While the Republican bills that have been introduced 
     provide a great deal of needed relief, we believe that (1) 
     some additional relief to providers, (2) some beneficiary 
     improvements (in particular help with the high cost of 
     pharmaceuticals), and (3) some alternative policies are 
     desperately needed.
       The amendments we propose would provide an additional $2.4 
     billion in paid-for relief, with some going to beneficiaries 
     in lower pharmaceutical prices and other program 
     improvements. Our amendments would also eliminate several 
     policies in the Republican bill which the Administration has 
     identified as unworkable or which would hurt Medicare 
     beneficiaries.
       As fiscally responsible Democrats, we are concerned that 
     the Republican bill is not paid for, and we urge you to find 
     a way to pay for it, rather than further spending Social 
     Security surpluses. For example, because it is not currently 
     paid for, the Ways and Means bill (HR 3075) shortens the 
     solvency of the Medicare Part A Trust Fund by at least a 
     year, and increases Part B premiums for seniors.
       Therefore, to avoid this problem, we pay for the additional 
     relief offered by our amendments. Thus we do not hurt 
     Medicare's solvency. The $2.4 billion in relief over five 
     years is paid for by $2.4 billion in Medicare savings from 
     the President's budget proposal of last January. These 
     savings come from Medicare anti-fraud, waste, and abuse 
     proposals.


                   Providing Needed Additional Relief

       The $2.4 billion provides important, much needed additional 
     relief to
       --beneficiaries to meet the cost of fighting cancer and the 
     high costs of pharmaceutical insurance \1\
---------------------------------------------------------------------------
     \1\ We assume that the bill the Majority brings to the floor 
     will include an expansion of Medicare's coverage of immuno-
     suppressive drugs, so that transplant patients do not suffer 
     organ rejection. If this provision is not included, we ask 
     permission to include it and pay for it with additional anti-
     fraud and abuse provisions.
---------------------------------------------------------------------------
       --teaching hospitals,
       --safety net hospitals, which have the lowest overall 
     operating margins,
       --rural hospitals, which have the lowest Medicare margins,
       --skilled nursing homes,
       --home health agencies which are serving the sickest 
     patients,
       --a more rational rehabilitation cap program that will help 
     our most severely disabled stroke patients and amputees,
       --help for hospice agencies facing sky-rocketing 
     pharmaceutical costs for end-of-life painkillers, and
       --the Medicaid and Children's Health Insurance Program, to 
     help the providers serving the low income and to help Puerto 
     Rico and the Possessions with more adequate payment rates.
       This additional relief will further ensure that Medicare 
     beneficiaries are buffered from the cuts in the 1997 BBA and 
     will allow Medicare beneficiaries to continue to receive high 
     quality care.
       The attached memo describes these amendments in more 
     detail.


           Help Seniors with the High Cost of Pharmaceuticals

       We believe we need to help all Medicare beneficiaries with 
     a prescription drug insurance benefit, but that is a larger 
     issue that cannot be addressed in this limited BBA 
     corrections legislation. We hope, Mr. Speaker, that you will 
     make this a priority issue for the Second Session of this 
     Congress.
       In the meantime, we do believe that this bill gives us the 
     one opportunity this year to help seniors with the exorbitant 
     cost of prescription drugs. We propose an amendment which was 
     offered in the Ways and Means Committee by Rep. Karen Thurman 
     (and supported by all the Democratic members of the 
     Committee) that makes the Allen-Turner-Waxman-Berry 
     pharmaceutical discount bill (HR 664) germane to Medicare. 
     Basically, the amendment says that if a drug manufacturer 
     wants to sell pharmaceuticals to a hospital participating in 
     Medicare, it must also make available to pharmacies for sale 
     to seniors drugs at the best available price for which they 
     offer that drug. By some estimates, this type of program 
     could lower drug costs to seniors by as much as 40%.
       If we can't pass a major Medicare drug reform bill this 
     fall, we can at least give seniors a chance for the discounts 
     available to large buyers.


                        Preventing Bad Policies

       If the Majority bill includes certain provisions, we ask 
     that the rule governing debate permits us to strike those 
     anti-beneficiary and anti-consumer provisions:
       Specifically, we are concerned that the Administration has 
     warned that the hospital out-patient department (HOPD) 
     provisions of the Ways and Means bill are so complicated that 
     they will delay the start of HOPD Prospective Payment (PPS) 
     by at least a year. Such a delay in the PPS will cost 
     beneficiaries about $1.4 billion, with patients' share of 
     total HOPD payments running about 50%. We would move to 
     strike the House HOPD provisions in favor of the Senate's 
     more administrable proposals, but keep the amount of relief 
     to hospitals and patients at the House level.
       Second, if the Majority bill includes the `Commerce 
     Republicans' provision giving ``deemed status'' to HMOs, we 
     would strike that provision. An overwhelming number of House 
     members have just voted in favor of higher quality in managed 
     care plans. Therefore, we find it incredible that the 
     majority may be proposing an amendment to the BBA which would 
     weaken our ability to ensure quality by turning over approval 
     of these plans to participate in Medicare to private groups 
     which are often dominated by the very industry they are 
     supposed to be regulating. If such `deemed status' language 
     is included, we will seek to strike it in order to protect 
     beneficiaries.
       Third, as mentioned above, we propose to strike the 
     unworkable $1500 limit on rehabilitation caps for two years 
     while the Secretary develops a rational therapy payment plan. 
     This is the same approach as taken by the Senate Finance 
     Committee.
       In conclusion, our beneficiaries and providers need the 
     improvements made by the Democratic amendment. We urge you to 
     make it in order. Thank you for your consideration.
           Sincerely,
       Neil Abercrombie, Gary Ackerman, Tom Allen, Robert Andrews, 
     Tammy Baldwin, Tom Barrett, Jim Barcia, Xavier Becerra, 
     Shelly Berkley, Howard Berman, Marion Berry, Bob Borski, Rick 
     Boucher, Corrine Brown, Sherrod Brown, Lois Capps, Michael 
     Capuano, John Conyers, Ben Cardin, Julia Carson, Bob Clement, 
     Bill Coyne, Elijah Cummings, Danny Davis, Jim Davis.
       Peter DeFazio, Diane DeGette, Rosa DeLauro, Peter Deutsch, 
     John D. Dingell, Julian Dixon, Lloyd Doggett, Eliot Engel, 
     Anna G. Eshoo, Lane Evans, Eni Faleomavaega, Sam Farr, 
     Michael Forbes, Bart Gordon, Gene Greene, Ralph Hall, Earl 
     Hilliard, Maurice Hinchey, Darlene Hooley, Steny Hoyer, Paul 
     Kanjorski, Carolyn Kilpatrick, Ron Klink, Dennis J. Kucinich, 
     John LaFalce, Tom Lantos.
       Barbara Lee, Sandy Levin, John Lewis, Nita M. Lowey, Bill 
     Luther, Karen McCarthy, Jim McDermott, Jim McGovern, Mike 
     McNulty, Carolyn B. Maloney, Jim Maloney, Ed Markey, Matthew 
     Martinez, Robert T. Matsui, Carrie Meek, Robert Menendez, 
     George Miller, Joe Moakley, Jerry Nadler, Richard Neal, 
     Eleanor Holmes Norton, Jim Oberstar, John Olver, Major Owens.
       Frank Pallone, Donald Payne, Nancy Pelosi, David Phelps, 
     Earl Pomeroy, Nick Rahall, Charles Rangel, Lynn Rivers, Ciro 
     Rodriguez, Carols Romero-Barcello, Lucille Roybal-Allard, 
     Bobby Rush, Martin Sabo, Bernie Sanders, Tom Sawyer, Jan 
     Schakowsky, Louise Slaughter, Vic Snyder.
       Debbie Stabenow, Peter Stark, Ted Strickland, Bart Stupak, 
     Ellen Tauscher.
       Mike Thompson, Karen Thurman, John Tierney, Edolphus Towns, 
     Jim Traficant, Peter Visclosky, Maxine Waters, Melvin Watt, 
     Henry Waxman, Robert Wexler, Robert Weygand, Bob Wise, Lynn 
     Woolsey, Al Wynn.

                                  ____
                                  

     Issue Area:
       In addition to HR 3075, a $2.4 billion paid-for package 
         [dollars expressed as additions to costs in HR 3075]
     Hospitals:
       Freeze indirect medical education cut for 1 year more than 
         HR 3075 ($0.2); Freeze disproportionate share hospital 
         cuts for 1 year more than HR 3075 ($0); Carve out DSH 
         payments from payments to M+C plans. Moves about $1 
         billion per year to the nation's safety net hospitals; is 
         not in HR 3075 ($0).
     Rural hospitals:
       Tanner Amendment to protect rural and cancer hospitals 
         against outpatient department PPS cuts (HR 3075 phases in 
         cuts to these hospitals, still leaving huge payment 
         reductions) ($0.2).
     $1500 therapy caps:
       Strike HR 3075 limits by suspending caps for 2 years while 
         a new, more rational system is developed (net $0).
     Community health centers & rural CHCs:
       Establish a PPS system which protects CHCs against State 
         Medicaid cuts ($0.2).
     Nursing homes:
       Raise HR 3075's payment to high acuity cases from 10% to 
         30% ($0.1); Raise HR 3075's nursing home inflation 
         adjustment from 0.8% in FY01 to 1% ($0.1) and authorize 
         extra payments for hi cost of living in Hawaii and 
         Alaska.
     Physicians:
       Study of why payment rates in certain States and Puerto 
         Rico are low.
     Home health:
       Provide $250 million ``outlier'' pool for home health 
         agencies that treat tough cases ($0.3) HR 1917, by Rep. 
         Jim McGovern and 102 cosponsors.
     Hospice:
       Eliminate 1% cut in FY 01 and 02 ($0.2).
     Medicaid:
       Help for Medicaid DSH formula errors in NM, DC, MN, and WY 
         ($0.2) Permanent fix for CA Medicaid DSH problem $0; Help 
         families not lose Medicaid coverage as a

[[Page E2300]]

         result of delinking of welfare and Medicaid eligibility 
         ($0.2).
     CHIPs:
       Increase CHIPs amount for Possessions and provide technical 
         fix to CHIPs formula ($0.1).
     Beneficiary improvements:
       Immuno-suppressive drugs, cover without a time limit 
         ($0.3); Allow States to require M+C plans to cover 
         certain benefits (like MA used to do with Rx ($0); Allow 
         people abandoned by M+C plans to buy a medi-gap policy 
         which covers Rx ($0); Coverage of cancer treatment for 
         low-income women ($0.3) HR 1070, by Rep Eshoo and Lazio 
         and 271 cosponsors.
     Pay-fors:
       3 Medicare items from President's budget: mental health 
         partial hospitalization reform, Medicare Secondary Payer 
         data match, and pay for outpatient drugs at 83% of 
         average wholesale price. ($2.4).

         

                          ____________________