[Congressional Record Volume 146, Number 84 (Wednesday, June 28, 2000)]
[House]
[Pages H5423-H5426]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SENSE OF THE HOUSE CONCERNING USE OF ADDITIONAL PROJECTED SURPLUS FUNDS
TO SUPPLEMENT MEDICARE FUNDING
Mr. THOMAS. Mr. Speaker, I move to suspend the rules and agree to the
resolution (H. Res. 535) expressing the sense of the House of
Representatives concerning use of additional projected surplus funds to
supplement Medicare funding, previously reduced under the Balanced
Budget Act of 1997.
The Clerk read as follows:
H. Res. 535
Whereas Congress is responsible for oversight and spending
under the Medicare program;
Whereas the Balanced Budget Act of 1997 was passed in
response to major economic concerns about inflation in costs
in the Medicare program;
Whereas the savings resulting from enactment of that Act
exceeded the estimates at the time of enactment and has
resulted in payment rates for classes of providers below the
rates previously anticipated;
Whereas the Congress adjusted some elements of the Medicare
program in the Balanced Budget Refinement Act of 1999;
Whereas a significant number of Medicare+Choice
organizations is withdrawing, or considering withdrawing,
from the Medicare+Choice program because of inadequate
reimbursement rates;
Whereas the Medicare prescription drug bill pending in the
Congress will delay the date by which Medicare+Choice
organizations must decide whether to remain in the
Medicare+Choice program from July 1, 2000, to October 1,
2000; and
Whereas, because of improved economic performance, it is
anticipated that the Congressional Budget Office in its mid-
year reestimates will project dramatically increased non-
Social Security surpluses above those assumed in the adoption
of the most recent Congressional Budget Resolution for fiscal
year 2001: Now, therefore, be it
Resolved, That it is the sense of the House of
Representatives that, upon receipt of such mid-year CBO re-
estimates, the House of Representatives shall promptly assess
the budgetary implications of such reestimates and provide
for appropriate adjustments to the Medicare program during
this legislative session.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Thomas) and the gentleman from Tennessee (Mr. Tanner)
each will control 20 minutes.
The Chair recognizes the gentleman from California (Mr. Thomas).
Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, House Resolution 535 is an important resolution because
just as we have discussed, and the House has passed, Medicare
modernization and prescription drugs for seniors, there are still other
areas of Medicare that continue to need adjustment.
If we have additional surplus money, we want to make sure that we
alert both the seniors who are the recipients and the providers of that
Medicare care that we believe a high priority is to make sure that a
significant portion of that surplus is reserved for reinvestment back
into Medicare.
Mr. Speaker, I yield the balance of my time to the gentleman from
California (Mr. Bilbray) and ask unanimous consent that he be permitted
to control the time and yield further blocks of time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, today we have had a discussion between Democrats and
Republicans that I think the American people would prefer to see us
avoid in the future. Yesterday, we had some bipartisan efforts of
people reaching out across the aisle to work for betterment of this
country.
Resolution 535 is one of those resolutions that we can do this. This
is a chance for us to reach across the aisle in a bipartisan effort to
show that Medicare really is a priority of this body; and hopefully, in
the future we will find the funds to be able to do all of things that
both sides and America would like us to do.
Mr. Speaker, it is my pleasure to yield such time as she may consume
to the gentlewoman from New Mexico (Mrs. Wilson). Let me point out to
every Member, this Member has fought hard to raise this issue, to
articulate the issue that we have to continue to do better for our
seniors when it comes to Medicare. She has been a constant champion of
the fact that Republicans and Democrats need to put their differences
aside and truly work for our seniors in America.
{time} 2310
Mrs. WILSON. Mr. Speaker, I thank the gentleman from California (Mr.
Bilbray) for his kind words.
Mr. Speaker, when it became clear that we were going to do a
prescription drug bill, there is a part of this bill in title 3 that we
did not get a chance to talk about much today, and that has to do with
some changes that are needed for Medicare to provide some urgent relief
to hospitals in this country, particularly in a program called
Medicare+Choice. About half of the citizens in my district in New
Mexico choose Medicare+Choice. It is kind of managed care for Medicare.
They have the Lovelace Senior Plan or the Presbyterian Senior Plan.
The problem is that the reimbursement rates for Medicare+Choice and
for most of the other Medicare programs in the State of New Mexico are
terribly low. In New Mexico, if one is a part of the Lovelace plan,
Lovelace gets about $370 per member per month to cover one's health
care in the rural parts of New Mexico. It is about $430 a month if one
is in Albuquerque. That compares with a reimbursement rate in
[[Page H5424]]
Staten Island, New York of $811 and in Dade County, Florida of almost
$800 per member per month.
The reason is that New Mexico had managed care so much earlier than
other parts of the country. We had one of the earliest HMOs in the
country, Lovelace Hospital. We had controlled many of the costs that
everyone else was struggling to control. But we were penalized for
that, penalized for that continuing efficiency.
Now as CIGNA pulls out of Medicare+Choice and a lot of other
different States, we are facing that potential in New Mexico as well.
But it is not unique to New Mexico. There are seven States who are
suing the Federal Government because of the inequities in reimbursement
under Medicare, and they are right.
Mr. Speaker, what I wanted to try to do is to get some immediate
relief so that seniors do not lose their preferred medical care
coverage. The 1st of July is when a lot of companies have to decide
whether they are going to stay in Medicare+Choice. The bill that we
passed earlier today will extend that deadline to the 1st of October.
But there are some things I think we can do without hurting those
States that have high reimbursement rates to get some changes and some
fixes for those of us who are on the low end of the scale and losing
money because the Federal Government is inadequately subsidizing
Medicare.
Many of those fixes were included in this bill, but I wanted to see
them accelerated because the need is not 2004, the need is now.
Companies are having to decide whether the 1st of July or at the latest
the 1st of October whether they are going to continue to be able to
insure people under Medicare.
For a variety of procedural reasons, that is not possible today and
was not possible in the bill, mostly because we do not have the new
estimates from the Congressional Budget Office of projected surplus
next year.
But everyone in this House on both sides of the aisle knows that we
have a problem. It seems to me the right thing to do is to stand up and
acknowledge to the people of this country that we know we have a
problem with Medicare reimbursement rates, whether it is for physicians
or Medicare+Choice. We know that, within a month, we are probably going
to have some new projections on the amount of money we will have
available, and we also know and agree that a significant amount of that
money has to be put into health care in this country.
I support a prescription drug benefit, and I supported the Patients'
Bill of Rights. But if one does not have a doctor, a Patients' Bill of
Rights or prescription drug benefit does not do one much good.
While we were not able to solve everything in this bill, I would like
to see this House come together in a common commitment to fix some of
the problems in Medicare and the immediate crisis facing our health
care system. Because if we do not, we are going to have a lot of
seniors who are told that they are going to have to change their
doctors or that they can no longer have Medicare+Choice.
While some may think that that really affects those who are at the
upper end of the income scale, that is not the case in my district.
Those who are most likely to choose Medicare+Choice have an income of
below $20,000 a year. That is the option for those who cannot afford
some pretty expensive Medigap plans.
In fact, as this chart shows, this is insurance coverage by household
income in Albuquerque, New Mexico. Those who rely most on Medicare HMOs
are here. Almost 60 percent of those who have an income of $20,000 and
less are on Medicare+Choice, and it goes down from there. Those who
have Medicare Plus, a supplement, are generally upper income folks. But
still almost half of the folks in Albuquerque, New Mexico have
Medicare+Choice.
I would like to see us commit here tonight that we will use some of
the surplus that we expect to be available when the budget estimates
come out to fix some of the immediate problems with Medicare, to
accelerate some of these appeals mechanisms, and to provide some
immediate relief for the people who are providing health care to our
seniors.
Mr. TANNER. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we do not have any particular problem with this House
resolution, but it is almost surrealistic what we are seeing here. This
is not even a concurrent resolution, it is a sense of the House.
Now, 2 weeks ago, in the committee, I offered in statutory
legislative language an amendment to the debt reduction bill that would
have done just exactly what this House resolution says ought to be
done, and we would have it passed in law by the House tonight for
immediate relief for the providers in this country if it had not been
ruled out of order by the majority.
So it is hard to understand, given the fact that we have had three
different times we could have actually done something in law rather
than come down here with a House resolution after this procedure that
we witnessed all day today.
Number one, it could have been put on the debt reduction package.
Number two, it could have been put in the Medicare lockbox. Number
three, an hour ago, the majority voted down the motion to recommit
which says exactly what this House resolution says.
So when I say it is hard to understand, it is hard to understand from
the standpoint of asking what can we do as Members of Congress to bring
relief to these procedures. We could have already done it. We could
have already had the Medicare restoration fund that captures these
unanticipated savings. We could already be in the process of giving
immediate relief to the country. But, no, it was our idea, so I guess
that that is not the way this place runs.
We come with this House resolution. Real good. It says a lot of
things that everybody agrees with, but it does not do anything.
I understand being ruled out of order when it is not one's idea, and
I understand, I guess, a little something about politics. But when one
has an amendment on a bill that, in my view, is clearly in order 2
weeks ago that would have done this in law and been passed so that we
could replenish the Medicare trust fund with these captured savings
that were unanticipated when the Balanced Budget Act of 1997 was
passed, and then have a resolution to say we really want to do this, it
is awfully hard for some of us to believe in the credibility of this
one pager that says we really want to do something to help the
providers in Medicare.
Mr. Speaker, I reserve the balance of my time.
Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I would just like to say to the gentleman from Tennessee
(Mr. Tanner) that I am not on his committee. The gentlewoman from New
Mexico (Mrs. Wilson) and I are on the Committee on Health of the
Committee on Commerce.
Let me assure my colleagues that, even those of us who were on the
Committee on Commerce get ruled out of order every once in a while when
we know it is the right thing to do, it is common sense to do, but
sometimes procedures here stand in the way. I had that on the floor
here this week three times. So I appreciate that.
We did not have a chance to vote with the gentleman from Tennessee on
that issue. We did not have a chance to stand up and speak for him on
that motion at that time. But we do have a chance now using this
procedure to say party affiliation, procedural guidelines, whatever we
want to talk about, there is a consensus here that, if the projections
come in the way we are hoping it comes in, that Medicare should be a
priority.
{time} 2320
And I would just say to my colleague from Tennessee that I understand
his frustration; I have gone through the same thing. Here is a chance
for us, though, to say, yes, we can do what the gentleman wanted to do
on that day and at least move the ball forward. And as it was said with
campaign finance reform, let us not let the perfect be the enemy of the
good. This is an opportunity to move one step forward, and I hope the
gentleman will support us on that.
Mr. Speaker, I yield 4 minutes to the gentleman from Alabama (Mr.
Bachus).
Mr. BACHUS. First of all, Mr. Speaker, let me commend the gentleman
from California and the gentlewoman from New Mexico for bringing
forward
[[Page H5425]]
what I think is an opportunity for this entire House to make a strong
and unanimous statement that this surplus that we have, a lot of it,
can be placed on Medicare.
Achieving a balanced budget has long been a Republican economic
objective, and it is a good one; and we can credit our current strong
vibrant economy to our fiscal discipline. But damaging our health care
system was never our intent in passing the Balanced Budget Act. It was
the intent of Congress to slow the growth of Medicare to a manageable 5
percent. However, in 1999, it was actually a negative 1 percent.
Hopefully, we can all agree that is not acceptable.
The CBO now reports that Medicare reductions achieved through the
Balanced Budget Act are $124 billion larger than Congress actually
voted for, $124 billion; and part of that, a good bit of that, is
because of HCFA's restrictive interpretations.
Our hospitals are experiencing increasingly smaller profit margins,
and we should all realize that this threatens to diminish the quality
of care that they provide. Credible sources report that these margins
are currently at their lowest point in years. And some valid
responsible authorities are projecting that within 4 years half our
Nation's hospitals will actually be losing money.
In my home State of Alabama, studies are projecting that 70 percent
of our hospitals are currently running in the red and several will
close. We cannot stand by and let this happen and call it an unintended
consequence. That is what this resolution is about. We owe our
constituents more than that. Our challenge is to find a balance,
responsibly controlling government spending on one hand and
sufficiently funding our hospitals on the other.
America can boast the finest health care system in the world. There
have been incredible advances in medicine in recent years, with the
real hope of miraculous achievement in defeating illness, pain and
suffering. Just this week the magnificent accomplishment of mapping the
human Genome was formally announced, bringing with it the promise of
major breakthroughs in preventive medicine. But all of these new
miraculous developments come with a hefty price tag. Our hospitals must
have sound and reliable financial support to be able to offer these new
miracles to all of us. Making sure that our financial support is
available is a mandate we in Congress cannot sidestep. We should be
true to our obligations.
I close by saying, Mr. Speaker, that there is a bottom line in this
discussion. When our loved one is seriously ill, only the very best
medical care is good enough. We must not fail to provide sufficient
funding to assure such care is reasonably available to all. American
medical care is an honest and undeniable bargain by any measure. Its
true cost is not measured in dollars and cents alone but also in the
health and well-being of all our people.
For that reason, I enthusiastically support this resolution and hope
that people on both sides of the aisle will join with me.
Mr. TANNER. Mr. Speaker, I yield myself 1 minute to reply to my
friend from California that I understand about being ruled out of
order. What I am saying is an hour ago we had a motion to recommit that
did this. The gentleman could have joined with us on that motion to
recommit, any number of my Republican colleagues could have if they had
wanted to do something now.
This resolution is fine, but it ought to be a special order instead
of coming into the legislative process. We have a bill, 4770, that will
do this very thing. And so I understand that the gentleman is not on
the committee, but what goes on from here is nothing except, well, we
are going to do something later. Another promise.
Mr. Speaker, I yield 4 minutes to the gentleman from Washington (Mr.
McDermott).
Mr. McDERMOTT. Mr. Speaker, I think this is kind of a fitting ending
to this day. My colleague, the gentleman from Tennessee (Mr. Tanner),
says he cannot understand what this is. Well, let me give my colleagues
my interpretation. This is press release time. The Washington Post
called this the Pretend Congress, and this is a piece of activity we
are going to go through here that pretends to do something.
Now, there was a cartoonist by the name of Walt Kelly who created
Pogo. And one of his most famous cartoons is one in which they are
searching for who is doing some bad deed, and finally Pogo gets up and
says, ``We have found the enemy, and they is us.'' Well, the fact is
that it is the Congress that created the problems. We should not be
blaming bureaucrats.
The balanced budget amendments of 1997 were designed by the
Republicans, passed by the Republicans, to do one thing, let Medicare
wither on the vine, as we know it, and create Medicare+Choice. Now, a
few of us voted no because we knew enough about the situation to know
what they were doing.
This is not mystery. This is no bureaucratically created problem. It
was created by the Subcommittee on Health of the Committee on Ways and
Means, and they did it without talking to us. They did not want to have
any input. They said, we know what we are doing; we are going to get
rid of that old Medicare that does not work, and we are going to have
all these HMOs out everywhere.
We have had HMOs out all over everywhere, and they have been pulling
out. A million people have lost their health coverage in this country
in the last couple of years because of the system that my colleagues
tried to push onto people. My colleagues wanted to push them all into
the arms of the Medicare HMOs, and today it is boggling that having had
that experience with HMOs and insurance companies not working, that we
would go through and set up exactly the same process for delivering
prescription medications to seniors in this country.
My Republican colleagues are telling 90-year-old women like my mother
to go out and find themselves an insurance company and ask them if they
will sell them a policy that they can afford. And if they cannot afford
it, well then they can go on down to the welfare office and can ask
them for money, and they will cover what cannot be covered because they
are poor. That is what we set up today.
And the fact is, if I had done that, I would want to come out here
and put something in that looked like I was really in favor of really
fixing Medicare. But as the gentleman from Tennessee (Mr. Tanner) has
said, we have had opportunity after opportunity. That bill that went
through today was done without Democratic input. Not one single
amendment was accepted in the committee. Our Republican colleagues did
not allow an amendment out here. And when it fails, and my colleagues
are looking around for who did this, who put this plan out here, they
will have to take a good look in the mirror, because they did it to
themselves; and now they are trying to fix it.
I will bet when this is all done that all the money that we saved in
1997 we will have put back into the budget piece by piece by piece,
always blaming somebody else; well, they looked at the rules too
carefully, or they were too tight-fisted or something.
{time} 2330
But it was us who made those cuts. And we offered them right here $21
billion to fix Medicare, and we were ruled out of order. Everybody
said, no, we cannot do that. But less than an hour later, we are
seriously out here looking as though there is money right around the
corner.
We know that money is there. They know that money is there. But they
did not want to do it tonight. They want to do it tomorrow. Vote yes.
It will not hurt anything.
Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, my colleague the gentleman from Washington (Mr.
McDermott) said we know the money is there. Look, there are some of us
that are trying to work bipartisan here and have for years. But every
time we try to reach across the aisle, we hear the rhetoric about the
fact that we are just not spending money, let us keep going.
Why this resolution is here is because not until July are we going to
know if the money is there. Now, if this is a sin of saying let us not
spend or commit money until we have at least the commitment down there
that we think is coming down the pike. We are trying to be responsible
with this.
Now, in all fairness, I just asked any colleagues on the other side
how did
[[Page H5426]]
they sign on to the DeGette bill. I have signed on to the bill of the
gentlewoman from Colorado (Ms. DeGette). And though she may be a member
of the minority party, she is right on how to address that issue.
The gentleman from Kentucky (Mr. Whitfield) has got a Republican
version. But always we have to take the political cheap shot. We have
always got to do that.
For once, even on a resolution, if it does not say enough, then it
does not do that much damage. Can my colleagues not, at least, try to
meet us halfway? Those of us that have met them halfway more times than
they have ever come across our side of the aisle are standing here
today and asking them, those of us that have crossed the aisle
consistently, that on this resolution, all it is saying is, in July,
let us see if the money is there and let us make the effort.
Mr. Speaker, I yield such time as she may consume to the gentlewoman
from New Mexico (Mrs. Wilson).
Mrs. WILSON. Mr. Speaker, I know my colleagues wanted to do it today.
So did I. And that is why I offered an amendment in the Committee on
Rules.
The reason I was not ruled in order is probably the same reason my
colleagues were not ruled in order is because we cannot spend money in
this House that we do not yet have. But we all know in this room that
we expect new estimates within a month.
It would have, I think, been irresponsible on our part to not move
forward on prescription drugs and to keep this process moving forward
to get a prescription drug plan. And I support that. But I would not
want to have held that back to get a fix on more Medicare fixes this
year and in the year starting in October just because we do not have
the budget estimates yet. And that is the nature of this.
I have kind of taken this up as my personal cause on this side of the
aisle. I think some of my colleagues sitting here know that I make it a
pretty regular effort to do things in a bipartisan way, whether it is
on low-power radio or Superfund or a whole variety of other things we
are working on, Baca land in northern New Mexico, and quite a few
things in the Committee on Commerce. That is just kind of who I am, and
that is my style.
I commit to work with those of my colleagues who are concerned about
Medicare reimbursement rates and the disparity in different parts of
the country to try to make this work as soon as we have the budget
estimates to do so. I give my colleagues my personal word on that.
Mr. TANNER. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I just say to my friend from California (Mr. Bilbray),
as I said at the outset of my remarks, we are going to support his
resolution here. And there is nothing wrong with it.
It is just that when, at the end of this day, we had probably one of
the most important Medicare bills in the history of the program here,
this prescription drug benefit, and his leadership would not even give
the Democrats an alternative.
Today, an hour ago, we tried to do this very thing this resolution
does in a motion to recommit. Not one single vote for help. And so,
when my colleague says they reach across the aisle more than we do,
when their leadership does not even give us an alternative, reduces us
to nothing more than a motion to recommit and we cannot get that, when
we have a bill that does this, when we have an amendment that did this,
after a while we begin to say, what is going on here? Do these people
really want to do this?
We have the wherewithal to do it. It is called a bill. This
resolution is fine, and we are going to support it, and we are going to
reach across every time we can.
But I just tell my colleague, when we try to work legislatively and
we are virtually shut out, as we were today, from any input at all and
then after the fact, as the gentleman from Washington (Mr. McDermott)
said, they have a resolution that says we are going to promptly do
this, well, we could have promptly done it 2 weeks ago or tonight but
we did not.
So I do not want to be partisan, either. I just say there is a way to
do this called a bill and we are ready, willing, and able to do it. In
fact, we would have done it an hour ago if we would have had some help.
Mr. Speaker, I yield back the balance of my time.
Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I would just like to say that I appreciate the support
for this resolution. I just want to articulate that the gentleman is
not the only one who gets frustrated the way sometimes this House is
run. A lot of people were frustrated the way the House was run before
the new majority took over.
Remember, I have got family that served with the gentleman that
talked about the bad old days. So everybody gets frustrated with the
leadership, even those of us on the majority side.
What we are asking as two individuals here and three individuals here
that represent a lot of people out there that do not hold the Members
responsible for party affiliation. When my colleagues look across the
aisle, I hope they see the gentleman from California (Mr. Bilbray),
representative of San Diego, not just a Republican. And I think we need
do more of that.
The gentlewoman from New Mexico (Mrs. Wilson) is probably the most
sincere individual that could ever work on this issue, and I think that
my colleagues recognize that she has worked hard with both sides of the
aisle.
The gentleman from Alabama (Mr. Bachus) has made his efforts. All we
are asking is that here is a place we may disagree, we might have had
disagreements today, but let us finish off the evening by at least
saying this is something we can meet halfway and start building a
future from now on rather than talking about animosity in the past.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Pease). The question is on the motion
offered by the gentleman from California (Mr. Bilbray) that the House
suspend the rules and agree to the resolution, H.Res. 535.
The question was taken.
Mr. BILBRAY. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
____________________