[Congressional Record Volume 146, Number 136 (Thursday, October 26, 2000)]
[House]
[Pages H11209-H11230]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page H11209]]

House of Representatives

    WAIVING POINTS OF ORDER AGAINST CONFERENCE REPORT ON H.R. 2614, 
     CERTIFIED DEVELOPMENT COMPANY PROGRAM IMPROVEMENTS ACT OF 2000

  Mr. LINDER. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 652 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 652

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider the conference report to accompany the 
     bill (H.R. 2614) to amend the Small Business Investment Act 
     to make improvements to the certified development company 
     program, and for other purposes. All points of order against 
     the conference report and against its consideration are 
     waived. The conference report shall be considered as read.

  The SPEAKER pro tempore (Mr. Quinn). The gentleman from Georgia (Mr. 
Linder) is recognized for 1 hour.

                              {time}  1130

  Mr. LINDER. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Massachusetts (Mr. Moakley), 
pending which I yield myself such time as I might consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.
  Mr. Speaker, H. Res. 652 is a typical rule providing for 
consideration of H.R. 2614, the conference report for the Certified 
Development Company Program Improvements Act of 2000.
  The rule waives all points of order against the conference report and 
its consideration and provides the conference report shall be 
considered as read.
  House rules provide 1 hour of general debate divided equally between 
the chairman and ranking minority member of the Committee on Small 
Business and one motion to recommit, with or without instructions, as 
is the right of the minority Members of the House.
  I want to discuss briefly the conference report this rule makes in 
order. It includes important small business tax relief, community 
renewal and retirement security provisions, as well as
    

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[[Page H11210]]

 long-term care and health care initiatives that benefit all Americans. 
     In addition, this bipartisan measure includes H.R. 5538, 
     legislation introduced by the gentleman from Ohio (Mr. 
     Traficant) to raise the minimum raise. This bipartisan 
     language is patterned after the Traficant-Martinez 
     amendment passed by the House earlier this year.
  First, I am pleased that H.R. 2614 contains important tax relief 
provisions to help ease the burden on small businesses. It will also 
allow small businesses to expense additional qualifying properties 
costs, speed up the phase-in for deduction of meal expenses, and extend 
income-averaging benefits for farmers to include commercial fishermen. 
The conference report will also extend the Work Opportunity Tax Credit 
to assist businesses in hiring disadvantaged workers and repeal the 
installment method accounting requirement, an issue on which many of us 
have heard from our constituents.
  H.R. 2614 also contains much needed provisions to increase retirement 
security for working people. It raises IRA limits to $5,000 and 
increases the contribution limits for 401(k)-type plans to $15,000. 
This bill also increases the portability of retirement plan assets and 
simplifies the pension system to encourage small businesses to offer 
pension plans.
  This conference report also creates 40 Renewal Communities with 
targeted pro-growth tax benefits, regulatory relief, savings accounts, 
brownfields cleanup, and homeownership opportunities. It also includes 
a zero capital gains tax rate for business assets in these communities. 
These and other provisions will help ensure that all communities have 
an opportunity to share in our current prosperity.
  I am pleased that conferees also included long-term care health care 
incentives to help make care more affordable and accessible. A 
substantial deduction for expenses related to long-term care and 
deductibility for the purchase of long-term care insurance policies 
will help ease the burden on seniors and their families.
  H.R. 2614 also provides immediate 100 percent deductibility for 
health insurance for the self-employed and health care deductibility 
for people who purchase health care outside of their employer.
  Finally, I am pleased that the conferees included the foreign sales 
corporation tax revision in this conference report. This provision will 
maintain current tax treatment for foreign sales corporation 
beneficiaries in a manner that the U.S. believes to be WTO compliant. I 
commend the conferees for the inclusion of this revision so important 
to our U.S. trade and our ability to compete in world markets.
  This rule was favorably reported by the Committee on Rules. I urge my 
colleagues to support the rule today on the floor so that we may 
proceed with the general debate and consideration of this important 
conference report.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MOAKLEY. Mr. Speaker, I thank the gentleman from Georgia (Mr. 
Linder), my friend, for yielding me the customary time, and I yield 
myself such time as I may consume.
  Mr. Speaker, this rule really makes a mockery of the legislative 
process. I strongly urge my colleagues to oppose it, not only for the 
substance of the bill, but also for the process by which it is being 
brought to the floor.
  Just to give my colleagues a little bit of the background, just 
before midnight last night, the Committee on Rules was informed that we 
would not meet until 8 o'clock this morning and that the House would 
stay in recess until we completed the consideration of these rules.
  Once we met at 8 o'clock and filed the rules, the House adjourned 
immediately, and it immediately reconvened. This convoluted process has 
been in order to stretch one calendar day, the 26th of October, into 
two legislative days. The reason for that, Mr. Speaker, is because my 
Republican colleagues are then able to bring up a number of rules to 
the floor the very same day that they were reported out of the 
Committee on Rules. This way Members, particularly Democratic Members, 
have virtually no idea what is in these bills, especially, Mr. Speaker, 
since we were excluded from all the negotiations.
  Mr. Speaker, this bill contains major unrelated provisions that look 
like everything but the kitchen sink. The tragic part, Mr. Speaker, it 
still does not do enough for high school construction or high school 
modernization.
  Democrats want $25 billion in interest-free school construction 
financing over the next 10 years with prevailing wage protections. But, 
instead, this bill contains a school arbitrage provision which will 
only help schools that can delay school construction for 2 years.
  Mr. Speaker, this is essentially a tax incentive to keep children in 
trailers and in dilapidated school buildings rather than building new 
schools. It contains only half of the Johnson-Rangel interest-free 
construction funding, and it leaves out the prevailing wage 
protections.
  The first provision in the bill is a small business bill that is not 
particularly objectionable. The second is an excellent idea to raise 
the Federal minimum wage from $5.15 an hour to $6.15 an hour over 2 
years.
  Mr. Speaker, of the 10 million people who work for minimum wages in 
this country, most of them are women and minorities. They take care of 
our young children. They take care of our elderly parents. They cook 
our meals. They pump our gas. They clean our offices. They really 
deserve a raise.
  But since this long overdue raise is being included in an otherwise 
bad bill, it very well might not get signed into law, and that might be 
just the way that my Republican colleagues want it.
  The third provision is a package of tax cuts designed primarily to 
benefit the very rich, which will endanger our Social Security and 
Medicare by spending the budget surplus.
  In order to enact the third provision of the bill, it also includes a 
fourth provision which would exempt, listen closely, this would exempt 
this enormous tax cut for the rich from the pay-go sequester that would 
automatically force cuts in Medicare, student loans and farm programs.
  Essentially, Mr. Speaker, my Republican colleagues are turning off 
the effects of the current law to pass their tax cuts for the rich, 
even though these tax cuts will have a disastrous effect on the 
economy. As far as the pay-go scorecard goes, thanks to this bill, 
these tax cuts are free and so is every other entitlement increase and 
tax cut that we do in this Congress.
  Mr. Speaker, the fifth provision is known as the balanced budget 
amendment fix. When my Republican colleagues passed the so-called 
balanced budget, they caused very dangerous cuts in Medicare. 
Hospitals, many of them in my district, found themselves faced with 
bankruptcy. Everyone, including my Republican colleagues, knew they had 
made a mistake and they needed to fix it.
  So in response, this bill will replace some of the money that they so 
carelessly cut, but it is tilted dramatically in favor of HMOs and does 
not do anywhere near enough for the hospitals. Only about 15 percent of 
the Medicare enrollees are in HMOs, but the HMOs get 40 percent of the 
money in this bill. That, too, Mr. Speaker, may be a deal breaker.
  Finally, Mr. Speaker, the sixth provision overturns Oregon's assisted 
suicide law.
  In short, Mr. Speaker, this is a very important bill with very far-
reaching consequences that has not even had the benefit of proper 
legislative consideration. Like so many other bills this session, it 
will help rich people instead of helping the working American families.
  I urge my colleagues to oppose the previous question so that we can 
offer a Democrat alternative.
  Mr. Speaker, I reserve the balance of my time.
  Mr. LINDER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am just rising out of confusion as to whether the 
gentleman from Massachusetts (Mr. Moakley) states that raising IRA 
limits to $5,000 is a tax cut for the rich. Does increasing 
contribution limits for 401(k) plans for regular workers, is that a tax 
cut for the rich? How about increasing the portability of retirement 
plans so people can move from one job to another? Is that just for the 
rich?
  If we simplify the pension system to encourage small businesses to 
offer their employees pension plans, is that

[[Page H11211]]

another tax cut for the rich? We have got some small business tax 
relief in here to allow them to expense certain kinds of costs. Is this 
tax cuts for the rich? Or has the gentleman from Massachusetts (Mr. 
Moakley) just pulled out on old speech and rerun it one more time?
  Mr. Speaker, I reserve the balance of my time.
  Mr. MOAKLEY. Mr. Speaker, I yield 2 minutes to the gentleman from 
Oregon (Mr. DeFazio).
  Mr. DeFAZIO. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, this is a pretty sad day in the House of 
Representatives. Yes, as the gentleman from Georgia (Mr. Linder) just 
stood up a moment ago and mentioned, there are a couple of provisions 
in this bill that actually before today have seen the light of day, 
have gone through the legislative process, have been voted on by this 
House, such as the pension reform provisions, which I supported. But 
one cannot mix those up with a number of other things that have never 
ever gone through committee, never been voted on, never been published.
  Sometime between midnight and 7 a.m., behind closed doors, a few 
Republican leaders cobbled together a year-end tax bill designed to get 
a veto from the President so they can say, ``Look what we would have 
done if only Bush, Jr., was in the White House. Look what we will do 
next year. We will give the HMOs all the money, lock, stock and barrel. 
We will sell out the patients. No Patients' Bill of Rights. No quality 
controls. No cost controls. But billions more for the HMO plans, a 
blank check.'' That is in this bill.
  There are other outrageous provisions, but I have got to focus on one 
that is extraordinarily outrageous. Twice, two times, two times the 
people of Oregon have gone to the ballot box, once by initiative and 
once by referral from a Republican legislature, to uphold the principle 
of assisted suicide, death with compassion for people with terminal 
illness.
  Now, if the right wingers around here are offended by that, every 
other day of the week, they are for States' rights. But guess what? 
When a State does something they do not like, they are not for States' 
rights anymore.
  They passed the bill in the House to overturn this, but we got more 
than a third of the votes. We could uphold the veto by the President. 
They could not even get the bill up in the Senate. They could not get 
it through the regular legislative process.
  And sometime between midnight and 7 a.m., at the behest of a few very 
powerful right-wing Members of the majority, this legislation 
overturning the will of the people of the State of Oregon was inserted 
into this miscellaneous tax bill. This is an outrageous abuse of 
legislative power.
  Mr. LINDER. Mr. Speaker, I am pleased to yield 4 minutes to the 
gentleman from Illinois (Mr. Weller), a member of the Committee on Ways 
and Means.
  (Mr. WELLER asked and was given permission to revise and extend his 
remarks.)
  Mr. WELLER. Mr. Speaker, I rise in strong support, not only of this 
rule, but of this legislation. This afternoon, we are going to vote on 
a pretty modest package of tax relief as well as a very generous 
contribution of additional funding for reimbursements for Medicare. 
That is what this legislation contains.
  So the most important provisions are provisions such as those which 
help working people, working families where we allow people to set 
aside more for retirement, more for their savings, by increasing what 
one contributes to their IRA from $2,000 to $5,000, if one has a 
401(k), increasing it from its current level from $10,000 to $15,000, 
tax savings to help one save for the future.
  I also note that we have special provisions which will benefit 
working moms. I think of my sister Pat, who does not want everybody to 
know, but she is over 50. She has taken a few years out of the 
workforce. Now she is back in the workforce, a little extra income. She 
can make up her missed contributions to her IRA and 401(k) she was not 
able to make when she was at home with the kids. That is a good 
provision to help working moms and working people.
  I also want to point out this legislation helps the entrepreneurs, 
the self-employed. A lot of people have talked about it. This 
legislation does it. We give 100 percent deductibility for the self-
employed for their health insurances. Corporations have gotten it for 
years. The self-employed only get 60 percent. It is time we give them 
100 percent.

                              {time}  1145

  I also want to point out another large group of working folks that 
benefit. We repeal the section 415 limits that have penalized 10 
million building trade union members, building tradesmen and people who 
have their pensions limited unfairly because of section 415. I think of 
Larry Kohr from La Salle County, Illinois, a retired laborer who 
currently gets about $16,000 a year. He will receive almost $30,000, 
what he should be receiving for his pension, thanks to this 
legislation. That is good for working folks.
  As we work to revitalize our blighted communities, I am proud to say 
that we expand the low-income housing tax credit, a key initiative that 
Ronald Reagan signed into law that enlists the private sector to, of 
course, create affordable housing for working poor and low-income 
families. As a result of this, we will probably see another 30,000 
units of affordable housing provided every year as a result of the 
increase from the low-income housing tax credit.
  Something else that is important in the Chicago area. We have about 
2,000 brownfields. These are old industrial sites. Every community has 
one, but we have about 2,000 in the Chicago region. Of course, because 
of the financial costs of the environmental cleanup, private investors 
are hesitant to buy that old industrial park on the side of town, so 
that old industrial park just sits there and blights the community. We 
expand the current brownfields tax incentive, which means that every 
community in America, whether a middle-class community, a suburban 
community, a rural community, or the big cities, if they have a 
brownfield, a private investor can fully deduct, 100 percent, the 
environmental cleanup costs. That will help the communities, and it is 
good for the environment.
  Lastly, I want to point out something that is pretty important. For a 
lot of us, our biggest employers in town are our local hospitals, our 
nursing homes, our home health care. We care about health care in this 
House, and we want to ensure that we have quality affordable health 
care. Because of the way the Health Care Financing Administration has 
interpreted the Balanced Budget Act, they have squeezed our local 
hospitals, they have squeezed our local nursing homes, they have 
squeezed and hurt home health care. They have pushed providers out of 
Medicare+Choice. Because of the pressure of the Health Care Financing 
Administration, this Congress last year set aside an additional $16 
billion to increase reimbursements for local hospitals and nursing 
homes as well as home health care to help our seniors and to help 
families.
  That is good news, but I want to point out we need to do more, and I 
really want to salute the leadership in this House for realizing that 
we need to do more in Medicare. We provide $28 billion of additional 
reimbursements to help ensure that we provide quality health care to 
our local hospitals, our local nursing homes, our local home health 
care, and ensure that seniors have a choice in Medicare by ensuring 
that we have providers that get fair reimbursement for participating in 
Medicare+Choice.
  This is good legislation. We are hearing the usual rhetoric on the 
other side, the partisan rhetoric. We are 12 days from election. We 
expect that. But this is good legislation that helps a lot of people 
all throughout America. It helps people save for retirement, it 
revitalizes communities, and ensures we have quality health care in our 
local communities. The bottom line is it is a good bill, and it is 
legislation that comes at a modest cost that will help a lot of people. 
I urge bipartisan support.
  Mr. MOAKLEY. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Stark).
  Mr. STARK. Mr. Speaker, this rule paves the way for the cruelest hoax

[[Page H11212]]

that the Republicans have yet perpetrated on seniors, children, and the 
health care system in our country.
  Forty-seven percent of this bill over 10 years goes to managed care 
plans without asking the managed care plans to do a thing except raise 
their own profits and put the money in their pockets. Ninety-four 
percent of the tax cuts go to people who are already insured. What does 
that do? That just gives the employers an incentive to cut back on 
insurance benefits, as they are doing every day. Sure, it helps the 
rich employers while it penalizes the poor employees.
  Long-term care tax deductibility. Fifty percent of the seniors are 
living on incomes of less than $15,000 a year. What does that do for 
the seniors when we have ignored long-term care benefits that we should 
have.
  Children's benefits have been dropped out of this bill. Lou Gherig 
benefits. Eighty-two Republicans co-sponsored a bill, along with 200 
Democrats, to give improved benefits to people with Lou Gherig's 
disease. It was dropped out. Cruel.
  Forty-seven percent going to managed care plans, where we do not have 
any control, where we need the Patients' Bill of Rights. What could we 
do with that money? We could expand the hospital aid for an additional 
year. We could expand hospice care for an additional year. We could 
withhold the 15 percent cut on home health care for an additional year. 
Why are we not doing that instead of giving this to the Republican 
friends in the managed care companies who will see nothing but their 
prices go up on Wall Street while they continue to deny care and deny 
drug benefits and fold up their tents and leave smaller communities?
  Nothing in this bill will change that. It will reward the managed 
care plans for basically harming the beneficiaries and our seniors. 
That is not the way to go about this.
  This is a bill constructed to help the small percentage of the rich. 
It is a bill purposely crafted to deny children's health benefits. 
Children cost $400 or $500 a year to insure. A child without health 
insurance is a child without health care. The Republicans take great 
joy in telling us we are going to deny children health benefits. That 
is not the kind of people we want to have running this country.
  We should protest this bill to show that the Republicans have no 
mercy for children, no mercy for the seniors. They care nothing except 
for the very richest. They will deny health care if it helps the 
employers at the cost of the employees. Call this bill what it is. It 
is an arrogant play of pandering to the rich, of pandering to the 
wealthy at the expense of the poor and the people without health 
insurance.
  They should be ashamed of themselves for this bill. The President 
will veto it, as well he should. I urge a ``no'' vote and a ``no'' on 
the rule.
  Mr. LINDER. Mr. Speaker, I yield such time as he may consume to the 
gentleman from California (Mr. Dreier), and just comment that I will 
put the gentleman from California down as undecided.
  (Mr. DREIER asked and was given permission to revise and extend his 
remarks.)
  Mr. DREIER. Mr. Speaker, I thank my friend for yielding me this time 
and congratulate him on the hard work that he has put into this 
measure.
  Let me say that as I listened to my fellow Californian talk about 
this measure, it sounded as if he was disturbed over the fact that we 
are not moving in the direction of establishing a national health care 
plan. That really seems to be the goal that a number of people have, 
moving towards single payer.
  What this bill does specifically is it provides incentives for people 
to plan and create more choices when it comes to the area of health 
care. It provides a substantial deduction for expenses related to long-
term care; it provides deductibility for the purchase of long-term care 
insurance policies; it provides an immediate 100 percent deductibility 
for health insurance for the self-employed; and it provides health care 
deductibility for those who purchase health care outside of their 
employer.
  The idea here is to provide a wider range of choices rather than 
getting the government more and more involved in the issue of health 
care.
  Let me talk about a couple of other very important provisions in this 
measure, Mr. Speaker. Sitting over here is my good friend, the 
gentleman from Ohio (Mr. Traficant). He has worked long and hard, as 
the gentleman from Georgia said in his opening statement, to put 
together a bipartisan package which I am happy to say was introduced 
with our now Republican colleague, another fellow colleague, the 
gentleman from Californian (Mr. Martinez), to deal with the issue of 
the minimum wage.
  It is clear I have not been a supporter of the Federal Government 
imposing a minimum wage, but I do want to say that the gentleman from 
Ohio (Mr. Traficant) deserves a great deal of credit for the bipartisan 
effort that he has put into this, and I want to congratulate him for 
that.
  I also want to say that as we look at these measures that have been 
mischaracterized by our friends on the other side of the aisle, I think 
we have to really sort of open up and look at what exactly we have 
here. There is nothing in here that is designed to benefit the rich. 
Quite frankly, I am one who is proud of doing what we can to create 
more incentives for those who have been successful. I make no bones 
about that. I am a proponent of encouraging even more people to join 
the investor class.
  The fact is, if we look at the provisions which allow for the 
increase to $5,000 for contributions to individual retirement accounts, 
up to $15,000 for 401(k)'s, those are designed to try to help middle-
income Americans who are working and want to have an opportunity to 
plan and save for their retirement. That is something that has enjoyed, 
again, very much bipartisan support here.
  As I listened to my friend from Oregon a few minutes ago talking 
about these issues which had not passed the House, staff has just 
informed me as we go through this litany of items here, everything has 
passed through the House, most of it with strong bipartisan support.
  I will tell my colleagues that when we look at the extraordinarily 
important measure in here, I do not know how the President could 
possibly consider vetoing legislation that includes this very important 
community renewal and the provisions that are there which are designed 
to go in to areas that have been devastated economically and zero out 
capital gains. The capital gains incentive, by zeroing it out, would 
encourage investment and say to those who are less fortunate that there 
is going to be an opportunity for them to in fact get on to that first 
rung of the economic ladder and pull themselves up.
  That is exactly what has been put together here, again in a 
bipartisan way. The President has been supportive of that measure, and 
that is one of the bulwarks of this bill.
  So here we are in the waning hours of the 106th Congress. We are 
hoping to complete our work today. The President can help us do that by 
signing this very balanced piece of legislation, which is encouraging 
economic growth, and is designed to help people plan and save for both 
retirement and their health care, it targets the inner city blighted 
areas so that we can encourage investment there to improve the quality 
of life for those who are less fortunate in this country, and it 
provides very important relief for the signal business sector of our 
economy.
  It is a balanced measure. It deserves our support, as does this rule, 
and I urge my colleagues in a bipartisan way to vote for this measure 
and then to encourage the President to do the right thing and sign this 
bill.
  Mr. MOAKLEY. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Oregon (Ms. Hooley).
  Ms. HOOLEY of Oregon. Mr. Speaker, I thank the gentleman for yielding 
me this time.
  This bill contains a provision that would overturn Oregon's Assisted 
Suicide Law. Now, I appreciate the fact that we were given a whole day 
to debate this bill, and it was an up-and-down vote. We got enough 
votes if the President decided to veto it that we could uphold that 
veto.
  On the Senate side we were told that it would not be attached to 
another bill; that it would be a fair fight; that, again, it would be 
an up-and-down vote. And here we stand today at the end of the session 
with a piece of legislation that contains a lot of provisions

[[Page H11213]]

I like in it. But I will tell my colleagues something that is more 
important to me. More important to me than anything else is our system 
of democracy. More important to me than anything else is the people's 
right to vote and that their voices are heard and that their vote 
counts for something.
  In our State, not once but twice, people said we want physician-
assisted suicide. Somehow or another my colleagues here seem to know 
better. They seem to say that they do not care about the people's vote; 
that it does not count; they do not care that the people's voices are 
not heard; they know better; they are going to overturn the people's 
law.
  Well, let me tell my colleagues two things: one, they are overturning 
the will of the people of my State; and, number two, they are breaking 
promises. This promise was made that it would be an up-and-down vote on 
the Senate side; that it would not be attached to this bill. Yet here 
we find that happening today.
  I urge my colleagues to vote ``no'' on this rule.
  Mr. LINDER. Mr. Speaker, I yield 5 minutes to the gentleman from Ohio 
(Mr. Traficant).
  (Mr. TRAFICANT asked and was given permission to revise and extend 
his remarks.)
  Mr. TRAFICANT. Mr. Speaker, there is no one in the House I respect 
more nor love more than the gentleman from Massachusetts (Mr. Moakley), 
so I hope he will not be offended by what I have to say. I think it is 
time to tell it like it is.
  Democrats were in power for 48 years. They did not reform welfare, 
they did nothing about prescription drugs, they did not reform the IRS. 
They would not even hold hearings on a Traficant bill that made a big 
difference, and I am proud of that.
  Look back at the minimum wage, I think the Republicans raised the 
minimum wage the last two times. I support the rule, I support the 
conference report, and I want to thank the Republican leadership for 
giving me the courtesy to sit down on the minimum wage issue, so 
important to America and to my district.
  The gentleman from California (Mr. Dreier), the chairman of the 
Committee on Rules, did not want a minimum wage increase.

                              {time}  1200

  There are parts of this bill I do not find all that great. But the 
President is absolutely an expert at reconciling differences. And no 
one better than the Speaker and the gentleman from Florida (Mr. Young) 
and the gentleman from Texas (Mr. Armey) and the gentleman from Texas 
(Mr. DeLay) and their staff, the gentleman from Georgia (Mr. Linder), 
they have gone to them. And his statement is for the betterment of 
America. Let us find common ground. Mr. President, let us find the time 
to find common ground.
  There is pension reform in this bill. The earned income tax 
provisions are good. Let us get off the class warfare on the tax cuts. 
My colleagues, what good is the minimum wage of $1 an hour over 2 years 
if the boss cannot afford it and lays off the very people we are trying 
to help the most? Give the boss a break.
  The Republicans are right. How much more of this Democrat versus 
Republicans, liberals versus conservatives? It may be good for politics 
or for winning the majority, but it is bad for America because it ends 
up being rich versus poor, men versus women, old versus young, black 
versus white, ``the haves'' versus ``the have-nots.'' If there is no 
company, there is no job.
  Let us get off it. This is nothing but political machinations to who 
is going to run this place. The American people want this conference 
report. They may not like all of it, but they know we have the 
leadership in the gentleman from Florida (Mr. Young) to sit down with 
the President and work it out, for the Speaker to sit down and to make 
those compromises that are necessary.
  I would just like to close by saying this: It is time to close the 
Congress. It is time to pass this conference report. And for those 
Democrats who are going to come out here for partisan reasons and vote 
against this bill, they may encourage the President to veto it, but, in 
my opinion, they are not vetoing a bad bill, they are vetoing a bill 
that is good for the American people.
  Mr. MOAKLEY. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman from 
Massachusetts (Mr. Moakley) very much for yielding me the time.
  I am very delighted to follow my colleague because I know his 
sincerity. I do not think any of us want to divide black or white or 
brown, we do not want to divide Americans. But I believe what we want 
to do is to say to America we accept the challenge to do better.
  I want this rule defeated so that we can go back to the drawing board 
and do better. And the reason why I say that is because I have lived 
the experience of hospitals being closed in Texas.
  Some 10 to 15 years ago, the Attorney General of the State of Texas 
appointed me to an advisory committee to explain and to advise how we 
could restore rural health centers and rural hospitals. In Texas they 
were closing even then. I would imagine that Americans would tell me 
about hospitals that closed 20 years ago, 5 years ago, 10 years ago, or 
yesterday. What a tragedy for communities that have to travel miles 
away from their neighbors to get health care.
  And so, this rule should be defeated, Mr. Speaker, because $11 
billion goes to insurance companies. I am crying out for my rural and 
urban hospitals, public hospitals where they take their children, where 
they take their old mother or father, their aunts or their neighbor. 
Why am I giving $11 billion to insurance companies and doors of my 
hospitals still closing? I want my hospital CEOs in my district who 
know that I have been on the front line on this issue to understand why 
I want this rule defeated.
  Mr. Speaker, we can do better for Americans. Do not give this money 
to the HMOs. They are not guaranteeing any guaranteed prescription drug 
benefit. In fact, one of the HMOs said, it is really hard to enhance 
our drug benefit for seniors. They do not want to work on this problem. 
We need this money going directly to the providers.
  And what is happening to the home health care centers? They are 
getting zero, no money. And if any of my colleagues have dealt with 
them, they know that many of their relatives prefer going to those home 
health care centers that give them personalized treatment.
  We can do better for America united. Do not divide us. Send this rule 
back and defeat this bill.
  Mr. LINDER. Mr. Speaker, I reserve the balance of my time.
  Mr. MOAKLEY. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I want to stress that my opposition to the 
rule and this bill is not based on any ideology or any politics, 
Democrat or Republican. The problem here is that this bill is not going 
to help the average American. And that is what we are all concerned 
about, and we are all united to try to help the average guy.
  I heard the chairman of the Committee on Rules say that he supports 
this bill because it is going to help the investor class or get more 
people in the investor class. Well, let me tell my colleagues, if I am 
a person that does not have health insurance and I am not getting it 
through my employer, I am the little guy, I am not going to be able to 
take advantage of whatever tax deduction is in here to buy health 
insurance and to get myself an insurance policy. It is not going to 
happen.
  The bottom line is that we know that the reason why most people do 
not have health insurance today who are employed is because the 
employers do not provide the insurance.
  There is a disincentive with this above-the-line health insurance 
deduction for the employer to continue or to expand health insurance 
for their employees. So we are going to have more people join the ranks 
of the uninsured. This notion that somehow they are going to be able to 
take this deduction and buy health insurance is a lot of garbage. It is 
not going to happen.
  Secondly, let me talk about the hospitals that are suffering. I had a 
hospital in my district that closed and others that have the potential 
to close because they are not getting enough

[[Page H11214]]

money from Medicare from the Federal Government.
  Do not tell me that we are going to give this money to the HMOs, 
something like 40 percent of the funds, and we are not going to help 
our hospitals, our home health care agencies, our nursing homes. Many 
of them are bankrupt and closing. If we are going to do anything to 
help with the reimbursement rate, it should be to those providers, the 
hospitals, so they do not close.
  What about the HMOs? The HMOs that are benefiting from this bill are 
having no strings attached to the extra money that they are getting. 
They do not have to stay in the Medicare program. And many of them have 
moved out of it. Something like 700,000 seniors who were in HMOs have 
been dropped by HMOs in the last couple years. So no strings attached. 
They get the money. They do not have to stay in the Medicare program.
  Nor do they have to do anything about their benefits. They do not 
have to guarantee they are going to provide prescription drugs. They do 
not have to do anything to increase the benefits.
  The HMOs are getting a sweetheart deal, and they are doing nothing 
for the American people in return. Vote against this rule. Vote against 
this bill. It does not help the average guy. Forget the ideology. It 
does not help the average American.
  Mr. MOAKLEY. Mr. Speaker, I am very happy to yield 2 minutes to the 
gentleman from Michigan (Mr. Levin).
  (Mr. LEVIN asked and was given permission to revise and extend his 
remarks.)
  Mr. LEVIN. Mr. Speaker, this bill and this rule are useful in one 
sense, and that is that it really shows what the majority is all about. 
Truly, it makes a mockery of all the talk about bipartisanship. There 
was not, in the last 24 hours, I think, 1 minute of discussion between 
the majority leadership and the minority leadership. There was no 
effort to dialogue with the administration. Instead, I guess the 
majority thought they would put together a stew of the bad and the good 
and try to get this through.
  There has been a lot of talk about compassion in this campaign. This 
makes a mockery out of the talk on the majority side about compassion. 
They delete provisions regarding pregnant women and children. They 
delete the provision for people with Lou Gehrig's disease, just among a 
couple of important aspects of this.
  And then, look, hospitals in my district, many of them are in 
trouble. And so what they do is hand a bundle, 40 percent, to HMOs and 
they shortchange the hospitals that really need it.
  Whose side are they on?
  So they want a Presidential veto. I would have thought they would 
have learned by now. They are going to get one. The President will get 
on the bully pulpit, as he can do so well, and tell America what this 
bill is all about. And I hope he takes that pulpit all around this 
country. Because this puts in place what Republicans are really all 
about.
  Halloween, it unmasks their efforts on compassion. It takes the mask 
off all of this talk about bipartisanship. This is a totally partisan 
effort on their part, and I think it will not pay them dividends on 
November 7 and it will hurt the American people.
  Mr. LINDER. Mr. Speaker, I yield 3 minutes to the gentleman from 
Minnesota (Mr. Gutknecht).
  Mr. GUTKNECHT. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I was not going to speak on this. But listening to some 
of this heated rhetoric, I really feel compelled to respond.
  I cannot really understand why these people are so opposed to this 
bill. In fact, we heard our colleague from New Jersey just a few 
moments ago say that this would not work.
  I have to ask, what are we afraid of? What is wrong with allowing 100 
percent deductibility for health insurance for the self-employed? I 
mean, as far as I am concerned, this Congress should have done that a 
long time ago.
  Look at the other provisions in this bill. Now, I must tell my 
colleagues that I am not a big fan of some of these omnibus bills and 
putting a lot of things that may not be related into the same bills. 
But the truth of the matter is, as I look through the provisions of 
this bill, virtually every one of them is going to benefit somebody.
  Now, we do not have many HMOs in my district. I would like to have 
HMOs. I would like to give people more choices. Now, we can argue 
whether too much went to this particular group and too much went to the 
other. There is no such thing as a perfect balance. But I think, on 
balance, this is a very good bill. This does a lot of things for an 
awful lot of people. I think the hospitals, the nursing homes, the 
people back in my district are going to be very happy with this bill.
  Now, how we got into this mess we can all debate about. But this is 
the right thing to do. And I have to ask my colleagues, what are they 
afraid of? What is it in this bill that somehow is going to make 
matters worse for people who need health care, for people who need to 
go to nursing homes, for people who want to deduct their health 
insurance premiums, for those people who want to make larger 
contributions to their IRAs.
  I mean, with the long list of good things that is in this bill, I am 
somewhat surprised at the incredibly heated rhetoric that we are 
hearing on this rule.
  So I stand in strong support of this rule and in support of the 
underlying bill.
  Mr. MOAKLEY. Mr. Speaker, it gives me great pleasure to yield 5 
minutes to the gentleman from Missouri (Mr. Gephardt), the Democratic 
leader of the House.
  (Mr. GEPHARDT asked and was given permission to revise and extend his 
remarks.)
  Mr. GEPHARDT. Mr. Speaker, I rise in strong opposition to a 
Republican tax package that reflects this Congress at its worst. This 
package reveals the larger flaws of the Republican tax philosophy that 
have been on exhibit over these past years, really a 6-year attempt to 
give tax cuts to people and institutions that do not need them and not 
giving tax relief to people and institutions that need tax relief.
  First, there is nothing in this bill that guarantees a single new 
school will be built. The only thing we have had from Republicans is a 
consistent effort to fuzz the issue of who is for school construction 
and who is against it.
  Two days ago, Republican leaders rejected the bipartisan Johnson-
Rangel bill supported by 228 Members, Democrats and Republicans, to 
help districts with school construction; and they came up with a 
different plan that was a day late and a dollar short.
  The largest part of that plan creates incentives that we think 
actually delay school construction, and half the benefit does not even 
go to school districts but to bondholders, private investors, not 
children, not principals, not teachers, but bondholders.

                              {time}  1215

  This is a typical ploy, part of an effort to fool people into 
thinking that they support education. This has become an exercise in 
illusion.
  They put forward school construction provisions that bear resemblance 
to Democratic and bipartisan bills in name only. They trudge to the 
Capitol and hold press conferences a few hours ago and talk about 
middle-class fairness when nothing could be farther from the truth. We 
call on the leadership to bring up the bipartisan school construction 
measure to help modernize our schools in the Labor-HHS-Education bill. 
The Johnson-Rangel bill reduces the burden on local taxpayers 
struggling to finance new school construction in their communities. We 
further urge the leadership to set aside their opposition and drop the 
tax cuts that really do not perform a useful function. They should 
provide enough funding for teachers, emergency school repairs, after-
school programs, teacher training and put all of these measures in the 
Labor-HHS-Education bill so that the President can sign a bill that 
improves our schools this year in all of these ways.
  This package is just as flawed on the health care side. After 
blocking an effective Patients' Bill of Rights, an effective 
prescription drug benefit under Medicare, now Republicans come forward 
with a package that does not help the vast majority of Americans or 
square with the needs of working families. The BBA piece does not do 
enough for people and hospitals and gives too much for HMOs. Their 
deductions will

[[Page H11215]]

not substantially reduce the number of Americans without health 
insurance, they weaken employer-based health coverage, and they do 
virtually nothing for families who provide their own long-term care.
  We support restoring cuts to Medicare. We want tax relief. In fact, 
the President and Democrats have put forward a sensible bill that helps 
fix the problems for providers and beneficiaries in Medicare and 
Medicaid and gives relief to families and hospitals that truly need it. 
But Republicans choose to go behind closed doors and not tell us what 
is in their tax package until a few hours before it comes on the floor. 
They choose the path of conflict, not consensus. Dictation, not 
dialogue.
  Well, the President is going to veto this bill; and we are going to 
be right back here where we started passing more CRs because we were 
unable to do the work of working with one another to get the job done. 
The package we reject today reflects the larger problems with misplaced 
priorities, misplaced tax cuts, and raids on Social Security.
  Just today, a nonpartisan group of financial experts predicted that 
Governor Bush could not cut taxes and divert Social Security payroll 
taxes without blowing a huge hole in the budget. The Nation's best 
economists and actuaries found that by 2015, Governor Bush's plan would 
return us to the days of big deficits. His plan would undermine Social 
Security, and we would be headed right back to where we were in a sea 
of red ink in the 1980s. This makes clear that the Bush plan would 
weaken Social Security and ruin fiscal discipline.
  So we are not getting our work done. We are not hiring a single new 
teacher. We are not improving a single new school building. We have not 
spent a dime on quality teaching and after-school programs. We need to 
make the passion and purpose of this Congress in its closing days our 
children, our public schools, our teachers, our parents, our children, 
making sure that every child in this society is a productive, law-
abiding citizen. We are now going to have to pass a new CR every day 
because we are behind in our work. Let us get to work together to find 
a consensus to get these things done and get them done in the next 2 
days.
  Mr. LINDER. Mr. Speaker, I yield myself such time as I may consume.
  I am confused. I was sent down here to discuss the rule on a tax 
bill, and we have just debated the Bush-Gore presidential race. I am 
glad he got the time to do it because it shows that those folks in 
charge for 8 years did not get any of the things done that he wanted 
done.


                             Point of Order

  Mr. RANGEL. Point of order, Mr. Speaker.
  The SPEAKER pro tempore (Mr. Burr of North Carolina). The gentleman 
will state his point of order.
  Mr. RANGEL. Mr. Speaker, I would ask the Parliamentarian whether it 
is within the rules of this House for a person to discuss the 
presidential campaign in the course of our legislative debate.
  The SPEAKER pro tempore. All Members should conform their remarks to 
the pending legislation.
  Mr. LINDER. I do believe that is a point I was making after the 
gentleman from Missouri (Mr. Gephardt) spoke that he did nothing but 
speak about the presidential race.
  Mr. Speaker, I am happy to yield 5 minutes to the gentlewoman from 
Connecticut (Mrs. Johnson).
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I rise in support of the 
rule, and I regret to say that I think it is a sad day on this House 
floor when the minority leader confuses issues so completely as to 
mislead the American public. For him to say there is not one penny in 
this bill for teacher training or after-school care, is misleading. 
Those things are in the appropriations bill. That is, in the health and 
human services appropriations bill, and we will discuss that tomorrow; 
and I am proud that in that bill there is more money for public 
education than the President asked for. It is a good bill. But we will 
talk about that tomorrow.
  This is a tax bill. Of course it does not appropriate dollars for 
those purposes. I am very proud that in this bill we move from $400 
million for school construction to almost $16 billion to help our towns 
and cities construct and modernize their schools. Is it my bill and the 
gentleman from New York's bill, which I thought was the best bill? No, 
it is not exactly. But it does apportion the money the way we did in 
our bill, and it does put lots more money out there. And yes, the money 
goes directly to the cities.
  So to pretend that there is no help for our towns and cities is 
misleading. It may not be the $25 billion I wanted or exactly the bill 
I thought was a better distribution mechanism and I certainly do think 
the bill that the gentleman from New York and I worked out was the 
best. Nonetheless, this bill does increase school construction funding 
dramatically, more than any other year and more than any year when the 
Democrats were in total control of this House and the Senate. This is a 
great leap forward for our towns and cities.
  Let us look at Medicare. The Medicare section is far more money, by 
about a third, than the President proposed only a few weeks ago. The 
hospitals are going to benefit. The home health care agencies are going 
to benefit. The nursing homes are going to benefit. And frankly they 
are desperate for that help. I would certainly hope that the President 
does not veto this when it not only provides more money for Medicare 
providers than he proposed, but also a bill of rights for Medicare 
recipients that participate in Medicare+Choice plans. We have been 
trying to do this for ages. The average appeal time for a Medicare 
recipient appealing a denial of care under Medicare is 500-plus days if 
it is in one part of Medicare and almost 300 days in the other part. 
Yes, I am sorry we did not do a Patients' Bill of Rights for people 
under 65. But let us do Medicare Patients bill of Rights and add-backs 
so the providers will flourish and be able to provide care not only to 
our seniors but our community hospitals will survive to provide care to 
everyone.
  Let us also remember that this is a great step forward in providing 
patient rights for seniors under Medicare+Choice. So maybe it is not 
everything the President wants. He was not very clear about that. His 
only objection was in the managed care plus choice plans where he said 
we were doing too much. We are only doing 3 percent. That is less than 
we are doing for hospitals, less than we are doing for other providers, 
and those managed care choice plans are providing more for my low-
income severely ill seniors than Medicare is. That is why they like 
them.
  I am hearing more about the anguish and fear of my seniors who are 
losing their managed care choice plans than I am about their desire for 
prescription drugs. They want prescription drugs, but they are panicked 
because they are losing their managed care choice plans. And they are 
not even eligible for MediGap coverage. They either cannot afford it, 
or they are excluded for preexisting conditions. So while the President 
says 3 percent is too much, it is less than we are giving anybody else, 
and these plans, until we modernize Medicare and make it a better 
program for all, these plans must be kept alive because they are 
providing crucial care for very poor and ill elderly.
  And you know who is going under next? It just amazes me. The next 
group of plans to pull out are the group that serves New York City and 
the suburbs. It is the densely populated areas where any plans are 
surviving at all. They are the next to go out. Mark my words, because 
we are only doing 3 percent, our seniors in those areas are going to 
suffer.
  I want to say one other thing about the tax provisions. As I walk 
through the factories in my district, the small factories where the 
factory owner is not able to provide 100 percent of the premiums for 
health care, the employees at the machines, the workers, are carrying 
50 percent of their premiums. They will be able to deduct this cost 
under this bill. The high earners already get full medical care, and 
the company takes the deduction for their premium. This is about the 
little guy who either has to pay his own premium or 50 percent of his 
premium.
  This is a good bill. It goes to the heart of working men's needs and 
working women's needs for health care, for opportunities for pension 
savings, for jobs in our most debilitated urban areas and for Medicare 
for our seniors. Maybe it is not everything the President wants, but 
there is not anything in here that most Members have not already voted 
for. Do not let the politics

[[Page H11216]]

of the presidential race be the enemy of progress for working people in 
America.


                         Parliamentary Inquiry

  Mr. MOAKLEY. Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state it.
  Mr. MOAKLEY. Mr. Speaker, is it proper for a Member to say that a 
Member is misleading the public by a statement he makes here on the 
floor?
  The SPEAKER pro tempore. The rules of decorum in debate prohibit any 
descent to personalities.
  Mr. MOAKLEY. So it is not in order for a Member to say that a Member 
intentionally misled someone by his statements?
  The SPEAKER pro tempore. If it is an accusation of deceit, the 
gentleman is correct.


                         Parliamentary Inquiry

  Mr. LINDER. Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state it.
  Mr. LINDER. Mr. Speaker, if a speaker on the floor makes a statement 
that is incorrect and someone corrects the statement, such as there is 
no money in here for school construction and in fact there is $15 
billion, is that a statement of derision against the speaker or a 
correction of facts?
  The SPEAKER pro tempore. The rules of the House would distinguish 
between deceit and mistake.
  Mr. MOAKLEY. Mr. Speaker, I yield 3 minutes to the gentleman from New 
York (Mr. Rangel), the ranking member of the Committee on Ways and 
Means.
  (Mr. RANGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. RANGEL. Mr. Speaker, I am glad that the gentlewoman from 
Connecticut is on the floor with all of her candor. I would ask the 
gentlewoman from Connecticut to pay particular attention to what I am 
saying so that she might take down my words if they appear to mislead. 
Because I know that the President of these United States has written to 
the Republican leadership to say basically, Can we talk? Can we talk 
taxes? Can we talk about a $250 billion tax cut over 10 years?
  I know that. I also know that the Republican leadership, rather than 
take these tax issues to the United States Congress, rather than take 
them to the House of Representatives, rather than take them to the 
committee which the gentlewoman from Connecticut and I are privileged 
to serve, sought not to take it to the Committee on Ways and Means. I 
would think the best way to deal with this is to leave the floor 
because the deception that is going on here today is that most people 
thought that when we adjourned yesterday, we adjourned yesterday.
  I want my words taken down to say that it is a fraud on the American 
people to say that we adjourned yesterday 8 o'clock this morning in 
order to trick the American people into believing that yesterday is 
today. If you want to take my words down, we will go to the 
Parliamentarian and ask does that make any sense.
  Does it make any sense to have a tax bill not come out of the tax 
committee? How dare them think that is what is best. The gentlewoman 
from Connecticut said that she and I had come to a state of mind in 
terms of a bill that has 230 cosponsors as to how we can modernize and 
how we can construct new schools.

                              {time}  1230

  Would Republican leadership talk with Democrats about how we could 
work out something, like the gentlewoman from Connecticut (Mrs. 
Johnson) and I have worked out? Would they call the White House and ask 
whether or not they can work out something?
  For whatever reason, the Republicans are looking for a train wreck. 
They are asking for a veto, because each and every thing that the 
President has asked for they gave it to him, but put in a poison pill 
with each and every one of those things.
  Sure, we want to improve the Medicaid and Medicare bill and give it 
back. Why is it you leave out hospitals and put in HMOs? There are 
things we can do, not as Democrats, not as Republicans, but as Members 
of Congress.
  All of a sudden we are supposed to go home now and say we do not need 
the Congress. A handful of Republicans can ignore the President; a 
handful of Republicans. They do not go to the Republican committee 
members, they do not go to their Democrat counterparts, they do not go 
to the President of the United States. They just figure that they are 
going to get out of here and just are going to bring anything to the 
floor.
  Well, it is not going to work that way. If we want to get out of here 
with some semblance of mutual respect, if we want to give credibility 
to the House of Representatives, we have to respect our committee 
system, and no one is going to tell us what to do and what to vote for 
and what to pass, and the President reserves the right to veto.
  Mr. LINDER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would just like to make note that the letter the 
President sent us after we had passed this original bill in the spring 
of this year, the letter he sent us that asked could we sit down and 
talk about taxes, arrived yesterday.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MOAKLEY. Mr. Speaker, I yield 1 minute to the gentleman from 
Mississippi (Mr. Taylor).
  Mr. TAYLOR of Mississippi. Mr. Speaker, the citizens of America 
entrust us with running their Nation. We are going to be asked in less 
than 3 hours to vote on a 960-page document that was just delivered to 
the House. No one knows what is in it. There could be a tax on 
handguns; there could be a tax on cigarettes; they could bring back 
prohibition. Neither the Speaker of the House nor the gentleman from 
Georgia (Mr. Linder) have any idea what is in this bill. But if the 
House votes for it and the Senate votes for it, it becomes the law of 
the land, until it is repealed. That could take 1 year, that could take 
100 years.
  This Nation squanders $1 billion on interest on the debt. I hear my 
Republican colleagues say we finally turned a profit. We have an $8 
billion surplus for the first time in 30 years. I would tell you that 
surplus compared to the debt is like a person who, for 30 years, has 
been charging things to his Visa card and finally breaks even at the 
end of 1 year and has $1,000 left, and says, ``Honey, let's go blow 
it,'' ignoring the fact that he is $686,000 in debt on his credit 
cards. That is the comparison of this year's surplus to the accumulated 
debt of $5.7 trillion.
  Mr. MOAKLEY. Mr. Speaker, I yield 1 minute to the gentleman from 
Oregon (Mr. Blumenauer).
  Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentleman's courtesy.
  Would that the rule that we are debating here today simply had given 
us a tax bill that somebody may be able to comprehend. As my colleague 
from Mississippi pointed out, there is nobody in this Chamber that 
knows exactly what they are voting on.
  I look forward to the debate later today on the merits of the 
proposals that we have heard argued briefly before us. But this rule 
snuck in provisions that are extraneous to taxation.
  I give you just one example: It does not just overturn Oregon's death 
with dignity law, the only such provision in the United States, but it 
would criminalize the critical doctor-patient relationship dealing with 
the management of pain.
  This is something that is objected to by a number of medical 
societies around the country. Any thinking professional who considers 
the potential of criminalizing this sensitive relationship understands 
on this basis alone it calls for the rejection of the rule and the 
underlying bill.
  Mr. MOAKLEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I urge a no vote on the previous question. Only by 
defeating the previous question will the House be allowed to vote on 
the Democratic alternative.
  Our plan would include an increase in the minimum wage. Our plan 
would include targeted tax credits. It would provide $25 billion in 
real school construction and modernization financing with the 
prevailing wage protections. Our plan would improve Medicare, Medicaid, 
children's health benefits, and would include many, many other items.
  Mr. Speaker, I include for the Record the text of my amendment.

[[Page H11217]]

  Previous Question Amendment Conference Report on the Small Business 
                             Investment Act

       At the end of the resolution insert the following;
       ``Sec. 2. Upon adoption of this resolution, the House shall 
     be considered to have adopted a concurrent resolution 
     introduced by Representative Gephardt on October 26, 2000, 
     directing the Clerk of the House of Representatives to make 
     corrections in the enrollment of the conference report on 
     H.R. 2614 to amend the Small Business Investment Act to make 
     improvements to the certified development company program, 
     and for other purposes. The concurrent resolution deemed to 
     have been adopted by the House shall consist of the 
     Democratic alternative to the conference report including an 
     increase in the minimum wage, targeted tax relief--including 
     $25 billion in real school construction and modernization 
     financing with prevailing wage protections--and Medicare, 
     Medicaid and SCHIP benefit improvements and protections, and 
     other matter.

  Mr. Speaker, I yield back the balance of my time.
  Mr. LINDER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I include for the Record a list of 40 or 50 health care 
organizations, from the Federation of American Hospitals, American 
Cancer Society, et cetera, who are in support of this bill and the 
provisions in it.


                             Federation of American Hospitals,

                                 Washington, DC, October 19, 2000.
     Hon. Dennis Hastert,
     Speaker of the U.S. House of Representatives, Washington, DC.
     Hon. Trent Lott,
     Majority Leader of the U.S. Senate, Washington, DC.
       Dear Leader(s): On behalf of the nation's 1,700 privately-
     owned and managed hospitals, the Federation of American 
     Hospitals is pleased to offer its strong support of the 
     Medicare, Medicaid & S-CHIP Beneficiary Improvement & 
     Protection Act of 2000. In the wake of the unintentionally 
     negative impact of the Balanced Budget Act of 1997 (BBA), 
     hospitals and health providers across the country have 
     struggled financially, straining their ability to provide 
     quality patient services. This legislation is a major step 
     toward addressing some of the excesses in the BBA, and 
     restoring stability to our health care delivery system.
       By providing hospitals with a full inflation update for 
     fiscal year 2001, Congress will allow us to be better 
     prepared to meet the costs of delivering care to the millions 
     of patients that we annually serve. By addressing excessive 
     reductions in Medicaid, in Medicare Disproportionate Share 
     payments, and in payments for indigent care, the bill targets 
     its assistance at the precise payment policies that have so 
     negatively impacted hospitals in recent years. Would 
     hospitals like more relief, for a longer duration, including 
     the restoration of our full inflation update for 2002? 
     Certainly, but we appreciate the significant assistance of 
     this bill. Above all, we want to ensure that the relief that 
     is included in this package becomes low before Congress 
     adjourns.
       In addition to the broader provisions that impact all 
     hospitals, the bill also includes significant provisions to 
     assist rural hospitals, hundreds of whom are Federation 
     members. Among numerous important rural provisions, the 
     changes to the Medicare DSH program thresholds that will 
     allow far more rural hospitals to participate, may be the 
     most important. Many struggling hospitals in rural 
     communities, serving predominantly low-income populations, 
     will receive vital new assistance that will allow them to 
     maintain services to poor Medicare patients.
       Finally, this summer, after many years of development, 
     hospitals moved to outpatient prospective payment (PPS). 
     Despite improvements under the new outpatient PPS, 
     beneficiary copayments remain high for some services due to 
     historical design flaws in the program. This bill will 
     significantly reduce many of those copayments, lowering costs 
     to seniors.
       These are just a few of the many positive provisions that 
     have been included in this legislation to help patients and 
     their health care providers. As a result, the Federation 
     strongly supports the Medicare, Medicaid & S-CHIP Beneficiary 
     Improvement & Protection Act of 2000. We will work with 
     Congress and the President to encourage its swift enactment.
       We look forward to working with Congress and the 
     Administration to further educate our leaders on the 
     difficulties facing our health providers. Both the President 
     and Congress have shown a significant appreciation for the 
     reimbursement problems facing our hospitals, and we hope that 
     we can continue this dialogue. Only with a sustained 
     bipartisan dialogue can our hospitals, and our biggest 
     insurer--the government--continue to provide the world's 
     finest health care in an increasingly complex fiscal 
     environment.
           Sincerely,
                                                 Thomas A. Scully,
     President & CEO.
                                  ____



       National Association of Community Health Centers, Inc.,

                                 Washington, DC, October 18, 2000.
     Hon. Trent Lott,
     Majority Leader, U.S. Senate, United States Capitol Building, 
         Washington, DC.
     Hon. J. Dennis Hastert,
     Speaker, U.S. House of Representatives, United States Capitol 
         Building, Washington, DC.
       Dear Majority Leader Lott and Speaker Hastert: On behalf of 
     the National Association of Community Health Centers (NACHC), 
     thank you for your efforts to protect health care access for 
     more than 11.5 million medically underserved Americans by 
     including the Medicaid prospective payment system for 
     Federally qualified health centers in the final version of 
     BBA relief legislation.
       As you know, the BBA eliminated a fundamental underpinning 
     of America's health center safety net by phasing-out and 
     eventually terminating the Medicaid cost-based reimbursement 
     system for Federally qualified health centers. Health centers 
     believe that your efforts to include a new prospective 
     payment system for health centers in your BBA relief 
     legislation is essential to their continued survival and will 
     ensure that they remain a viable part of America's health 
     care safety net.
       Thank you again for your commitment to protecting health 
     centers through your BBA relief legislation. Enactment of 
     this prospective payment system is essential to protect the 
     struggling health care safety net and will ensure the place 
     of health centers in providing access to care for millions of 
     uninsured Americans. We stand ready to work with you to make 
     meaningful BBA relief for health centers a reality.
       Please feel free to contact me if there is anything that I 
     can do for you.
           Sincerely,
                                           Thomas J. Van Coverden,
     President and CEO.
                                  ____

                                   American Medical Rehabilitation


                                        Providers Association,

                                 Washington, DC, October 19, 2000.
     Hon. William V. Roth, Jr.,
     Chairman, Committee on Finance, Dirksen Senate Office 
         Building, Washington, DC.
       Dear Chairman Roth: The American Medical Rehabilitation 
     Providers Association (AMRPA) thanks you for your leadership 
     in securing passage of the ``Medicare Medicaid and SCHIP 
     Beneficiary Protection Improvement Act of 2000.'' This 
     legislation will provide crucial and immediate relief to 
     Medicare providers adversely affected by cuts imposed by the 
     Balanced Budget Act of 1997 (BBA 97). We strongly support its 
     immediate passage.
       In particular, we would like to thank you for ensuring 
     inclusion of two provisions addressing concerns of the 
     rehabilitation hospital industry. Section 305 of the Act will 
     eliminate, for FY 2002, a two percent cut on overall 
     rehabilitation spending imposed by BBA 97. This provision 
     will help shore up the financial strength of the industry as 
     we begin the transition to a prospective payment system 
     (PPS). Section 305 of the Act also gives rehabilitation 
     facilities which are ready to proceed immediately to full PPS 
     reimbursement the opportunity to do so, rather than requiring 
     them to gradually transition over a two-year period as in BBA 
     97. Fully funding this provision helps to ensure the ability 
     of rehabilitation providers to provide high quality, cost-
     effective care during the PPS transition.
       As indicated in MedPac's June 1999 report citing the 
     decrease in rehabilitation hospital margins to 1.8%, 
     rehabilitation hospitals nationwide have been hurt 
     substantially by funding cuts under the Balanced Budget Act 
     of 1997. If additional funding becomes available for short-
     term relief for providers, we respectfully request that you 
     consider making the 2% restoration effective July 1, 2001 and 
     extending the psych hospital provision in Section 306 to 
     include rehabilitation hospitals and units.
       Please know that your leadership is appreciated by the 
     rehabilitation hospital industry, and by hundreds of 
     thousands of rehabilitation patients served by rehabilitation 
     hospitals nationwide. We hope we can count on Congressional 
     intervention for future additional financial relief for 
     rehabilitation hospitals. Thank you again.
           Sincerely,
                                              Edward A. Eckenhoff,
     Chairman.
                                  ____



                                                 Health South,

                                 Birmingham, AL, October 19, 2000.
     Hon. Jim McCrery,
     U.S. House of Representatives, Washington, DC.
       Dear Representative McCrery: Please accept this as my 
     sincere thanks and appreciation for all of your efforts with 
     the ``Medicare Refinement and Benefits Improvement Act of 
     2000.'' It is because of men such as yourself that give their 
     attention to matters of concern to all people that we are 
     able to make progress in much needed areas.
       Rehabilitation hospitals across the nation will benefit 
     from this legislation but greater still will be the benefit 
     to the patients. Your help and continued support of this 
     issue is again deeply appreciated.
           Best regards,
                                               Richard m. Scrushy,
                  Chairman of the Board & Chief Executive Officer.

[[Page H11218]]

     
                                  ____
                                      National Association of Long


                                               Term Hospitals,

                                  Stoughton, MA, October 19, 2000.
     Via Facsimile Only
     Hon. William M. Thomas,
     Chairman, Committee on House Administration, Longworth House 
         Office Building, Washington, DC.
     Hon. William V. Roth, Jr.,
     Senator, Hart Senate Office Building, Washington, DC.
     Hon. Michael Bilirakis,
     Representative, Rayburn House Office Building, Washington, 
         DC.
       Dear Chairman Thomas, Senator Roth and Representative 
     Bilirakis: I am writing you in my capacity as President of 
     the National Association of Long Term Hospitals (``NALTH'') 
     to express the strongest possible support for Medicare 
     program and payment refinements which are presently pending 
     before Congress. Long term hospitals are particularly 
     dependent on Medicare program policy. Typically 60% to 70% of 
     all patients admitted for inpatient services in long term 
     hospitals are Medicare beneficiaries. These individuals 
     constitute perhaps the most profoundly ill and disabled 
     segment of Medicare beneficiaries since they all require an 
     atypically long hospital stay and specialized programs of 
     care.
       Congressional proposals relating to long term hospitals 
     implement long standing bipartisan recommendations of policy 
     makers to achieve the development of a long term hospital 
     prospective payment system and, in the interim, to equalize 
     the payment system. These payment and policy changes are 
     desperately needed in order to support the multitude of 
     programs and dedicated personnel who serve this very 
     vulnerable Medicare population.
       I wish to underscore that the failure to implement these 
     provisions, at this time in light of past reductions of 
     payments to long term hospitals, would have an immediate and 
     direct adverse affect on hospital employees and programs.
       NALTH is appreciative of the thoughtful approach which 
     Congress has taken on these issues and is mindful that it is 
     important that the entire hospital industry achieve a 
     baseline of economic health in order to support the continuum 
     of care which is so important to Medicare beneficiaries.
       We believe it is important that the President assume a 
     leadership role with his colleagues in Congress and approve 
     all Medicare refinements proposed by Congress.
       I wish to thank members of Congress for all of their 
     efforts to secure and improve the Medicare program with this 
     very important legislation.
           Sincerely,
                                              Geraldine Brueckner,
     President.
                                  ____

                                          Acute Long Term Hospital


                                                  Association,

                                 Alexandria, VA, October 19, 2000.
     Hon. Jim McCrery,
     U.S. House of Representatives, Washington, DC.
       Dear Representative McCrery: On behalf of the nearly 100 
     hospital-members of the Acute Long Term Hospital Association 
     (ALTHA), I would like to express our sincerest gratitude for 
     your leadership and commitment toward ensuring final passage 
     of the Medicare Refinement and Benefits Improvement Act of 
     2000. We are particularly grateful for your strong efforts to 
     secure inclusion of the following provisions: Sec. 210, which 
     increases potential reimbursements and requires HCFA to 
     develop a workable PPS system by October 1, 2002, and ensures 
     that long term care hospitals, and only long term care 
     hospitals (as defined by law) will be eligible for 
     reimbursement under the new system; Sec. 404, which imposes a 
     2 grandfather clause on HCFA's pending provider-based status 
     rule, and substitutes HCFA's ``75/75 zip code'' scheme with a 
     more reasonable 35-mile zone provision; and Sec. 202, which 
     increases reimbursement for bad debt.
       Please do all you can to ensure these provisions remain and 
     the bill is passed into law in this session of Congress. Once 
     again, we greatly appreciate your leadership and strong 
     efforts on behalf of our patients and our hospitals.
           Sincerely,
                                              S. Bradley Traverse,
     Executive Director.
                                  ____

                                           National Association of


                                         Children's Hospitals,

                                 Alexandria, VA, October 19, 2000.
     Hon. William M. Thomas,
     Chairman, Subcommittee on Health, Committee on Ways and 
         Means, U.S. House of Representatives, Washington, DC.
       Dear Mr. Chairman: On behalf of the National Association of 
     Children's Hospitals (N.A.C.H.), I am writing to thank you 
     for your recognition of the different financial circumstances 
     of children's hospitals and your efforts to address their 
     concerns with the Medicare outpatient prospective payment 
     system (OPPS).
       In particular, we appreciate the inclusion of a change in 
     the application of the Medicare OPPS to children's hospitals 
     in both the Ways and Means Health Subcommittee's ``Medicare 
     Benefit and Improvement Act'' and the consolidated 
     legislation you are developing to amend those health related 
     provisions of the ``Balanced Budget Act of 1997,'' which 
     threaten to jeopardize the financial stability of different 
     health care providers. Your proposal will treat children's 
     hospitals the same as cancer hospitals for purposes of 
     Medicare OPPS implementation, which will ensure that 
     children's hospitals are effectively held financially 
     harmless.
       This legislative action is important to take into account 
     the disproportionately large adverse effect that the Medicare 
     OPPS could have on children's hospitals' ability to serve 
     those children who qualify for Medicare. It is even more 
     important to demonstrate to other payers of health care, 
     which seek to model their reimbursement systems on 
     Medicare's, that without adjustment, the adoption of the OPPS 
     system used by Medicare can put children's hospitals at 
     financial risk and would be inappropriate.
       Any change in outpatient reimbursement methodology, such as 
     the new Medicare OPPS, which does not reflect children's 
     unique health care needs, can significantly affect children's 
     hospitals' fiscal health overall, because the volume of 
     outpatient care they provide is substantial and the greatest 
     growth in their patient care is in outpatient services. For 
     example, on average in FY 1998, a typical large freestanding 
     children's acute care hospital provided care for children in 
     more than 220,000 outpatient visits, eight percent more than 
     in FY 1997.
       Thank you again for focusing on the unique outpatient needs 
     of children's hospitals.
           Sincerely,
                                                Peters D. Willson,
     Vice President for Public Policy.
                                  ____



                                    Kennedy Krieger Institute,

                                  Baltimore, MD, October 19, 2000.
     Hon. William Roth,
     Chairman, Senate Finance Committee, Dirksen Senate Office 
         Building, Washington, DC.
       Dear Chairman Roth: On behalf of Kennedy-Krieger, a unique 
     children's hospital which addresses the needs of children 
     with severe disabilities, we are expressing our enthusiastic 
     support for the conference report on the Medicare and 
     Medicaid refinements legislation.
       Included in the bill is a provision which treats children's 
     hospitals in the same manner as cancer hospitals with respect 
     to the Medicare hospital outpatient prospective payment 
     system (OPPS). This provision will be of great assistance to 
     us as we work to serve out community by performing at the 
     highest level while providing the greatest value possible for 
     those children who obtain services through the Medicare 
     program.
       We respectfully request that this provision become law this 
     year, and we are grateful for your efforts.
           Sincerely,
                                             Gary Goldstein, M.D.,
     President.
                                  ____



                                         Rural Health Clinics,

                                 Washington, DC, October 18, 2000.
     Hon. Denny Hastert,
     Speaker of the House, House of Representatives, Washington, 
         DC.
     Hon. Trent Lott,
     Majority Leader, U.S. Senate, Washington, DC.
       Dear Speaker Hastert and Majority Leader Lott: This letter 
     is written in support of the agreement you have reached on 
     Medicare and Medicaid refinements legislation. As you know, 
     this bill makes a number of important changes that will 
     greatly enhance the ability of Rural Health Clinics to 
     continue to deliver high-quality, cost-effective health care 
     in underserved rural communities. We are particularly pleased 
     that you have included the language of the Safety Net 
     Preservation Act of 1999.
       We are urging you colleagues in the House and Senate to 
     support your package of changes and we are also asking 
     President Clinton to support this package as well. We believe 
     it is extremely important that Congress and President Clinton 
     act on your proposal as quickly as possible. As you know, 
     Rural Health Clinics are particularly vulnerable to the 
     adverse effects of low Medicaid payments and your proposal 
     ensures that Medicaid payments for RHC services are 
     predictable and adequate.
       This legislation represents a major improvement in the 
     Medicare and Medicaid programs for both providers and 
     beneficiaries. Your hard work and dedication to improving 
     access to care for underserved population is is greatly 
     appreciated.
           Sincerely,
                                                  Bill Finerfrock,
     Executive Director.
                                  ____

                                     National Association of Urban


                                    Critical Access Hospitals,

                                 Washington, DC, October 19, 2000.
     Hon. Thomas Bliley, Jr.
     Chairman, House Commerce Committee, Washington, DC.
       Dear Chairman Bliley: On behalf of the National Association 
     of Urban Critical Access Hospitals (NAUCAH), I would like to 
     thank you for this opportunity to comment on your agreement 
     on the Medicare and Medicaid Refinement legislation. We are 
     appreciative of congressional efforts to restore funding for 
     hospitals significantly impacted by the Balanced Budget Act 
     of 1997 (BBA). NAUCAH supports several of the provisions 
     contained in this restoration package aimed at providing 
     additional relief from the devastating impact of the BAA for 
     hospitals that treat a large number of low-income seniors.
       NAUCAH is a nationwide coalition of private, non-profit, 
     large urban hospitals that treat a significant number of 
     Medicare and Medicaid patients. Approximately 275 hospitals 
     in the U.S. today meet these criteria. Urban critical access 
     hospitals are very much a part of the health care safety net 
     in

[[Page H11219]]

     the U.S. today. In most communities in which they are 
     located, they are the primary sources of care for the urban 
     elderly and poor, if not the only source.
       Because of our significant number of low-income seniors, 
     the impact of the BBA Bad Debt reduction, the Medicare 
     Disproportionate Share Payments reductions, and Medicaid 
     Disproportionate Share Hospital limit reductions is 
     particularly burdensome on NAUCAH hospitals. NAUCAH hospitals 
     rely on these payments for their survival.
       NAUCAH strongly supports the provision in your restoration 
     package, which provides for the immediate restoration of 
     Medicare bad debt reimbursement from 55 percent to 70 
     percent. NAUCAH hospitals, by definition, treat a large 
     number of low-income seniors who are the poorest and often 
     sickest of the elderly. Low-income seniors, at or near the 
     poverty level, are the most likely Medicare beneficiaries to 
     be unable to pay their co-payments and deductibles. 
     Consequently, NAUCAH hospitals have higher proportions of 
     Medicare bad debt than other hospitals and reductions in 
     these payments impact our hospitals to a greater degree than 
     other hospitals. You have shown your understanding of the 
     significant financial impact Medicare bad debt payments have 
     on hospitals like ours by your willingness to increase the 
     level of Medicare bad debt funding.
       NAUCAH also supports the provision of your package, which 
     freezes the BBA reductions in the Medicaid Disproportionate 
     Share Hospital (Medicaid DSH) program for fiscal year 2001 
     and then correspondingly increases funding by the CPI. As you 
     know, our hospitals provide a large amount of care to 
     Medicaid recipients. Restoration of the Medicaid DSH 
     limits will ensure that our state Medicaid agencies will 
     not have to reduce our Medicaid revenues. However, our 
     state Medicaid programs generally like to plan for longer 
     terms than one year. It is difficult to predict how our 
     state Medicaid agencies will react to short term changes 
     in federal policy. This in turn makes it difficult for us 
     to plan for the future, since we depend on these payments 
     for a significant portion of our overall revenue. For this 
     reason, while we are pleased with your provision for 
     Medicaid DSH, we would have preferred a policy that would 
     have lasted for a longer period to allow stability in our 
     state Medicaid programs. Nonetheless, we cannot overstate 
     our appreciation for a one-year freeze and we hope that we 
     have convinced you that a long-term freeze of the Medicaid 
     DSH reduction is important and will be seriously 
     considered when this issue is discussed in the future.
       In addition to Medicaid DSH, Medicare disproportionate 
     share hospital payments (Medicare DSH) are an important part 
     of the overall revenue of NAUCAH hospitals. Medicare DSH 
     payments are made as part of the Medicare inpatient program 
     and are intended to help ensure Medicare beneficiaries access 
     to hospitals in their communities which might be impacted by 
     the significant number of low-income patients they treat. 
     NAUCAH supports your provision that freezes reductions to 
     Medicare DSH and fully restores Medicare DSH in 2003.
       We strongly believe that any revisions to the current 
     Medicare DSH program that would increase the numbers of 
     hospitals eligible for Medicare DSH payments or increase 
     payments to some sets of hospitals, requires additional 
     funding rather than reductions in payments to hospitals that 
     presently receive Medicare DSH funds. NAUCAH hospitals are an 
     integral part of the nation's safety net and cannot afford 
     reductions in Medicare DSH payments if they are to continue 
     to serve in this capacity. NAUCAH supports your language that 
     provides additional Medicare DSH payments to rural and small 
     urban hospitals without taking money away from large urban 
     providers.
       Once again, NAUCAH appreciates this opportunity for input. 
     While we continue to ask that a provision to freeze the 
     Medicaid DSH reductions for an additional year be added to 
     the restoration package if an opportunity to do so becomes 
     available this year, we are pleased that the concerns of the 
     nation's private safety-net hospitals were seriously 
     considered as this year's legislation was being crafted. The 
     much-needed relief is sincerely appreciated. It is clear to 
     us that you are concerned about the role that Medicare and 
     Medicaid programs play in financing the safety-net for NAUCAH 
     hospitals and that you considered our requests to be 
     necessary and reasonable.
       We look forward to working with you in the future on these 
     issues so vital to the health care needs of America's low-
     income city residents.
           Sincerely,
                                             Charles L. DeBrunner,
     Executive Director.
                                  ____

                                                  American Medical


                                            Group Association,

                                                 October 19, 2000.
     Senator Trent Lott,
     Senate Majority Leader,
     Washington, DC.
       Dear Senater Lott: As the 106th Congress enters its final 
     session, the American Medical Group Association (AMGA) would 
     like to take this opportunity to commend members of Congress 
     for their hard work and diligence on a Medicare ``givebacks'' 
     bill. The Beneficiary Improvement and Protection Act of 2000 
     (BIPA) is a positive step in restoring many of the 
     unanticipated cuts suffered by Medicare providers as a result 
     of the Balanced Budget Act of 1997 (BBA). AMGA has had an 
     opportunity to view the bill in its entirety and would like 
     to offer our full endorsement.
       AMGA represents over 300 medical practice groups employing 
     over 60,000 physicians in 41 states. Our members are the 
     physician providers for over 30 million patients. AMGA 
     members are among the largest and most prestigious medical 
     groups in the country and include such renowned organizations 
     as the Mayo Foundation, the Palo Alto Medical Foundation, the 
     Lahey Clinic, the Henry Ford Health System, the Cleveland 
     Clinic, and the Permanent Federation, Inc. AMGA's mission is 
     to improve the health care environment by advancing 
     accessible, high quality, cost-effective, patient-centered 
     and physician-directed health care.
       There are several aspects of the bill that we feel would 
     greatly benefit our members. AMGA specifically supports the 
     following provisions:
       AMGA supports the elimination of the payment reductions for 
     Indirect Medical Education (IME).
       AMGA supports the clarification of physician certification.
       AMGA supports a Medicare demonstration project for group 
     practices.
       AMGA supports provisions relating to the increased 
     reimbursement for medicine services.
       AMGA applauds the additional relief for rural hospitals. 
     This is important to our members that provide access to basic 
     health care services for Medicare and Medicaid beneficiaries.
       AMGA believes that many of the managed care provisions will 
     not only be beneficial to our members but will also afford 
     better care to the patients we serve. AMGA specifically 
     supports several provisions in the bill relating to managed 
     care:
       AMGA supports a $475 floor as well as the $525 urban floor 
     for metropolitan statistical areas with populations of 
     250,000 people or more as current reimbursement amounts are 
     inadequate.
       AMGA supports the 10% phase-in of the risk adjuster, which 
     will greatly benefit individuals with chronic conditions.
       AMGA supports expansion of application of entry bonus 
     payments in 2001 that will facilitate greater participation 
     from all health care providers.
       AMGA enthusiastically supports and applauds BIPA, and 
     believes that it represents a significant step in the right 
     direction of restoring equity to health care providers. Each 
     of the provisions mentioned above will not only allow AMGA 
     members to continue to participate in the Medicare program 
     but also facilitate it. We encourage members of Congress to 
     work together in a bipartisan manner to make sure this bill 
     is passed and signed into law. We encourage Democrats and 
     Republicans to come together to vote for this bill, as it 
     will greatly enhance the availability of health care services 
     to all Medicare beneficiaries. Lastly, we encourage the 
     President to sign this bill and restore many of the 
     unanticipated cuts.
       Thank you for your consideration.
           Sincerely,
                                      Donald W. Fisher, Ph.D., CAE
     President and Chief Executive Officer.
                                  ____



                             Mississippi Hospital Association,

                                    Jackson, MS, October 23, 2000.
     Hon. Trent Lott,
     U.S. Senate, Washington, DC.
       Dear Senator Lott: On behalf of the Mississippi Hospital 
     Association I want to express our appreciation for the 
     exemplary work that you have done in regard to the House/
     Senate GOP package for Balanced Budget Act relief. The $28 
     billion five-year package, which includes $10 billion in 
     assistance to hospitals, is a vital step in providing them 
     relief from the unintended consequences of the '97 BBA.
       I understand the tough position with which you are faced in 
     attempting to balance the needs of numerous constituencies, 
     the House of Representatives and the White House.
       Thank you for your support of the hospital industry and the 
     patients and families we serve.
           Sincerely,
                                                   Sam W. Cameron,
     President and CEO.
                                  ____

                                                 October 19, 2000.
     Hon. Fred Thompson,
     U.S. Senate, Washington, DC.
       Dear Senator Thompson: On behalf of more than 150 hospitals 
     and health systems in Tennessee, I would like to thank you 
     and your staff for your continued support of meaningful 
     relief from the Balanced Budget Act of 1997 (BBA). We 
     sincerely appreciate your diligent efforts to provide ``give 
     backs'' to providers for some of the unintended Medicare cuts 
     that are quickly approaching two times the amount that 
     Congress originally intended.
       We applaud your committee's work as the first to endorse 
     the notion of a two-year full inpatient market basket 
     update--an idea that THA strongly supports. In the remainder 
     of the draft compromise language, I am confident that you 
     have also created some real relief in many of the provisions 
     as included by your committee. Specifically, we continue to 
     strongly support your:
       increases in the inpatient, outpatient, SNF and home health 
     market basket updates;
       increases for Medicare bad debt reimbursement;
       improvements in Medicare DSH both in terms of overall 
     payments and qualifying

[[Page H11220]]

     thresholds between urban and rural providers;
       delay of the home health cuts another year--as well as 
     other operational improvements;
       increases to teaching hospitals via improvements in IME and 
     GME payments;
       other targeted fixes for rural, psychiatric, 
     rehabilitation, and other providers.
       While these provisions (along with the fixes from last 
     year) are very helpful to providers, they still only 
     partially address the problems with the BBA. Therefore, I 
     urge you to eliminate the remaining two years of reductions 
     in the hospital inpatient system and ask that no additional 
     reductions be made in FY 2003 and beyond. Additionally, we 
     ask that you fully restore Medicare bad debt payments and 
     eliminate the 15% reduction in home care payments.
       As you know, without these relief measures, the BBA will 
     continue to have a devastating effect on the providers in 
     your home state. Coupled with the increasing levels of 
     uncompensated care from TennCare and charity care, these cuts 
     cannot be sustained and will continue to erode the health 
     care infrastructure in Tennessee.
       Given the projections for the budget surplus in coming 
     years, we are asking for nothing more than adequate 
     reimbursements to providers to cover their costs of 
     delivering care. As evidenced by your support thus far, you 
     and the Senate Finance Committee fully understand the 
     repercussions of a failure to provide anything short of 
     significant, substantial BBA relief--and we thank you for 
     that.
       Again, senator, we truly appreciate your continued work on 
     behalf of our providers and their patients and communities. I 
     am hopeful that you and the Committee will continue to 
     support these non-partisan efforts to restore provider 
     payments and urge the Administration to do the same.
           Sincerely.
                                            Craig A. Becker, FACHE
     President.
                                  ____



                               The University of Texas System,

                                     Austin, TX, October 19, 2000.
     Chairman Bill Roth,
     Senate Finance Committee, U.S. Senate, Washington, DC.
       Dear Chairman Roth: At your request we have reviewed the 
     broad outlines of your legislation to provide much needed 
     relief to health care providers, more specifically your 
     provisions to help our Nation's teaching hospitals. We fully 
     recognize the enormity of this task--seeking to provide 
     assistance that is fair, balanced and appropriate among 
     equally compelling claims from providers all across the 
     health care system. Striking a balance among these competing 
     needs while continuing to address the long-term solvency of 
     the Medicare Trust Fund is the challenge. We appreciate your 
     dedication to these goals and your willingness to consider 
     that assistance to America's teaching hospitals is in the 
     long-term interest of preserving our world preeminence in 
     research and medical advancement.
       In particular, we believe that provisions addressing 
     Medicare's Direct (DGME) and indirect Graduate Medical 
     Education (IME) programs, and those provisions addressing the 
     Medicaid Disportionate Hospital Share (DSH) program, 
     represent a good faith attempt on the part of Congress to 
     correct the largely unforeseen inequities that arose from the 
     Balanced Budget Act of 1997 (BBA). Each of our Nation's 
     teaching hospitals and academic health centers confronts 
     different financial constraints and pressures, the result of 
     a constantly changing, evolving health system.
       We congratulate you for your efforts and skill in writing a 
     balanced legislative package that addresses many of our 
     needs, and we commend your dedication to sound policies in 
     support of academic medicine and the students and patients 
     that we serve.
           Sincerely,
                                          Charles B. Mullins, M.D.
     Executive Vice Chancellor for Health Affairs.
                                  ____

                                              National Association


                                of Psychiatric Health Systems,

                                 Washington, DC, October 19, 2000.
     Hon. William Thomas,
     Chairman, House Ways and Means Health Subcommittee, House of 
         Representatives, Washington, DC.
       Dear Chairman Thomas: On behalf of the National Association 
     of Psychiatric Health Systems, I want to express our 
     gratitude to you for including in the House-Senate Medicare 
     relief package the provision that would provide a 1% bonus 
     increase in TEFRA payments to psychiatric hospitals and units 
     of general hospitals. We support passage of this bill in the 
     House and oppose a presidential veto.
       This financial relief is very much needed, as demonstrated 
     in MedPAC's June 2000 Report to Congress. MedPAC data shows a 
     post-1977 Balanced Budget Act (BBA) decline in Medicare 
     margins (from 2.6%-2.3%) for psychiatric facilities--findings 
     that are consistent with an earlier financial impact analysis 
     of the effects of the BBA on psychiatric facilities prepared 
     for NAPHS by Health Economics Research, Inc. Compounding 
     these BBA payment reductions has been an 11-year decline in 
     the value of employer-provided behavioral benefits, according 
     to a 1999 study by the Hay Group.
       For these reasons, we are grateful for your efforts needed 
     financial relief to psychiatric hospitals and support House 
     passage of the Medicare package with the 1% bonus increase 
     for psychiatric facilities.
           Sincerely,
                                                      Mark Covall,
     Executive Director.
                                  ____



                               Health Care Leadership Council,

                                 Washington, DC, October 19, 2000.
     Hon. William M. Thomas,
     Chairman, Ways and Means Subcommittee on Health, Rayburn 
         House Office Building, Washington, DC
       Dear Chairman Thomas: The Healthcare Leadership Council 
     (HLC) urges that Congress pass and the President sign 
     Medicare refinement and benefits improvement legislation. 
     This legislation will provide significant and much needed 
     relief for Medicare providers and plans while also enhancing 
     benefits and allowing quicker access to medical innovations 
     for beneficiaries.
       The HLC is comprised of chief executives of America's 
     leading health care organizations, representing a cross 
     section of the entire industry. Our members represent 
     community and teaching hospitals, pharmaceutical companies, 
     Medicare+Choice plans, medical technology companies and other 
     organizations providing products and services to Medicare 
     beneficiaries. They know firsthand the serious effects 
     Medicare payment reductions have on the delivery of services 
     to Medicare beneficiaries. While this package will not 
     restore all of the reductions enacted in 1997, it will 
     provide substantial immediate relief to help stabilize the 
     Medicare program.
       It is imperative that this legislation be enacted to assure 
     that Medicare beneficiaries receive the highest quality care 
     and coverage and so we can lay a solid foundation for 
     achieving comprehensive Medicare reform in the near future.
       We look forward to working with you to achieve enactment of 
     this important legislation.
           Sincerely,
                                                   Mary R. Grealy,
     President.
                                  ____



                           National Association for Home Care,

                                 Washington, DC, October 19, 2000.
     Hon. William Thomas,
     Chairman, Subcommittee on Health, Committee on Ways and 
         Means, House of Representatives, Washington, DC.
       Dear Mr. Chairman: Many thanks for once again providing 
     leadership to help blunt some of the unintended consequences 
     of the Balanced Budget Act of 1997 (BBA). Your efforts, as 
     always, are greatly appreciated.
       Balancing concerns about fiscal responsibility with the 
     interests of Medicare beneficiaries and the providers that 
     serve them is a very difficult job. We are grateful that you 
     have offered to delay the scheduled 15 percent cut for an 
     additional year, to provide a full market-basket inflation 
     update for fiscal year 2001, and to extend periodic interim 
     payments for two months. These provisions will be of great 
     help to home health agencies and the patients they serve. 
     However, with all due respect, as the benefit most hard-hit 
     by the BBA, home health providers and the patients they serve 
     are in need of additional support in order to further 
     stabilize the program and enhance access to needed care.
       As you know, under the BBA, home health outlays dropped 54 
     percent in a two-year period and the total number of 
     beneficiaries served dropped by nearly 1 million. The BBA has 
     exacted $70 billion from the home health program, more than 
     four times the $16 billion savings target set by the 
     Congress. The number of home health agencies has dropped by 
     about one-third, and the budgets of those agencies remaining 
     have dropped by close to 40 percent.
       We urge your further consideration of several proposals 
     that are designed to help shore up the ailing home health 
     program--specifically, requiring payment for non-routine 
     medical supplies on a fee schedule rather than as part of the 
     prospective payment base payments (this proposal would be 
     budget-neutral); increasing allowable expenditures for high 
     cost, outlier patients; and additional payments for care 
     provided to rural patients. Senator William Roth has seen fit 
     to include these provisions in a bipartisan legislative 
     package he has proposed, and we would encourage you to work 
     with your colleagues to address these areas as you finalize 
     the BBA refinements package.
       Your assistance in this regard will be greatly 
     appreciated--not only by the home health agencies, doctors, 
     nurses, and home health aides that provide these important 
     services, but also by the millions of vulnerable Medicare 
     beneficiaries that rely on us for their care and protection.
       Many thanks for your thoughtful consideration of our 
     requests.
           Sincerely,
                                              Val J. Halamandaris,
     President.
                                  ____



                            American Association for Homecare,

                                 Alexandria, VA, October 19, 2000.
     Hon. William Thomas,
     Subcommittee on Health, Longworth House Office Building, 
         Washington DC.
       Dear Chairman Thomas: The American Association for Homecare 
     representing over 3,000 home nursing and durable medical 
     equipment providers supports enactment of the legislation 
     crafted by the House and the Senate health policymakers.
       Recognizing the current proposal refines the Balanced 
     Budget Act of 1997 for the fiscal year 2001, the Association 
     would like to

[[Page H11221]]

     thank you for your efforts to support homecare. The following 
     provisions will help homecare providers within the next year 
     by:
       Restoring the durable medical equipment providers CPI for 
     fiscal year 2001;
       Delaying any reduction of payment by HCFA of the average 
     wholesale pricing for drugs to ensure patient access to 
     quality equipment and supplies with a study by the General 
     Accounting Office;
       Restoring the home health market basket update for fiscal 
     year 2001;
       Extending the home health periodic interim payments for two 
     months;
       Clarifying the definition of homebound to permit home 
     health services to be furnished to patients in adult day care 
     settings;
       Delaying the 15% cut for home health services for one-year; 
     and,
       Requesting a study to review the consolidated billing 
     requirements under PPS.
       As you know, the homecare industry has undergone 
     significant reductions that have resulted in the lack of 
     patient access to needed medical services and supplies. The 
     latest figures show a reduction of more than 50% from 1997 to 
     1999 with over one million eligible Medicare beneficiaries 
     who are no longer receiving homecare services. The 
     Association continues to strongly advocate for complete 
     elimination of the additional 15% cut to home health 
     services. This provision has both wide-spread, bi-partisan 
     Congressional as well as consumer support, and we look 
     forward to working with you on a Medicare proposal in the 
     future that will help to address this issue.
       The Association would appreciate your consideration of the 
     following technical changes to the legislative proposal:
       Require the Medicare Payment Advisory Commission (MedPAC) 
     to study the necessity of the 15% cut for home health 
     services rather than the General Accounting Office; and,
       Expedite the requirement by the General Accounting Office 
     to study the consolidated billing provisions under the home 
     health PPS and impose a delay of the requirement until such 
     study is completed. If this is not feasible, require HCFA to 
     suspend medical review on both DME and home health providers 
     until clear guidance by HCFA and its Medicare contractors has 
     been issued to providers.
       Thank you for your consideration on these two technical 
     changes. Once again, the American Association for Homecare 
     greatly appreciates your efforts to help homecare providers, 
     and we look forward to working with you next year on these 
     important issues.
           Sincerely,
                                            Thomas A. Connaughton,
     President and CEO.
                                  ____

                                               American Federation


                                  of HomeCare Providers, Inc.,

                              Silver Spring, MD, October 19, 2000.
     Congressman William Thomas,
     Chairman, House Ways and Means Health Subcommittee, House of 
         Representatives, Washington, DC.
       Dear Congressman Thomas: The American Federation of 
     HomeCare Providers appreciates your addressing several issues 
     of critical importance to Medicare participating home health 
     agencies in your Medicare refinement legislation. Our members 
     are primarily freestanding providers, the majority of which 
     have been severely affected by the Balanced Budget Act of 
     1997.
       We are pleased that you have included a provision to 
     postpone for another year, to October 1, 2002, the additional 
     15 percent reimbursement reduction, and that you have 
     provided for an update of 2.2 percent of the HHRG rates for 
     the second half of Fiscal Year 2001, adding back $1.3 billion 
     in finding over a five-year period. Extension of PIP for two 
     months will assist providers who might otherwise be 
     financially destabilized by the unadjusted rates and payment 
     disruptions in the initial phase of home health PPS. In 
     addition, you have indicated your desire to address the 
     issues of non-routine medical supplies, the definition of 
     ``homebound'' and branch office policy, commissioning GAO 
     studies in all three cases, and clarified the role of 
     telemedicine in the home care setting. We are appreciative.
       It is critical to the survival of home health providers, 
     however, that the 15 percent reduction be permanently 
     eliminated. Additionally, it is imperative that the issue of 
     access to home care services for medically complex and high 
     cost patients be addressed, perhaps as envisioned in 
     Congressman John Peterson's legislation. While your bill 
     addresses issues related to the new prospective payment 
     system, we have outstanding concerns about patients who lost 
     their access through the strictures of the Interim Payment 
     System, which cut $79 billion from the benefit. And for the 
     sake of the effective administration of the home care 
     benefit, consolidated billing of non-routine medical supplies 
     should be addressed forthwith, by simply eliminating the 
     requirement and reimbursing on a fee schedule basis.
       We urge you to continue to work with other Members of 
     Congress and the Administration in the next few days to 
     address these pressing concerns, which as they related to 
     access for complex and high cost patients can be a matter of 
     life and death. We want to work with you and your colleagues 
     the rest of this session, and early in the next Congress, for 
     restoration of beneficiary access lost under IPS, permanent 
     elimination of the 15 percent cut, and a more rational 
     medical supply policy under PPS.
       Again, thank you for your attention to our concerns.
           Sincerely yours,
                                                    Ann B. Howard,
     Vice President for Policy.
                                  ____



                   The Alliance for Quality Nursing Home Care,

                                                 October 19, 2000.
     Hon. Bill Roth,
     Chairman, Senate Committee on Finance, Washington, DC.
     Hon. Bill Archer,
     Chairman, Committee on Ways and Means, Washington, DC.
     Hon. Tom Bliley,
     Chairman, Committee on Commerce, Washington, DC.
       Dear Chairman Roth, Chairman Archer and Chairman Bliley: On 
     behalf of the Alliance for Quality Nursing Home Care, I want 
     to express our gratitude for your leadership in recognizing 
     the crisis that exists today in the delivery of skilled 
     nursing care to Medicare beneficiaries. The efforts Congress 
     have undertaken this year to refine Medicare reimbursement 
     levels will ensure that seniors continue to have access to 
     quality nursing home care. The Alliance for Quality Nursing 
     Home Care supports the Medicare, Medicaid and SCHIP Benefits 
     Improvement and Protection Act of 2000, and we urge Congress 
     to overwhelmingly support its passage during the remaining 
     days of the 106th Congress.
       Your attention to increasing the nursing component for the 
     prospective payment system will help nursing homes working to 
     address some of the most critical issues facing our 
     profession: Retaining, recruiting and training quality 
     nursing home staff. In addition, we look forward to 
     continuing to work with Congress and the Administration on 
     addressing the fundamental payment shortcomings of the 
     current market basket inflation index that understates the 
     cost of caring for medically complex patients.
           Sincerely,
     Michael Walker.
                                  ____

         American Association of Homes and Services for the Aging
                                 Washington, DC, October 19, 2000.
     Hon. Dennis Hastert,
     Speaker, U.S. House of Representatives, Office of the 
         Speaker, Washington, DC.
       Dear Mr. Speaker: As members of the Interfaith Coalition 
     representing faith based and other non-profit providers of 
     long term care services, we are writing to express our 
     concern on a provision contained within the Medicare 
     ``Giveback'' legislation of great importance to seniors. The 
     Balanced Budget Act Refinement bill approval by the Ways and 
     Means Health Subcommittee included language to provide 
     seniors in managed care health plans the option of returning 
     to their nursing home or long-term care facilities to receive 
     care after hospitalization. This portion of the bill, which 
     was championed by Representatives Pryce and Hobson, will 
     allow seniors control over their own health care needs.
       When elderly nursing home or retirement community residents 
     who belong to managed care plans are hospitalized, upon 
     discharge they are often not allowed to return to their home 
     facilities for further care if those facilities are not part 
     of the managed care plan's network. We should not allow our 
     elderly and frequently frail nursing home residents to be 
     forced to uproot themselves and possibly endanger their 
     health following a severe health crisis. The ``Return to 
     Home'' provisions require Medicare+Choice plans to cover the 
     care provided in the long-term care facility where the 
     residents lived prior to hospitalization.
       It is our understanding that this important provision will 
     be included in the final version of the bill. These 
     provisions will help improve the health and well-being of 
     seniors by enabling them to return to the skilled nursing 
     facility where they have strong personal and in many cases 
     family ties. On behalf of our organizations which 
     respectively represent over tens of thousands of members, 
     encourage you to help all seniors by protecting the ``Return 
     to Home'' provisions and passing Medicare legislation before 
     the end of the 106th Congress.
       We offer our appreciation for your efforts to this 
     extremely important matter.
           Sincerely,
         American Association of Homes and Services for the Aging 
     Volunteers of America.
                                  ____

                                                             VNAA,


                       Visiting Nurse Associations of America,

                                                 October 20, 2000.
     Hon. William M. Thomas,
     Chairman, Health Subcommittee, House Ways and Means 
         Committee, Washington, DC.
       Dear Chairman Thomas: On behalf of the Visiting Nurse 
     Associations of America (VNAA), I would like to thank you for 
     developing legislation to further relieve the unintended 
     adverse effects that the Balanced Budget Act of 1997 (BBA) 
     has had on Visiting Nurse Agencies (VNAs) and other home 
     health care providers.
       VNAA supports the ``Medicare, Medicaid and SCHIP 
     Beneficiary Protection and Improvement Act of 2000'' because 
     of its provisions to: Delay the 15% cut until fiscal year 
     (FY) 2003; Provide an extension of Periodic Interim Payments 
     (PIP) to PIP providers through November 30, 2000; and 
     Increase the Medicare home health prospective payment base 
     rate by 2.2% for the second six months of FY 2001.
       VNAA believes a study of the costs of non-routine medical 
     supplies and the appropriateness of bundling such supplies 
     into

[[Page H11222]]

     PPS rates is greatly needed. We are pleased that your 
     legislation accomplishes this goal. VNAA encourages you to 
     expedite this study because of our strong concerns about the 
     cost of supplies used in the treatment of wounds, 
     incontinence, and outpatient therapy.
       We also are concerned about our operational ramifications 
     involving health medical equipment (HME) suppliers and home 
     health providers. Currently, there are not electronic 
     measures to determine if patients at admission are receiving 
     supplies from either a HME supplier or a home health 
     provider. Patients who have chronic conditions and have been 
     receiving medical supplies for years are often not clear 
     about the origin of their supplies. Did they originate with 
     the physician?, the hospital?, the HME supplier?, the nurse? 
     Therefore, innocent provisions of such supplies by both the 
     HME suppliers and the home health agency to the same patient 
     could easily subject providers to medical review and 
     allegations of fraud and abuse. VNAA urges you to suspend 
     medical review of medical supplies until such electronic or 
     other means is operational.
       VNAA was very pleased to meet with you, to testify before 
     your subcommittee, and to work with your staff, Linda Fishman 
     and John McManus this year. As you know, repeal of the 15% 
     cut is critical to VNA's survival. We greatly appreciate your 
     assurance to us that cost-effective and ethical home health 
     providers will never be subject to the 15% cut. We ask for 
     your support to achieve full elimination of the 15% cut next 
     year. Full repeal of this provision would ease the concerns 
     of financial lenders, thereby improving cash flow for VNAs 
     during difficult financial times. In addition, please require 
     the Medicare Payment Advisory Commission (MedPAC), rather 
     than the U.S. General Accounting Office (GAO), to conduct the 
     study regarding the 15% cut. We do not believe that the GAO 
     has conducted thorough and fair studies regarding Medicare 
     home health issues.
       Finally, we cannot thank you enough for your support of 
     VNAA's recommendation to extend PIP to ease cash flow during 
     the transition to PPS. This provision in your legislation 
     will literally prevent the closure of several VNAs.
       VNAA looks forward to continuing to work with you next year 
     and in the future.
           Sincerely,
                                                Carolyn S. Markey,
                                                President and CEO.
                                 ______
                                 
         National Hospice and Palliative Care Organization,
                                                 October 19, 2000.
     Hon. William V. Roth, Jr.,
     Chairman, Finance Committee, U.S. Senate, Washington, DC.
       Dear Mr. Chairman: We write to express our support for 
     passage of the Medicare, Medicaid and SCHIP Improvement Act 
     of 2000 which further refines the Balanced Budget Act of 
     1997. Medicare reimbursement of hospice care has not kept 
     pace with the increasing costs of care for terminally ill 
     Medicare beneficiaries as they approach death. Therefore, we 
     support the hospice provisions included in your legislation; 
     specifically, restoration of the full market basket increase 
     (MBI) in the current fiscal year (FY 2001), maintenance of 
     the fiscal year 2002 update as provided in the Balanced 
     Budget Refinement Act (MB minus 0.25%), and full MB in FY 
     2003.
       We appreciate the interest by many senators to improve the 
     Medicare hospice benefit. Indeed, it is our hope that by 
     clarifying the physician certification language in the 
     statute to clearly rely on a physician's clinical judgment 
     regarding the expected course of illness, physicians will 
     feel more confident in referring terminally ill Medicare 
     beneficiaries to hospice care. We are pleased that you 
     include this provision in your legislation.
       The National Hospice and Palliative Care Organization 
     (NHPCO) has worked diligently to provide cost data to justify 
     the need for a rate increase. Earlier this year, Milliman and 
     Robertson provided interim data based on a large sample of 
     10,000 Medicare hospice patients. The cost data demonstrate 
     significant increases in the cost to hospice providers of 
     prescription drugs (1500+%) and outpatient services (500%) 
     that was not envisioned when the original Medicare rates were 
     established nearly twenty years ago. Coupled with these 
     increased costs is a dramatic decrease in the length of 
     hospice service. Recently, the General Accounting Office 
     found that 28% of Medicare beneficiaries stayed in hospice 
     for one week or less. As a point of comparison, the length of 
     service was 70 days at the time the hospice rate was 
     established. Since hospice providers are paid on a per diem 
     and subject to an overall payment cap, significantly shorter 
     stays eliminate providers' ability to absorb the higher cost 
     days, especially when a patient is first admitted to hospice 
     and again in the period immediately preceding death. Hospice 
     has experienced consistent updates below the market basket 
     increase. Over the years, the statutory reductions have 
     amounted to more than 9.25%. Therefore, restoration of the 
     reductions prescribed in BBA will assist hospice providers in 
     meeting the complex care needs of those Medicare 
     beneficiaries who choose to die at home under the care of 
     hospice providers.
       Finally, we look forward to continuing to work with you to 
     strengthen the Medicare hospice benefit. Hospice is an 
     expanded and all inclusive benefit package, including 
     outpatient prescription drugs, palliative chemotherapy and 
     radiation, and bereavement support for family members. It can 
     be viewed as a substitute benefit providing terminally ill 
     Medicare beneficiaries with a choice other than the 
     traditional fee-for-service program. It is our hope that we 
     can work together in the future to assure that Medicare 
     reimbursement adequately reflects the true cost of caring for 
     terminally ill Medicare beneficiaries, maintains a high 
     quality of care, and protects this important choice for those 
     who wish to die with dignity in the setting of their choice, 
     surrounded by family.
           Sincerely,
                                                   Karen A. Davie,
     President.
                                  ____



                                    National PACE Association,

                              San Francisco, CA, October 19, 2000.
     Hon. Bill Thomas,
     Chairman, Health Subcommittee, House Ways and Means 
         Committee, Longworth House Office Building, Washington, 
         DC.
       Dear Congressman Thomas: On behalf of the National PACE 
     Association (NPA) and its members, I am writing to express 
     the Association's appreciation for your continued support of 
     the Programs of All-inclusive Care for the Elderly (PACE) 
     through inclusion of provisions for PACE in The Medicare, 
     Medicaid and SCHIP Benefits Improvement Act of 2000. The 
     Act's provisions to expand the opportunities for flexibility 
     in implementation of PACE programs and to ease the transition 
     of existing demonstration sites to permanent provides status 
     will have an immediate and ongoing positive impact on PACE 
     programs and the frail elderly adults they serve.
       Although we have not had an opportunity to study the 
     legislative package in its entirety, your efforts on behalf 
     of Medicare and Medicaid beneficiaries to strengthen those 
     programs should be acknowledged and receive careful 
     consideration from members of Congress and, if enacted, from 
     the President as well as the bill makes its way through the 
     final days of this legislative session.
           Sincerely yours,
                                                   Judith Baskins,
     President.
                                  ____

         Association of Ohio Philanthropic Homes, Housing and 
           Services for the Aging,
                                   Columbus, OH, October 19, 2000.
     Hon. Dennis Hastert,
     Speaker of the House, The Capitol, Washington, DC.
       Dear Representative Hastert: I am writing to express my 
     support (and the support of 185 not-for-profit nursing homes 
     and retirement communities serving over 22,000 frail Ohioans) 
     on a provision contained within the Medicare ``Giveback'' 
     legislation. This provision is of great importance to seniors 
     everywhere including those states which have had similar laws 
     (hence the need for federal legislation) declared ``null and 
     void'' by the Health Care Financing Agency--states such as 
     California, Florida, Illinois, and Maryland.
       The Balanced Budget Act Refinement bill approved by the 
     Ways and Means Health Subcommittee, included language to 
     provide seniors in managed care health plans the option of 
     returning to their nursing home or long-term care facility to 
     receive care after hospitalization. This portion of the bill, 
     previously introduced by Representatives Pryce and Hobson as 
     the ``Seniors Healing at Home Act,'' will allow seniors 
     control over their own health care and healing.
       When elderly consumers who belong to managed care plans are 
     hospitalized and then discharged, they are often not allowed 
     to return to where they had been living for further care if 
     those facilities are not part of the managed care plan's 
     network. The ``Seniors Healing at Home'' provision requires 
     Medicare+Choice plans to cover the care provided in a 
     senior's place of residence. It is my understanding that this 
     important provision will be included in the final version of 
     the bill.
       The ``giveback'' legislation will help to bring stability 
     to the Medicare program by ensuring proper payments to those 
     who help to heal our nation's seniors. One of the most 
     frequent reasons voiced by residents of our facilities for 
     not joining a Medicare HMO is the fear that they will not be 
     permitted to return to their community following 
     hospitalization.
       On behalf of my organization and its 330 not-for-profit 
     members, I encourage you to help seniors by protecting the 
     ``Seniors Healing at Home'' provision, and passing the 
     legislation before the end of the 106th Congress.
           Very Truly Yours,
                                                     Clark R. Law,
     President/CEO.
                                  ____

                                                 October 19, 2000.
     Hon. Dennis Hastert,
     U.S. Congress, Washington, DC.
       Dear Speaker Hastert: As faith-based organizations 
     concerned about the health and welfare of elderly Americans, 
     we strongly support your efforts to include Representatives 
     David Hobson's (R-OH) and Deborah Pryce's (R-OH) Seniors 
     Healing at Home Act (H.R. 5042) in the Balanced Budget 
     Refinement Act under current consideration by Congress. We 
     understand that this provision, an important step in ensuring 
     that senior citizens are able to receive compatible skilled 
     nursing care in their home communities, will be included in 
     the final version of the BBRA.
       The increasing prevalence of managed care among elderly 
     individuals has had both positive and negative effects. 
     Managed care can

[[Page H11223]]

     lead to increased coordination of care and decreased costs, 
     but it can also limit access to facilities that are close to 
     home or culturally appropriate. An increasing number of older 
     individuals are choosing to live in senior housing or 
     assisted living complexes on campus settings with facilities 
     that offer varying levels of care including convalescent and 
     skilled nursing care. These individuals choose to live in 
     this type of setting so that they can spend the remainder of 
     their lives close to family and friends, frequently in an 
     environment that facilitates religious observance.
       A recent trend of great concern is that many indvidiuals in 
     such communities are, upon discharge from a hospital, unable 
     to return to the community where they had been living if that 
     community's skilled nursing facility is not part of the 
     Medicare+Choice plan's network of providers. The managed care 
     plan may instead require that the consumer be discharged to a 
     long term care facility in the plan's network, even though 
     the facility may be distant from friends, family and spouse.
       We believe that denying seniors the ability to return to 
     their community of origin negatively impacts on quality of 
     care. Access to close friends and loved ones may help prevent 
     the isolation, depression and even trauma that can increase a 
     frail individual's physical recovery time and the cost of 
     care. The patient's medical care may suffer as well, since 
     the staff of the facility where the individual had been 
     living may be more familiar with the person's chronic care 
     needs.
       ``Return to Home'' legislation would ensure that seniors 
     living in a facility on a campus that provides skilled 
     nursing care will be able to return to that facility for 
     convalescent care. On behalf of our organizations and our 
     members, we urge and applaud your continued support for the 
     Seniors Healing at Home Act, and encourage you to pass this 
     legislation before the end of the 106th Congress.
           Sincerely,
       Adventist Health Systems, Donald L. Jernigan, Executive 
     Vice President.
       American Jewish Committee, Richard T. Foltin, Legislative 
     Director and Counsel.
       American Protestant Health Alliance, Sherry Hayes, 
     President.
       Association of Brethren Caregivers, Steve Mason, Executive 
     Director.
       Association of Jewish Aging Services, Jodi Lyons, 
     President.
       Baptist Senior Adult Ministries, Edythe J. Walters, 
     Executive Director.
       Catholic Health, Association of the U.S. Julie Trocchio, 
     Director of Long Term Care.
       Church Women United, Tiffany L. Heath, Legislative 
     Assistant.
       Florida Council of Churches, Rev. Fred Morris, Executive 
     Director.
       Friends Committee on National Legislation, Florence 
     Kimball, Legislative Education Secretary.
       Jewish Council for Public Affairs, Reva Price, Washington 
     Representative.
       Lutheran Office for Governmental Affairs, Evangelical 
     Lutheran Church in America, Rev. Russell O. Siler, Director, 
     Washington Office.
       Lutheran Services in America, Joanne Negstad, President/
     CEO.
       National Council of Catholic Women, Annette Kane, Executive 
     Director.
       National Council of Jewish Women, Sammie Moshenberg, 
     Director, Washington Office.
       National Interfaith Coalition on Aging, Rev. Dr. Richard H. 
     Gentzler, Jr., Chair.
       Pennsylvania Council of Churches, Rev. K. Joy Kaufmann, 
     Acting Executive Director and Director for Public Advocacy.
       Union of American Hebrew Congregations, Mark J. Pelavin, 
     Esq. Associate Director, Religious Action Center of Reform 
     Judaism.
       Union of Orthodox Jewish, Congregations of America, Nathan 
     J. Diament, Director, Institute for Public Affairs.
       Unitarian Universalist Association of Congregations, Rev. 
     Meg Riley, Director, Washington Office for Faith in Action.
       United Church of Christ, Office for Church in Society, Rev. 
     Patrick Conover, Policy Advocate.
       United Jewish Communities, Diana Aviv, Vice President for 
     Public Policy.
       The United Methodist Church, General Board of Discipleship, 
     Rev. Dr. Richard H. Gentzler, Jr., Director, Office of Adult 
     Ministries.
       Volunteers of America, Ronald H. Field, Vice President of 
     Public Policy.
                                  ____

                                                 Patient Access to


                                    Transplantation Coalition,

                                 Washington, DC, October 20, 2000.
     Hon. William V. Roth, Jr.,
     Senate Finance Committee, Senate Dirksen Office Building, 
         U.S. Senate, Washington, DC.
       Dear Chairman Roth: The Patient Access to Transplantation 
     Coalition would like to express our support for Section 113 
     of the Medicare, Medicaid and SCHIP Beneficiary Protection 
     and Improvement Act of 2000. We are pleased that this 
     provision of the final conference agreement will eliminate 
     the current three-year limitation on coverage for 
     immunosuppresive drugs under the Medicare program. We would 
     especially like to thank you, Senator DeWine, and Chairmen 
     Bliley, Thomas and Bilirakis for your tremendous leadership 
     on this important transplant patient issue.
       This provision is urgently needed to ensure that Medicaid 
     beneficiaries who receive organ transplants can continue to 
     have access to these lifesaving drugs. We are confident that 
     the Medicare program will ultimately save money as a result 
     of this provision, since it will reduce the number of organ 
     failures which necessitate subsequent retransplantation. We 
     also believe that, by reducing the number of organ 
     rejections, this provision will result in the availability of 
     an increased number of organs for the almost 70,000 patients 
     who are currently waiting to receive the gift of life.
       Once again, we appreciate and commend your efforts to 
     expand Medicare coverage of immunosuppressive drugs this 
     year. Your efforts will help ensure that transplant patients 
     across the country continue to have access to lifesaving 
     immunosuppressive therapies.
           Sincerely yours,
                      Patient Access to Transplantation Coalition.
                                 ______
                                 
                                                 October 19, 2000.

                  Pat coalition Institutional Members

       Clarian Health Partners (Indianapolis, IN).
       Emory University (Atlanta, GA).
       Froedert Memorial Lutheran Hospital (Milwaukee, WI).
       Henry Ford Health System (Detroit, MI).
       Inova Health System (Fairfax, VA).
       Jewish Hospital (Louisville, KY).
       Louisiana State University (Shreveport, LA).
       Medical University of South Carolina (Charleston, SC).
       Memorial Hermann Healthcare System (Houston, TX).
       Memorial Medical Center (New Orleans, LA).
       Ochsner Medical Institutions (New Orleans, LA).
       Ohio State University Medical Center (Columbus, OH).
       Oklahoma Transplantation Institute (Oklahoma City, OK).
       Oregon Health Sciences University (Portland, OR).
       St. Louis University Hospital (St. Louis, MO).
       St. Vincent Medical Center, CHW (Los Angeles, CA).
       Scripps Clinic (La Jolla, CA).
       Tampa General (Tampa, FL).
       Tulane University (New Orleans, LA).
       University of Alabama at Birmingham (Birmingham, AL).
       University of Colorado Health Sciences Center (Boulder, 
     CO).
       University of Florida/Shands Hospital (Gainesville, FL).
       University of Kansas (Lawrence, KS).
       University of Kentucky (Lexington, KY).
       University of Medicine and Dentistry of New Jersey (Newark, 
     NJ).
       University of Michigan (Ann Arbor, MI).
       University of Washington (Seattle, WA).
       University of Wisconsin-Madison (Madison, WI).
       Vanderbilt University Medical Center (Nashville, TN).
       Virginia Commonwealth University Medical College of 
     Virginia (Richmond, VA).
       Westchester Medical Center (Valhalla, NY).
                                  ____



                                 Lifecare Management Services,

                                     Dallas, TX, October 19, 2000.
     Re: Provider Based Determinations
     Hon. Dennis Hastert,
     Speaker of the House, House of Representatives, Washington, 
         DC.
       Dear Rep. Hastert: I would like to thank you for your time 
     and assistance in supporting legislation designed to treat 
     long-term care hospitals equitably in terms of payment and 
     program administration.
       We are particularly grateful for your support for the 
     provision that would provide a two year delay in the 
     application of HCFA's new provider-based determination rule 
     (See Section 404 enclosed).
       We gratefully appreciate your leadership and know you will 
     do everything you can to make certain the enclosed provision 
     is adopted as part of this year's BBA Relief Package.
           Sincerely,
                                                    David LaBlanc,
     President.
                                  ____

         American Cancer Society, National Government Relations 
           Office,
                                                 October 19, 2000.
     Hon. J. Dennis Hastert,
     Speaker of the House of Representatives, U.S. Capitol 
         Building, Washington, DC.
       Dear Mr. Speaker: On behalf of the more than 18 million 
     volunteers and supporters of the American Cancer Society, I 
     am writing to thank you for supporting an extension of 
     Medicare's current colonoscopy benefit to average risk 
     beneficiaries in the Balanced Budget Refinement Act (BBRA) 
     currently being negotiated. Securing this change has been one 
     of the Society's top legislative priorities, as it will have 
     a direct impact on reducing the incidence and mortality rates 
     of colorectal cancer among the Medicare population.
       As you know, this provision has broad bipartisan support 
     and was included in all the bills considered by the House 
     Ways and Means Health Subcommittee, the House Commerce 
     Committee, and the Senate Finance Committee. President 
     Clinton has also called for expansion of the current Medicare 
     colon cancer screening benefit before the adjournment of this 
     session of Congress. The bipartisan provision currently in 
     the BBRA bill would bring Medicare coverage more in line with 
     the American Cancer Society's current colorectal cancer 
     screening guidelines. Colorectal cancer--the nation's second 
     leading cause of cancer deaths in men and

[[Page H11224]]

     women--most often is diagnosed in individuals considered to 
     be ``average risk'' for the disease with approximately 70-90 
     percent of colorectal cancers diagnosed in average or 
     moderate risk individuals. As daunting as these statistics 
     are, colorectal cancer is second only to lung cancer in our 
     ability to prevent cancer from ever occurring. This disease 
     is easily preventable through the early identification and 
     removal of pre-cancerous polyps, detectable only through 
     colorectal cancer screenings.
       Recent studies published in the New England Journal of 
     Medicine found that colonoscopy is the most effective 
     screening tool currently available. We know that if we were 
     able to get all individuals screened for colorectal cancer--
     according to our guidelines--that we could reduce overall 
     colorectal cancer mortality by 50 percent or more.
       Increasing the numbers of Medicare beneficiaries that have 
     access to the full range of effective colorectal cancer 
     screening tests could save money on the cost of treatment. 
     Colonoscopy can examine the entire colon and it is the most 
     effective test at catching cancers at early stages. 
     Colonoscopy also permits the health care provider to identify 
     and remove adenomatous polyps--a procedure that can prevent 
     colorectal cancer from ever developing. Other screening tests 
     are not only less effective at detecting polyps and cancer 
     but if polyps or signs of cancer are identified (e.g. occult 
     blood) the patient then requires a colonoscopy. By providing 
     average-risk patients the option of a screening colonoscopy, 
     a second follow-up procedure in many cases can be avoided 
     which not only saves Medicare money, but also saves the 
     patient from additional hassle and discomfort.
       We know that cancer is most effective when the cancer is 
     caught early. For example, when cancer is diagnosed in the 
     earliest stages--before it has become symptomatic--patients 
     have a 90 percent chance of survival. Yet, if a patient is 
     not diagnosed until symptoms are exhibited, the chance of 
     survival drops to 8 percent and care during the remaining 4-5 
     years of life can cost up to $100,000. The Medicare 
     reimbursement rate for colonoscopies is currently $337. While 
     that may seem high, the Society's guidelines specify that a 
     colonoscopy need only be performed once every ten years in 
     individuals who have had a previous normal exam.
       The Society strongly recommends that public and private 
     health plans provide coverage for the full range of effective 
     colorectal and other cancer screening tests according to the 
     Society's guidelines. The current Medicare benefit provides 
     coverage for: An annual fecal occult blood test (FOBT) for 
     all beneficiaries over 50, A flexible sigmoidoscopy every 4 
     years for average or moderate risk beneficiaries*, A 
     colonoscopy every 2 years for high risk beneficiaries*.
       *A double contrast barium enema may be used as an 
     alternative if a physician determines that its screening 
     value is equal to or better than a flex-sigmoidoscopy or a 
     colonoscopy.
       The language in the BBRA bill provides average risk 
     beneficiaries with coverage for either a colonoscopy every 10 
     years or a flexible sigmoidoscopy every four years. We 
     applaud your action in embracing this change as it will 
     provide the greatest flexibility for patients and their 
     physicians in determining which screening modality is best 
     for the individual beneficiary, while considering other 
     factors such as costs and possible complications. This 
     correctly places the screening decision with patients and 
     providers and ensures that lack of coverage will not be a 
     reason for a beneficiary to go without a potentially life-
     saving test.
       The American Cancer Society thanks you for your support of 
     this important public health matter and is hopeful that this 
     change in policy will be enacted before Congress adjourns. 
     While the Society is not in a position to comment on the 
     merits of the full BBRA bill--both because we have not had an 
     opportunity to analyze the specifics of this large package 
     and because we understand that the package contains 
     provisions that are beyond the scope of current ACS policy 
     and legislative priorities--we urge all parties to continue 
     to work toward ensuring enactment of the expanded colorectal 
     cancer screening benefit. Therefore, we strongly urge Members 
     of Congress and the Administration not to allow end-of-
     session politics to jeopardize this critical opportunity to 
     save lives.
       We look forward to working with you and your colleagues to 
     ensure that this provision becomes law, Should you have any 
     questions or if you would like additional information, please 
     contact Wendy Selig, Managing Director of Federal Government 
     Relations (202/661-5704), or Ilisa Halpern, Director of 
     Federal Government Relations (202/661-5717).
           Sincerely,
                                                  Daniel E. Smith,
            National Vice President, Federal and State Government 
     Relations.
                                  ____

                              Alliance to Save Cancer Care Access,


                   Americans United in Support of Cancer Care,

                                 Washington, DC, October 19, 2000.
     Hon. [Lott/Daschle/Hastert/Gephardt]
       Dear Sir: We would like to express our appreciation for 
     your focus on problems impacting the Medicare program, as 
     well as our strong support for legislative reform that 
     rationalizes Medicare reimbursement and preserves patient 
     access to care.
       As you know, many throughout the cancer community have long 
     contended that the Medicare program employs a flawed 
     reimbursement structure, overpaying for many drugs while 
     underpaying for many services. For example, the Medicare 
     program does not adequately support the critical role played 
     by oncology nurses, forcing caregivers to engage in a form of 
     ``cost shifting'' in which they have to use drug overpayments 
     to offset Medicare's deep underpayment for the treatment 
     services provided to beneficiaries. At the same time, the 
     Health Care Financing Administration has acted upon a 
     proposal to restrict Medicare coverage of injectable 
     therapies that are needed by and have been historically 
     provided to seniors and disabled Americans suffering from 
     cancer, multiple sclerosis, AIDS, and other diseases.
       These problems are widely considered to be unacceptable for 
     several reasons: They are they source of great uncertainty 
     for seniors and people with disabilities, they place 
     significant pressures on the professional caregivers who care 
     for them, and they are made necessary by correctable flaws in 
     the Medicare statute.
       Fortunately, legislation developed by Congress addresses 
     these problems in a responsible and commendable manner. 
     Provisions included in the Medicare reform package direct the 
     Secretary to revise the payment methodology for all drugs 
     currently covered by Medicare and charges the General 
     Accounting Office to undertake the meaningful analysis which 
     will support this much-needed correction. Meanwhile, another 
     provision in the legislative package clarifies coverage of 
     drugs that are usually not self-administrable and strengthens 
     access to this important form of care. This combined response 
     puts Medicare on the road to real, balanced, and sustainable 
     reform by ensuring that the program provide appropriate 
     reimbursement for drugs and will eliminate underpayments for 
     services related to the provision of those therapies.
       For these reasons, we are pleased to extend our 
     congratulations to you and your colleagues for the fine work 
     you have done to address these vital issues. We are pleased 
     to extend to you our support for these provisions and hope 
     that they will not be subject to any changes. Rather, we 
     respectfully urge Members to strengthen patient access to 
     cancer care by supporting the measure in which these 
     provisions are brought before the Congress. We also express 
     our appreciation to the president for his leadership in 
     cancer care issues and our hope that he sign these important 
     reforms into law.
       On behalf of the seniors and disabled Americans we are 
     honored to serve and represent, we would like to thank you 
     for your consideration and your support.
           Sincerely,
     American College of Radiation Oncology Association of 
     Community Cancer Centers National Patient Advocate 
     Foundation.
     Oncology Nursing Society United Seniors Association US 
     Oncology.
                                  ____

                                                              ICC,


                                 Intercultural Cancer Council,

                                                 October 19, 2000.
     Hon. William V. Roth, Jr.,
     Chairman, Committee on Finance, Washington, DC.
       Dear Senator Roth: On behalf of the Intercultural Cancer 
     Council (``ICC''), including our 55 members and hundreds of 
     affiliated organizations and supports, I write in support of 
     the minority cancer demonstration provisions included in the 
     Balanced Budget Act Relief Legislation. The ICC is the 
     largest nationwide cancer coalition addressing the tragic 
     disparities in cancer incidence and mortality rates in our 
     nation's ethnic minority and medically underserved 
     populations. The ICC's members work daily in the areas of 
     cancer prevention and control, research, treatment and 
     survivorship.
       The Intercultural Cancer Council commends your leadership 
     for including Rep. John Lewis' amendment in the final 
     ``Medicare, Medicaid, SCHIP Beneficiary Protection and 
     Improvement Act of 2000''. This timely demonstration effort 
     should facilitate development of needed models and 
     evaluations of methods to improve the quality of items and 
     services provided to targeted individuals in order to reduce 
     disparities in early detection and treatment of cancer among 
     Medicare beneficiaries. We urge Congress to direct the Health 
     Care Financing Administration to proceed expeditiously to 
     implement this provision and ensure that these demonstrations 
     are launched in a timely manner.
       As the ICC's mission includes identifying problems in 
     access to cancer detection and treatment, developing 
     collaborative solutions, and promoting new partnerships to 
     implement those solutions, we endorse the direction of the 
     proposed demonstration language. We believe special attention 
     should be given in demonstration projects to mechanisms 
     designed by and for the ethnic minority and medically 
     underserved communities that suffer the grossly 
     disproportionate burden of cancer in this country.
       Again, we appreciate your recognition of the need to 
     address disparities in access and cancer treatment for ethnic 
     and racial minorities who are Medicare-eligible. Enactment of 
     this provision represents a first step in moving forward to 
     address a significant health disparity problem facing this 
     nation

[[Page H11225]]

     and we are grateful for your leadership in this area.
           Sincerely,
     Armin D. Weinberg.
                                  ____

                                     The Susan G. Komen Breast    
                                                Cancer Foundation,


                                        National Headquarters,

                                      Dallas, TX, October 6, 2000.
     Hon. William Roth,
     Chairman, Committee on Finance, U.S. Senate, Washington, DC.
       Dear Chairman Roth: On behalf of the Susan G. Komen Breast 
     Cancer Foundation, I am writing to urge you to include 
     funding for digital mammography in the Medicare initiative 
     currently being shaped by Congress.
       The Medicare, Medicaid and SCHIP Improvements Act of 2000 
     provides a valuable opportunity to recognize and promote a 
     new technology that offers many exciting possibilities. The 
     Komen Foundation urges its inclusion in the interest of 
     advancing women's health. Digital mammography creates high 
     definition pictures for detection and diagnosis of breast 
     cancer in its earliest, most curable stages. Doctors can 
     easily transmit images from remote areas to specialists 
     worldwide for expert consultation. Digital mammography also 
     requires fewer tests and yields faster results, which 
     translates into lower exposure to radiation and greater 
     convenience for Medicare beneficiaries.
       The Komen Foundation recognizes the limitations of current 
     mammography and has dedicated its own research funding 
     towards the pursuit of new screening and diagnostic 
     technologies, including digital mammography. Now that this 
     cutting-edge technology has received FDA approval and shown 
     promise in the early detection of breast cancer, it is 
     important to distribute it widely and enable women all over 
     the country to receive its benefits. In the closing days of 
     Congress, Komen asks you to please help promote this new 
     scientific advancement for women's health. The estimated cost 
     is only $87 million over five years.
       The mission of the Susan G. Komen Breast Cancer Foundation 
     is to eradicate breast cancer as a life-threatening disease 
     by advancing research, education, screening, and treatment. 
     To this end, the Komen Foundation dedicates millions of 
     dollars annually towards scientific research, education and 
     community outreach. But we cannot do it alone. The 
     eradication of breast cancer as a life-threatening disease 
     requires the support of dedicated Members of Congress like 
     you. Your continued efforts in the battle against breast 
     cancer are deeply appreciated.
       Thank you very much.
           Sincerely,
                                                    Nancy Brinker,
     Founding Chairman.
                                  ____

                                       National Kidney Foundation,


                       Office of Scientific and Public Policy,

                                                 October 19, 2000.
     Hon. William M. Thomas,
     Committee on Ways and Means, Washington, DC.
       Dear Representative Thomas: The National Kidney Foundation 
     (NKF) supports the package of Medicare improvements under 
     consideration in Congress, particularly the provisions 
     described below. NKF is the country's oldest and largest 
     voluntary health agency serving the needs of kidney patients 
     with over 30,000 members from every part of the nation and 
     from every walk of life, including consumers and their 
     families, nurses, dietitians, social workers, physicians, 
     dialysis technicians and concerned members of the lay public.
       The National Kidney Foundation urges Members of Congress to 
     vote for the package and exhorts the President to sign the 
     legislation. We especially endorse the following provisions 
     and thank you for including them in the bill.
       Two provisions in the Beneficiary Improvement section would 
     be of enormous benefit to kidney patients. They result from 
     recommendations made by the Institute of Medicine of the 
     National Academy of Sciences last December as part of studies 
     mandated by Congress in the Balanced Budget Act of 1997. 
     Section 113 removes the existing time limitation on Medicare 
     coverage for immunosuppressive medications needed by 
     transplant recipients. Without this enhanced benefit, tens of 
     thousands of transplant recipients run an increased risk of 
     rejecting their transplants. Rejection could result in a 
     return to dialysis, which Medicare covers and which costs the 
     government much more than the drugs which preserve the 
     functioning of a transplant. Section 105 authorizes Medicare 
     payments for nutritional counseling for pre-dialysis and 
     post-transplant patients. This could benefit 80,000 Americans 
     who are faced each year with the prospect of irreversible 
     kidney failure and the changes in diet which are required to 
     prepare these patients for that eventuality, as well as 
     12,000 kidney transplant candidates who receive the Gift of 
     Life annually and thus need to adjust their dietary intake 
     when they become transplant recipients. Nutritional 
     counseling has been shown to reduce morbidity and mortality 
     in these populations.
       Section 422 under Part B Improvements provides for an 
     update in the reimbursement rate paid for kidney dialysis 
     treatments as recommended by the Medicare Payment Advisory 
     Commission. NKF has pioneered in the development of practice 
     guidelines which can assist health service professionals in 
     their efforts to improve the quality of care provided to our 
     nation's 250,000 dialysis patients. Dialysis clinics need 
     this reimbursement update in order to be able to implement 
     these recommendations.
           Sincerely,
                                                       John Davis,
     CEO.
                                  ____



                                      The Glaucoma Foundation,

                                                 October 19, 2000.
     Hon. Dennis Hastert,
     U.S. Congressman, U.S. House of Representatives, Washington, 
         DC.
       Dear Mr. Speaker: I am writing to urge your support of 
     section 105 of the Ways and Means Committee Budget Refinement 
     Package for Medicare. This provision provides for screening 
     for glaucoma, the nation's leading cause of preventable 
     blindness, for those at risk. The Glaucoma Foundation 
     supports this forward-looking initiative, which will help 
     preserve the precious gift of sight.
           Sincerely,
                                                   John W. Corwin,
                                               Executive Director.
         Juvenile Diabetes Foundation International, The Diabetes 
           Research Foundation.
     Hon. J. Dennis Hastert,
     Speaker of the House, House of Representatives, Washington, 
         DC.
       Dear Mr. Speaker. I write on behalf of the Juvenile 
     Diabetes Foundation International (JDF) regarding the 
     Balanced Budget Act ``Givebacks'' bill that is currently 
     under consideration.
       The legislation contains three years of funding for 
     critically important diabetes programs. The bill increases 
     funding to $100 million for the special juvenile diabetes 
     research program created in the Balanced Budget Act of 1997 
     and extends the program's funding through fiscal year 2003. 
     The bill provides the same level of funding for the Native 
     American diabetes program.
       JDF strongly supports these provisions in the bill and we 
     urge its approval. As you know, JDF has been pursuing at 
     least five years of funding for these programs to provide a 
     more stable stream of resources that can be most efficiently 
     used by scientists. We encourage you to extend these programs 
     through at least 2005 to make them even more effective in our 
     battle against diabetes.
       Mr. Speaker, on behalf of the JDF and everyone whose lives 
     have been impacted by diabetes, we want to thank you for your 
     leadership in promoting these important diabetes initiatives, 
     and we look forward to continuing to work with you in our 
     battle to cure this devastating disease.
           Sincerely,
                                                      Leah Mullin,
     Chairman, Government Relations.
                                  ____

          National Multiple Sclerosis Society,
                                 Washington, DC, October 19, 2000.
      Hon. Trent Lott,
      U.S. Senate,
      Hon. Dennis Hastert,
      House of Representatives, Washington, DC.
       Dear Majority Leader Lott and Speaker Hastert: The National 
     Multiple Sclerosis Society supports legislation to increase 
     Medicare payments to health care providers. We strongly 
     advocate that members of Congress vote for this legislation, 
     and that the President sign it into law. Medicare 
     reimbursements to health care providers must be increased so 
     that beneficiaries with chronic conditions will have access 
     to necessary health care services.
        In addition to increasing access to Medicare health care 
     services, we are also concerned about restoring Medicare 
     coverage for self-injectible drugs and biologicals to 
     beneficiaries who are unable to self-administer. There are 
     three FDA approved self-injectible drugs that can alter the 
     course of the disease, and slow the onset and progression of 
     physical disabilities, Avonex, Betaseron and Copaxone. Each 
     drug annually costs $10,000 to $12,000. The National MS 
     Society recommends that patients diagnosed with relapsing-
     remitting MS begin taking one of these drugs immediately 
     after diagnosis, and stay with the therapy.
        Prior to 1997, Medicare carriers had the discretion to 
     determine whether reimbursement was appropriate for self-
     injectible drugs, if they were administered incident to a 
     physician's care. Since 1997, when Medicare terminated 
     Medicare coverage for self-injectibles, we have worked to 
     restore this coverage arguing that MS patients often 
     experience temporary or permanent physical disabilities that 
     make it very difficult, if not impossible, to self-administer 
     these drugs.
        Our understanding is that language in the Medicare bill 
     begins to address this problem. However, the language does 
     not go far enough. The self-injectible provision continues to 
     rely on drug labeling rather than the beneficiary's ability 
     to self-inject. This language leaves many MS beneficiaries 
     without coverage when they are physically unable to self-
     inject necessary treatments that help to slow the progress of 
     their disease. We believe that if a physician determines that 
     the patient cannot self-inject, then Medicare should cover 
     the drug.
        The National Multiple Sclerosis Society, established in 
     1946, is dedicated to ending the devastating effects of 
     multiple sclerosis. Multiple sclerosis is an often 
     progressive, degenerative disease of the central nervous 
     system that affects one-third of a million Americans. 
     Symptoms may be mild, such as numbness in the limbs, or 
     severe, such as paralysis or loss of vision.
        Please let us know if we can provide any additional 
     information on administration of

[[Page H11226]]

     self-injectible drug and biologicals or be helpful in any 
     other way.
            Sincerely,
                                                       Mike Dugan,
     President and CEO.
                                  ____

         American College of Gastroenterology,
                                  Arlington, VA, October 19, 2000.
     Hon. William V. Roth, Jr.,
     Chairman, Committee on Finance, Dirksen Senate Office 
         Building, Washington, DC.
       Dear Chairman Roth: The American College of 
     Gastroenterology (ACG) wants to be among the first to applaud 
     you and the other Members of the Senate and House of 
     Representatives for your work in shaping fair and equitable 
     Medicare-related provisions for the pending Balanced Budget 
     Act legislation. Although in the short time afforded us to 
     review the bill, we have not had the chance to evaluate all 
     aspects and ramifications of all the provisions of the 
     legislation, we are particularly supportive and appreciative 
     that the current bill includes an important provision that 
     will enhance the Medicare colorectal cancer screening benefit 
     to offer for the first time beneficiaries who are at average 
     risk of colorectal cancer the option of receiving a 
     colonoscopy once every ten years, instead of a flexible 
     sigmoidoscopy every four years. This is a very essential step 
     forward in advancing patient options and public health.
       As you know, we remain deeply concerned about the site-of-
     service problem for those procedures with less than 10% 
     office volume, and particularly the lower and inadequate 
     physician professional fee for those services that are 
     performed in a Medicare-certified ambulatory surgery center, 
     or the hospital outpatient department. We are also concerned 
     that so few Medicare beneficiaries are availing themselves of 
     the cancer screening benefit you have so wisely provided. 
     With only 1% of Medicare beneficiaries actually using this 
     preventive benefit, according to GAO, we continue to believe 
     that this benefit will fall far short of its potential and 
     that the proposed new study in Section 411 is more likely to 
     delay and possibly confuse the problem. Just as we learned 
     with pap smears and cervical cancer, we believe if will be 
     necessary for Congress to intervene to reverse a HCFA-driven 
     economic/reimbursement policy which serves to undercut the 
     Medicare colorectal cancer benefit by financially penalizing 
     physicians who perform colorectal cancer screenings.
       We look forward to working with you at the earliest 
     appropriate time to deal with the site-of-service issue and 
     find ways to increase the use of these life-saving 
     screenings.
       Very truly yours,
                                   Rowen K. Zetterman, M.D., FACS,
                                                        President.
                                     Federal Affairs Division,    


                                       American Academy of    

                                                Ophthalmology,

                                 Washington, DC, October 19, 2000.
     Hon. William M. Thomas,
     Chairman, House Ways and Means Subcommittee on Health, 
         Longworth House Office Building,
     Washington, DC.
       Dear Chairman Thomas: The American Academy of Ophthalmology 
     congratulates you on completion of a Medicare refinement and 
     benefits improvement bill and we call on Congress to quickly 
     pass the Medicare Refinement and Benefits Improvement Act of 
     2000.
       Although we are disappointed that the committee did not 
     include the much needed relief for specialists from Medicare 
     practice expense cuts scheduled for 2001, we hope to work 
     with you next year to get the Health Care Financing 
     Administration (HCFA) to make the refinements necessary to 
     protect beneficiaries' access to life saving and sight saving 
     procedures that have been adversely impacted. The practice 
     expense cuts come on top of a decade of cuts that speciality 
     physicians like ophthalmologists have experienced in an 
     effort to protect the solvency of the Medicare program. The 
     committee's decision to include several new Medicare benefits 
     and other program improvements for beneficiaries, however, is 
     highly significant and must be commended.
       Specifically, this bill reaches out to our nation's seniors 
     to help preserve their sight and independence by providing a 
     glaucoma detection eye examination once every two years to 
     those beneficiaries at high risk of developing glaucoma such 
     as African Americans and those with a family history.
       It is time to address the devastating effects of glaucoma. 
     The scientific verdict is in--treatment for glaucoma is 
     effective and can preserve sight and quality of life. An 
     estimated 120,000 Americans are legally blind due to 
     glaucoma, and estimates show at least 2 to 3 million people 
     have glaucoma although half are not aware of it. Glaucoma 
     affects 2 to 3 percent of the nation's seniors and another 5 
     to 10 million individuals have elevated intraocular 
     pressure--a risk factor for developing glaucoma. African 
     Americans are six to eight times more likely to develop 
     glaucoma than other populations. Other risk factors include 
     family history and advanced age.
       Early detection is the key to saving sight and this bill 
     helps those who need it. The Academy is pleased to support 
     the Medicare Refinement and Benefits Improvement Act of 2000.
           Sincerely,
                                          William L. Rich III, MD,
     Secretary for Federal Affairs.
                                  ____

                                                        President,


                              American Optometric Association,

                                  St. Louis, MO, October 19, 2000.
     Hon. William V. Roth, Jr.,
     U.S. Senate, Washington, DC.
       Dear Senator Roth: The American Optometric Association 
     applauds your efforts to include new and important benefits 
     in the pending Medicare Refinement Package. The American 
     Optometric Association (AOA) represents the interests of more 
     than 30,000 Doctors of Optometry and their patients.
       We are particularly pleased that the glaucoma eye 
     examination benefit is a part of this package. This bi-
     partisan supported provision is an important step in 
     preventing blindness due to undetected glaucoma. The National 
     Eye Institute has estimated that almost three million 
     Americans have glaucoma. Half of these people are not aware 
     that they have the disease. Of those who have been diagnosed 
     with glaucoma, about 120,000 are blind. Moreover, glaucoma is 
     a leading cause of blindness in older adults. Although 
     glaucoma can often be controlled if it is diagnosed early, in 
     may Americans the disease goes untreated, leading to visual 
     impairment or blindness. Because there are no early warning 
     signs, this disease often develops undetected until permanent 
     vision loss has occurred.
       Again, the AOA appreciates inclusion of this important 
     preventive service in the Medicare Refinement and Benefits 
     Improvement Act. It is an important part of ongoing efforts 
     to improve public health and prevent unnecessary vision loss.
           Sincerely,
     Howard J. Braverman, O.P.
                                  ____

                                The American Dietetic Association,


                                Chicago, IL, October 19, 2000.

     Hon. Bill Roth, Chairman,
     Hon. Daniel Patrick Moynihan,
     Senate Finance Committee, Washington, DC.
     Hon. Bill Archer, Chairman,
     Hon. Charles Rangel,
     House Ways and Means Committee, Washington, DC.
     Hon. Tom Bliley, Chairman,
     Hon. John Dingell,
     House Commerce Committee, Washington, DC.
     Hon. Bill Thomas, Chairman,
     Hon. Pete Stark,
     Health Subcommittee, House Ways and Means Committee, 
         Washington, DC.
     Hon. Mike Bilirakis, Chairman,
     Hon. Sherrod Brown,
     Health Subcommittee, House Commerce Committee, Washington, 
         DC.
       Dear Chairman and Ranking Members: The American Dietetic 
     Association is pleased to support the Medicare, Medicaid and 
     SCHIP Benefits Improvement Act of 2000 which provides 
     critical support to Medicare providers while enhancing 
     benefits for our nation's senior citizens. In particular, we 
     are pleased that the legislation includes coverage of medical 
     nutrition therapy for patients with diabetes and kidney 
     disease. We believe this is an important first step in 
     providing this critical service to all Medicare beneficiaries 
     and we urge enactment of this legislation.
       Nutrition therapy has been shown to be effective in the 
     management and treatment of many chronic conditions which 
     affect Medicare beneficiaries, including dyslipidemia, 
     hypertension, heart failure, diabetes and chronic renal 
     insufficiency. Medicare beneficiaries undergoing cancer 
     treatment may also benefit from nutrition therapy aimed at 
     controlling side effects or improving food intake. In fact, a 
     recent study, conducted by the National Academy of Sciences 
     Institute of Medicare and requested by Congress in the 
     Balanced Budget Act of 1997, concluded that medical nutrition 
     therapy--upon physician referral--should be a covered benefit 
     under the Medicare program.
       The 70,000 members of the American Dietetic Association 
     look forward to working with you to ensure that all Medicare 
     beneficiaries have access to medical nutrition therapy and, 
     as a result, see a significant improvement in their health 
     and quality of life.
           Sincerely,
                                       Jane V. White, PhD, RD, LDN
     President.
                                  ____

                                                 October 19, 2000.
     Hon. William V. Roth, Jr.,
     Senate Finance Committee, U.S. Senate,
     Washington, DC.
       Dear Chairman Roth: The American Association of Blood 
     Banks, America's Blood Center, and the American Red Cross 
     would like to express our support for the Medicare, Medicaid 
     and SCHIP Beneficiary Protection and Improvement Act of 2000. 
     We are pleased that Section 301 of the final conference 
     agreement contains both the House and Senate provisions 
     concerning blood and blood products. We would especially like 
     to thank you, Senator Hatch and Chairman Thomas for your 
     tremendous leadership on blood safety and reimbursement 
     concerns.
       The blood banking community believes the House provision 
     pertaining to blood is needed to ensure that the Health Care 
     Financing Administration accurately reflects the costs of 
     blood and blood products in the next revision of inpatient 
     reimbursement rates. The Senate provision is needed to ensure 
     that the current system will be able to account for future 
     blood safety costs in a timely manner.

[[Page H11227]]

     We are delighted that the final package contains both these 
     provisions. We strongly support Congressional enactment of 
     the legislation and urge the President to sign the bill into 
     law.
       Once again, we appreciate and commend your efforts to 
     address reimbursement for blood and blood products in 
     legislation this year. Your efforts will help ensure that 
     patients across the country have access to state-of-the-art 
     blood products and services and the safest possible blood 
     supply.
           Sincerely yours,
     American Association of Blood Banks,
     America's Blood Centers,
     American Red Cross.
                                  ____

                                                  Advanced Medical


                                       Technology Association,

                                 Washington, DC, October 20, 2000.
     Hon. Bill Thomas,
     Chairman, Ways and Means Subcommittee on Health, Washington, 
         DC.
       Dear Chairman Thomas: On behalf of the Advanced Medical 
     Technology Association (AdvaMed), its more than 800 member 
     companies, and the millions of Medicare patients whose lives 
     are saved and improved by our innovative medical tests and 
     treatments each year, I am writing to endorse the Medicare 
     Refinements legislation now before Congress. This bill takes 
     important, needed steps to strengthen the program and ensure 
     seniors' access to quality health care. We hope that the 
     President will sign it into law.
       The Medicare Refinements package will protect seniors' 
     access to important medical services and expand and establish 
     new preventive health benefits like screening for cervical 
     cancer, colorectal cancer, and glaucoma.
       Building on important first steps taken in the Balanced 
     Budget Refinement Act of 1999, the bill includes additional 
     changes to improve seniors' health by ensuring access to the 
     latest advances in medical technology. Key provisions in this 
     area will:
       Create new payment and coding mechanisms to improve access 
     to new hospital inpatient technologies;
       Establish special payment categories for innovative medical 
     devices under the new hospital outpatient payment system;
       Mandate special methods to pay for breakthrough diagnostic 
     tests and require Medicare to set clear, open procedures for 
     coding and payment decisions;
       Require Medicare to issue annual reports to Congress on how 
     long it takes to make coverage, coding, and payment 
     decisions; and
       Strengthen seniors' right to appeal a non-coverage decision 
     for a new medical technology.
       Once enacted, these provisions will ensure that all 
     seniors, regardless of where they seek medical treatment, 
     have access to the life-saving and life-enhancing 
     technologies and procures they need.
       It would be a disservice to the 39 million seniors and 
     people with disabilities who will benefit from your Medicare 
     bill if I did not bring to your attention now a separate 
     Medicare patient access issue. We just learned from HCFA on 
     October 18th that outpatient ``pass-through'' payments for 
     new medical technologies and medicines will be cut by 50% on 
     Jan. 1, 2001. The Agency is taking this action despite its 
     prior commitment in an April 7 regulation not to consider any 
     cuts until 2002.
       These severe and unexpected payment reductions could 
     significantly restrict patients' ability to receive 
     innovative treatments in this setting, forcing them to 
     receive more costly and time-consuming inpatient procedures. 
     The late hour at which HCFA disclosed these cuts and the 
     serious implications they hold for Medicare patient access to 
     medical technology compel me to raise the issue at this time. 
     We hope that you will encourage HCFA to administratively 
     delay these reductions until 2002 when the agency has had 
     time to gather more complete data.
       We greatly appreciate the sustained efforts you are making 
     to oversee the Medicare program and make sure it continues to 
     deliver essential health care services to seniors in the 21st 
     century. Your work will greatly benefit the millions of 
     seniors and people with disabilities who are covered by this 
     program in the years to come.
       Thank you for your leadership in this area. We 
     wholeheartedly support your efforts to ensure seniors get the 
     health care services they need and look forward to continuing 
     to work with you toward this goal.
           Sincerely,
     Pam Bailey.
                                  ____

                                               GE Medical Systems,


                                     General Electric Company,

                                  Milwaukee, WI, October 19, 2000.
     Hon. J. Dennis Hastert,
     Office of the Speaker of the House,
     Washington, DC.
     Hon. Trent Lott,
     Office of the Senate Majority Leader,
     Washington, DC.
       Dear Speaker Hastert and Majority Leader Lott: GE Medical 
     Systems strongly supports the Medicare Balanced Budget 
     Refinement Leadership Compromise Package that provides for 
     differential reimbursement for new technology associated with 
     screening mammography.
       GE Medical Systems--a global leader in medical diagnostic 
     equipment, services, and health care information management--
     is committed to ensuring that Medicare beneficiaries have 
     access to breast cancer screening using the latest advances 
     in medical technology. In partnership with the U.S. 
     government, we have invested significant resources in the 
     development of digital mammography technology that holds the 
     promise for dramatically improving patient outcomes through 
     early detection and diagnosis of breast cancer. The 
     compromise package provides for adjustment of Medicare 
     payment rates for screening mammography to reflect the costs 
     associated with new technology advances like digital 
     mammography.
       We welcome the opportunity to work with the leadership to 
     ensure that access to the benefits of digital mammography 
     technology is a reality for Medicare beneficiaries. Thank you 
     for your support of this important initiative.
           Sincerely,

     Jeff Immelt.
                                  ____


     To: The Honorable William J. Clinton, President.
     Date: October 19, 2000.
     Subject: Medicare Refinement Package.
       As a representative of Tenet Healthcare Corporation, I want 
     to inform you of our support for final passage of the 
     Medicare Refinement Package being advocated by Congress. 
     While we fully understand and agree with your position that 
     hospitals should get a fairer share of the restoration funds, 
     we fear any delay may impede final passage of any Medicare 
     restoration. As you are well aware, hospitals would suffer 
     severely from lower reimbursements that would result.
       For the last two years, many others and I have spent 
     significant time and effort in asking Congress to restore 
     funding reduced by the draconian cuts imposed in 1997. We 
     have demonstrated the short and long range negative effects 
     on the overall quality and stability of our industry as a 
     result of the cuts. We greatly fear that the health care 
     industry may not be capable to meet the needs of the public, 
     much less the increased demand of the baby boomer generation. 
     We have been able to convince a large number of members to 
     begin to restore funding both in 1999 and this year. While 
     the restorations are not significant compared to the cuts, 
     they are at least a move in the right direction.
       This year we had at least hoped to receive more than one 
     year of restoration, but settled in recent days for one year, 
     appreciative of the Medicare and Medicaid DSH increases and 
     the 70% bad debt allowances. We fear any last minute efforts 
     may deter the final package. As we said before, this would be 
     devastating. Therefore, while we appreciate your efforts to 
     provide hospitals a more equitable share of the restoration, 
     we ask you to assure passage of the bill this session.
       Thank you for your interest.
           Sincerely,
     Phyllis Landrieu.
                                  ____

                                           Association of Surgical


                                                Technologists,

                                  Englewood, CO, October 19, 2000.
     Hon. Denny Hastert,
     Speaker of the House,
     House of Representatives, Washington, DC.
     Hon. Trent Lott
     Majority Leader,
     U.S. Senate, Washington, DC.
       Dear Speaker Hastert and Majority Leader Lott: This letter 
     is written in support of the agreement you have reached on 
     Medicare and Medicaid refinement legislation. As you know, 
     this bill makes a number of important changes that will 
     greatly enhance the ability of hospitals to continue to 
     delivery high-quality, cost-effective health care.
       We are urging your colleagues in the House and Senate to 
     support your package of changes and we are also asking 
     President Clinton to support this package as well. We believe 
     it is extremely important that Congress and President Clinton 
     act on your proposal as quickly as possible.
       This legislation represents a major improvement in the 
     Medicare and Medicaid programs for both providers and 
     beneficiaries. Your hard work and dedication to improving 
     Medicaid is greatly appreciated.
           Sincerely,
                                        William Teutsch, CAE, CEO,
     Executive Director.
                                  ____

                                                 October 19, 2000.
     Hon. J. Dennis Hastert,
     Speaker, U.S. House of Representatives, Washington, DC.
       Dear Mr. Speaker: The National Orthotics Manufacturers 
     Association (NOMA) strongly supports the Medicare Refinement 
     legislation pending in Congress that includes important 
     provisions for the orthotic and prosthetic community. We are 
     hopeful that the President will join the health care 
     community and support this legislation.
       Specifically, we support those provisions that establish 
     standards for billing of prosthetics and a limited number of 
     custom-fabricated orthotics, which should help bring greater 
     fiscal integrity to the Medicare program and ensure that 
     beneficiaries receive the appropriate O&P items that their 
     physicians have ordered. As well, we applaud the equity of 
     allowing O&P to receive a full CPI update for the first time 
     in three years, since the limited updates granted since 1998 
     have not kept pace with inflation.
       For these reasons, we respectfully encourage your office to 
     ensure that these important provisions remain part of any 
     final Medicare bill that is sent to the President.
           Sincerely,

                                                        ------

                                             The National Orthotic
                                 Manufacturers Association (NOMA).

[[Page H11228]]

     
                                  ____
                                               American Orthotic &


                                       Prosthetic Association,

                                                 October 18, 2000.
     Hon. J. Dennis Hastert,
     Speaker, U.S. House of Representatives, Washington, DC.
       Dear Mr. Speaker: The American Orthotic and Prosthetic 
     Association (AOPA) strongly support the inclusion of certain 
     provisions in the pending Medicare package that is of great 
     interest to the O&P community.
       Speficially, we support those provisions that establish 
     standards for billing of prosthetics and custom orthotics, 
     which will bring great fiscal integrity to the Medicare 
     program. We believe the final payment language is a step in 
     the right direction toward guaranteeing that Medicare 
     beneficiaries receive the best care possible and the 
     appropriate O&P items that their physicians have ordered, as 
     well as implementing the recommendations of the HHS Office of 
     Inspector General and addressing the fraud and abuse of the 
     Medicare payment system.
       Also, we applaud the equity of allowing O&P to receive a 
     full CPT update for the first time in three years, since the 
     limited updates granted since 1998 have not kept pace with 
     inflation. Finally, we support all legislative efforts which 
     work toward improving the negative impact on the frail 
     disabled which has resulted from the Health Care Financing 
     Administration's (HCFA) issuance of Ruling 96-1, and we look 
     forward to the results of the study included in the bill.
       For these reasons, we respectfully encourage your office to 
     ensure that these important provisions remain part of any 
     final Medicare bill that is sent to the President.
       This is important legislation, and AOPA hopes the President 
     will sign it.
           Sincerely,

                                                        ------

                                      President, American Orthotic
     and Prosthetic Association.
                                  ____



                                                  UBS Warburg,

                                   New York, NY, October 19, 2000.
     Hon. J. Dennis Hastert,
     Speaker of the House of Representatives, Capitol Building, 
         Washington, DC.
       Dear Mr. Speaker: We appreciate your time and leadership to 
     date in structuring national Medicare benefit and spending 
     refinements. As always, we appreciate your willingness to 
     listen to our thoughts on Medicare. We cannot stress how 
     important the current leadership's Medicare and Medicaid 
     relief package proposal is to healthcare providers, and to 
     investors. We are concerned about the potential for the 
     Medicare relief package to be de-railed by politics. Such an 
     unfortunate scenario would, in our view, damage any private 
     sector (investor) faith in the Medicare system that has been 
     restored since the original Balanced Budget Act of 1997, if 
     such faith deteriorates again, we do not believe the private 
     sector will continue to meaningfully fund the healthcare 
     industry, the government would end up spending exponentially 
     more to provide care, and quality of care could be 
     jeopardized in the near-term.
       Medicare spending has been almost frozen over the last 
     three fiscal years, and that (along with intended and 
     unintended cuts) has taken its toll on the provider system. 
     According to MEDPAC, roughly 35% of all hospitals are losing 
     money on Medicare and another 31% are surviving with less 
     than a 2% profit margin. We estimate that 18% of all skilled 
     nursing beds are operating under Chapter 11 protection, and 
     that 10% of all home health and hospice agencies have closed 
     or exited the business over the past 18 months. To put this 
     in financial terms, roughly $60 to $80 billion of value 
     (equity and debt) has been lost--most of this by investors 
     and lenders.
       In short, we believe the very care of the healthcare 
     delivery system (a system that has historically relied on 
     private sector investment to meet its capital needs) is at 
     risk of losing this essential, primary funding source. It is 
     critical that the pending Congressional package of broad 
     Medicare and Medicaid benefit and spending refinements is 
     enacted before Congress adjourns. No legislation is perfect, 
     however, the current package is good and offers necessary 
     progress toward resuscitating healthcare providers and 
     establishing investor confidence in the sectors. We hope and 
     anticipate that next year's Congress will continue the 
     progress to date and address other structural Medicare 
     issues. But for now, please focus your efforts on passing the 
     existing package.
       We appreciate your leadership in restoring confidence and 
     solvency to healthcare delivery and your time in weighing our 
     views and recommendations. As always, we welcome any 
     opportunity to further discuss these issues with you and your 
     staffs.
           Sincerely,
     Howard G. Capek,
       Executive Director, U.S. Healthcare Services Research.
     Matthew J. Ripperger,
       Director, U.S. Healthcare Services Research.

  Mr. Speaker, let me just say this is not the best tax relief bill in 
the world. I think the best tax relief bill in the world would reduce 
taxes on everyone. But we have seemed to have got even ourselves in the 
habit of saying we want to give tax relief only to the right people, 
which is an incredibly arrogant position for us to find ourselves in, 
that we would pick and choose the people in America who are the right 
people for tax relief.
  For example, we have heard in campaigns this year that people who 
have photovoltaic cells in their roofs are the right people and they 
can get in line; people that drive hydroelectric cars are the right 
people, they can get in line; people with a child under 1 year of age 
can get in line for tax relief, provided that child is in a day care 
center approved by the government.
  We ought not be picking and choosing winners and losers. As 
representatives of all the American people, we ought to set policy 
everybody can succeed in, create opportunities for everyone to do well, 
and we ought not ever again be able to say we are only giving tax 
relief to the right people.
  I think this is a good start in helping small businesses, but it 
should go to everyone. We should have let people deduct insurance, 
medical insurance, whether they were a large corporation or small 
business, a long time ago. This is a step in the right direction to do 
that.
  Mr. Speaker, I strongly urge my colleagues to support the previous 
question, support the rule.
  Mr. LINDER. Mr. Speaker, I yield 2 minutes to the gentleman from Iowa 
(Mr. Leach).
  Mr. LEACH. Mr. Speaker, I thank the gentleman for yielding me this 
time, and I rise to alert the House that there is a provision in this 
statute that I think is of seminal significance for the small business 
community.
  Since 1933, there has been a prohibition in the banking industry on 
the capacity of banks to pay interest on demand deposits for business. 
In this bill is a repeal of that prohibition. For the first time small 
business in the United States will be allowed to receive interest on 
their checking accounts at depository institutions.
  It is a phased-in circumstance over several years, with, at the 
beginning, a concept called sweep accounts involved, and then a 
complete prohibition comes into play.
  But I would just simply alert the body that this provision is in this 
bill, and I would like to also express my deep appreciation of the 
leadership for allowing this very important banking bill to come under 
consideration at this particular time.
  Mr. RUSH. Mr. Speaker, I rise to vote against the rule on H.R. 2614, 
the Certified Development Program Improvements Act. On September 26, 
2000, the House Commerce Committee approved the Beneficiary Improvement 
Protection Act of 2000, H.R. 5291. This bill was the result of 
extensive bipartisan negotiations between committee Members. Both 
Republicans and Democrats sat down at the same table and worked through 
their differences to forge a bill which addressed the concerns of 
hospitals, HMOs, home health networks and other providers.
  Despite the differences of opinion amongst the various Members, we 
worked through our disagreements and passed a bill that had broad 
bipartisan support. I want to commend my colleagues on both sides of 
the Commerce Committee for their tireless efforts on that bill.
  However, instead of building on the bipartisan efforts of the 
Commerce Committee, the Republican majority chose to go its own way and 
start from scratch. One month after the Commerce Committee acted, 
Democrats have been waiting for the Republican majority to bring us 
into negotiations, to recognize our willingness to compromise and to 
extend us the same courtesy. Last Friday, we received a document that 
looked nothing like the bill forged by the bipartisan efforts of the 
Commerce Committee. Aggravating this situation, the Republican majority 
has made it clear that they are not interested in entering into true 
negotiations on their bill. Rather they have chosen to squander this 
opportunity by using the calendar to pressure Members into agreeing to 
a ``quick fix.'' Each day the majority places one or two provisions 
back into the bill in an attempt to pressure enough Members who would 
rather obtain some relief, than nothing at all.
  This approach is unacceptable. In Illinois, neither HMO's nor 
hospitals can wait another session for relief. This situation is not 
unique to Illinois, I know many of you are hearing daily from your 
seniors and health care providers who are pleading for relief. For the 
foregoing reasons, I must vote against this rule.
  Mr. LINDER. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.

[[Page H11229]]

  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. MOAKLEY. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  Pursuant to clause 9, rule XX, the Chair will reduce to 5 minutes the 
minimum time for any electronic vote on the question of agreeing to the 
resolution.
  The vote was taken by electronic device, and there were--yeas 209, 
nays 195, not voting 29, as follows:

                             [Roll No. 555]

                               YEAS--209

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bereuter
     Biggert
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Everett
     Ewing
     Fletcher
     Foley
     Fossella
     Fowler
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Green (WI)
     Greenwood
     Gutknecht
     Hansen
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones (NC)
     Kasich
     Kelly
     King (NY)
     Kingston
     Knollenberg
     Kolbe
     Kuykendall
     LaHood
     Largent
     Latham
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (OK)
     Manzullo
     Martinez
     McCrery
     McHugh
     McInnis
     McKeon
     Mica
     Miller (FL)
     Miller, Gary
     Moran (KS)
     Morella
     Myrick
     Nethercutt
     Northup
     Norwood
     Nussle
     Ose
     Oxley
     Paul
     Pease
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Regula
     Reynolds
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Sherwood
     Shimkus
     Shuster
     Simpson
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Sweeney
     Tancredo
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Upton
     Vitter
     Walden
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weller
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)
     Young (FL)

                               NAYS--195

     Abercrombie
     Allen
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bishop
     Blumenauer
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brown (FL)
     Brown (OH)
     Capps
     Capuano
     Cardin
     Carson
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Cummings
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Forbes
     Ford
     Frank (MA)
     Frost
     Gejdenson
     Gephardt
     Gonzalez
     Gordon
     Green (TX)
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Hooley
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     Kleczka
     Kucinich
     LaFalce
     Lampson
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Lucas (KY)
     Luther
     Maloney (CT)
     Maloney (NY)
     Markey
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (VA)
     Murtha
     Nadler
     Napolitano
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Peterson (MN)
     Phelps
     Pickett
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schakowsky
     Scott
     Serrano
     Sherman
     Shows
     Sisisky
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Stabenow
     Stark
     Stenholm
     Strickland
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thurman
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Waters
     Watt (NC)
     Wexler
     Weygand
     Wise
     Woolsey
     Wu
     Wynn

                             NOT VOTING--29

     Ackerman
     Blagojevich
     Brady (PA)
     Campbell
     Chenoweth-Hage
     Crowley
     Danner
     Engel
     Franks (NJ)
     Hoekstra
     Klink
     LaTourette
     Lazio
     McCollum
     McIntosh
     Metcalf
     Neal
     Ney
     Owens
     Packard
     Peterson (PA)
     Shays
     Spratt
     Stupak
     Talent
     Thompson (MS)
     Waxman
     Weiner
     Weldon (PA)

                              {time}  1258

  Mr. TIERNEY and Mr. KUCINICH changed their vote from ``yea'' to 
``nay.''
  Mr. McKEON changed his vote from ``nay'' to ``yea.''
  So the previous question was ordered.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore (Mr. Burr of North Carolina). The question is 
on the resolution.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. MOAKLEY. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 207, 
noes 200, not voting 26, as follows:

                             [Roll No. 556]

                               AYES--207

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bereuter
     Biggert
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Everett
     Ewing
     Fletcher
     Foley
     Fossella
     Fowler
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Green (WI)
     Greenwood
     Gutknecht
     Hansen
     Hastert
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones (NC)
     Kasich
     Kelly
     Kingston
     Knollenberg
     Kolbe
     Kuykendall
     LaHood
     Largent
     Latham
     Leach
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (OK)
     Manzullo
     Martinez
     McCrery
     McInnis
     McKeon
     Mica
     Miller (FL)
     Miller, Gary
     Moran (KS)
     Morella
     Myrick
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Ose
     Oxley
     Paul
     Pease
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Regula
     Reynolds
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simpson
     Skeen
     Smith (MI)
     Smith (TX)
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Sweeney
     Tancredo
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Upton
     Vitter
     Walden
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weller
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Young (AK)
     Young (FL)

                               NOES--200

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bishop
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brown (FL)
     Brown (OH)
     Capps
     Capuano
     Cardin
     Carson
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello

[[Page H11230]]


     Coyne
     Cramer
     Cummings
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Forbes
     Ford
     Frank (MA)
     Frost
     Gejdenson
     Gephardt
     Gonzalez
     Gordon
     Green (TX)
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Hooley
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Kucinich
     LaFalce
     Lampson
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Lucas (KY)
     Luther
     Maloney (CT)
     Maloney (NY)
     Markey
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHugh
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (VA)
     Murtha
     Nadler
     Napolitano
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Peterson (MN)
     Phelps
     Pickett
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schakowsky
     Scott
     Serrano
     Sherman
     Shows
     Sisisky
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Stabenow
     Stark
     Stenholm
     Strickland
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thurman
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Waters
     Watt (NC)
     Weiner
     Wexler
     Weygand
     Woolsey
     Wu
     Wynn

                             NOT VOTING--26

     Blagojevich
     Brady (PA)
     Campbell
     Chenoweth-Hage
     Crowley
     Danner
     Engel
     Franks (NJ)
     Hoekstra
     Klink
     LaTourette
     Lazio
     Lewis (CA)
     McCollum
     McIntosh
     Metcalf
     Neal
     Owens
     Packard
     Peterson (PA)
     Spratt
     Stupak
     Talent
     Thompson (MS)
     Waxman
     Weldon (PA)

                              {time}  1309

  Mr. HORN changed his vote from ``no'' to ``aye.''
  So the resolution was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________