[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.
____________________