[Congressional Record Volume 146, Number 137 (Friday, October 27, 2000)]
[House]
[Pages H11435-H11442]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE: THE UNFINISHED AGENDA
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is
recognized for 60 minutes.
Mr. PALLONE. Mr. Speaker, this evening I would like to take to the
well again and talk about health care issues, because I do believe that
when we talk about health care issues, that this is really the
unfinished agenda that this Republican Congress has not addressed.
Of course, there is still time. We are still here. We are here over
the weekend, are probably going to be here a good part of next week.
There was an effort yesterday when the tax bill was brought up by the
Republican leadership, to suggest that somehow some of the health care
issues were being addressed in some minor way.
Mr. Speaker, what I wanted to begin tonight was talk about how that
bill really does not accomplish anything significant to help the
average American with the health care problems that they face and with
the hospitals and the nursing homes and the home health agencies that
are trying to provide quality health care.
Then after that, I would like to get into the three major issues that
most of my constituents and most Americans talk to Members of Congress
about, and that is trying to reform HMOs, trying to provide a
prescription
[[Page H11436]]
drug benefit for seniors, and trying to deal with the 42 million
Americans who now have no health insurance.
Let me start with this tax bill that was voted on and that the
Republican leadership brought up, because they suggested, I think
inaccurately, that what they were trying to accomplish was to deal with
some of the problems that occurred with the Balanced Budget Act which
was passed a few years ago which cut back significantly on the money
that was going to hospitals, to home health care agencies, to nursing
homes, and to HMOs, and that the reimbursement rate from the Federal
Government, from Medicare, Medicaid, and some of the other Federal
programs that provide funding to these facilities or to these programs
that provide health care services, needed to be readdressed. That there
was too little of a reimbursement rate under Medicare and Medicaid and
that more money needed to go back to these programs or facilities if
they were going to provide a quality health care.
The problem, though, was that in making these adjustments in this tax
bill, the Republican leadership essentially gave most of the money to
HMOs in a fashion that I find totally objectionable, because the HMOs
were not only getting huge amounts of money back from the Federal
Government, but were really not caused to do anything for the average
American in order to receive those funds.
I said today in a press conference that we had outside on the lawn of
the Capitol with some of my Democratic colleagues that the reason this
was happening, the reason why the tax bill was so favorable to the
HMOs, is because basically the Republican leadership has bought into
the HMOs and the special interests that are associated with the HMOs
and supports them because of the special interest funding that is made
available.
{time} 1800
What we see the HMOs doing is that the HMOs are leading the battle
against the Medicare prescription drug benefit and leading the battle
against HMO reform.
The Democrats and some Republicans have tried to pass a bill called
the Patients' Bill of Rights. We know it as the Norwood-Dingell bill.
It is bipartisan, but it is opposed by the Republican leadership. The
Norwood-Dingell bill would make significant reforms to address the
abuses of the HMOs. But the HMOs are fighting that tooth and nail as
well as the prescription drug benefit.
So I think that basically what happened here is the Republican
leadership sides with the HMOs because they are basically against the
Medicare prescription drug benefit and against the Patients' Bill of
Rights.
We also see that the HMOs are spending a lot of money funding
negative ads against those individuals, Democrats and against some
Republicans who support the Patients' Bill of Rights, who support HMO
reform, who support having a prescription drug benefit under Medicare.
So this is the sort of unholy alliance here that manifested itself
yesterday with this tax bill to give more money back to the HMOs.
Now, let me talk a little bit about this bill because I just want to
show how unfair it was and how little it would accomplish in terms of
addressing the health care needs that Americans face today.
First of all, and just to give my colleagues some figures about the
amount of money that was going to the HMOs, the Republican plan, this
tax bill, increases payments to Medicare HMOs by over $10 billion over
5 years and over $30 billion over 10 years, despite the fact that only
16 percent of Medicare beneficiaries are enrolled in HMOs right now.
We know that what the HMOs have been doing is they have been dropping
senior citizens left and right. As of July 1, I think there are over
700,000 seniors across the country that have been dropped by HMOs to
provide their Medicare benefits over the last few years. So a lot of
these HMOs got into the Medicare program, and then they dropped the
seniors.
Yet, over one-third of the allocation in this tax bill, over one-
third of the allocation for health care, that goes back to health care
providers, goes to HMOs. Only 16 percent of Medicare beneficiaries are
enrolled in HMOs. My colleagues get some idea there of the inequity
here.
Now, in addition to that, we know that a lot of these HMOs have
dropped out of Medicare, so one might say to oneself, well, if they are
making an argument they need more money to stay in Medicare, then why,
when we give them this windfall, these billions of dollars, this 30
percent of this overall budget, then why do we not require that they
come back into Medicare and provide certain benefits?
Well, that makes sense. But that is not what the Republican
leadership did. There was no guarantee that these HMO plans will not
drop out of communities or Medicare altogether when it is no longer in
their interest to remain, as many of them have. There is no guarantee
that they will put new money towards maintaining benefits rather than
shoring up their bottom line.
So we could have said, okay, we will give HMOs all this money in the
tax bill, but they have to sign a contract saying they are going to
stay in Medicare for 2 years or 3 years or even 1 year.
We could have said, okay, we will give them this money, but they have
to make sure that they provide at least a level of benefits and
prescription drugs for these 16 percent of seniors that are on Medicare
that they are providing now.
But we do not have that in the bill, nothing like that. Just give
them the money, and that is fine. They can continue to drop out of the
program if they want to. It is blatantly unfair. It is just basically
pandering to special interests.
Now, let me go beyond that to the next issue. Why is it that so much
of this money is going to HMOs again when so few seniors are in HMOs
that are in Medicare? We know that we have greater needs in a lot of
other areas.
The hospitals do not get that much. Hospitals, many have closed. I
had one in my district in South Amboy that closed within the last year
or so. Nursing homes. Many nursing homes are bankrupt. I visited with
some. I went to a nursing home last week, one of the days, and talked
to some of the residents. I found out from the operators that there
are, I do not know what the percentage is, but a significant percentage
of the nursing homes in the State of New Jersey are now bankrupt, and
some of them are closing. Home health care agencies, very little money
under this tax bill. These are the providers.
Remember, the HMO is an insurance company. They are getting this
money now from this windfall from this Republican tax bill, and they
are going to go out and they are going to pay the hospitals or they are
going to pay the nursing homes or they are going to pay the providers
of health care services. They are not providing the services.
But, yet, we shortchange the providers. We do not give the money to
the hospitals, some of which are closing. We do not give the money to
the nursing homes, some of which are closing. We do not give the money
to the home health care providers who are directly providing services.
It makes no sense. It makes no sense at all unless one looks at it
from the point of view that the HMOs are special interests that are
doing the Republican leadership a favor and that are railing against
HMO reform and a Medicare prescription drug benefit.
Now, let me go to the last thing, then I am going to get off the
issue of this tax bill, but I do think it is important; and that is
that the Republican leadership said, well, one of the things we are
going to do in this tax bill is we are going to try to address the
problems of the uninsured by giving what we call an above-line
deduction for health insurance, a tax deduction.
Okay. Well, we know that there are 42 million or so Americans now
that do not have health insurance. Now, these are working people
because, if one is really poor and one is not working, one is eligible
for Medicaid, and the Federal Government pays for one's health
insurance.
But if one is in a low-income bracket but one is working, or even
middle-income bracket, it depends, and one is working, a lot of times
one's employer will not provide one with health insurance because maybe
it is costing him too much, or whatever the reason, and one has to go
and try to buy one's
[[Page H11437]]
health insurance on the private market, or maybe the employer has some
kind of a plan, but it is very expensive. Whatever the reasons, these
42 million people are pretty much working people that do not have
health insurance on the job or cannot afford to buy it in the private
market.
So what the Democrats have been saying, what Vice President Gore and
President Clinton have been saying, let us gradually try to address
some of the groups that make up this uninsured. We know the largest
group is the children. We know the second largest group is near elderly
people, between 55 and 65, that are not eligible for Medicare yet.
These are some of the groups.
What the Democrats have been doing, and we actually did get the
support of the Republicans eventually, we had to drag them along on
this, but we eventually did get the support of the Republicans to pass
a kids health initiative a couple years ago that gradually has been
getting to the point where we think about half of the children that are
uninsured will have some sort of insurance with money paid for by the
Federal Government.
Well, what Vice President Gore has been saying is that he wants to
increase the income eligibility so that, right now, if one is, say, 200
percent of poverty and one is eligible for this kids care program, we
will raise it to 250 percent of poverty or 300 percent of poverty and
try to get more of these lower middle class people who are working and
their kids into this CHIP or kids care program.
Well, we found, of course, that the Republican leadership does not
want to do that. That would have been the logical thing to do in this
tax bill would be to expand eligibility for the kid care program.
Or another thing that we could have done, and this is another thing
that Vice President Gore has proposed and the Democrats here in the
House, is to enroll the parents of those kids in the health insurance
program, because we know that those parents, if they cannot get health
insurance for the kids other than through the Federal Government, they
are not able to get it for themselves.
In this tax bill, we could have put a provision there for the near
elderly. What the Democrats have been saying is they would like to see
the people between 55 and 65 be able to buy into Medicare. At their own
expense, they would buy into Medicare.
But, no, the Republican leadership does not want to do any of those
things. This is what they said. They said, we are going to give you an
above-line tax deduction.
I am not going to get into all the details of that, but basically
that has two problems. First of all, very few of the people who are now
without health insurance, who are sort of lower middle class category,
very few of them will be able to take advantage of this deduction and
go out and buy health insurance, first of all, because most of them do
not have incomes where that deduction is significant enough to be able
to use it to buy a health insurance policy which in the private market
may be $3,000 to $4,000 a year.
Secondly, what we find with this above-line deduction is that it
creates a disincentive for employers to provide health insurance. As a
consequence, a lot more employers may decide not to provide health
insurance and, instead, actually increase the ranks of the uninsured.
The only people that really are able to take advantage of this are
people that already have health insurance that are making a decent
income and can take advantage of the deduction.
But if one is trying to increase the number of insured people and
take the uninsured off the rolls, this accomplishes virtually nothing.
It just helps people who are in a higher income bracket and who already
have health insurance.
Again, it sounds so critical. The Republican leadership brought up
this bill yesterday, or the day before when they brought it out here;
and they said, we are going to try to do all these things. We want to
address some of the health care concerns of the American public with
this bill.
But whether it is the question of the uninsured, it is ineffective.
Whether it is the question of addressing the prescription drug prices,
it is ineffective, because it does not provide any guarantees one is
going to get prescription drugs under any kind of HMO plan. Certainly
it does not even address the effort to reform the HMOs with the
Patients' Bill of Rights that the Democrats have been talking about.
So I just want to say, once again, we see the Republican leadership
aligned with the special interests, the drug companies, the HMOs, the
health insurance companies, not doing anything that is going to help
the average American.
Now, I wanted to talk a little bit, because I think it is important,
I mentioned before earlier that there are three major health care
issues that are not being addressed by this Congress. We only have a
few more days. Every one of these issues could have been addressed and
could have come to the floor. The Democrats have been pushing for them,
for these issues, and for legislation to address these concerns to come
to the floor. It appears in the dying days of this Congress that these
issues are simply not going to be addressed. They should be. It is not
fair. It does not address the concerns of the average American.
Now, the first one I want to talk about is the Patients' Bill of
Rights, HMO reform. We know from our own constituents, I can certainly
say for my constituents, that one of the biggest problems people face
is, if they are in an HMO, oftentimes they are denied access to the
care that they need, that their physician says that they need.
Now, that may be the individual who goes to the hospital and finds
that the doctor says to them that they need to stay a couple extra days
in the hospital after recuperating from a particular operation. Or it
may be the individual who has the need for a particular operation, and
the HMO says they are not going to pay for it, they are not going to
cover it.
There are so many situations. There are situations where people,
their HMO plans say that they cannot go to the local hospital, they
have to go to a hospital 50 miles away. They may be in a situation
where they want to go to the local emergency room, and they have to go
to the one 50 miles away; otherwise, it is not covered.
These are the kinds of abuses that we see, not every day, but on a
fairly regular basis. A lot of people come to my office and complain
about these things.
Now, what the Democrats said is, well, we want to address these
abuses. Generally, the plan that the Democrats put forth, with some
Republicans, the Patients' Bill of Rights, the Norwood-Dingell bill,
has two major ways of correcting the abuses in sort of an overall
sense.
One is that it provides that, if a decision has to be made about what
kind of care one is going to get, that that decision, rather than being
made by the insurance company, is made by the physician and the
patient. The definition, if you will, of what is medically necessary,
the hospital stay, the particular operation, of what is medically
necessary is made by the physician and the patient, and not by the
insurance company.
The second thing it does in a broad sense is the Patients' Bill of
Rights says that, if one is denied care because the insurance company
says one cannot have that operation, for example, then one has to have
an ability to redress that grievance.
The Patients' Bill of Rights does it in essentially two ways. One, it
says that one can go to a board outside the jurisdiction or outside of
the umbrella of the HMO, an independent review board that will look at
the case and decide whether the HMO made the wrong decision in denying
one that care. Absent that or sort of an appeal from the review board
is that one can go to court and one can bring suit. These are really
very simple things.
Basically what happened here is that the Democratic leadership, the
Vice President, the President got together, and we were able to get
some Republicans on the other side, initiated by Republicans that were
physicians, the gentleman from Georgia (Mr. Norwood), the gentleman
from Iowa (Mr. Ganske) and some others, to join us and put together the
Patients' Bill of Rights, the Norwood-Dingell bill.
The Republican leadership opposed it. The Republican leadership did
not want to bring it to the floor. We went out and got a discharge
petition, which is a way of coming up to the well here
[[Page H11438]]
and getting almost a majority of the Members to sign a petition saying
we want it brought to the floor.
The Republican leadership eventually brought it to the floor. It
passed with almost every Democrat and maybe a third of the Republicans.
It went over to the Senate where it was killed by the Senators who will
not even let it come out of conference between the two Houses.
But, again, this is an important piece of legislation, just as
important as a prescription drug benefit under Medicare, just as
important as trying to address the problems of the uninsured; and we
find that the Republican leadership in this House of Representatives
simply will not let any of these good measures move forward.
{time} 1815
They have stopped them, and they are still stopping them in the
waning hours of this Congress.
I see I have been joined this evening by two of my colleagues who
have been out front on all of these issues over the last 2 years, and
even beyond that, and I am very pleased to see them here.
I will first yield to my colleague from Texas (Mr. Turner), who has
done so many things, but I think probably the best example I saw was
the period of time in his district where he spoke to the different
senior groups and had them bring in their prescription drugs and tell
him about the problems that they faced with prescription drugs, and
actually brought the pill bottles down here, and suggested the rest of
us do the same, and we very dramatically showed, along with the
gentleman from Texas, about what kind of problems the average senior
faces in Texas and in all of our districts.
So I yield to the gentleman from Texas at this point.
Mr. TURNER. It is good to join my colleague here on the floor tonight
to talk about the important issues that are still pending before this
Congress that have not been acted upon.
Here we are, very near the end of this session of Congress, and still
we have been unable to see the patient's bill of rights put into law,
which is so very essential to all Americans to ensure that they are
able to make their medical decisions with the consultation of their
doctors and not have that interfered with by the insurance company
clerks that work for the HMOs. I think it is way pastime for Congress
to act on this very, very critical issue.
I had the opportunity when I was in the Texas legislature in 1995 to
carry the first patient's bill of rights. It passed overwhelmingly in
the legislature, had only 4 no votes, as I recall, out of 31 members of
the State Senate. It passed by voice vote in the House.
We recognized early on, as many States did, that we needed patient
protection to be sure that doctors and not insurance companies are
making medical decisions affecting our lives and our health.
Unfortunately, in 1995, our governor, Governor Bush, vetoed that bill.
We were at the end of the session and had no opportunity to override,
which we certainly would have done had time not run out on the session.
But we did see the legislature in 1997 come back and pass similar
legislation. And part of that the governor signed, and another part,
relating to accountability, he let become law without putting his
signature on the bill.
In any event, we found ourselves in a position, after many States
adopted patient protection legislation, of seeing lawsuits arise, filed
by the big insurance companies and the HMOs, alleging they should not
have to be bound by these State protections that many legislatures
adopted, simply because, they said, they were multi-State plans and
covered by Federal law, which preempted all State regulations. So that
is why in this Congress many of us have united together to try to
provide protection for all patients, whether they are covered under a
State plan or whether they are covered under a multi-State plan that
does not have any regulation or patient protection unless we in the
Congress pass a Federal law to protect patients.
Thus far, as the gentleman has pointed out so clearly, even though we
have passed a good strong, bipartisan bill in this House, the Senate
watered it down, and that bill is stuck in conference committee because
the majority, who passed that bill in this House, were not appointed to
that conference committee. That bill has never been moved forward. I
think that is a great disservice to the people of this country, and I
am hopeful that we can see action soon on a good strong patient's bill
of rights.
I also believe it is a failure of this Congress not to deal with the
problem of prescription drug coverage for our seniors under Medicare. I
was looking at a Texas paper the other day, the Dallas Morning News,
that had a long article talking about the problems that our senior
citizens have faced with affording prescription drugs. This article is
entitled ``A Dose of Reality.'' It tells the stories of three seniors.
Their stories are like the many that I have heard in my district over
the past 2 and 3 years, since we have been working to try to get some
action out of this Congress on this issue.
Those stories, over and over again, tell about seniors who are taking
six, eight, twelve prescriptions a month and are having to make the
difficult choice of do they fill their prescription or do they buy
their food or pay for their utilities or pay the rent. And in a country
as prosperous as we are and as compassionate as we would like to say we
are, one would think that we could provide a prescription drug benefit
under Medicare to allow all of our seniors to be able to afford their
prescription medicines.
I am hopeful that this Congress will act on this issue before we
adjourn, because I think it is a sign of a true failure of this
Congress if we fail to provide our seniors some help on prescription
drugs. The gentleman from New Jersey and the gentleman from Maine (Mr.
Allen), who is here with us tonight, have all worked diligently on this
problem. There is no reason in a country like ours to think that our
citizens have to pay prescription drug prices that are twice as high as
anyone else in the world pays.
I think, frankly, when it comes right down to it, the inaction of
this Congress can be traced straight to the influence of the big drug
manufacturers over some in leadership in this Congress. Because the
truth of the matter is, the drug companies have spent millions of
dollars trying to defeat our efforts to put a prescription drug benefit
under Medicare. And it is easy to understand, because they know that if
we ever have a prescription drug benefit under Medicare, the government
is not going to pay the same high prices that a senior is having to pay
today when they walk in a local retail pharmacy. They will not pay
those kind of prices. The big drug companies have it their way now and
they do not want to give it up.
I was very proud when the Vice President made as a part of his agenda
a prescription drug benefit under Medicare to provide affordable
prescription drug coverage for seniors. The truth is we cannot wait
another 4 or 5 years to provide that kind of coverage. And this idea
that Governor Bush has espoused of giving a little money to the States
to just take care of the low-income seniors, that is only half a loaf.
The truth is, whether or not an individual is low-income or not does
not determine whether or not they are having a hard time paying for
their prescription medicines. It is how sick an individual is as well
as how big their pocketbook is.
I guaranty my colleagues there are many middle-income seniors in this
country today that have high prescription drug costs, and they cannot
afford them. Even though they may be classified as middle income
seniors, they simply cannot afford those six and eight and twelve
prescriptions they are having to fill every month. Those people also
need help.
And if we all believe in Medicare, and everybody around here seems to
say they believe in it, then there is certainly nothing wrong with
bringing it up to the 21st century to be sure that it covers
prescription drug costs. I think, frankly, when President Lyndon
Johnson, from my State of Texas, signed Medicare into law in 1965, it
would have had a prescription drug benefit if prescription drugs had
been as large a portion of our health care costs as they are today.
So these are the items that this Congress has failed to deal with,
and I am proud to be among those on this floor tonight who have worked
hard to try to bring this kind of prescription drug coverage and this
kind of legislation to
[[Page H11439]]
protect patients enrolled in managed care, because the American people
want it. And I do not think they understand the influence of the
insurance industry and the drug industry that is keeping us from being
able to get a majority of this Congress to support this legislation.
So we are here tonight to sound the call for action once again, and I
am proud to join with the gentleman.
Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Texas. I
think that when he talks about the substance of all this, and obviously
that is crucial and that is why we are here tonight, but more than
anybody else the gentleman has brought home to us, with the things he
has done in his district, about how this is really something that
affects the average person, and that our constituents are suffering,
that our seniors are having problems getting prescription drugs because
of the price and because of the price discrimination.
We are not just talking about something that is pie in the sky. This
is something that is real for the average citizen.
I will now yield to my other colleague, the gentleman from Maine (Mr.
Allen), and just point out that he, probably more than anybody else,
has brought out this whole issue of price discrimination, not only
between different Americans but even by comparison to prices abroad. So
I yield to the gentleman.
Mr. ALLEN. I thank the gentleman for yielding to me and for his
leadership on this issue, along with the gentleman from Texas (Mr.
Turner). We have been going at this now for over 2 years.
It is interesting to watch in the public and in the debate in this
chamber how the issue has taken form. It now has gotten so fuzed up, so
complicated that we cannot blame people for having a tough time
figuring what is going on, when under the surface it is actually very
simple.
Seniors pay the highest prescription drug prices in the world, and
the adversaries, the people who are trying to keep them paying the
highest prices in the world, is the pharmaceutical industry. The
gentleman was talking a moment ago about the special interests. Because
of the law that this Congress passed dealing with so-called section 527
organizations, we now have information that we did not have before.
This group called Citizens for Better Medicare is a group that has been
out there running ads now for about a year and a half now around the
country. It is a wonderful name, is it not, Citizens for Better
Medicare? The trouble is they are not citizens, it is the
pharmaceutical industry, and they are not for better Medicare because
they do not want Medicare to provide a prescription drug benefit. They
want insurance companies and HMOs to provide that benefit.
But we just have a report filed with the FED from Citizens for Better
Medicare which shows that between July 1 of this year and September 30
of this year they spent $8.5 million running TV ads around the country.
And if my colleagues look at what those TV ads are trying to do, they
are trying to make black white and white black. What they are really
doing is saying that the people who have been fighting for a Medicare
prescription drug benefit are terrible and are not for seniors, and the
people who have been fighting against a Medicare prescription drug
benefit for seniors are heroes.
If we look at the legislation that we have been working on, the bill
that I introduced, that the gentleman from Texas (Mr. Turner) has
worked on, that the gentleman from New Jersey (Mr. Pallone) has been an
advocate for for a long time, it is very simple, Prescription Drug
Fairness for Seniors Act, that bill does not have any significant cost
to the Federal Government. No new bureaucracy. Yet we have 152
cosponsors and not one Republican. Not one Republican will stand up and
support giving a discount to Medicare beneficiaries so they can get the
advantage of the best price to the Federal Government. Not one
Republican is willing to stand up and support that approach.
When we turn to the Medicare prescription drug benefit, which is
where the government would help to pay for part of, not all but 50
percent of the initial cost of prescription drug prices for seniors, my
recollection is that we do not have one single Republican on that bill;
am I right?
Mr. PALLONE. That is true, we do not.
Mr. ALLEN. Yet if we listen to the debates, George W. Bush said
during the debates that he wanted to do a Medicare prescription drug
benefit. Three months ago there was no plan from the Republican nominee
George W. Bush. He did not have a plan for prescription drugs. Now he
has one.
He adopted it based on what the Republicans in this chamber did. And
what was that? That was a plan that the pharmaceutical industry loves,
and only the pharmaceutical industry could love, because it was a plan
that provided government subsidies to insurance companies so that they
could provide private sector health insurance to cover prescription
drugs.
Little detail. Small problem. The health insurance industry has said
loudly and clearly and repeatedly, we will not provide stand-alone
prescription drug coverage for seniors. So who is the prescription for?
The answer: It is for Republican candidates.
{time} 1830
Get them past November 7 and then we will deal with it. But by then
it will be too late to deal with seniors to give them what they really
need. They keep coming back. The way to do this is real simple. Follow
the money. Follow the money. And the special interest money from the
pharmaceutical industry through Citizens for Better Medicare, through
the U.S. Chamber of Commerce, through other business groups is not
reliable.
Basically, we have been fighting for seniors to get them lower prices
and coverage for prescription drugs for 2 years with no help from
Republicans on the other side of the aisle. And now the effort is, of
course, by the pharmaceutical industry, they can spend enough money on
confusing television ads maybe. Maybe they can confuse the American
people enough as to who is really on their side to get them through
November 7.
Mr. PALLONE. Mr. Speaker, I want to develop what my colleague said a
little bit if I can maybe go back and forth a little here because I
think it is so true and so important.
First of all, with regard to this special interest money, I wanted to
say and I have said many other times on the floor that I was a victim
of this 2 years ago in 1998 when I was running for election. At the
time, of course, I was an advocate for HMO reform and I was an advocate
for the health care agenda that we have talked about here tonight. And
as a consequence, a group was formed and at that point they did not
have any disclosures, which the gentleman is pointing out now about how
they have to disclose and he has those documents from the FEC was not
true before.
Basically, a group was formed to do an independent expenditure
against me that was primarily financed by the health insurance
industry, by the HMOs and by the pharmaceuticals. And they spent about
$5 million in these independent ads, about $3 million on New York TV,
which is the most expensive market in the country.
And of course, even though they were financing it, they did not talk
about the health care issues. I do not even remember what they talked
about. I think it was that I was raising taxes or something unrelated,
if you will, to the health care issues. I had to bring out the fact
that this money was coming from the health care industry, from the
pharmaceutical industry, and why they were doing it because I was
supporting HMO reform and supporting a prescription drug benefit and
supporting the things that we talked about this evening.
No disclosure. Corporate money, what we call soft money, not the
individual kind of contributions. If people want to contribute to us,
they have to make an individual contribution, they have to disclose it.
The maximum is a thousand dollars. This was all corporate. This was
hundreds of thousands of dollars adding up to $5 million.
This goes on all the time. I mean, I still think that even with the
disclosure that the gentleman is talking about there is still a lot
ways to get around this under current law.
Mr. ALLEN. Mr. Speaker, let us turn just for a moment to another
special interest, the HMO industry.
[[Page H11440]]
This is a report done by the General Accounting Office that came out
in August of this year, August 2000. The title is ``Medicare+Choice.''
That is the managed care plan. That refers to managed care plans that
operate within the Medicare system. This was an approach to get HMOs
into Medicare that the Republicans pushed very hard in 1997. It was
incorporated into the Balanced Budget Act. I think a lot of us hoped
that it might work, that it might drive down costs.
But what this GAO study says, the title is ``Payments Exceed Cost of
Fee-for-Service Benefits Adding Billions to Spending.''
This report concludes that although HMOs were allowed to come into
Medicare on the theory that it would help reduce costs and expand
benefits, it turns out that what has happened is the costs are higher
for Medicare+Choice, for managed care and Medicare, than they are for
the traditional fee-for-service benefit, the way Medicare has operated.
So at this point you have to say what is the purpose of having HMOs
operate under Medicare.
Now, look at what we did just yesterday. Just yesterday, the
Republican majority brought to the floor of this House a tax relief
bill which had attached to it a whole array of different things, but
one of the things was what we have been calling in Medicare a BBA give-
back, a Balanced Budget Act give-back.
Why was that brought to the floor? A lot of us had supported an
earlier bipartisan version. Because when we go back to our districts,
we hear from our hospitals, we hear from our home health care agencies,
we hear from our long-term care agencies that what happened in 1997 was
too severe, the cuts have been too great, there has got to be some
restoration or we are going to find hospice programs, hospitals,
nursing homes, and home health care agencies simply going out of
business.
So the bill that comes to the floor yesterday is a bill that gives
$11 billion back not to hospitals and the other providers but to the
HMOs over the first 5 years and $34 billion to the HMOs over 10 years.
Now, what good does this do? Absolutely none. It does no good,
because the money just goes to the HMOs. There is no accountability.
There is no requirement that an HMO stay in a particular State, that it
serve people it is serving now, that it serve people that it is not
serving now. It is simply funneling money to an HMO industry, which
just coincidentally gave $4.8 million to the to the Republican party
and its candidates in 1999 through June of this year.
Now, we have to be suspicious. When we have our providers, the
hospitals and others saying we have to have some restoration of these
funds, when we have a bipartisan group working on a plan and it is
moving along well, and then at the last minute that bipartisan plan is
yanked and we get something that puts 40 to 47 percent of the benefit
of that give-back straight to the HMO industry, we have really got to
wonder.
The truth is this is again another case of whose side are they on.
They can be on the side of seniors and can they help their providers,
but they cannot do that and also be funneling money to the HMOs.
Mr. TURNER. Mr. Speaker, I just want to tell the gentleman that I
think the medical providers and the hospitals across this country have
figured out what was wrong with that bill that the Republican majority
passed on the floor of this House the other day.
I have got a letter here in my hand that came in just a couple of
days ago. This is from a hospital administrator in my district, George
Miller. George is a real fine administrator of Christus Jasper Memorial
Hospital down in Jasper, Texas, in my district. Here is what he writes
me.
He says, ``We are extremely concerned because, in the present
language in the bill,'' referring to the one that was passed yesterday,
``it provides one-third to one-half of the Balanced Budget Act
relief,'' that is the money, one-half to one-third of the money, ``over
10 years would go to HMOs, leaving less for providers and beneficiaries
in East Texas, such as Christus Jasper Memorial Hospital.''
Further, he writes, ``The bill does not prohibit HMOs from dropping
benefits or leaving the community, as they have done here in Texas and
left many of our patients without HMO coverage. We need your help.''
This is from my hospital administrator in my district in Jasper.
I want to tell my colleagues, I have had town meetings in my district
during the August break and I went around to talk about the problem of
prescription drug coverage for seniors, and what I was confronted with
was seniors who were angry because they had just received their letter
of cancellation from their HMO, seniors that had signed up for Medicare
Choice HMO plans solely because the HMOs said, we will put on a
little prescription drug coverage for you if will you go with us and
get off traditional Medicare.
As long as we cannot get this Congress to approve a prescription drug
benefit under Medicare, those HMOs have a real strong leverage to
appeal to those seniors. That is another reason we are having a hard
time putting a prescription drug benefit under Medicare is because not
only do the drug companies oppose it because they are afraid they
cannot charge the same high prices to the Government as they are doing
to our seniors, but the insurance industry knows that they are sunk if
we put a prescription drug benefit under Medicare because they have
been selling seniors HMO Medi-
care+Choice plans with the benefit of some prescription drug coverage
and if they lose that advantage, our seniors are going back to regular
Medicare.
And why are we promoting seniors going into HMO Medicare+Choice plan,
whether, as the gentleman from Maine (Mr. Allen) pointed outside, the
General Accounting Office, the bipartisan agency that advises this
Congress, tells us that Congress is already spending more money
allowing seniors to be enrolled in HMOs than they would if we just let
them be in regular Medicare.
So we have got an issue before this Congress right now, and I am
confident the President is going to veto that bill when it ever reaches
his desk. Because the truth of the matter is I have got hospitals in my
district that are about to close because we have not provided enough
money to them under the Medicare reimbursement plan.
I just do not think it is right to be lining the pockets of the
insurance companies by increasing dramatically almost half of the money
going into Medicare is going to these HMOs to allow them to increase
the bottom line profit for them while I have got hospitals in rural
East Texas that are going to close because we are not putting the money
into the Medicare program that will reimburse them for their services.
Instead, this Congress wants to give it to the big insurance
companies. That is just not right. And I am proud the President has
already spoken out saying he is not going to stand for it. And I think
sooner or later the American people are going to figure out who is on
their side in this Congress. And I guarantee you, it is not the
insurance companies and the big drug companies and those who are
dancing to their tune.
Mr. PALLONE. Mr. Speaker, I just want to follow up on what the
gentleman from Maine said.
First of all, I have to say to my colleague from Texas that he is
always so good at bringing these issues down to the average person and
how it affects his hospitals and how it affects his seniors. I want to
keep saying over and over again, that is why we are here talking about
this because it directly affects our constituents.
But I wanted to go back to the GAO report that the gentleman from
Maine (Mr. Allen) mentioned. Because I mean, he just brought that out
so well. I mean, the problem here with this tax bill that the President
is going to veto, we are giving all this money to the HMOs and they are
already costing the Federal Government more than the traditional
Medicare fee-for-service. And I can think of at least three reasons
why.
First of all, what do they do with that money? They are taking it and
they are paying for political ads against the people that do not
support their interests. They are using the money to pay for the
administrative costs of their CEOs' bill salaries, vacations, who knows
what.
The other thing that I was thinking about, too, is advertising. In my
district I have been to some of these meetings where they do all of
this huge
[[Page H11441]]
advertising in the papers. I remember once there was a local diner and
they had all the seniors come to the diner and they were giving them
lobster dinners if they came to the diner to sign up for the HMO. So
that is where all that money is going for all these other costs.
The amazing thing is that the hospitals and the nursing homes and the
home health care agencies that are not getting the money from this tax
bill, or getting much less, they are more direct providers. I mean,
that money is going almost directly to them. Medicare fee-for-service
has very little overhead. So they are just paying the money to them to
take care of the people's health needs as opposed to all this other
nonsense that the HMOs are doing.
Mr. ALLEN. Mr. Speaker, the gentleman talks about the overhead. It is
very simple. Medicare is equitable. It covers everyone all over the
country who qualifies for it. Medicare does not pick up and leave the
State if it is not making money. This is a program that has continuity
and predictability and stability. And get what? Its administrative
costs are around three percent.
When they go to the private sector to these HMOs and these insurance
companies, they have got administrative costs that they do not have at
all with Medicare. First of all, they pay their executives millions and
millions of dollars. And there is no one in Medicare, no one at HCFA or
anywhere else here who is being paid millions of dollars. And second,
they have got to earn a profit. And third, they have got all sorts of
marketing costs that Medicare would not have.
So compared to the two to three percent administrative cost for
Medicare, they have got 20 percent, 30 percent depending on the
insurance company, they have got very big administrative costs.
{time} 1845
I want to bring this back to my home state. In Maine, as of July 1,
there was a notice. We had only 1,700 people in Maine that were signed
up for managed care. That is 1,700 people in Medicare signed up for
managed care. And they all got a notice shortly after July 1 from the
carrier saying that come December 31, the carrier was pulling out of
the state. Two of those people were my parents. That was how they got
their prescription drug coverage. Now they have got to go out and buy
some other kind of supplemental insurance, but it will not be any
managed care plan.
So the benefits of HMOs and Medicare are now gone. There are none.
There are going to be none in the State of Maine, and they will have to
go find some Medigap policy. But the trouble with those policies is, A,
they are expensive, and B, they have very limited coverage. They do not
have anything like the kind of catastrophic coverage that is part of
the Democratic plan, what Al Gore proposed, as a way to deal with
prescription drugs.
So I look at this so-called tax relief bill, this Balanced Budget Act
give-back that we passed yesterday, and I know that that $34 billion
over the next 10 years is not going to the State of Maine, it is not
going to east Texas, it is not going to hospitals, it is not going to
home health care agencies, it is not going to nursing homes; it is just
going straight into the pockets of the HMOs.
That is fundamentally wrong, fundamentally wrong. Here we are, trying
to make sure that seniors, for whom health care is a real worry, the
people I talk to, are very worried that their money is going to run
out. They are very worried they are just not going to be able to take
the prescription drugs that the doctors tell them they have to take.
With all the anxiety, what this Republican Congress is doing is
catering to the special interests, the pharmaceutical industry and the
HMOs. It is wrong and it needs to change.
Mr. TURNER. If the gentleman will yield, it is really amazing when
you really get down and look at the hard, cold facts of the bill that
was passed in this House yesterday, that gave almost half of the
additional funding for Medicare goes to the HMOs and the insurance
companies, because, the truth is, there are only about 15 percent of
America's seniors that even have or live in an area where they have the
opportunity to select a Medicare+Choice HMO plan.
In my 19 county Congressional district, today there are only two
counties where there is even an HMO Medicare+Choice plan offered by the
insurance companies. Now, why in the world, if only 15 percent of the
senior population of this country even have the opportunity to buy one
of those HMO plans and take advantage of the little add-ons they are
able to offer, prescription drug coverage, eyeglass coverage, why would
we give almost half of the additional money that we choose to
appropriate this year to those HMO plans which are only available to 15
percent of the seniors?
It is just not right, particularly when you have got hospitals all
across this country that are about to close their doors because the
Medicare reimbursements are so low.
Now, it does not take a smart person to see the fallacy in what is
going on around here, and I think it is pretty apparent that the
insurance industry and their lobbyists are carrying the day, not the
American people.
In Texas, in Texas we have 270,000 seniors who were forced to skip a
necessary prescription in 1998 because they could not afford it. We had
800,000 seniors in Texas who were forced to pay for their own
prescription drug costs because they had no insurance coverage of any
kind.
You would think that, surely, we can do better. And I believe we must
do better. Prescription drug coverage for seniors under Medicare,
patient protection legislation to be sure everyone enrolled in managed
care gets to make their medical decisions with their doctor, not having
some insurance clerk interfere, and to think that we cannot figure out
how to accomplish these things in this Congress is really more than
many of us here can understand.
So I am just hoping and praying that we will get the kind of
legislation that the American people want and need. I was here
yesterday, sat right up here in the gallery with a young family,
husband and wife and a young daughter from Newton County in my
district. The young daughter has leukemia.
I sat there and listened to the father talk about their experience
with managed care. He even told me about his experience of his wife,
who needed surgery a few months back and had to fight her managed care
company to get the surgery approved, and, after they finally got it
approved and she had it, they had to fight with the same HMO to get the
bill paid.
There are people all across this country that can tell similar
stories about dealing with their HMOs, and I think this Congress must
act. I am proud to be here tonight with my colleagues to continue the
battle that ultimately we will win, because we are on the right side of
this issue for the American people.
Yes, I think, as the vice president said, it is really a choice of
are we for the people, or are you for the powerful, and I think we had
better come down on the side of the American people.
Mr. PALLONE. I appreciate the gentleman's comments. I know we do not
have a lot of time left and I want to yield to the gentleman from
Maine, but I wanted to say the issues of abuses by the HMO affect
everyone, by insurance companies.
I had a situation myself, and I have not mentioned it for a while
because we now have the law that we passed in the previous Congress
that says that for the drive-through deliveries, you have to allow at
least 24 hours, I think is it is now 2 days for normal delivery, and
maybe 4 days for a C-section, when a you have a baby. They had changed
the rules in between my daughter being born and my son being born, when
they were both born by C-section.
We were actually at Columbia Hospital for Women here in D.C. between
the two births. The law had changed, or at least the insurance company
changed it, and when my son was born, after the second day, they said
my wife had to come home and he had to come home from the hospital. It
was only because there was a law in D.C., and I do not think it exists
in a lot of states, that says before the child goes home he has to be
examined by a pediatrician for certain things, and they found he was
jaundiced. So they let the two of them stay, my wife and son stay, an
extra day in the hospital. Then we passed the law to prohibit the
drive-through deliveries. But these abuses impact everyone. It is
across the board.
[[Page H11442]]
I yield to the gentleman from Maine.
Mr. ALLEN. I thank the gentleman for yielding. In conclusion, I
thought I would try to simplify this about the prescription drug
benefit. The Democrats are saying, all of us are saying, that what we
want is a Medicare prescription drug benefit. That is, seniors would
get their prescription drug benefit as part of the Medicare package.
This is exactly what every Member of this House has through his or
her own insurance, because everyone in this House has some plan through
the Federal employees insurance, and it is a plan that you sign up for
and other Federal employees get, and if they have prescription drug
coverage, which I suspect almost everyone here does, they have it as
part of the plan. If they have a Blue Cross plan, they have a Blue
Cross prescription benefit; if they have an Aetna plan, they have an
Aetna prescription benefit.
All we are saying on the Democratic side of the aisle is, let us have
a Medicare prescription drug benefit. And what the Republicans are
saying is no, no, no, no, no, that would be wrong, because, after all,
Medicare is a Federal health care plan. We would not want Medicare to
provide a prescription drug benefit. That would be somehow wrong,
because it is a government plan. That is nonsense. It is not right. It
is absolutely not right.
The benefit, the prescription drug coverage should come through
Medicare. It is the health care plan for our seniors and our disabled
people, and there is no excuse to try to create some Rube Goldberg
system involving private insurance companies and HMOs as an
alternative. But that is what the folks on the other side of the aisle
have been trying to put over on the American people.
Mr. PALLONE. I listened to that third debate between the two
presidential candidates, and I was very upset to hear Governor Bush say
he was providing a Medicare prescription plan. I believe he used the
term Medicare.
Mr. ALLEN. He did.
Mr. PALLONE. Yet the Republican plan and his plan is a voucher. It is
not under Medicare. It a voucher that you get if you are below a
certain income, not for most people, but if you are below a certain
income, to go out and try to find an HMO or somebody to cover your
prescription drugs. So, to even suggest that somehow this is a Medicare
plan is not accurate. It is not under Medicare.
I think that is a major distinction between the Democrats and the
Republicans on this issue, that we want to use traditional Medicare for
the prescription drug benefit, and the Republican leadership does not.
That is a key difference here, no question about it.
Mr. TURNER. If the gentleman will yield, you know, I think you are
right on target. When you combine that fact with the fact that these
Medicare+Choice plans are not even available, and you hear the proposal
that Governor Bush makes to give the seniors a voucher so they just get
25 percent of the premium for their insurance covered by the
government, what we are moving toward, and I think it is wrong, it is a
system where no longer do you have the same coverage no matter where
you live in this country.
Medicare, as I have always understood it, said that no matter where
you live in this country, whether you live in the city or in the
country, in rural America, urban America, you have the same coverage
and the same benefit. And when you refuse to provide a prescription
drug benefit under Medicare, and you only allow the HMOs to offer plans
that can add on a prescription drug benefit, what you have done is
changed in a very dramatic way what Medicare should mean to every
senior, no matter where they live in this country.
Mr. PALLONE. I want to thank my colleagues for joining me tonight.
____________________