[Congressional Record Volume 146, Number 139 (Sunday, October 29, 2000)]
[House]
[Pages H11495-H11504]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




MOTION TO INSTRUCT CONFEREES ON H.R. 4577, DEPARTMENTS OF LABOR, HEALTH 
AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS 
                               ACT, 2001

  Mr. PALLONE. Mr. Speaker, I rise to offer a motion to instruct.
  The SPEAKER pro tempore (Mr. Thornberry). The Clerk will report the 
motion.
  The Clerk read as follows:

       Mr. Pallone moves that the managers on the part of the 
     House at the conference on the disagreeing votes of the two 
     Houses on the Senate amendment to the bill H.R. 4577 be 
     instructed, in resolving the differences between the two 
     Houses on the funding level for program management in 
     carrying out titles XI, XVIII, XIX, and XXI of the Social 
     Security Act, to choose a level that reflects a requirement 
     on Medicare+Choice organizations to offer Medicare+Choice 
     plans under part C of such title XVIII for a minimum contract 
     period of three years, and to maintain the benefits specified 
     under the contract for the three years.

  The SPEAKER pro tempore. Under the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from California (Mr. Thomas) 
each will be recognized for 30 minutes.
  The Chair recognizes the gentleman from New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I yield myself 5 minutes.
  Mr. Speaker, the motion I am offering is an amendment to inject some 
needed accountability into the Medicare+Choice program. It instructs 
the conferees to support language that would require HMOs participating 
in the Medicare+Choice program to stay in their given markets for 3 
years. In addition, it instructs the conferees to support language that 
requires HMOs to provide all the benefits they promised to 
beneficiaries when they enrolled in Medicare HMOs.
  Last week, the Republican leadership passed a Medicare refinement 
bill that is really nothing more than a special interest giveaway to 
the managed care industry. Over 40 percent of the money in this bill is 
given to the managed care industry, and it is given to the industry 
with virtually no strings attached.
  Mr. Speaker, there is nothing in this bill that passed last Thursday 
that guarantees any stability for seniors or that the plans will stay 
in a given area. The only thing that is guaranteed is that the managed 
care industry will be granted a massive government windfall. I suppose 
it is a reward of sorts for the managed care industry from the 
Republican leadership for their effective campaign to prevent the 
patients' bill of rights from reaching the President's desk.
  Unfortunately, the managed care industry's gain translates into a 
significant loss for Medicare beneficiaries and the entire spectrum of 
Medicare providers in the health community. Every Member in this 
Chamber has heard from providers in their districts, be it hospitals, 
home health care providers, nursing homes, hospices, community health 
centers and others, that are being crushed by the unintended financial 
burden of the balanced budget agreement. Despite last year's BBA 
refinement package, there are countless Medicare providers around the 
country whose ability to provide care to Medicare beneficiaries is 
precarious because of the lack of adequate reimbursement. In my 
district, I have already seen a hospital forced to close its doors.
  Mr. Speaker, it would have been infinitely more appropriate to spread 
what money has been set aside in the budget for Medicare refinements 
more evenly throughout the program than to give a disproportionate sum 
to an industry that has a clear record of putting profits ahead of 
patients. Working with the White House, we will continue to fight for a 
more equitable distribution of funds so that the Medicare beneficiary, 
not the HMO executive, will come first.
  It would have also been appropriate to require that the HMOs are held 
accountable for the care they are supposed to provide beneficiaries in 
exchange for the windfall the Republican leadership wants to give them. 
As we saw a few days ago, and as we have seen for the last several 
years, the Republican leadership is unwilling to break its special 
interest bond with the managed care industry. They remain steadfastly 
opposed to any measure that would require the managed care industry to 
act in a more responsible manner that Medicare beneficiaries and all 
patients have been demanding.
  Mr. Speaker, let me also say that my motion is not an attempt to 
hamstring the managed care industry or weaken it in any way. I want to 
preserve it and make it stronger for all seniors who may want to enroll 
in HMOs for their care. In fact, I have introduced legislation myself 
that would restore funding to Medicare HMOs.
  I am not, however, willing to simply give HMOs untold billions and 
then allow them to continue to pull the rug out from underneath seniors 
who are lured into HMOs with the promise of extra benefits. And this 
latter point about benefits is very important. Medicare beneficiaries 
are not just destabilized when their HMOs pull out of the market. They 
are oftentimes destabilized when their HMO stays and their HMO just 
rescinds the extra benefits that attracted the beneficiaries in the 
first place, the most popular example of that being prescription drug 
coverage.
  Seniors should be afforded some peace of mind and be able to know 
that when they enroll in an HMO for prescription drug coverage or 
whatever extra benefits they enroll for, they are going to get those 
benefits. If the Republican leadership remains wedded to giving the 
managed care industry multibillion dollar special interest giveaways at 
the expense of all other Medicare providers, the least the Congress can 
do is require that seniors are going to get what they are promised.
  If my colleagues on the other side are as committed as they purport 
they are to providing seniors with a Medicare prescription drug 
benefit, they should have no opposition to requiring managed care 
companies to agree to provide what they promised beneficiaries they 
will provide for at least a 3-year period. I do not think that is a lot 
to ask for and that is what this motion to instruct is all about.
  Mr. Speaker, I reserve the balance of my time.
  Mr. THOMAS. Mr. Speaker, yield myself such time as I may consume.
  Mr. Speaker, I think first of all we should look at this motion to 
instruct. There are several levels of clearance that are required for a 
motion to instruct to be in order, and it has to deal with funding. 
Obviously, in this motion to instruct, it says that in resolving the 
differences between the two Houses on the funding level for program 
management of the Social Security Act. So it meets that test level.
  But then it goes on to say that through the funding mechanism, they

[[Page H11496]]

are supposed to choose a level that reflects a requirement on 
Medicare+Choice organizations to offer a minimum contract period of 3 
years. There is no funding mechanism that would require or even allow a 
3-year contract under Medicare. Medicare+Choice programs are funded for 
1 year under the Health Care Financing Administration. The amount that 
a Medicare+Choice program receives is based upon a number of factors: 
where it is located, the cost of medical services in the area, and, 
most importantly, the makeup of the beneficiaries that have signed up 
for that Medicare+Choice program. That is, what is their age, what is 
their medical condition?
  All of these factors are taken into consideration when the level of 
reimbursement to the Medicare+Choice plan is determined. The difference 
by the Medicare+Choice program of offering the statutory mandatory 
benefits is what the Health Care Financing Administration has 
determined to be its payment level. If there are dollar differences 
between those two areas, by law that plan must either offer additional 
benefits or that money has to be refunded back to the Health Care 
Financing Administration; but it can only be done on a 1-year basis 
under current law.
  Beneficiaries can sign up for a Medicare+Choice program and leave the 
program. That is, the patient profile of a plan can change from year to 
year to year. So it is nonsensical to think that a level of funding can 
produce a 3-year contract. It is also nonsensical to think that it can 
produce a set benefit package for a 3-year period. One of the reasons 
some of these plans are pulling out of areas is because they can no 
longer offer the benefits they had offered under their shrinking profit 
structure dictated and determined by the Health Care Financing 
Administration.

                              {time}  1930

  So make no mistake, not only does this motion to instruct have no 
legal binding requirement, but it is nonsensical. It is germane. It 
does affect the funding level. But in no way does just affecting the 
funding level bring about any ability to create a 3-year contract or a 
guaranteed 3-year level of benefits. It is just nonsensical.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from New 
York (Mr. Ackerman).
  Mr. ACKERMAN. Mr. Speaker, I would like to thank the gentleman from 
New Jersey (Mr. Pallone) for taking the initiative on this issue, which 
is of a critical nature to our senior citizens throughout this country 
and specifically to our constituents who happen to live presently on 
Long Island in New York.
  Mr. Speaker, I would just like to disagree with my learned colleague 
on the other side of the aisle who said that this is nonsensical. I 
think some of us read it in a different way that choosing a level that 
reflects a requirement, and the key word is a ``requirement,'' on the 
Medicare+Choice organizations to offer plans that are no less than 3 
years old. We think that that means that they can expend no funds other 
than to write a contract that would last 3 years. Anything else would 
be unacceptable under the language that we are offering.
  Our senior citizens are in trouble in this country. They are not 
doing as well as so many other segments of society. There is so much 
uncertainty and insecurity in their lives that the instability that the 
current system offers them is totally unacceptable.
  We approach things a little bit differently on Long Island, our 
congressional delegation that is, and we try to do things in more of a 
nonpartisan way when it affects our constituents. So we worked 
together, each and every one of us, Democrats and Republicans alike. 
And in the County of Suffolk, which is on the eastern end of Long 
Island, which I proudly share with our colleague, the gentleman from 
New York (Mr. Lazio), we have a situation which is critical that is 
highlighted by this legislation.
  Every single Medicare+Choice plan, with the exception of one, has 
announced that they are leaving Suffolk County because they are not 
being reimbursed quickly enough or adequately enough; and our senior 
citizens, those of the gentleman from New York (Mr. Lazio) and mine, 
are absolutely traumatized. They do not know what is going to happen.
  The one remaining plan has already announced they are going to have 
an additional $75 premium each month. Somebody has to come down here to 
the floor and stick up for those senior citizens who are living in 
abject fear, whether they be in the district of the gentleman from New 
York (Mr. Lazio) or my district on Long Island.
  And those are not the only places. All of these, these are single-
space lists of counties throughout the country where this problem is 
imminent right now. But in our county, that of the gentleman from New 
York (Mr. Lazio) and mine, the announcement has already been made that 
they are packing up and leaving. They have given their 6-month notice.
  These people have nowhere to go. There is but one plan left. What 
happens to my colleague's seniors? What happens to my seniors with the 
remaining plan if they are only limited to one more year? Where will 
these people go? They will have no coverage. And if that is the case, 
shame on each and every one of us for not providing to our constituents 
the protection that they need.
  The constituents of the gentleman from New York (Mr. Lazio) need it. 
My constituents need it. And the constituents of so many Members whose 
districts appear on these lists need it, as well.
  Mr. THOMAS. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, I would tell the gentleman that we certainly share his 
concern, but the idea of trying to get plans to stay for 3 years when 
there would be total uncertainty in the second and third year of what 
the contract might be will increase the chances of destabilizing the 
program, not decrease it, the exact opposite effect that the gentleman 
seeks.
  For example, in the Med Pac report, March 2000, one concern ``that 
may contribute to the lack of new plans and plan types and which may be 
discouraging current participants is uncertain future revenue streams 
for plans.''
  Mr. Speaker, I yield 3 minutes to the gentleman from Louisiana (Mr. 
McCrery), a member of the subcommittee.
  Mr. McCRERY. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, before I address the remarks of the last speaker on the 
minority side, let me just go over the numbers here so everybody has a 
clear understanding of what we are talking about.
  There has been some misstatements made in several quarters about the 
amount of money in this Medicare package for HMOs or Medicare+Choice 
program. Here we see the numbers laid out by the CBO for each category 
in this package.
  For hospitals there is $11 billion, 34.9 percent of the total 
package. Beneficiary assistance and preventive benefits, $6.7 billion 
dollars, 21.3 percent of the total package. And then we get to 
Medicare+Choice, the Medicare HMOs. There is $6.3 billion in this 
package for Medicare HMOs, and that is 20 percent of the total package.
  Now, I really believe that both sides on this issue are well-
intentioned. I agree with the gentleman from New York (Mr. Ackerman). I 
think it is terrible that we have Medicare HMOs leaving certain parts 
of our country and, therefore, leaving those seniors with no coverage 
for things like prescription drugs, in some cases their deductibles, 
their copays, because those Medicare HMOs, those Medicare+Choice 
programs often provide those benefits.
  I know in my district I had one Medicare HMO; and they left last 
year, the only one. I heard from hundreds of seniors in my district 
about that plan leaving. They wanted it back. They said that is the 
greatest thing we have ever had in Medicare, and we want it back. So I 
agree with the gentleman that we ought to try to encourage those plans 
to come to a locale and stay there.
  But encourage is one thing; mandate is another. And in my opinion, I 
just have an honest disagreement with the gentleman as to how the 
market works. I think that if we mandate that

[[Page H11497]]

a plan stays in a locale for 3 years, we will have fewer and fewer 
plans locating in those marginal locales where the reimbursement rate 
is at the margin for them to make a profit.
  So it is an honest disagreement, but I think the gentleman who has 
offered the motion to instruct is just wrong about the effects of his 
motion if it were to become law.
  And so for that reason, I would urge all Members on both sides of the 
aisle who are interested in having their seniors have access to these 
type Medicare plans to vote no on this motion to instruct.
  Mr. PALLONE. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, what the gentleman from Louisiana (Mr. McCrery) is not 
mentioning is that there are buried or hidden indirect pass-throughs 
which are actually part of that chart. In other words, what happens is 
that money goes to the providers like the hospitals; and then it is 
passed through to the HMOs, about one-sixth of what goes to hospitals 
and other providers. So it is still $11 million, and it is still 40 
percent of the total no matter how you cut it, and that is outrageous 
given that there are no strings attached.
  Mr. Speaker, I reserve the balance of my time.
  Mr. THOMAS. Mr. Speaker, I yield 1 minute to the gentleman from 
Louisiana (Mr. McCrery).
  Mr. McCRERY. Mr. Speaker, I thank the gentleman for yielding me the 
time, and I will be glad to yield to my friend from New Jersey.
  Mr. Speaker, the gentleman is right, there are interactions with the 
increased payments that we make to hospitals. Because, as the gentleman 
knows, in figuring the payment rate for the Medicare+Choice plans, it 
is the fee-for-service rate in that region that has an impact on the 
reimbursement rate for the Medicare+Choice program. That is true.
  But certainly the gentleman would not suggest that we not raise the 
payments to the hospitals and the other providers that we are doing in 
this bill, would he?
  Mr. PALLONE. Mr. Speaker, will the gentleman yield?
  Mr. McCRERY. I yield to the gentleman from New Jersey.
  Mr. PALLONE. Mr. Speaker, the bottom line is that the HMOs are 
getting $11 million, 40 percent of the total, no matter how you cut it.
  Mr. McCRERY. Mr. Speaker, reclaiming my time, but the gentleman is 
not suggesting that we should not be raising the reimbursement rate to 
hospitals and other providers?
  Mr. PALLONE. Mr. Speaker, if the gentleman will continue to yield, 
no.
  Mr. McCRERY. Mr. Speaker, then as a natural consequence, we are going 
to get higher reimbursement for the Medicare+Choice plans. That is an 
interaction that is unavoidable in this plan. I am glad that the 
gentleman is not suggesting that we do not give higher reimbursement 
rates to our hospitals and other providers.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am just pointing out that the $11 million figure and 
the 40 percent that goes to HMOs still stands. The gentleman was trying 
to contradict that and he cannot.
  Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. 
Green).
  (Mr. GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GREEN of Texas. Mr. Speaker, I thank my colleague from New Jersey 
and the Chair of our Democratic Task Force on Health Care for having 
this motion to instruct.
  In a way I agree with my colleague from Louisiana that this may not 
be the best way to get the attention of the HMOs that predominantly 
serve our seniors. But it is our only battle tonight. And hopefully 
there is another way we can get their attention instead of just 
throwing more money at it.
  HMOs only cover about 15 percent of our senior citizens. And yet, the 
bill we voted on last week would provide at least 40 percent and over 
10 years 47 percent to HMOs for those 15 percent. Actually, in Houston, 
we have a little over 15 percent of our seniors who are served by an 
HMO.
  I have a similar problem that my colleague from New York has. In 
Houston, Texas, we are down to one HMO left and they are capped, 
because they do not have the network to be able to add more seniors to 
it. So, as of December 31, our seniors will not be able to have access 
to an HMO.
  Now, I am not real thrilled about HMOs to begin with. But let me tell 
my colleagues what happened in Houston, Texas. We at one time had four 
or five HMOs. But one big insurance company, and I will not name them 
because they have done this around the country, they bought up the 
other HMOs. They bought up NYLCare 65, Prudential. And then they served 
notice a little less than 6 months or maybe a little more than 6 months 
later that they are not going to serve the market.
  That is what HMOs are doing. That is our only way to do this is to 
make them stay in the market because they actually controlled over 65 
percent of the market, and then they announced they are not going to 
serve it. That is not doing a service to my seniors in Houston any more 
than they are doing it to Long Island, and that is what is frustrating.
  The Medicare BBA provider bill last week actually gave 40 percent and 
then 47 percent. A lot of us voted against this bill simply because of 
that. We need to provide more for hospitals and for providers and for 
doctors and for home health care, you name it. But if we are going to 
provide more for HMOs, and I do not mind it, I voted for it last year 
in 1999 and I will vote for it again, but let us put some restrictions 
on them. Maybe not 3 years, but let us do something instead of just 
giving them a blank check and then they still will not serve the 
seniors in my district.
  Mr. THOMAS. Mr. Speaker I yield 4 minutes to the gentleman from 
Tennessee (Mr. Bryant), a member of the committee that shares 
jurisdiction, the Committee on Commerce.
  Mr. BRYANT. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I thank my colleagues from the other side who have 
talked about a spirit of bipartisanship and something I certainly agree 
with. I am concerned that this bill is going to be vetoed by the 
President. In the spirit of bipartisanship, I would ask my colleagues 
on the other side and our Vice President, who is from Tennessee, not to 
allow this to happen, to go to the President and to ask him to sign 
this bill.
  Because my State of Tennessee really needs this legislation. Our 
Medicare beneficiaries in Tennessee will receive $4.3 billion that will 
help reduce their Medicare copayments, the money they have to pay out 
of their pockets and other assistance, as well as they need the $1.4 
billion that this bill provides for new preventive benefits under the 
Medicare program. And our Tennessee hospitals need this legislation 
also.
  Altogether, this bill will benefit hospitals to the tune of nearly 
$14 billion through direct and indirect funding. If our hospitals in 
Tennessee are forced to close or cut services, the effect on our 
patients and on the more than 52,000 hospital employees could be 
devastating.
  I also want this bill not vetoed because it contains $1.6 billion in 
critical funding for nursing homes and $1.8 billion for home health 
care and hospice service. The legislation also expands Medicare 
coverage for telemedicine services. This is important to the rural 
areas of the State of Tennessee that I represent.
  Using today's cutting edge technology, telemedicine or telehealth has 
the potential to revolutionize the way we practice medicine in this 
country, and it has the potential to erase the disparities in medical 
care and quality of care between rural areas and urban areas.
  And last, but not least, I would hope the Vice President would 
realize about his home State of Tennessee that, without this 
legislation, we will lose in Tennessee $27 million for our State's 
children's health insurance program, or the S-CHIP program.
  Because Tennessee had already covered many of our S-CHIP eligible 
children under our State Medicare waiver program, Tennessee has had to 
work much harder to get children to enroll in S-CHIP. As a result, it 
has taken us longer to use all of the money allotted to the State for 
the S-CHIP program.

                              {time}  1945

  I hope the Vice President realizes that this bill will allow 
Tennessee 2

[[Page H11498]]

more years to use most of its S-CHIP money so that more Tennessee 
children can be covered. Now I know that our Vice President, Mr. Gore, 
spent a lot of time on this campaign trail talking about health 
insurance for children in Texas but, Mr. Speaker, I hope the Vice 
President will consider the needs of Tennessee's children in his 
discussions with the President about whether or not to sign this bill.
  I urge my colleagues to vote against this motion to instruct and I 
urge the President to sign H.R. 2614.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Turner).
  Mr. TURNER. Mr. Speaker, I am glad to hear the gentleman from 
Tennessee (Mr. Bryant) express his concern about his rural hospitals 
and his health care providers in his district because I have the very 
same concern, and that is why I hope that he will join with us in 
urging this Congress to put a larger percentage of the increased 
funding for Medicare in increasing those reimbursement rates to those 
rural hospitals and to those rural health care providers instead of 
giving about 40 percent of it directly to the insurance companies that 
we do not even know if they will be passing that money along to those 
rural hospitals. That is why I oppose the Medicare funding plan that 
the Republican leadership has put before this body.
  The truth of the matter is, Medicare+Choice HMO insurance plans are 
not working for our seniors and they are not working for the taxpayers. 
The bottom line is, in my district, as I went around in August talking 
to my seniors at town meetings, they stood in lines to tell me that 
their Medicare+Choice plans have been cancelled. In fact, 5,000 of them 
in my district received notices of cancellation just a month ago, and 
the truth of the matter is Medicare+Choice is being cancelled all 
across this country. That is why we need greater accountability, and 
that is what this motion is addressing.
  Thirty percent of all Medicare beneficiaries in this country will 
have no Medicare+Choice option. Last year, 328,000 seniors got these 
notices of cancellation. This year almost a million seniors got notices 
of cancellation.
  If one has looked at the recent General Accounting Office report on 
Medicare+Choice plans which was just issued, it will reaffirm the case 
that I am making tonight that our HMO plans are failing our seniors and 
our taxpayers.
  Listen to this from the summary of the GAO report: Industry 
representatives contend that the Balanced Budget Act's payment rates 
are too severe and that low Medicare payment rates are largely 
responsible for the plan withdrawals. However, since the BBA was 
enacted, Medicare+Choice rates have risen faster than per capita fee-
for-service regular Medicare spending. In addition, many plans have 
attracted beneficiaries who have lower than average expected health 
care costs while Medicare+Choice payments are largely based on the 
expected costs of beneficiaries with average health care needs. The 
result is that Medicare can pay more for a beneficiary who enrolls in a 
plan than if the beneficiary had remained in regular fee-for-service 
Medicare. As we, the GAO, recently reported, these additional payments 
amounted to $5.2 billion or 21 percent more in 1998 than the fee-for-
service program would have spent to provide Medicare coverage benefits 
to plan enrollees.
  The plans offered by the HMOs are costing the taxpayers more money 
than regular Medicare and increasingly those HMO plans are withdrawing 
from our seniors, and they need to have something better. That is why 
we fought for a prescription drug benefit under regular Medicare, which 
works for our seniors.
  Mr. THOMAS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Pennsylvania (Mr. English), a member of the Committee on Ways and 
Means.
  Mr. ENGLISH. Mr. Speaker, briefly I urge my colleagues to vote 
against this perverse and misguided motion to instruct. I agree the 
trend of Medicare+Choice plans pulling out of areas across the country 
is enormously disturbing, but may I suggest to the folks on the other 
side that they have offered exactly the wrong solution. By forcing 
plans to commit to 3 years, we are ensuring that plans who are 
struggling to maintain their service will leave now, right now. 
Medicare+Choice funding, as the gentleman from California (Mr. Thomas), 
noted, is too unpredictable under current HCFA policy.
  This motion adds no accountability; just a poison pill. I find it 
ironic that the Democrats and the President have spent the past week 
tearing apart the Medicare bill that this House passed, calling the 
money spent on Medicare+Choice plans unjustified. If anyone thinks that 
the money dedicated to shoring up Medicare+Choice plans is 
unjustifiable, I invite them to come to Erie, Crawford, and Mercer 
County, Pennsylvania. I invite them to explain that to seniors who are 
facing copays that will double in January and decrease benefits.
  If they are indeed serious about stabilizing Medicare+Choice, then I 
urge our friends on the other side of the aisle to drop this and urge 
the President to sign the House package and work with us to ensure that 
seniors relying on these plans continue to have access to quality 
health care. Do not simply adopt populist poses and deploy vacant 
partisan rhetoric while requiring Medicare+Choice plans to be at the 
mercy of HCFA for 3 years. This is no solution. They will simply leave 
and seniors will be left holding the bag.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Ohio (Mr. Brown), the ranking member of our Subcommittee on Health.
  Mr. BROWN of Ohio. Mr. Speaker, I thank my friend, the gentleman from 
New Jersey (Mr. Pallone), for his leadership on this issue.
  Mr. Speaker, December 31, 1998, Medicare managed care plans dropped 
400,000 Medicare beneficiaries. December 31, 1999, Medicare managed 
care plans dropped 327,000 beneficiaries. On December 30 of this year, 
Medicare managed care plans will again unceremoniously drop 900,000 
more senior citizens. Seniors in my district were dropped by United 
Health Care in 1998. Some switched to QualChoice, which dropped them in 
1999. Some switched to Aetna, which will dump them at the end of this 
year.
  A Medicare HMO is not real insurance. It is a roll of the dice that 
calls itself insurance. Why is the plus choice program failing seniors? 
Ask the HMOs and they will say it is because the Federal Government is 
underpaying and overregulating them. Ask the Inspector General and ask 
the General Accounting Office, and they will say we are actually 
overpaying and underregulating Medicare HMOs. They choose to hoard the 
profits they make in some counties while dumping those in less 
profitable counties.
  This does not make them bad. It makes them businesses. It does, 
however, throw a wrench in it-is-all-the-government's-fault campaign 
that they are waging. If we are going to pay the managed care industry 
more, we owe it to beneficiaries and to taxpayers to demand that HMOs 
act responsibly towards those senior citizens who have enrolled in 
their plans. That means once HMOs enter a county, they should agree to 
stay put and they should agree to offer predictable benefits for at 
least 3 years. That way senior citizens will finally know exactly how 
long they can depend on their managed care plan. Before we hand over 
$10 billion, almost half of the new Medicare dollars this Congress is 
appropriating, before we hand over $10 billion of taxpayers' money to 
HMOs, before we hand over one dollar, we should do at least that much 
for beneficiaries. Support the Pallone motion.
  Mr. THOMAS. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, the gentleman from Ohio (Mr. Brown) should know, and 
perhaps he does not, that in the language of the Medicare provisions 
that were passed last week included was language requested by the 
Health Care Financing Administration and the Clinton administration, 
which we agreed with, which we think is appropriate. The language says 
any dollars contained in this bill as an increase to Medicare+Choice 
programs must, must go to the beneficiaries in lowered premiums or 
increased benefits.
  Mr. Speaker, I yield 2 minutes to the gentleman from Kentucky (Mr. 
Whitfield), a member of the Committee on Commerce and someone extremely 
interested in this issue.

[[Page H11499]]

  Mr. WHITFIELD. Mr. Speaker, I am delighted that we are having this 
discussion tonight about this important issue and, of course, as we 
move closer to an election it is politically wise, I believe, to attack 
HMOs. And we recognize that all HMOs, there are some deficiencies there 
but also I think we must recognize that HMOs play a valuable part of 
providing health care to people throughout America. As a matter of 
fact, HMOs for our senior citizens are the only entities offering 
prescription drugs today, offering eye glasses today and so there are 
many benefits from HMOs that seniors receive.
  There has been some discussion this evening about placing mandates on 
HMOs, and obviously we do need some mandates, but excessive mandates 
are not the answer. We have learned that lesson all too well in the 
State of Kentucky. Our Governor, about 6 years ago, placed such heavy 
mandates on the insurance companies offering health insurance in 
Kentucky that every one of them left, with the exception of one, and 
the insurance premiums in Kentucky skyrocketed and the number of 
uninsured in Kentucky skyrocketed because of mandates.
  Now we can solve the health care problems in America today, but we 
cannot blame it all on the HMOs. We cannot blame it all on HCFA. But we 
have to work together. It is a complex issue, and I think that we can 
solve it.
  I am particularly disappointed, however, that so many on the other 
side of the aisle and the President is now threatening to veto this 
bill that provides additional money for Medicare, about $31 billion, 
$6.5 billion to strengthen the Medicare+Choice program; more than $500 
million in increased funding for diabetes treatment, nearly $500 
million to the Ricky Ray Fund to compensate hemophiliacs, more than $12 
billion to strengthen hospitals, particularly rural hospitals. So I 
would urge the defeat of this motion to instruct.
  Mr. PALLONE. Mr. Speaker, I yield 3 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 rise to support the motion 
to instruct by the gentleman from New Jersey (Mr. Pallone). I thank the 
gentleman very much for his leadership.
  Mr. Speaker, it is interesting, as I have listened to this debate, I 
heard the distinguished gentleman from Pennsylvania (Mr. English) make 
the comment that is absolutely true. They will simply leave, and that 
is why we are on the floor this evening because the HMOs around this 
country have simply left. They have left with no admonishing, no 
requirements, no responsibility, no concern and no compassion; whether 
it is conservative compassion or liberal compassion.
  I have in my hands pages and pages of those who have left Harris 
County, and when I go to my senior citizen meetings all of them are 
looking at me with incredulity asking the question, why are the HMOs 
closing. And so I believe this is a very instructive and very important 
motion to instruct, because the good gentleman from California (Mr. 
Thomas) mentioned a provision that was put in, the stabilization fund, 
he knows full well that there is no requirement for those dollars to go 
back to the beneficiaries. The HMO can sit on those dollars forever and 
forever and forever.
  It is interesting, I heard the gentleman from New York (Mr. Ackerman) 
speak about his district. He mentioned the district of the gentleman 
from New York (Mr. Lazio). My good friend, the gentleman from Tennessee 
(Mr. Bryant), mentioned the HMOs closing in his district. They are 
closing in my district. What we are talking about here is 
responsibility, and to refer to the fact that it is only a 1-year 
contract that is incorrect, because the language in the regulation says 
at least 1 year. It does not say only 1 year. It says at least. That 
means it can go up to 2 years or 3 years.
  In addition, Mr. Speaker, might I say that there is some conversation 
about this actuarial language in the bill; and I hope the President 
does veto it, in the tax bill. When we call the chief actuary and talk 
about them reviewing HMOs, he already has 30 people working overtime. 
He says he needs another 20 to be working to do what this tax bill 
wants him to do.
  This is wrong directed and wrong headed. I want two things out of 
this tax bill. I want my hospitals to remain open, particularly my 
public hospitals; and I do not believe we should be giving $34 billion 
to HMOs where only 15 percent of the seniors are actually enrolled. 
Give them an obligation to stay in our communities, and I might 
consider their tax bill.
  Secondarily, give us the money to keep our public hospitals and our 
private hospitals open. When I talk to my constituents, they knew they 
could not work with the amount of money we had in this tax bill. It 
does not help home health centers, nursing homes, hospitals. It does 
not help anyone but the insurance companies. I believe this bill should 
be vetoed so the senior citizens all over this Nation can have HMOs 
that will stay in their communities with the requirement to sign a 
contract for 3 years and the doors of our hospitals will stay open to 
help the people who are really in need, and that compassionate 
conservative or conservative compassion, whatever it is, is really a 
reality that works for the American people. That is what we should be 
doing here and doing it today.

                              {time}  2000

  Mr. THOMAS. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, I would tell the gentlewoman that a letter from the 
American Hospital Association said, ``We are urging Members to vote in 
favor of this legislation and we recommend that the President not veto 
this legislation,'' along with 48 other organizations, many of them 
providers.
  I am a bit perplexed by the gentlewoman's $34 billion number going to 
Medicare+Choice programs, since the Congressional Budget Office score 
of H.R. 5543 says the total spending over the 5-year period is $31.5 
billion.
  Mr. Speaker, I yield 2 minutes to the gentleman from Arizona (Mr. 
Hayworth), a member of the committee.
  Mr. HAYWORTH. Mr. Speaker, I thank my friend from California for 
yielding me time.
  Mr. Speaker, listening to this debate tonight, and mindful of the 
reality of where we stand on the calendar, Mr. Speaker, here we are 
again with, sadly, my friends on the left apparently attempting to put 
politics before people. Perhaps it is not intentional, a 
misunderstanding, a misquoting of figures.
  Believe it or not, despite the discord and debate, I do hear some 
common themes. I do hear friends on both sides of the aisle saying that 
health plans are crucial for seniors. Indeed, my friends on the left 
seem to be swearing by these HMO-Medicare+Choice programs, even as they 
swear at them. So if we agree that these programs are important, why do 
we not work now to save them?
  That is what this House did last week, Mr. Speaker, with the 
legislation we passed, with the majority of funds going to hospitals. 
Of special concern to me are rural hospitals across the Sixth 
Congressional District of Arizona.
  Indeed, Mr. Speaker, based on the fact that people knew we were 
working on this, the gentleman from the Fifth District of Arizona and 
I, working with our colleagues in the Senate, actually got a decision 
reversed on a health care provider preparing to leave Pima County.
  Now, when we try to set arbitrary guidelines here, what we are doing 
is padlocking the insurance provisions. What we are doing is trying to 
stack the deck, and, in the process, kill the very thing we want to see 
happen.
  Mr. Speaker, I would implore those on the left to put people before 
politics. We have a solution here and now that can work, that can keep 
insurance programs in place for seniors who have come to depend on 
those programs. That is why we must defeat this motion to instruct 
conferees and move forward with the legislation we passed.
  Mr. PALLONE. Mr. Speaker, I yield 15 seconds 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, let me just say the American 
Hospital Association may be supporting it, but I have a letter 
indicating that the Texas Hospital Association is against it, as are 
the Greater

[[Page H11500]]

 New York Hospital Association, the California Healthcare Association, 
the Massachusetts Hospital Association, New Jersey is against it, and 
the Health Care Association of New York State.
  So I do think we have some disagreement. This bill should be vetoed.

                                                 October 19, 2000.

                        [Letters to the Editor]

     The New York Times,
     New York, NY.
     To the Editor:
       Re ``Medicare Bill That Favors H.M.O.'s Faces a Veto'' 
     (Oct. 18): The Balanced Budget Act of 1997 (BBA) enacted 
     unprecedented and damaging funding cutbacks to hospitals and 
     other health care providers throughout the country. These 
     federal cutbacks are doing serious--and possibly 
     irreparable--damage to our country's health care providers. 
     Now it appears that Congressional leaders are putting forward 
     a BBA relief package that provides disproportionate funding 
     to the HMOs at the expense of desperately needed relief for 
     hospitals and other health care providers. We, who 
     collectively represent more than 1,800 hospitals and other 
     health care providers, applaud the Clinton Administration's 
     call for meaningful bipartisan action to restore urgently 
     needed funds to health care providers. We have consistently 
     supported bipartisan legislation in the Congress, sponsored 
     by a majority in both Houses, which reflects the urgency of 
     desperately needed Medicare funding restorations. Bipartisan 
     leadership and action is needed before Congress adjourns.
           Sincerely,
     Gary S. Carter,
       President, New Jersey Hospital Association.
     C. Duane Dauner,
       President, California Healthcare Association.
     Ronald M. Holander,
       President, Massachusetts Hospital Association.
     Kenneth E. Raske,
       President, Greater New York Hospital Association.
     Daniel Sisto,
       President, Healthcare Association of New York State.
     Terry Townsend,
       President, Texas Hospital Association.

  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Florida (Mrs. Thurman).
  Mrs. THURMAN. Mr. Speaker, I thank the gentleman for yielding me 
time.
  Mr. Speaker, I just listened to the last speaker on the other side. 
Do you know what my seniors are telling me at home? They are telling me 
they want stability. They are tired of joining a plan, having to give 
up their traditional providers and their Medigap insurance just because 
the plan offers extra benefits, and then have the plan abandon the 
extra benefits the very next year or in fact just pull out in general. 
They are tired of this.
  Mr. Speaker, I would say to the gentleman from California (Chairman 
Thomas), the gentleman knows I came to the committee and I asked for a 
2-year non-pullout time. I said, ``Do you know what? My constituents, 
the ones that I sat in an open forum with, said to me, 'We do not want 
to lose this because we have problems. We are sick. We need to have 
stability. We want you to go up there, Mrs. Thurman, and we want you to 
fight for at least 2 years. Let us at least have 2 years, so that we 
can have some stability in our plan.' ''
  Well, do you know what? We offered that, and it was defeated. Tonight 
we are on the floor offering a 3-year. But, do you know what? I just 
found out something. How many of you have gotten letters in your 
district from your constituents who have gotten letters from their 
Medicare+Choice programs that have said, you know what? Your Congress 
needs to give us more money.
  So do you know what we are doing? We are giving them more money, and 
all we are asking back is one simple thing: stay there for 2 years. Let 
us not keep pulling people in and out of that.
  But let me tell you what is happening to them. Profits, third quarter 
profits in one company, was 26 percent. Third quarter profits. But 
listen to what happened. This is a letter from a constituent that has a 
plan. Their monthly plan premium is going from $19 to $179, $19 to 
$179. That does not include what they are going to get from whatever we 
pass to them. Outpatient, $10 visit copayment to $15. Outpatient 
hospital, $20 to $35. Under inpatient hospital care, they had no 
copayment in 2000. Now it is going to be $200 per day, a limit of three 
copayments per year. Inpatient hospital stay, no copayment last year, 
now $500 copayment per admission. Then prescription drugs, they even 
get a lesser prescription drug benefit.
  Two years, three years, let us pass this motion.
  Mr. THOMAS. Mr. Speaker, it is my pleasure to yield 4 minutes to the 
gentleman from Louisiana (Mr. Tauzin), a senior member of the Committee 
on Commerce.
  Mr. TAUZIN. Mr. Speaker, I thank my friend for yielding me time.
  Mr. Speaker, I think it is time we put this in perspective. 
Medicare+Choice programs are exactly that, they are Medicare plus, and 
they are choice programs. Nobody forces a senior to join them; nobody 
says you have to join it; nobody says you have to stay in it if you do 
not like it.
  In fact, seniors join these Medicare+Choice programs because they 
like them, because they add new benefits, primarily prescription drug 
coverage, but sometimes even other nice benefits. Prescription drug 
benefit coverage obviously is something seniors want to have, and that 
is why this House passed a prescription drug benefit bill and sent it 
on to the Senate.
  But for those seniors who join these programs, of course we all agree 
that we do not want these programs to shut down and move out. They have 
shut down in my district. They are threatening to move out in my 
district as well.
  But the reason cited as the most important reason why they are moving 
out, according to the MedPac March 2000 report, is the uncertainty of 
future payments. So can we all agree that the problem of reimbursement 
is one of the principal causes of hospitals shutting down in the rural 
parts of America and Medicare+Choice programs moving out?
  So we pass the bill, H.R. 5543, which includes new reimbursement 
formulas, new monies to hospitals, new monies for the Medicare+Choice 
programs; and as the gentleman from California (Mr. Thomas) correctly 
pointed out, it included language that said the money that went to the 
Medicare+Choice programs must be used for lower premiums and/or more 
benefits. It has to be used for that. So we provided more money to keep 
them there, to keep them home, and to keep them investing in our 
communities, providing these Medicare+Choice programs for seniors. We 
want to encourage them to stay.
  The problem with the motion to instruct is that it may have the 
perverse effect of destabilizing them even more. What it says is you 
have to stay for 3 years, whether or not the program is working, 
whether or not the reimbursements are adequate to cover the benefits 
that are provided under the program.
  The reason why this motion to instruct is wrong, even though we all 
agree that these are good programs that seniors want to have, even 
though we all agree that we do not want to see them move out of our 
districts, even though we all agree they are programs that provide 
extra coverage for our moms, for our dads and for our grandparents who 
desperately need extra coverage, the reason why this motion to instruct 
is wrong is it has the effect of destabilizing the presence of 
Medicare+Choice programs in our communities.
  Why would someone come into a marginally profitable area? Why would 
they come into an area where the reimbursements are not quite adequate 
to cover the benefits? Why would they come in if they were told, 
whether or not it works, you have to stay 3 years? They would not come 
in at all. The chances of them not coming in, not being present for my 
mom, not being present for our grandparents around America, to have 
these programs available to them, is much stronger if this motion to 
instruct passes.
  On the contrary, we ought to encourage the signature on H.R. 5543. 
Let me remind my friends on the other side, you voted to give more 
money to Medicare+Choice programs. You voted under the Medicare 
prescription drug bill we passed, or the Stark substitute. You voted 
for $3 billion more to go to those programs. So you agree with us we 
ought to help them more, we ought to stabilize them, we ought encourage 
them to stay so seniors can have them.

[[Page H11501]]

  But what we ought not do in this motion to instruct is further 
discourage them, further say there is a bigger risk in your coming to 
Thibodaux, Louisiana, where seniors would like you to be around. You 
see, there is a disconnect here. You cannot on the one hand attack 
these programs and refuse to help them out financially, and then on the 
other hand say that whether you make it or not, you have got to stick 
around for 3 years.
  Mr. Speaker, this is a bad motion to instruct. We ought to defeat it.
  Mr. PALLONE. Mr. Speaker, I yield 3\1/4\ minutes to the gentlewoman 
from Connecticut (Ms. DeLauro).
  Ms. DeLAURO. Mr. Speaker, I thank the gentleman for yielding me time.
  Mr. Speaker, this debate is about holding HMOs accountable. It is 
about accountability. The Republican leadership does not wanted to hold 
HMOs accountable. They in fact would like to reward them for outrageous 
behavior.
  Evidence: The Patients' Bill of Rights, HMOs are making medical 
decisions all of the time. Some of those decisions go wrong. We have 
tried to pass a Patients' Bill of Rights in this body. The Republican 
leadership has held that up. All we are asking is if they make a 
medical decision that goes wrong, that they are held accountable.
  Let us take a look at this bill that we are talking about this 
evening. Medicare HMOs should stop breaking their promise to seniors. 
When a senior signs up with a Medicare+Choice plan, they should have 
the security of knowing they will not see their coverage reduced or 
dropped for at least 3 years. We should be able to protect our seniors 
from those Medicare HMOs that are pulling the rug out from under them.
  These were the folks that were supposed to provide seniors with more 
choices, with prescription drug coverage that seniors cannot get 
through traditional Medicare, but they are giving seniors no choice at 
all.
  Let me talk about my State of Connecticut. They have jettisoned 
56,000 people. I went to Milford, Connecticut, to a senior center, to 
say to these people, do not get scared. You can go back to traditional 
Medicare. We came to allay your fears.
  A woman raised her hand and she says, Rosa, do not tell me not to be 
scared. I am scared. You have insurance. I do not have insurance. What 
am I going to do?
  That is what this is about, accountability, HMO accountability. 
Instead of protecting seniors, Republican Congress protects the 
Medicare HMOs. We should have passed a bill here last week that would 
have provided desperately needed funding to our Nation's hospitals, 
rural, urban, home health, hospice providers. They faced deep cuts in 
1997. They need that kind of help from us.
  Instead, the Republican Congress turned this bill into an $11 billion 
early Christmas present to the Medicare HMOs, 40 percent of the money 
in the bill, even though they only serve 15 percent of the seniors. 
They did it without any single guarantee that the Medicare HMOs will 
not stop reducing benefits or dropping seniors' coverage altogether.
  Mr. Speaker, we should have learned something from the last time we 
increased the payment to Medicare HMOs. Last year we gave them an 
additional $1.4 billion. Let me tell you how they returned the favor; 
they dropped nearly 1 million seniors. That is why we are asking here 
for tonight for the HMOs to have some guarantee that they need to stay 
for 3 years.
  One more item. My Republican colleagues would go one step further. 
They would put the prescription drug benefit into the hands of HMOs; 
imagine, people who decided to cut the rug out from 1 million people.
  Mr. Speaker, this motion says if Congress is going to give $11 
billion to Medicare HMOs, then Medicare HMOs should provide seniors 
with the coverage they promise. Keep faith with America's seniors and 
support the motion to instruct tonight.

                              {time}  2015

  Mr. THOMAS. Mr. Speaker, it is now my very great pleasure to yield 3 
minutes and 10 seconds to the gentlewoman from Connecticut (Mrs. 
Johnson), a member of the Committee on Ways and Means.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I would ask my colleague 
from Connecticut to read the bill and be honest with the seniors of 
Connecticut. Talk straight. The bill clearly sends every penny of new 
money to lower premiums or more benefits. Read the legislation.
  The gentlewoman is right, our seniors are scared; and they have every 
right to be scared, because, my colleagues, when you push seniors out 
of Medicare+Choice, and you are going to with this kind of proposal, 
you are going to close up every plan within a month of passing this 
kind of legislation because the plans will have no choice. The seniors 
are scared because they are not going to be able to get into medigap 
plans. Most of them cannot afford them and those plans discriminate on 
the basis of preexisting conditions. Seniors will have no choice but 
Medicare, and they are in Medicare+Choice plans mostly because they are 
poor and need those copayments paid, and they are ill and they need a 
lot of care. So the seniors are afraid and this resolution will force 
many more plans to withdraw from the market realizing the greatest 
fears of our seniors.
  My Democrat colleagues are going to close them up, because listen to 
what they want to do. They want the plans to commit to stay in 3 years 
and cover benefits, and every year we increase benefits, and they are 
going to make them cover them, but they do not say one word in their 
amendment about paying for those benefits. Not one word.
  Do my Democrat colleagues do their homework? Have they called their 
plans in the last year and asked them why they are losing money? Have 
they gone in and looked at the data that the plans have given them? Did 
it occur to my colleagues that when this body has given bigger 
increases to hospitals, nursing homes and home health cares every 
single year for the last 3 years and a 2 percent increase at maximum to 
our Medicare+Choice plans that they might be having trouble paying for 
the benefits that we want them to pay for? Of course. That is the 
problem.
  That is why the Committee on Ways and Means Democrats voted with the 
Committee on Ways and Means Republicans to give these plans a 4 percent 
increase this year; and, as a result of the amendment of the 
gentlewoman from Florida (Mrs. Thurman), because as she passionately 
described the fear and problems for her seniors if these plans go 
under, we gave them a higher increase, if they would come back into the 
market. Yes, we did that on a bipartisan basis, because we examined the 
facts. We talked to the plans, we talked to HCFA, we evaluated the 
information. That is our job on this committee with primary 
responsibility over Medicare.
  Then, the President comes out and he says he wants 1 percent. Do we 
think they are going to stay in the markets with 1 percent when they 
have only been able to stay in the markets with the highest AAPCC at 
this time? And those happen to be the most densely populated markets, 
so they have the highest number of participants and it helps them stay 
in?
  I am outraged, outraged that my Democrat colleagues would let 
politics bring this House floor to this level of dishonesty when they 
know that no plan will be unable to commit to 3 years and cover the 
benefits when they do not even guarantee them payment.
  This amendment says nothing. It says negotiate. Well, the President 
wants 1 percent. Remember? The President said we only needed to add $21 
billion back to Medicare. The Republicans said no. We have to add $28 
billion back, or our hospitals will go under, our nursing homes will go 
under, our home health agencies will go under.
  Give our seniors a break. Give our seniors a break. Give our health 
care providers the money they need to stay alive to not only serve our 
seniors, but serve the rest of the community that depends on our 
community hospitals, our nursing homes and our home care agencies. And 
yes, give them that choice of Medicare+Choice plans.
  Mr. PALLONE. Mr. Speaker, I yield myself 30 seconds.
  I just wanted to read from this report of the GAO that came out in 
September and it says, ``Although industry representatives have called 
for Medicare+Choice payment rate increases, it is unclear whether 
increases

[[Page H11502]]

 would affect plans' participation decisions. In 2000, 7 percent of the 
counties with a Medicare+Choice plan in 1999 received a payment rate 
increase of 10 percent or more. Nonetheless, nearly 40 percent of these 
counties experienced a plan withdraw.''
  The bottom line is, the Republicans are saying they want to give all 
of this extra money to the HMOs. The minimum they could do is provide a 
3-year guarantee and keep the benefits the same way, because otherwise, 
it will not work.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Massachusetts (Mr. Olver).
  Mr. OLVER. Mr. Speaker, it is a hard act to follow from my colleague 
from Connecticut, but I rise in support of the motion to instruct. 
Rural areas like mine in western Massachusetts, and not so rural areas 
like the gentleman from New York (Mr. Lazio) like Long Island, have 
been left high and dry by Medicare HMOs. They have largely abandoned 
rural markets to providing a prescription drug benefit for senior 
citizens, and those plans that do remain have raised premiums by as 
much as 300 percent in some cases.
  Now, I support giving better reimbursements to health care providers 
that were harmed by the Balanced Budget Act. Hospitals, nursing homes, 
home health providers, and even HMOs need our help. But it makes no 
sense to me to give billions of dollars to HMOs, while allowing them to 
abandon senior citizens in rural America without coverage for 
prescription drugs. Such a handout to HMOs without holding them 
accountable is a reckless use of taxpayer dollars.
  Mr. Speaker, if we are to give money back to the HMOs, we should have 
some guarantee that they will not take the money and run. We must add, 
we must require HMOs to offer a fair plan to all seniors for drug 
coverage that they desperately need.
  Mr. THOMAS. Mr. Speaker, it is my pleasure now to yield 1 minute to 
the gentleman from Georgia (Mr. Kingston).
  Mr. KINGSTON. Mr. Speaker, I want to speak to my friends on the other 
side of the aisle.
  My dad is 82 years old. He has macular degeneration, and he has 
diabetes. That means he is legally blind, he cannot read his blood 
sugar level, and he is trying to live independently.
  Now, I do know not what my Democrat colleagues think about when they 
play games with our seniors like my father, but it seems to me that 
there is a consistent pattern around here for the last 3 weeks to put 
politics over people over and over again.
  Here is a bill that has been endorsed by the American Hospital 
Association, the American Cancer Society, the American Federation of 
Home Health Care Providers, the National Association of Childrens 
Hospitals, the National Association of Rural Health Care Clinics, which 
I know they do not care about that, because the gentleman from Rhode 
Island (Mr. Kennedy), their leader says, and I quote, ``We have written 
off rural America.''
  Now, I know they are proud about that and I know what this is about, 
but the fact is, I would like my colleagues to think about people out 
there who have diabetes, people out there who are in nursing homes, 
people out there who yes, are scared, because you know what? It is 
November and every 2 years there are certain members of the Democrat 
party who cannot get reelected, so they get scared and they know the 
only way they can keep getting elected is to scare senior citizens. It 
is not right. I have a 97-year-old great grandmother. She does not 
appreciate putting politics over people. We are tired of it.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from New 
Mexico (Mr. Udall).
  (Mr. UDALL of New Mexico asked and was given permission to revise and 
extend his remarks.)
  Mr. UDALL of New Mexico. Mr. Speaker, I would say to the gentleman 
from Georgia (Mr. Kingston), first of all, that we believe in rural 
America and the reason the gentleman in New Jersey (Mr. Pallone) is 
offering this motion is because we support rural America; and we want 
accountability. I rise in strong support of this motion.
  Congress has a responsibility to protect seniors and stop protecting 
the HMO industry. This motion is designed to require accountability for 
Medicare HMOs. This issue is especially important to my home State of 
New Mexico. Earlier this year, between 15,000 and 17,000 New Mexico 
seniors were told that by year's end, they were being dropped from 
their Medicare+Choice coverage. Needless to say, a frantic plea for 
help rang out from seniors asking for a solution.
  Mr. Speaker, I am opposed to the solution offered by the majority to 
shovel more and more money to HMOs; and I urge support of the Pallone 
motion.
  Mr. THOMAS. Mr. Speaker, it is now my pleasure to yield 2 minutes to 
the gentleman from North Carolina (Mr. Burr), a member of the Committee 
on Commerce.
  Mr. BURR of North Carolina. Mr. Speaker, I thank the gentleman from 
California for yielding me this time.
  Mr. Speaker, I have sat and listened to this tonight and what misses 
out of this debate is the human face behind the issue. It is that 
senior who sits at home, that has no coverage; that senior who has a 
Medicare system that this institution has refused to change year after 
year after year, that does not meet the needs of medicine today, the 
diagnostic tools that exist and the treatments that are available to 
those that can pay.
  We ought to have a debate today about the changes in Medicare, but we 
are not. We are going to have a debate about how we hamstring choice 
for seniors, how we tie up the companies who can provide that choice so 
that, in fact, they will not, further taking seniors and limiting them 
to the existing system.
  Now, the gentleman before me, the gentleman from New Mexico (Mr. 
Udall) said that it is just about paying them more money. One of the 
reasons that they are dropping out of the system is that we underfunded 
this particular portion, and every Member bipartisanly has agreed to 
that. But the question is, is there accountability? Can they prove the 
value of their service? I believe that they can; I believe that this 
motion to instruct in fact hampers any additional plus choice options 
in the marketplace for seniors that either have been dropped or are 
currently underserved.
  Mr. Speaker, I would encourage every Member to vote against this 
motion to instruct and to vote for additional choices for seniors with 
health care.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Dingell), the ranking member of the Committee on 
Commerce.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Speaker, facts are awfully hard to quarrel with. 
What are the facts? Last year, we gave the HMOs $2 billion and more. 
This bill gives them $34 billion and more. HMOs have pulled out. Last 
year they pulled out and left about a half a million Americans without 
coverage. They have pulled out on almost 1 million more this year. The 
motion to instruct says one thing, and that is, if you are going to 
take this money, stay for 3 years.
  What is so hard for my colleagues on the Republican side to 
understand? This is simply about accountability. They are going to get 
a lot of Government money, and they ought to stay to take care of the 
senior citizens.
  Now, perhaps that is hard for my Republican colleagues to understand; 
but it is not hard for the GAO or for the Inspector General of HHS who 
said that the HMOs are now being overpaid. They have got more money 
than they need, but they do not have enough to satisfy them.
  Now, some of the statements that were made on this side of the aisle 
have really touched my heart, and I would be much impressed if they 
were true. They talked about these important unfortunate HMOs. Well, 
these poor HMOs are pulling out on America's senior citizens and 
leaving them without coverage. That is what they are doing. The motion 
to instruct says, you are going to take a lot of Federal money, some 
$34 billion or $36 billion last year and this year, so stay around for 
a while and provide services. What is so hard for my Republican 
colleagues to understand about that simple fact?
  Now, if I were crafting this bill, I would do it to really help the 
senior citizens. I would see to it that we put in a decent program for 
prescription medicine so that they have it. HMOs

[[Page H11503]]

could take this money, they do not have to do anything for it, except 
put it in the pockets of their executives or to see to it that it goes 
into the bottom line in dividends.
  I would see to it that it goes to hospitals, to home nursing, and to 
nursing homes, so that we can really help those who need it. That is 
how we do the job.

                              {time}  2030

  Mr. THOMAS. Mr. Speaker, I yield 1 minute to the gentlewoman from New 
Mexico (Mrs. Wilson), a member of the Committee on Commerce, who can 
tell my colleagues the real impact of this bill.
  Mrs. WILSON. Mr. Speaker, the gentleman from Michigan (Mr. Dingell) 
who just spoke talked how he would write this bill if he had the 
opportunity to, but the underlying bill went through the Committee on 
Commerce, and he voted for it.
  The reason he voted for it is it is a bipartisan bill, and it is a 
good piece of legislation. I want to talk about the Medicare+Choice 
provisions because I was the author with the gentleman from Minnesota 
(Mr. Luther), a Democrat, of the underlying bill. Senator Wyden and 
Senator Domenici were the authors in the Senate.
  The biggest threat to eliminating the discrimination against States 
like New Mexico is not a motion to instruct. It is that the President 
of the United States has said he intends to veto this bill which will 
save health care coverage for a million Americans, 15,000 of whom live 
in New Mexico. And do my colleagues know who runs the HMOs in New 
Mexico? The Catholic church, the Presbyterian church, both of them 
running nonprofit corporations and Loveless hospital that has been 
serving our community for almost 60 years.
  Mr. Speaker, I encourage the President of the United States to sign 
this bill and restore health care for America's seniors.
  Mr. THOMAS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I think we need to understand that the motion to 
instruct really ought to be, as the gentlewoman from New Mexico (Mrs. 
Wilson) said, to instruct the President to sign the bill. It is time to 
stop the politics. This is a bill that not only funds the providers, 
the hospitals, the home health care skilled nursing, but it creates a 
biannual test for Pap smears.
  It screens glaucoma. It screens colonoscopy. It eliminates the time 
on Medicare benefits for immunosuppressive drugs. It puts limits on 
prescription drug charges so seniors are not bilked by unscrupulous 
providers. Yes, and it tells the plans that if we provide them with 
money, that money must go to beneficiaries.
  This motion to instruct is all politics, and the President's failure 
to sign the bill is all politics. Let us end the politics. Vote no on 
this motion to instruct and tell the President to sign the bill.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of the time.
  Mr. Speaker, this motion is to protect the seniors and make sure they 
do not get thrown out of their HMOs and they do not lose their 
benefits, including their prescription drug benefits. And what the 
Republicans want to do in opposing this motion is they want to give all 
this money to the special interest HMOs so they can use it for their 
executives, so that they can put more ads on to try to lure seniors in 
to a benefit plan that they are not going to really get, and so that 
they can use the money for special interests for lobbying and to lobby 
to come down here and avoid HMO reform and the Patients' Bill of Rights 
and a Medicare prescription drug program.
  This bill that the Republicans have proposed is for the special 
interests. What the Democrats are saying with this motion is let us 
make sure that the seniors can stay in a program that they can get 
their benefits. We are worrying about the little person who is being 
thrown out of the HMO all over this country, including in my district.
  Mr. Speaker, I had a woman that had to go to a dinner. She was lured 
to a dinner with advertising by the HMO to get into a program with a 
lobster dinner. They gave her a lobster dinner so she would sign up for 
the HMO, and then she is thrown out of the HMO and she has nowhere to 
go.
  It is a disgrace. Vote for the motion to instruct.
  Ms. VALAZQUEZ. Mr. Speaker, I rise in support of the Pallone Motion 
to Instruct. This motion addresses yet another failure of the managed 
care system. The Medicare Plus Choice plans are currently constructed 
so that an HMO in the system can drop out at any time, leaving its 
patients to find another choice provider, or to re-enter the standard 
Medicare system. Often, this happens on very short notice.
  This motion seeks to ensure that our frailest citizens do not 
suddenly find themselves kicked out of the system they depend on for 
their health coverage. Since January of 1999, this has happened to over 
700,000 senior citizens nationwide. The Health Care Financing 
Administration estimates that over the next year, 10 to 15 percent of 
the nation's Medicare Plus Choice beneficiaries will find themselves in 
the same situation.
  Therefore, we must support this motion to ensure that all providers 
offer coverage to seniors for at least three years after they join the 
system.
  More importantly, rather than trying to mend an already fraying 
safety net, we need to pass comprehensive legislation--in particular, a 
patient's bill of rights to protect all Americans. If we had done this 
in this Congress, HMOs would already have been put on notice that we 
will not allow them to place profits over the health of people.
  Last October, 275 Members of this House, from both sides of the 
aisle, passed a strong HMO reform bill. The Republican leadership has 
allowed it to die in conference, again thwarting the will of the House.
  Even worse, Republicans are ignoring the demand of the American 
people for health care reform. They are also showing that they are more 
concerned about big business than the health of the American people.
  My colleagues, we have a chance today to say that we will no longer 
stand by while the health of our senior citizens is sacrificed on the 
altar of corporate greed. If you agree, then I urge you to vote in 
favor of this motion.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Thornberry). Without objection, the 
previous question is ordered on the motion to instruct.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct 
offered by the gentleman from New Jersey (Mr. Pallone).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. PALLONE. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 170, 
noes 183, not voting 79, as follows:

                             [Roll No. 576]

                               AYES--170

     Ackerman
     Aderholt
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barcia
     Barrett (WI)
     Bentsen
     Berkley
     Berman
     Berry
     Bilbray
     Blagojevich
     Blumenauer
     Bonior
     Borski
     Boswell
     Boyd
     Brown (OH)
     Capps
     Capuano
     Cardin
     Carson
     Clement
     Clyburn
     Condit
     Costello
     Coyne
     Cramer
     Cummings
     Davis (FL)
     DeFazio
     DeGette
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Doyle
     Edwards
     Emerson
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Ford
     Frost
     Ganske
     Gejdenson
     Gephardt
     Gilman
     Gonzalez
     Green (TX)
     Hall (OH)
     Hall (TX)
     Hill (IN)
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kildee
     Kind (WI)
     Kleczka
     Kucinich
     Lampson
     Larson
     Leach
     Lee
     Levin
     Lewis (GA)
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Luther
     Maloney (CT)
     Maloney (NY)
     Markey
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McKinney
     McNulty
     Meeks (NY)
     Millender-McDonald
     Miller, George
     Mink
     Moakley
     Mollohan
     Moore
     Morella
     Nadler
     Napolitano
     Neal
     Obey
     Olver
     Ortiz
     Pallone
     Pastor
     Payne
     Pelosi
     Phelps
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Sanders
     Sandlin
     Sawyer
     Saxton
     Schakowsky
     Scott
     Serrano
     Sherman
     Shows
     Sisisky
     Skelton
     Slaughter
     Smith (NJ)
     Stabenow
     Stenholm
     Strickland
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thurman
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Waters
     Watt (NC)

[[Page H11504]]


     Waxman
     Weiner
     Wexler
     Wilson
     Woolsey
     Wu

                               NOES--183

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

                             NOT VOTING--79

     Abercrombie
     Allen
     Archer
     Barr
     Becerra
     Bereuter
     Bishop
     Boucher
     Brady (PA)
     Brown (FL)
     Campbell
     Clay
     Clayton
     Conyers
     Cooksey
     Crane
     Crowley
     Danner
     Davis (IL)
     Delahunt
     Dickey
     Dooley
     Forbes
     Fowler
     Frank (MA)
     Franks (NJ)
     Gillmor
     Gordon
     Gutierrez
     Hastings (FL)
     Hefley
     Hilliard
     Hulshof
     Hyde
     Kanjorski
     Kaptur
     Kasich
     Kennedy
     Kilpatrick
     Klink
     Kolbe
     LaFalce
     Lantos
     LaTourette
     Lazio
     Lipinski
     Martinez
     McCollum
     McInnis
     McIntosh
     McIntyre
     Meehan
     Meek (FL)
     Menendez
     Metcalf
     Moran (VA)
     Murtha
     Owens
     Oxley
     Pascrell
     Pickett
     Riley
     Sanchez
     Shaw
     Shays
     Shuster
     Snyder
     Spratt
     Stark
     Stupak
     Talent
     Tancredo
     Thompson (MS)
     Visclosky
     Watkins
     Watts (OK)
     Weygand
     Wise
     Wynn

                              {time}  2055

  Messrs. CANADY of Florida, ISTOOK and MINGE and Mrs. CHENOWETH-HAGE 
and Mrs. KELLY changed their vote from ``aye'' to ``no.''
  So the motion to instruct was not agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________