[Congressional Record Volume 146, Number 140 (Monday, October 30, 2000)]
[House]
[Pages H11595-H11601]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            DEMOCRATS' CONCERNS REGARDING HEALTH CARE ISSUES

  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 as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I listened to the previous speaker on the 
Republican side, and I know he is well intended. But I wanted to say 
that I feel very strongly that one of the reasons we are still here, 
and certainly one of the reasons that has been articulated by the 
President in his opposition to this Republican tax bill that he has 
said he will not sign, he will veto if it comes to his desk, is because 
Democrats and the President and the Vice President feel very strongly 
that with regard to a number of issues, and I am going to spend time 
primarily this evening on the health care issues, that the Republican 
leadership has simply not done its job.
  Mr. Speaker, we as Democrats are very concerned about the average 
citizen and what we do in the House of Representatives and feel very 
strongly that on a number of issues, and again particularly with regard 
to health care, that the Republican leadership has simply failed to 
address the problems that the average American cares about.
  We know that we are in times of great economic prosperity and as a 
result of the President's programs, that prosperity continues. There is 
a significant Federal surplus for the first time now in a long time. 
But the problem is that we still have some unmet needs, and 
particularly with regard to health care. What we see in this tax bill 
that the previous gentleman from South Dakota (Mr. Thune) mentioned, 
and that has been the discussion of much debate over the last few days, 
is that the Republicans really are prioritizing what I call special 
interests, particularly with regard to HMOs, as opposed to the public 
interest.
  I have been very critical of the fact that this tax bill that came to 
the floor last Thursday gave the lion's share of the money to the HMOs 
without any strings attached, without any requirement that they stay in 
the Medicare program.
  Many of my constituents have complained to me about the fact that 
they signed up with an HMO under Medicare, and then a year later or so 
they were notified that the HMO was no longer going to cover them and 
they had to find some other way to cover their health insurance. 
Granted, they can go back to the traditional Medicare fee-for-service 
system, and that is fine. For most people, 85 percent of people who are 
under Medicare, that is fine and that is great.
  But there are problems in the sense that traditional fee-for-service 
does not cover prescription drugs. Many of my seniors signed up for 
HMOs because they were sort of lured into it by promises on the part of 
the HMOs that they would get a prescription drug benefit, and then all 
of a sudden they found that they did not have one.
  Well, what the HMOs did is they came back to the Republican 
leadership and said, look, we are getting out of Medicare because we 
are not getting enough money, so give us more money. Give us a larger 
reimbursement rate, and we will get back into the program. The problem 
is that the tax bill the Republicans put up last week did not attach 
any strings. They are saying, okay, we are going to give 40 percent of 
this new money that we have in the surplus, or 40 percent of the money 
allocated in this bill, to HMOs. But they do not say that they have to 
stay in the program for more than a year. They do not say that they 
have to guarantee any particular level of benefits.
  Mr. Speaker, I actually had a motion which I brought to the floor 
yesterday, or the day before last, which said that in order to get this 
additional money they would have to agree to stay in the Medicare 
program for at least 3 years and they would have to provide the level 
of benefits that they initially promised for that 3-year period. Of 
course, the reference is primarily to prescription drug benefits, which 
is why most seniors signed up for HMOs in the context of Medicare.
  The Republican leadership opposed that motion and they basically say, 
look, we want to give this money to the HMOs, and we are not going to 
have any real strings attached to it. The Democrats and the President 
have been saying that in addition to the fact that they are giving this 
money to the HMOs with no strings attached, they are taking away or 
they are not giving sufficient funds or prioritizing funding for the 
providers of Medicare, the hospitals, the nursing homes, the home 
health care agencies. They get significantly less percent of this money 
under the Republican bill than the HMOs do, and yet they are the ones 
that are really providing the service.
  The HMOs are just insurance companies that ultimately go to the 
hospitals and the nursing homes to provide the service. And these 
primary providers are getting less of a percentage of this pot than the 
HMOs. Again, I would say it is because the HMOs are aligned with the 
Republicans and basically the Republican leadership is doing their 
bidding.
  Now, what do the HMOs do with the money that they get from the 
Federal Government? Well, first they provide services. But we know a 
lot of them spend a significant amount of that money paying for their 
CEOs. They have huge overhead, huge administrative expenses for a lot 
of their executives. They do a tremendous amount of advertising. That 
is how they get the seniors to sign up for the HMOs, doing all of this 
advertising and having these meetings and giving out free dinners and 
different things to get the seniors to come and sign up.

[[Page H11596]]

  Then they also spend a significant amount of their money lobbying and 
spending money on political ads to lobby against the Democrats' 
initiative, the Medicare prescription drug program that we have 
proposed, and the HMO reforms, the Patients' Bill of Rights that we 
have proposed.
  They also spend a lot of their money just in direct or indirect 
independent expenditure contributions to argue against and for the 
defeat of Democratic candidates. I was one of the victims of that. I 
found myself, 2 years ago in 1998, the target of an independent 
expenditure primarily financed by HMOs and the pharmaceutical industry 
to the tune of $5 million spent in the last 2 or 3 weeks of the 
campaign to try to defeat me.
  So it is no wonder that it costs the HMOs so much money to operate 
and why they feel they need more money to operate, because so much of 
their expenditure goes for these other things that are not health care 
related.
  Now, what the Democrats did today is we tried, when there was a bill 
that came up to correct this tax bill with regard to another aspect, a 
minimum wage, the Democrats tried to bring up an alternative bill or 
amend the Republican legislation so that it included some changes that 
would diminish the percentage of the money that went to the HMOs and 
give more as a percentage basis to hospitals and primary providers, 
nursing homes, home health care agencies.
  At the same time, it would say that if the HMOs wanted to benefit 
from this additional money that was being provided under the bill, that 
they would have to stay in the Medicare program for 3 years and they 
could not reduce their benefits.

                              {time}  1645

  It seems to me that makes a lot of sense. We know the HMOs are 
getting out of the system. There have been many reports, one done by 
the GAO, the General Accounting Office, just last month in September 
that said that providing more money to the HMOs is not necessarily 
going to make them stay within the Medicare system. So why not try a 
different way of trying to get them into the system.
  I want to talk a little more about some of the other things that we 
had in this proposal today because I think it goes to the heart of my 
initial contention that the Democrats are trying to deal with the 
problems, the health care problems that the average American faces; 
whereas, the Republicans keep trying to do something with this bill 
that is primarily for the special interests and for the HMOs.
  Just to give my colleagues an idea, we had additional money, as I 
said, for hospitals. We had additional money for the staffing and 
quality control for nursing homes. We had additional payments to home 
health agencies. I have been critical of the fact that the Republicans 
have not been willing to bring up the patients' bill of rights, which 
is the HMO reform that prevents abuses in HMOs and says the decisions 
about what kind of care one gets, what kind of operation one gets, what 
kind of hospital stay one gets, that those decisions should be made by 
the insurance company and the patient and not by the HMO, the insurance 
company.
  The Republicans have not been willing to bring up the patients' bill 
of rights. They passed it in the House, but it is dead in the Senate. 
So what we put in this bill as an alternative to the Republican tax 
plan today also was a provision that says that, if one has to appeal a 
decision under Medicare because one has been denied care by an HMO, 
that one would have a better way to appeal that, go to an outside 
review board, if you will, to make that appeal so the HMO would not, 
basically, be reviewing its own decisions. Somebody else would.
  This is part of what we had proposed in the patients' bill of rights. 
So we were, not only trying to give more, we were not only trying to 
level the playing field with the HMOs and require them to stay in the 
Medicare program for longer period of time, we were also trying to 
address the issue or the need for HMO reform.
  Now, the other thing that we were trying to do in this bill today, 
which I think is a distinct improvement over what the Republicans had 
in mind, is that it relates to the issue of the uninsured. If we ask 
Americans today about health care and what are the primary problems, 
they will say HMO abuses, they will say the need for a Medicare 
prescription drug. But for those who do not have health insurance, 
which is about 42 million Americans, they will say it is the need to 
provide affordable health insurance so that they can get health 
insurance.
  Well, in this bill, in this tax bill that the Republicans put forward 
last week and has been the subject of discussion for the last few days, 
the Republicans said that they are going to give an above-line 
deduction for individuals who buy their health insurance. I have been 
critical of that because it is not going to help, again, the people who 
do not have health insurance. In other words, most of the people that 
would be able to take advantage of that are people who already have 
health insurance and they will get a deduction.
  But what about the 42 million people that do not. The type of 
deduction that is provided is not really going to provide a system for 
those 42 million, or few of them, to buy health insurance because their 
problem is their employer does not provide it, and they cannot afford 
it on the private market. A little bit of a deduction the way the 
Republicans have set forth is not going to get them to be able to 
afford health insurance.
  What the Democrats have been saying with regard to the uninsured, 
and, again, this is Vice President Gore's proposal, is that we have to 
build on the existing kid's health initiative which was passed here in 
the House of Representatives and became law a few years ago, that 
provides Federal monies back to the States so that they can sign up 
children of working parents who now cannot afford health insurance.
  What Vice President Gore has been saying, what President Clinton and 
what the Democrats have been saying is let us expand that program to a 
little higher income level so that the kids whose parents work but 
maybe are a little above the current guidelines will still be able to 
take advantage of this program.
  We have also been saying that, perhaps, we should let the parents of 
these children buy into the program. It is more likely that if a parent 
can provide or get health insurance for their children, that they would 
like to sign up the whole family for this program with these Federal 
dollars.
  So I have been critical of this Republican tax plan because it really 
does not do anything to get more people enrolled in health insurance 
who do not have it. I would like to see some changes, instead, in some 
money used under this bill to sign up more people and get more people 
involved in this kids health initiative.
  So what we have in the Democratic alternative that was discussed 
today but, of course, defeated was a way of providing additional 
coverage, money that would be used to do outreach to get more children 
enrolled in the program.
  Again, it is a different approach to what the Republicans have 
proposed, but I think it is an approach that will work in getting more 
people provided and covered by health insurance; whereas, I do not 
think the Republican proposal accomplishes that.
  I want to stress throughout this because I hear my Republican 
colleagues say that this tax bill is a great bill, and the President 
should sign it because it is going to help.
  Well, I am not going to argue that in some ways it might help a 
little; but given the amount of money that is being thrown to the HMOs, 
given the amount of money that is being given to a lot of these special 
interests, it is not going to help very much.
  We could use that same amount of money in a different way under the 
Democratic proposal to really do a lot more to make sure that seniors 
who are on Medicare can find an HMO that provides them with decent 
coverage, including prescription drugs, we can do a lot more to cover 
the uninsured with that same amount of money than what the Republicans 
are doing.
  Now, just to give my colleagues some perspective on this, in the tax 
bill that the Republicans put forward and passed, over one-third of the 
Federal dollars were allocated to HMOs. It is almost 40 percent, 41, 42 
percent. The Republican plan increases payments to Medicare HMOs by 
over $10 billion over

[[Page H11597]]

5 years and over $30 billion over 10 years, despite the fact that only 
16 percent of Medicare beneficiaries are enrolled in HMOs.
  Well, keep that in mind. In other words, if one has this senior, 
group of seniors and disableds that are in Medicare now, only 16 
percent of them are in an HMO. Yet, when we address the issue of trying 
to provide additional funding for Medicare, we are going to give for 
those 16 percent 40 percent of the money. The other 85 percent who 
would benefit more from having this money go to the hospitals or the 
nursing homes or the home health agencies directly, they are only 
getting 60 percent of the money.
  It makes no sense, other than if one looks at it from the perspective 
that the Republicans are with the HMOs because they are helping them 
with their campaigns. They are trying to get rid of Democrats, and they 
are doing all these other things to help the Republican cause.
  I also wanted to give my colleagues another example. This was an 
article that I took from USA Today back in February of 2000, but I have 
kept it because it really kind of says a lot about what the HMOs do 
with the money.
  This report found $4.7 million in questionable administrative costs 
among nine Medicare HMOs, including lobbying and gifts. One insurer 
spent $249,283 on food, gifts and alcoholic beverages. Four HMOs spent 
$106,490 for sporting events and theater tickets. Another leased a 
luxury box at a sports arena for $25,000. Customers, insurance brokers 
and employees at one HMO were treated to $37,000 in wines, flowers, and 
other gifts.
  I gave the example the other day, Mr. Speaker, of where an HMO in my 
district did this huge advertising campaign to get people to go to the 
local diner. They offered them a Maine lobster dinner for the evening 
to get good people to sign up for the HMO.
  I mean, this is crazy. Here we are being asked to give more money to 
the HMOs so that they can spend the money for these administrative 
costs, for this advertising, and these other things that ultimately do 
very little, if anything, to help the average senior or the average 
American.
  Now I wanted to, if I could, Mr. Speaker, spend a little time talking 
about the Democratic alternatives on the two issues of prescription 
drugs and HMO reform, and I will probably also get in a little bit to 
the issue of dealing with the uninsured. I talked so far about these 
issues in the context of this tax package today.
  But what I want to reiterate to my colleagues is the fact that, over 
the last 2 years, and even beyond, since the Republican leadership has 
been in the majority here, there are major overhauls of all these 
programs that could have been done and that, in fact, were proposed and 
even in some cases voted on by the House that were initiated by the 
Democrats with the help of some Republicans that would have made a huge 
difference in people's lives with regard to seniors access to 
prescription drugs, with regard to HMO abuses, with regard to the 
problem of these over 40 million Americans that have no health 
insurance.

  Yet, in each case, the Republican leadership stymied and tried to 
prevent this legislation from coming to the floor or, even if it did 
pass, they killed it in the other body or they did whatever they could 
in conference between the two Houses to make sure that it did not move 
forward.
  I guess the best example of that is the issue of HMO reform, which I 
still think, along with Medicare prescription drugs, is the number one 
issue that I hear back at home in my district in New Jersey.
  What the Democrats were saying with regard to the HMO issue is that 
we are tired of the abuses where the HMOs will say to an individual or 
a patient, okay, you cannot have this particular operation or you 
cannot stay in the hospital this particular length of time, or we are 
not going to let you have this particular medical equipment because we 
do not think it is necessary.
  We want to change that. The Democrats and some of the Republicans 
want to change that so the decision about what is medically necessary 
and what kind of care one gets is made by the physician and the 
patient, not by the insurance company. In addition, we want to give one 
some enforceable way of rectifying a grievance if one has been denied 
care because the insurance company said one cannot have it.
  Now, the answer to this that we put into bill form was a bill called 
the patients' bill of rights, also known as the Norwood-Dingell bill. 
It was mentioned by the Vice President in the last debate that he had 
with Governor Bush. He actually asked Governor Bush whether he would 
support the Norwood-Dingell bill and Governor Bush did not respond or 
certainly did not indicate that he would support it.
  The patients' bill of rights really does two things. It switches the 
decision making from the insurance company to the doctor and the 
patient; and it says that, if the insurance company denies one care, we 
are going to give one a way to go to an independent board that could 
overturn that negative decision, or failing that, or absent that, one 
could go to court and have the court enforce one's rights and make sure 
that one has the service that one and one's physician thinks are 
medically necessary.
  But let me just go into some of the other provisions of this bill 
before I talk about its fate and why I blame the Republican leadership 
for its not passing in this Congress. The legislation, first of all, 
protects all Americans and all health plans, it is not limited to 
certain types of health plans.
  It assures access to all emergency rooms when and where the need 
arises. Many of the HMOs now will say one can only go to certain 
hospital emergency rooms even if one feels that one is having a heart 
attack. If one goes to the local emergency room rather than the one 
they tell one to go to that is 50 miles away, and one does not die, 
then they will come back and say, well, you should have gone to the 
other emergency room 50 miles away, and they will not pay for it.
  Well, this says that is not acceptable if one thinks that one needs 
to go to the emergency room, one has a legitimate reason, one has chest 
pains or whatever, they have to pay for it.
  Some people are surprised to find that is true until they have the 
emergency and they find out it is not paid for.
  The patients' bill of rights also guarantees access to the 
specialists the patients need. One of the ways that HMOs limit care is 
they will say you could go to a particular specialist. I will give my 
colleagues an example of pediatrics. They will say one can only go to a 
certain pediatrician, but one cannot go to a pediatrician who 
specializes in certain disorders.
  Well, we say no. One has to be able, if they do not have the 
physician or the pediatrician in my example who deals with that 
specialty care within their network, then one has to be able to go to 
the doctor outside the network, and they have to pay.
  It guarantees that one has access to a fair and timely internal and 
independent external appeals process. This is what I said before. The 
HMO does not hear one's appeal. An independent group does outside of 
the HMO. It also assures access to clinical trials, assures patients 
can keep their health plans.
  There are a number of other things. I am not going to go into all the 
details because, you know, for lack of time.

                              {time}  1700

  What happened to this Patients' Bill of Rights? Well, when it was put 
together by the gentleman from Georgia (Mr. Norwood), who is a 
Republican, and the gentleman from Michigan (Mr. Dingell), who is the 
chairman of our Committee on Commerce on the Democratic side, we could 
not get it brought up on the floor of the House. The Republican 
leadership did not want it brought up. So we got a discharge petition. 
This is where we all come to the floor, as many of us as we can, and 
sign a petition demanding this bill be voted on, be considered on the 
House floor. As the number of that discharge petition increased and got 
to be almost a majority, the Republican leadership decided that they 
would let a bill come to the floor.
  Eventually, not easily, it was approved by a majority of the House. I 
think something like 60 Republicans even voted for it. But then, when 
it went over to the Senate and there was a conference between the two 
Houses, the Republican leadership here continued to oppose it, and the 
Republican

[[Page H11598]]

leadership in the Senate had always opposed it; and so they just 
basically let the conference die. I think the conference met once or 
twice; but that was it, and the bill is dead. They will not bring it 
up. So when I blame the Republican leadership for not addressing the 
issue of abuses within HMOs, it is because of the fact that they have 
basically killed this bill.
  The second major issue is the one with regard to prescription drugs, 
and this of course has become a major issue in the Presidential 
campaign. What the Democrats have been saying, and Vice President Gore 
of course the same, is that we have an existing Medicare program for 
seniors and the disabled that works well. Medicare does not have a huge 
overhead, administrative costs, and it works well. It is a government-
run system in the sense that the government pays the cost. So why 
should we not expand it to include prescription drugs?
  When Medicare started in the 1960s, prescription drugs were not that 
important. Preventive medicine was not that important. It has become 
so. People now can pay incredible bills, $4,000 or $5,000 a year, 
sometimes more, for prescription drugs. So we need to cover this under 
the rubric of Medicare. And rather than hoping that people will be able 
to find an HMO that covers it, and only 15 percent have, 15 percent of 
the seniors as we have said are all that are in HMOs right now, let us 
provide it as a basic benefit under Medicare that anyone can sign up 
for.
  Well, I will not get into the details, but that is essentially what 
the Democrats advocated. And what do we see on the other side? The 
Republicans say, no, we do not like Medicare, why in the world would we 
want to expand it to include prescription drugs? Instead of doing that, 
we recognize the fact that people below a certain income, seniors below 
a certain income need some sort of help; and so we will provide a 
subsidy or a voucher for them if they are below a certain income, and 
they can go out and either get an HMO to cover their prescription drugs 
with that voucher, or that subsidy, or they can find maybe some 
insurance company that will just cover prescription drugs.
  Well, that is not the answer. It is not the answer for a number of 
reasons. First of all, because the majority of the seniors would not be 
covered. The seniors that complain to me about not being able to afford 
prescription drugs are not just the poorer ones, they are the average 
senior. They are everybody. Obviously, maybe the people that are above 
a certain income do not care, but I find that 90 percent of my seniors 
feel that they are having a problem paying for their prescription 
drugs. So the Republican bill does not even address the problem for the 
majority of the middle-class seniors.
  In addition to that, I do not think the Republican proposal works. 
Again, it is primarily linked to HMOs, a person's ability to find an 
HMO that will cover them. We have already had experience with the HMOs, 
so many of which have dropped Medicare. Why should we believe this is 
the answer, particularly since only 15 percent of seniors are covered 
by an HMO? Or even worse, why should we believe if we give a voucher 
they will be able to find a company to cover just prescription drugs? I 
do not know any company that would do that. They might find one, but I 
feel confident it will be a pretty lousy policy, if they can even find 
it.
  So Democrats are saying forget the ideology. Practically speaking, 
the only way we will get all the seniors, or most of the seniors being 
able to have a prescription drug program that covers most of their 
needs is if we put it under Medicare. Forget the ideology, forget 
liking or not liking Medicare, forget the fact that it is a government 
program. It works. This is the way to do it, and probably the only way 
to do it given the marketplace and what is out there.
  Again, we tried to bring this up; but it was opposed by the 
Republican leadership. They did not want to bring it up. They brought 
up their own proposal, defeated ours, and even their proposal has not 
moved in the Senate and nothing has happened to it. So they are simply 
not addressing the issue at all. I suppose they would argue that this 
tax bill that I started talking about earlier this evening addresses it 
in some way by giving more money to the HMOs, but unless they guarantee 
the HMOs stay in Medicare and provide a prescription drug program at a 
certain level, I do not see how it helps. Practically speaking, I do 
not think it helps.

  So there again, the second important health care issue that affects 
the average American has basically gone down in flames in this 
Congress. There are a couple of days left here, but the Republican 
leadership refuses to address it; yet they keep saying they care about 
the average person and they are going to do something to help.
  Now, the last thing I wanted to discuss with regard to health care, 
and I have already touched upon it in the context of this tax bill that 
I talked about earlier, is the need to cover the uninsured, over 40 
million. How do we do it?
  Well, what the Democrats have been saying is that absent universal 
health care insurance, which some are for and some are against, I 
happen to be for it, but not everyone is even within the Democratic 
party; but absent universal health care, what can the government do to 
try to address the problems of these 40 million-plus Americans that 
have no health insurance? Well, when we break it down, we realize that 
the largest group that was not covered were children, and the second 
largest group that were not covered were the near elderly, people 
between 55 and 65 that are not yet eligible for Medicare but a lot of 
times find themselves, either because the working spouse died and the 
nonworking spouse, usually the wife, is not covered at that age, or 
because her husband died she does not have coverage, or in some cases a 
person got an early retirement and the early retirement did not cover 
their health benefits. Basically, they are waiting for Medicare to 
cover them at 65, but for those 10 years or so they are without health 
insurance, and they find it unaffordable to buy it in the private 
market.
  So what the Democrats have been saying, what President Clinton and 
Vice President Gore have been saying, and we actually managed to get 
one part of this addressed on a bipartisan basis, is let us see what 
the government can do to cover these people in some way. A couple of 
years ago we got together with the Republicans, and again I will not 
give them too much credit because they fought this thing tooth and nail 
until the bitter end, when they finally agreed to it, but they finally 
agreed to the CHIP program to give money back to the States so that 
they could sign up kids below a certain income.
  Now, I want everyone to understand that this is not welfare. These 
are not people that are not working. They are eligible for Medicaid and 
are already covered. These are working people who have children, but 
because the employer does not provide a health care benefit or because 
they cannot buy it privately, it is too expensive, they do not have 
coverage. So we put together this CHIP program, and we covered kids up 
to a certain percent of poverty. But again these are not kids in 
poverty. I am not sure what we would call them, perhaps lower middle 
class, working class parents.
  I have to point out also that not only did we have initial opposition 
by the Republican leadership to this, but when it went back to States, 
and particularly to Texas in the case of Governor Bush, he tried to 
limit the program to, I think, 150 percent of poverty rather than 200 
or 250 percent of poverty. But he eventually went along with it, with I 
guess the Democratic legislature insisting on the 200 percent, and it 
was passed.
  What the Democrats have been saying, or Vice President Gore has been 
saying, is let us raise the level of that to 250 percent of poverty or 
even higher. That is not really poverty, that is an income of maybe 
$25,000 or something like that. But a lot of people that are making 
$25,000 or $30,000, or even $35,000, they cannot afford health 
insurance for their kids if they have to go out and buy it privately. 
So that is what we are proposing for the kids.
  With regard to the near elderly, what we are saying is we will let 
them buy into Medicare and pay so much a month, maybe $300 or so a 
month, and they can get into Medicare by purchasing Medicare at the 
going rate of whatever it costs the government.
  Then, as I mentioned before, the Vice President has also proposed, 
and I have

[[Page H11599]]

been in favor of the idea, of letting the parents of the kids who are 
in the Federal kids care program to sign up and be eligible for the 
kids care program as well. If we did all that, we would make a 
significant dent in that 40 million or so who do not have health 
insurance.
  We could also link that to a tax deduction as well. We could also 
provide some sort of tax incentive or tax deduction to the employer to 
try to get more of them to provide health insurance for their 
employees, but it would have to be at a much larger amount than what 
Governor Bush and the Republicans have proposed.
  These are the things that need to be done. Again, they are not being 
addressed here by the Republican leadership; and I just find it tragic 
that at a time when we have a surplus, and when we know that most of 
the American people would support these initiatives, that the 
Republican leadership refuses to go along with them.
  I guess the last thing I want to do this evening, Mr. Speaker, is to 
point out that what I am proposing, what the Vice President has 
proposed, and what the Democrats have proposed, not so much based on 
any partisan ideology or any notion about Democrats being better than 
Republicans, but only because we have been out there and we have talked 
to people and we realize what can be done by the Federal Government in 
practical terms that would make a difference in people's lives.
  I do not come down here to argue D versus R, or who is going to be 
President or anything like that. I really want to get things done that 
will help my constituents. Every one of the things I mentioned tonight 
is directly related to somebody or some group of people who have come 
to me personally and said this is what should be done. I would just 
give a few examples.
  I can give an example of a woman who is a waitress in a restaurant in 
my hometown. When I am back in the district, I often go to lunch there. 
She came to me one day and said, I work in this luncheonette, and I 
have a very good relationship with the owner of the place. It is a 
small place. And I know the owner as well. He actually came over to me 
at one point and said that he really would like to provide health 
insurance, but given the way things are, he could not afford it. But I 
told her about the CHIP program and how we were trying to pass the CHIP 
program. I think she had a daughter. I am not certain exactly, but she 
hoped to get her child enrolled in the program.
  When we finally did pass it and it became law and I made her aware of 
it, she went out and enrolled her in the program. She came back a 
couple of months later and told me that she had enrolled and she had 
the benefits. It gave me such a good feeling that I could come down 
here, and that we all can come here, and accomplish something. Of 
course, then she found out that the Vice President is now talking about 
letting the parents of these kids enroll in the same program, and she 
is hoping that we will be able to accomplish that as well.
  Then I have another example, which I have mentioned a couple of times 
on the House floor, about HMO abuses. I have had so many people contact 
my office because they were denied care, they were thrown out of the 
hospital early, or they could not get a particular operation that they 
needed. I mentioned the example with the senior citizens that were, I 
say, lured into this diner one night for this lobster dinner.
  What we have to keep in mind is that many of these seniors, before 
they were in HMOs, had pretty good coverage under traditional Medicare. 
The only reason they got into the HMO is they thought they would get a 
better deal. Sometimes they are not very sophisticated about what that 
deal is. They do not necessarily read the fine print in the contract 
when they sign up. And then they do sign up and find out that it is not 
what it is supposed to be, or they are told or they get a notice saying 
they are going to be thrown out of the program within 6 months, and 
they do not necessarily understand that they can go back to the old 
traditional fee-for-service program. It has to be explained to them, 
and a lot of times they do not even believe that.
  So this disruption in their lives, going back and forth, and the idea 
that somehow they will be able to choose and they will be able to make 
decisions easily about which program is better, to some extent it is a 
hoax. I would like to believe that all seniors can make intelligent 
choices, and I am sure many can, but a lot of people, when they become 
older and frail, they do not have the ability to make those choices. So 
they buy into these ads, either on TV or on billboards or in the local 
media, that convinces them that somehow this is something better, and 
then they are shocked when they find out it is not better or they 
cannot even continue with it if it happens to be a good program.

                              {time}  1715

  So again, when I talked earlier about why we are giving so much money 
to the HMOs and not to the hospitals, well, I had a hospital close in 
my district. South Amboy Memorial Hospital closed in my district and 
cited the fact that they had inadequate Medicare payments.
  So when I say we are giving money to HMOs when the hospitals need it, 
I am not talking pie in the sky. I am talking about a hospital that 
closed and was serving people and now people have to go farther away to 
an emergency room in another hospital.
  I know we are at the end and there is probably not much that is going 
to be done. But even if the only thing that we can do is correct this 
tax bill that the Republicans have put forth by staying here a few more 
days and having the President threaten to veto, even if we can just 
accomplish that and the alternatives that we propose today, at least we 
will have accomplished something and I will feel that the last 2 years 
have not been in vain in this regard on so many of these important 
health care issues.
  I am glad to see that one of my colleagues from the Democratic side 
is here. And, of course, the gentlewoman is the representative of the 
Virgin Islands and is a physician and has been very active on these 
issues.
  Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. 
Christensen).
  Mrs. CHRISTENSEN. Mr. Speaker, I just wanted to join the gentleman in 
the discussion for a moment about the HMO give-backs. Because I was in 
Milwaukee yesterday visiting a church and one of the parishioners, a 
Ms. Riley, and this was at Greater Galilee Church in Milwaukee, came up 
to make an announcement to the congregation and in that announcement 
she told them that, as Medicare beneficiaries, the HMOs in their area 
were doubling their premiums.
  I thought that was outrageous. Because I thought here they are asking 
for 40 percent of the Medicare give-back and they are still gouging the 
seniors, at least in Milwaukee, and I am sure it is happening in other 
parts of the country, as well.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, this goes right to the 
heart of what I have been discussing and my colleague and others on the 
other side of the aisle have been discussing over the last 2 years and 
particularly in the context of this tax bill that the Republicans put 
up.
  What we are saying, with the prescription drug issue in particular, 
is we would rather have the Medicare program cover it because then they 
have a guarantee, they know what the premium is, they know what the 
benefits are, they know what drugs they are going to get, they know 
what the co-payment is, all those things that provide stability and I 
think are important for seniors. Because they look for stability in 
particular.
  What we have now is the system where they get a notice I guess 6 
months before, at least they have 6 months before they are dropped or 
they are told that the premium is going to double or they have a higher 
co-payment and they just do not know from one day to the next where 
they are going to be with the HMO.
  I mean, this is a good example of the problem.
  Mrs. CHRISTENSEN. Mr. Speaker, if the gentleman would continue to 
yield, is it not true that where prescription drug coverage has been 
tried in some States that trying to do it through providing it through 
HMOs is not working and that is why the Democratic proposal and the 
Vice President's proposal to provide it through Medicare is a much 
better way, it assures the seniors that it will be there when they need 
it?

[[Page H11600]]

  Mr. PALLONE. Absolutely. I have mentioned before a couple times on 
the floor, I have not mentioned it lately, that I think it was in March 
sometime in the spring of this year that the State of Nevada, under 
Republican controlled legislature and Republican governor, passed a 
State prescription drug benefit that was very similar to what Governor 
Bush and the Republicans here in the House have proposed, basically a 
subsidy below a certain income. I am not sure about the income aspect, 
but it was a subsidy in a voucher that let people go out and buy their 
own prescription drug insurance plan.
  For the longest time, I mean at least until the end of the summer 
when we got back after Labor Day, there was not one insurance company 
in the State that would offer the benefit. And so, the seniors were 
going without.
  Now, I was told a few weeks ago that now there is an insurance 
company that says that they are going to offer the benefit. But again, 
I wonder what kind of benefit it is going to be and how long they will 
stay in the program.
  I get the impression, I think it is the ideology when I talk to so 
many people on the Republican side, not everybody but a lot of them, it 
is sort of this ideological thing that, we like the fact that we are 
going to give them the voucher and they are going to go out and shop 
around because it is sort of like a capitalist thing and, so, 
idealogically it is very good. But so what? It does not work. I am a 
capitalist, too. But what is the point if it does not work?

  Mrs. CHRISTENSEN. Mr. Speaker, I think the point of the gentleman is 
that our seniors should not have to be made to shop around for 
prescription drug coverage.
  I would like to talk about an issue that came up today. I have joined 
the gentleman on the floor, as he said, several times this week on 
health care issues and also on education issues by the way. But today I 
am asking for this time, and I appreciate the gentleman yielding to me, 
to express my great disappointment that S. 1880, which is the Minority 
Health and Health Disparities Research and Education Act of 2000, was 
not passed with the other suspension bills today.
  But more than my disappointment, I am really disturbed by some of the 
race baiting, ultra conservative propaganda that is being used to 
distract Members from the important issue that this bill would begin to 
address and the important role that establishing such a center at the 
National Institutes of Health has, the role that it would have in 
eliminating disparities that all people of color and people in the low 
socioeconomic status suffer in this country.
  I think that the gaps in health care that we experience in this 
country is an ugly blemish on the record of our Nation and that each 
and every Member of this Congress should want to remove it by remedying 
the years of neglect and in some cases the outright denial of health 
care to the citizens of color in this country.
  The bill, S. 1880, is a key part to beginning this process. It was 
championed here by the gentleman from Illinois (Mr. Jackson) the 
gentleman from Mississippi (Mr. Thompson) and the gentleman from 
Georgia (Mr. Lewis) and in the Senate by Senator Edward Kennedy. It has 
enjoyed wide support at the Department of Health and Human Services, 
particularly that of our Surgeon General, Dr. David Satcher and many in 
the wider health community, such as the National Medical Association 
and the Association of Minority Health Professions Schools under the 
leadership of Dr. Lewis Sullivan, who is the President of Morehouse 
School of Medicine and former Secretary of Health and Human Services 
himself.
  We have also been really grateful, as we tried to work this through 
over the last 2 years, for the support of the now acting Director of 
NIH, Dr. Ruth Kirschstein.
  If I might just point out one of the key provisions of S. 1880. It 
establishes a National Center on Minority Health and Health Disparities 
at the National Institutes of Health, which would conduct and support 
basic and clinical research, training, and the dissemination of health 
information with respect to the health of racial and ethnic minority 
groups, as well as other populations, who are suffering health 
disparities.
  It authorizes the Director of the National Center, in collaboration 
with all of the other NIH institutes and centers, to establish a 
comprehensive plan and budget for the conduct and support of all of the 
minority health as well as other health disparities research activities 
at NIH. It establishes an extramural loan repayment program for 
minority health and health disparities researchers.
  It authorizes the Agency for Health Care Research and Quality to 
conduct and support research to improve the quality of outcomes of 
health care services for health disparity populations. This research 
would focus on identifying the causes of health disparities, including 
barriers to health care access and environmental factors.
  It also authorizes the Department of Health and Human Services 
Secretary, through the Health Resources and Services Administration and 
several other agencies, to support research and demonstration projects 
conducted by both public and nonprofit entities aimed at developing 
curricula to reduce disparities in health care outcomes, including 
curricula for cultural competency in graduate health professions 
education.
  And lastly, it authorizes the Secretary to establish an advisory 
committee on cultural competency and health professions curricula 
development.
  The bill is a good bill and it is an important bill. It is needed. 
Research plays an essential role in understanding the disparities and 
in uncovering the factors underlying them and developing the points of 
intervention and improved methods of treatment. Such research also 
provides the only means by which we can derive the knowledge necessary 
to prevent disease.
  A few points of information that will help paint a clearer picture: 
The gaps between life expectancies for blacks and whites have widened 
in recent years. Although infant mortality in African-Americans has 
decreased somewhat, the disparity has increased. And the same pattern 
is seen in Native Americans and Alaskan Natives.
  Under heart disease, the data indicates that the prevalence of 
cardiovascular disease is higher among African-Americans than among 
their white counterparts. Cardiovascular disease is nearly two times 
higher among African-American women than among their counterparts. And 
recent research has shown that African-American women of the same 
socioeconomic status and education level, with everything being equal, 
they are the least likely to receive the diagnostic tests and the 
treatment compared to other women.
  In cancer, despite significant advances in the detection and 
treatment of several forms of cancer, the data continues to indicate 
that communities of color continue to suffer disproportionately in 
terms of occurrence, the lateness at which the cancer is discovered and 
death from cancer.
  And AIDS we have talked about a lot. African-Americans comprise 
approximately 12 percent of the population, yet we are 37 percent of 
those diagnosed with AIDS since the beginning of the epidemic.
  In 1998, the rate of reported number of new AIDS cases was eight 
times higher among African-Americans than among whites. And we could go 
on and on.
  So I just wanted to say in closing that this bill was been worked on 
on a bipartisan basis in the committee. It went through the normal 
committee process before it was brought to the floor. It passed the 
Senate unanimously, which indicates that Members in the other body with 
widely disparate views supported this legislation. It was on the 
suspension calendar today. It was pulled.

  I just want to ask my colleagues who are opposing the bill to take 
another look at it, work with us, withdraw their objection to the bill, 
and I ask the leadership of the House to work together to bring the 
bill back to the floor and have it pass before we leave to go home, if 
we ever leave to go home.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for her 
remarks. I hesitate to put this in the context of everything else I 
have discussed tonight, but unfortunately it seems to fit the pattern 
where the Republican leadership does not want to

[[Page H11601]]

address so many of these health care issues.
  But unlike with most of the things I discussed tonight that are 
probably too late, it is not too late for that of the gentlewoman. I 
hope we can get the leadership to bring it up on suspension.
  Mrs. CHRISTENSEN. Mr. Speaker, and the leadership on both sides have 
been willing to work on bringing it back. There are some objections on 
the other side of the aisle and from some conservative groups in the 
country which have sent e-mail wrongly identifying the bill as a quota 
bill. It does not provide a quota for research. It does particularly 
state that minority research would be done because we are the ones who 
experience these disparities that must be eliminated. But it also does 
not exclude anyone. It is for any population group that experiences 
disparities and gaps in their health status and their access to health 
services.
  Among those would be our rural citizens. People in the rural areas of 
this country are also suffering from disparities in health care 
regardless of their race or ethnicity. And so, we feel that the bill is 
important. I think to the extent that there are citizens in this 
country who still do not have access to health care who do not enjoy 
the same quality of life as others because of health disparities, the 
country's health in general suffers and I think it is something we need 
to address.
  This bill, which has been worked on for many years, as I said, has 
been worked on on a bipartisan basis with the Department, the Congress, 
the White House, nonprofit national health organizations for years. Is 
a good bill and we would like to have it passed. It is past due.
  Mr. PALLONE. Mr. Speaker, I agree with the gentlewoman. I am glad 
that she came down to voice her concern. As I said, although some of 
these larger issues probably cannot be addressed in the last few days 
that we are here, certainly her issue and I think the whole issue of 
changing the priorities in this tax bill so that we address the 
problems of the providers, the hospitals, the nursing homes, the home 
health agencies, and also trying to make sure that whatever money we 
give to the HMOs has some strings attached so that we know that they 
will stay in the Medicare system for our seniors.

                              {time}  1730

  These things still can be addressed. You and I will work together and 
keep speaking out to make sure that in the last few days they are 
addressed.
  Mrs. CHRISTENSEN. I thank the gentleman for yielding on something 
that I feel is very important. I look forward to working with the 
gentleman on these health care issues and other health care issues.
  Mr. PALLONE. Let me say, Mr. Speaker, that again I know we only have 
a few days left here; but we certainly, and I will speak for my 
Democratic colleagues in the leadership, are going to continue to push 
every day and every night both on the floor, during the legislative day 
and as well as during the Special Orders at night to make sure that 
these health care initiatives are addressed and that these concerns for 
the average American with regard to health care are met.

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