[Congressional Record Volume 147, Number 20 (Tuesday, February 13, 2001)]
[House]
[Pages H309-H311]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Culberson). Under the Speaker's 
announced policy of January 3, 2001, the gentleman from New Jersey (Mr. 
Pallone) is recognized for 60 minutes as the designee of the minority 
leader.
  Mr. PALLONE. Mr. Speaker, I did want to indicate that I only plan to 
use about 20 minutes of the hour this evening, and then I would like to 
turn over the rest of the hour and yield to the gentlewoman, one of my 
colleagues from Ohio, who will be out here later, who is going to be 
talking, I believe, about Black History Month.
  Mr. Speaker, I wanted to take to the floor, to the well, this 
evening, to talk about health care, and essentially to map out why I 
believe very strongly in this session of Congress we have an 
opportunity, hopefully on a bipartisan basis, to enact some health care 
reforms that will ensure more access to health insurance to more 
Americans, many of whom, about 40 million, do not have any kind of 
health insurance right now; and, secondly, that we enact a true HMO 
reform, along the lines of the Patients' Bill of Rights, a bipartisan 
bill that passed the House of Representatives last session, 
unfortunately, it did not become law, in order to reform HMOs. Third, I 
think that we should enact a Medicare prescription drug benefit for all 
Medicare beneficiaries.
  I believe very strongly, Mr. Speaker, that these measures can pass in 
this Congress on a bipartisan basis.
  I have to say I was a little concerned, I did not plan to talk about 
tax cuts tonight, but when I heard my colleague on the other side of 
the aisle who was here in the well before me, I do become concerned 
that if the tax cuts that are being proposed by the President become 
too large, so that the entire surplus, or most of the surplus that we 
now have, is used up, we not only face the potential of having a 
deficit situation again, with all the bad ramifications for its 
economy, but it would make it impossible for the types of things that I 
am talking about tonight, a Medicare prescription drug benefit, 
increased access to health insurance for many who do not have it, these 
types of things would be impossible to pass.
  So I would ask my colleagues, when they look at these tax cuts, which 
all of us support tax cuts, and I certainly would like to see one 
passed, that it not be so large that it puts us back into a deficit 
situation or does not allow us to implement some of these needed health 
care reforms.

  What I want to start out, if I could, Mr. Speaker, is by saying that 
when I talk about expanding health insurance and access to health 
insurance, I think you know in previous Congresses we have worked, for 
example, to expand health insurance for children, the so-called CHIP 
program, which now allows children whose parents make more than would 
be eligible for Medicaid, and who mostly are working, are now allowed 
in their individual States to enroll in a Federal program so their kids 
are covered by health insurance.
  However, during the course of the last campaign it was quite clear 
that the Democrats felt very strongly and still feel strongly that the 
CHIP program needs to be expanded to include adults, the parents of 
those children who are in the CHIP program.
  It was very interesting, because during his confirmation hearings the 
new HHS Secretary, Secretary Thompson, actually said that he would like 
to see parents whose children are in the CHIP program be allowed to 
enroll in the program as well.
  I mention that because I think even though this was a Democratic 
idea, it is something obviously that is supported by the current Health 
and Human Services Secretary, who is a Republican. So, again, I hope 
that we see some of our Republicans coming along with this proposal.
  The other thing the Democrats have been championing for some time is 
the idea that people between the ages of 55 and 65 who are not eligible 
for Medicare now be able to buy into Medicare, the so-called ``near-
elderly.'' I would venture to say, Mr. Speaker, that if you were able 
to enroll all the kids that are now eligible for CHIP, and then expand 
the CHIP program to include all the parents whose children are in CHIP, 
and then expand Medicare so that the near-elderly, 55 to 65, could sign 
up, we would go a long way towards solving the problem of those 40 
million Americans who work but who have no health insurance. I would 
like to see that done on a bipartisan basis.
  Let me also mention the Patients' Bill of Rights, the HMO reform. It 
is abundantly clear to me that in the last Congress, even though the 
Patients' Bill of Rights was a Democratic initiative, the HMO reform, 
we had a number of Republicans who came forward and voted for it here 
in the House; and we had some very prominent Republicans who took the 
lead on it, the gentleman from Iowa (Mr. Ganske) and the gentleman from 
Georgia (Mr. Norwood), who took the lead on it.
  Why can we not pass that bill? We should be able to in this Congress. 
I know that most of the Republicans did not vote for it in the last 
Congress in the House, but there is no reason why we cannot do it.
  President Bush comes from the State of Texas. Texas has a Patients' 
Bill of Rights, or an HMO reform, very similar to the Democratic 
Patients' Bill of Rights proposal. Let us see what we can do to get it 
passed on a bipartisan basis.
  Finally, let me talk about the prescription drug benefit. I know when 
I go home and talk to my constituents, the seniors in my district, the 
biggest concern they have is the fact that Medicare does not cover 
prescription drugs, and many of them cannot sign up for Medigap 
programs or cannot get into an HMO where prescription drugs are 
covered, or may have been in such an HMO and had their coverage dropped 
as of January 1 of this year.
  So we need to enact a prescription drug program under Medicare. 
Everyone in Medicare should be eligible for

[[Page H310]]

prescription drug coverage, regardless of income, regardless of age, 
regardless of disability.
  I wanted to talk if I can tonight, again I said I want to limit the 
amount of time that I took, because I want to yield to some of my 
colleagues, but I just want to develop a little more what the Democrats 
have been saying with regard to HMO reform and the Medicare 
prescription drug benefit.
  What the Democrats have been saying is they want a strong enforceable 
Patients' Bill of Rights. This strong legislation with regard to HMO 
reform should include protections for all Americans and in all health 
plans. It should assure access to all emergency room care when and 
where the need arises. It should guarantee access to specialists when 
patients need it. It should guarantee access to a fair and timely 
internal and independent external appeals process, so patients can 
address disagreements with their health plans. It should have 
meaningful enforcement for patients who have been harmed as a result of 
health plan decisions. It should assure access to clinical trials and 
assure patients can keep their health plans.
  If I could summarize what the Democrats have been saying about HMO 
reform and the Patients' Bill of Rights, basically we are saying we 
want medical decisions no longer made by the insurance company or the 
actuaries, but by the patients and their physicians. We want to switch 
it so that now those medical decisions are made by the patients and 
their physicians. And we want it that if the health care plan, if the 
insurance company, denies you care, that you have a right, either 
internally or through some arbitration, to review and to appeal that 
decision and have it reviewed by somebody who is not part of the 
insurance company. Finally, that you have the right to sue if all else 
fails. Those are the basic tenets of what we think are important for 
HMO reform.

  Now, I have to say I was a little disappointed, because many of us, 
both Democrat and Republican, both House and Senate Members, most 
prominently Senator McCain as a Republican, Senator Ted Kennedy a 
Democratic, leaders on health care issues, just a week ago we had a 
press conference. I was there along with some House Members, the 
gentleman from Michigan (Mr. Dingell), the lead sponsor among the 
Democrats in the House in the last session, the gentleman from Iowa 
(Mr. Ganske), one of the lead sponsors on the Republican side in the 
House, and we put forward a new Patients' Bill of Rights that is very 
similar to what was on the law in Texas, is on the law now, was there 
when President Bush was the governor, and very similar to the Patients' 
Bill of Rights that passed the House last session. It actually went 
even a little further than some of us would have liked by limiting 
punitive damages that patients can recover.
  That was introduced last week on a bipartisan basis; and we were 
hopeful that President Bush, who talked about what existed in Texas 
during his campaign and how good it was, would go along with it. But, 
unfortunately, very quickly thereafter we saw the President's spokesman 
saying that this new bill, very similar to Texas law, very similar to 
the Patients' Bill of Rights in the last Congress, was not acceptable. 
In fact, I had a quote here from a letter that was sent, that the 
President wrote in the letter to the House and Senate GOP leadership, 
and he said he does not believe any bill currently before the Congress 
meets his principles.
  So, again, I do not know what kind of games the President is playing. 
It seems to me that he should get on board this bill, with so many 
Republican Senators, so many Republicans in the House, on a bipartisan 
basis, and support it, because we need HMO reform and we need it now.
  I am going to continue to speak out every night or as often as I can 
here on this issue, because I think it is important and it should pass 
and it can pass.
  Let me just talk a little bit, for about 5 minutes, about the 
Medicare prescription drug benefit. The Democrats have certain 
principles, and I am just going to go through them very quickly.
  We are saying the Medicare prescription drug benefit should be 
accessible and voluntary for all beneficiaries. Everybody in Medicare 
should be eligible for it, not just low-income people, not just certain 
people, everyone. It should be affordable to beneficiaries, it should 
be competitive and have efficient administration, because we do not 
want any waste, and it should provide high-quality and needed 
medications.
  Let me develop those a little more. When we talk about accessible and 
voluntary, we say it should be an option for all beneficiaries, not 
limited to low-income beneficiaries, and provide an option to those 
with few or no choices.
  It should be also available, whether or not you are in a traditional 
fee-for-service Medicare or you are in an HMO managed care. It should 
not matter. You are still eligible for the prescription drug benefit. 
It should ensure adequate access to pharmacists.
  Just as an idea, just to give you a little more detail about what we 
proposed, and we talked about it and tried to pass it in the last 
Congress, we are talking about $26 per month in the first year that 
covers 50 percent of total premium costs, no lower premiums for low-
income beneficiaries. I mean, if you are below a certain income, you 
would not pay any premium, is what we are saying. And there would be 
privately negotiated discounts gained by pooling beneficiaries' 
purchasing power, so we can keep the cost down.
  I am not going to get into all the details this evening, but I just 
wanted to give you an idea of what the Democrats have been proposing 
and why it is so different, unfortunately, from what President Bush 
proposed just a few weeks ago.
  This disturbs me a great deal, because during the course of the 
campaign, President Bush said, gave the impression, I thought, that he 
wanted a universal Medicare prescription drug benefit that everyone 
would be eligible for and all Medicare beneficiaries would have access 
to. But he is not proposing that.
  This was, I guess, on January 31, just a few weeks ago, he unveiled 
his prescription medicine proposal called Immediate Helping Hand. It 
establishes block grants for States to provide prescription coverage 
for some low-income seniors and some seniors with catastrophic drug 
costs.

                              {time}  2030

  His plan limits the prescription coverage to Medicare beneficiaries 
with incomes up to 35 percent above the poverty level; in other words, 
$11,600 for individuals, $15,700 for couples, and seniors with out-of-
pocket prescription spending of over $6,000 per year. That is the 
catastrophic coverage.
  What does this mean? Most Medicare beneficiaries will not be able to 
get this prescription drug plan. It is not universal. I think that is a 
terrible thing, because I will be honest, if I can use my own home 
State as an example, in New Jersey if one is below these guidelines 
that the President has proposed, they automatically get what we call a 
PAAD program financed with casino revenue funds, so one only pays about 
$5 for prescription drugs. It is the people above that that are 
hurting, middle-income people that have no access to a prescription 
drug plan, in most cases.
  Just to give an example about how few people the Bush plan would 
cover, for example, a widow with $16,000 in annual income and $5,000 in 
annual drug spending would be eligible for no help at all because she 
is below the income, but she is not getting to that $6,000 catastrophic 
coverage for the rest of the year.
  Also, administering through the States, through block grants, it is 
not going to work. A lot of the States are not going to do it. The 
National Governors Association actually opposes it. Already some of the 
Senators have opposed the Bush plan. Senator Grassley, the chairman of 
the Finance Committee, who is going to have so much input on this, he 
called the proposal dead before its arrival. I say, good. I think it 
should be dead before its arrival, because I think the bottom line is 
that we have to come up with a prescription drug plan into Medicare 
that covers all Medicare beneficiaries and is not just limited to low-
income individuals, and that is not basically run by the States but run 
like Medicare, just like the Medicare program, throughout. That is what 
we need.
  Again, we are going to be out here on a regular basis, the Democrats, 
talking about why this is necessary, not because we want to be 
partisan, because

[[Page H311]]

I do not think there is anything partisan about Medicare prescription 
drugs or HMO reform or coverage for more people who do not have health 
insurance.
  The bottom line is, the Democrats believe in certain principles. We 
know some of the Republicans will come along with us, but we need to 
have more come along with us, and we need the support of President Bush 
if we are ever going to get anywhere with this.
  Mr. Speaker, I yield to my colleague, the gentleman from Arkansas 
(Mr. Berry), one of the co-chairs of our Health Care Task Force, who 
has been outspoken on this issue and many others.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from New Jersey for 
yielding to me, and I appreciate his leadership ever since I has been 
in the Congress on these issues, and everything that he has done.
  As everyone knows, last year's Presidential race was the closest in 
history. The Senate is evenly divided, the House is very closely 
divided. I do not believe that the close elections give a mandate to 
gridlock. The American people expect us to get something done, and they 
should.
  Health issues are certainly among the most hotly debated issues in 
the campaign. Both sides promised to advance a Patients' Bill of Rights 
and Medicare coverage for prescription drugs. I see no obstruction or 
barrier that is so great that Congress and the new President should not 
be able to work out important ideological differences that exist, and 
reach an agreement soon.
  Last week I was happy to join with others in introducing a bipartisan 
Patients' Bill of Rights legislation that will ensure that every 
American with private health insurance has basic guaranteed protection.
  While some HMOs behave responsibly, the legislation is desperately 
needed to protect the vulnerable from insurance bureaucrats who place 
profits above all else. I encourage President Bush to come to the table 
and work with us to ensure a meaningful legislative package is enacted 
this year. For the sake of thousands of patients who are 
inappropriately denied health care daily, time is of the essence.
  I want to also speak just a minute about prescription drugs. No 
single issue places a greater toll on our senior citizens than the 
outrageously high prices that pharmaceutical companies charge for 
prescription medicine. It is absolutely time that we do something about 
it. Drug spending over recent years has been climbing steadily at 15 to 
20 percent a year. According to a study released last year by Families 
U.S.A., from January of 1994 to January 2000, the prices of 
prescription drugs most frequently used by older Americans rose an 
average of 30.5 percent. This increase was twice the rate of inflation.
  In order to meet the needs of America's seniors, Congress should take 
immediate action to create a Medicare drug benefit and reform the 
pharmaceutical marketplace to be sure that it is fair to all Americans 
and all people. It only makes sense that the government should use the 
purchasing power of 40 million Americans on Medicare to win 
prescription drug discounts and not break the bank in creating a 
prescription drug benefit under Medicare.

  I am encouraged that President Bush sent a prescription drug plan to 
Congress last week. However, I am disappointed that after an election 
in which the prescription drug issue was front and center, that the 
White House chose to unveil it in such a low-profile manner.
  I agree with the concerns raised by members of both parties that 
instead of putting an emphasis on block grants to States that only 
attempt to help low-income seniors, a much more comprehensive approach 
should be taken that gives all seniors the opportunity to receive a 
prescription drug benefit under Medicare.
  I look forward to working with members of both parties and the new 
administration to put a serious effort into seeing that meaningful HMO 
reform and Medicare prescription drug benefit is enacted in time to 
help all Americans who desperately need that help today.
  I have been in this people's House now for a little over 4 years. We 
had these same problems when I came here. It is very distressing to 
think that we yet allow this to go on when it is a very simple thing to 
stop it and to help our seniors, and to be sure that people do not get 
mistreated by insurance companies that are willing to put their health 
and safety second behind profits.
  Mr. PALLONE. Mr. Speaker, I thank my colleague for coming down here 
and joining me, as he has on so many other occasions.
  Quickly, the gentleman is absolutely right, we have been talking 
about this for 4 years. I think we were very hopeful during the 
campaign when we heard President Bush then talk about these issues, the 
HMO reform, prescription drug benefit, that we were going to see quick 
action on it. Even in the beginning of the Congress, at the time of his 
inauguration a month ago, it seemed like this was going to be a 
priority.
  We have heard very little about it. We have heard about the tax cuts, 
about defense spending, we have heard about a lot of other issues. When 
he unveiled his prescription drug benefit, it was almost like it was 
not even important. I just hope that that turns around, but we are 
certainly going to make sure that turns around. I thank the gentleman.

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