[Congressional Record Volume 147, Number 29 (Wednesday, March 7, 2001)]
[House]
[Pages H720-H722]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                TAX CUTS FOR ALL IS THE FAIR THING TO DO

  Mr. GANSKE. Mr. Speaker, tomorrow we are going to have a vigorous 
debate on the floor on a tax cut, and I am going to vote for that tax 
cut. We should cut taxes because we are collecting surplus taxes, 
because the Tax Code should be more fair, and maybe, Mr. Speaker, most 
urgently because the economy would benefit from a responsible tax 
stimulus.
  Mr. Speaker, I think it is very important that we act expeditiously. 
Just last week Federal Reserve Chairman Greenspan reiterated his 
support for using the increasing tax surplus for tax relief. In 
testimony before the House Committee on the Budget, Mr. Greenspan noted 
that a surplus of this size allows the government to significantly cut 
the Federal debt while providing tax relief. Greenspan testified that 
the economy is slowing down. According to the Bureau of Economic 
Analysis, real gross domestic product has slowed from 8.3 percent in 
the fourth quarter of 1999 to only 1.4 percent in the fourth quarter of 
the year 2000, last year.
  The Consumer Confidence Index has fallen 5 consecutive months. 
Unemployment increased by 300,000 in January. Manufacturing has 
experienced a severe downturn with 65,000 job losses in January, with 
the biggest loss in the auto industry. In December 2000, there were 
2,677 mass lay-off actions, quote/unquote, the highest since the Labor 
Department started collecting that data in 1995.
  Mr. Speaker, according to the Congressional Budget Office we have a 
$5.6 trillion tax surplus. Of this, $2.6 trillion lies in the Social 
Security trust fund and is off-limits. Another $400 billion is off-
limits in the Medicare budget. So the usable surplus is about $2.6 
trillion.
  The tax relief bill before the House of Representatives tomorrow 
would provide tax savings to taxpayers of $958 billion over 10 years. 
It provides immediate tax relief by reducing the current 15 percent tax 
rate on the first $12,000 of taxable income for couples, $6,000 for 
singles. The new 12 percent rate would apply retroactively to the 
beginning of 2001 and would also be the rate for 2002. The rate would 
then be reduced further to 11 percent in 2003 and 10 percent in 2006.
  The reduction in the 15 percent tax bracket alone provides a tax 
reduction of $360 for average couples in 2001, this year, or $180 for 
singles, and it increases to $600 for couples in 2006. The House bill 
reduces and consolidates rate brackets. By 2006, the present law 
structure of five rates, which is 15 percent, 28 percent, 31 percent, 
36 percent and 39.6 percent, would be reduced to four rates of 10 
percent, 15 percent, 25 percent and 33 percent. I believe that that is 
a more fair Tax Code.
  Currently, the top income tax rate, 39.6 percent, is 2.64 times 
larger than the bottom rate, at 15 percent. Under our bill, which we 
will be debating tomorrow, the top income rate, 33 percent, would be 
3.3 times the bottom rate. So proportionately it would be bigger than 
what we are currently dealing with.
  Some have argued that we cannot afford a tax cut and say that it 
would unfairly provide the greatest benefit to high-income taxpayers. 
Mr. Speaker, that is just not the case. The rate reductions and the 
marriage penalty relief portions of the Bush plan would, according to 
the Joint Committee on Taxation, show that the wealthiest 1 percent of 
taxpayers who are currently paying 31.5 percent of income taxes would 
receive 22 percent of the total reductions called for.
  Those earning more than $80,000 per year, or the top 10 percent, who 
pay 64 percent of income taxes would get 47 percent of this tax cut.

                              {time}  2115

  But lower- to middle-income earners would get a proportionately 
larger tax cut. Those making $50,000 to $75,000 per year who are 
currently paying 12.6 percent of income taxes would get 17 percent of 
the benefit, and those earning $30,000 to $50,000 per year who are 
currently paying 7 percent of income taxes would receive 12 percent of 
the tax cut we are going to vote on tomorrow.
  Now, Mr. Speaker, I also support marriage tax relief and death tax 
relief, but the House is dealing with the rate reductions first because 
the economic effects of rate reductions would be felt sooner. It may 
not be that people are going to get tomorrow some additional money in 
their pocket, but they know it will not be too soon and they will 
factor that in to economic decisions that they are making now. I think 
that with the current economic slowdown, which is why the Federal 
Reserve has lowered interest rates twice in the month of January, and 
is why most Fed-watchers believe that interest rates will be lowered 
sooner, that our economy needs that stimulus. However, it is beyond the 
power of the Federal Reserve to lower taxes, and that is why Fed 
Chairman Alan Greenspan has made an appeal to Congress to lower taxes.
  Mr. Speaker, I think it is very important to give the economy a boost 
now in order to try to avoid a further economic downturn. That is why 
the rate reductions in the lower brackets are accelerated and would be 
retroactive in the tax relief bill that the House is going to vote on 
tomorrow. That tax relief bill that we are going to vote on tomorrow is 
the responsible thing to do. In my opinion, those who vote ``no'' on 
that bill tomorrow will be the risk-takers.


               Current Status on Patients' Bill of Rights

  Mr. GANSKE. Mr. Speaker, let me speak for just a little bit about the 
Patients' Bill of Rights and where we are.
  This continues to be a problem that is affecting millions of people, 
literally every day, the problem about being treated fairly by their 
HMOs. I want to point out that some HMOs are being fair to their 
patients, but it is also fair to say that some are not. This cuts 
across all brackets, all groups of people, Republicans, Democrats, men, 
women. Just about every day, somebody comes up to me and tells me a 
story about the kind of problems they have had. Just a few days ago, a 
woman in Des Moines, Iowa, came up to me nearly in tears. She has had 
breast cancer. She has gone through chemotherapy. She needs a test that 
her doctor recommended, but her HMO refused. She has been, as she said, 
on an emotional roller coaster trying to get

[[Page H721]]

this medical test done. So she went through an appeals process. She 
thought it was authorized. She was up, she was happy, and then the rug 
was pulled out from underneath her because then her HMO turned her 
down.
  Mr. Speaker, a woman who has had breast cancer and who has had 
chemotherapy and who has been through a lot, and she has carried this 
fight with her HMO by herself, she told me, you know, Greg, I have 
never asked my husband to do this, but the other day, I said to my 
husband, you are just going to have to carry the load for me on this. 
That HMO has just worn me out. I do not have the energy to fight them 
anymore. Will you do this for me? And, of course, he answered yes.
  This is part of the problem that we have seen all along. It is the 
bureaucracies in some HMOs that delay and delay and delay needed and 
necessary medical care; and after a while, a patient gets beaten down, 
or maybe they just pass away, and then it is not the HMO's problem 
anymore.
  Well, about a month ago, a bipartisan group of Senators and 
Representatives who have worked on this for years, myself included, the 
gentleman from Georgia (Mr. Norwood), the gentleman from Michigan (Mr. 
Dingell), Senator McCain, Senator Specter, Senator Edwards, Senator 
Kennedy, a number of us, and that is just a short list, we have all 
worked together to put together a truly bipartisan bill to finally, 
after 5 or so years of battling the HMOs who have delayed and delayed 
and delayed, trying to get us worn down, well, we are not worn down. We 
are going to continue fighting for this. We put together a bipartisan 
bill and we put it in the docket on the Senate side and here. We laid 
down a mark. We took portions of work that has been done by other 
people interested in this issue, Senator Nickles, we incorporated 
language from his bill; substitutes that were here on the House floor 2 
years ago. We took language from the Goss-Coburn-Shadegg bill; wherever 
we could, wherever we could see that there were similarities; we took 
other pieces, pieces from other bills, we combined them together, and 
we think we have the best work product out there, something that 
continues to allow employers, especially across State lines, to set up 
a uniform benefits package under ERISA so that they are not subject to 
State-mandated benefits. We allow that to continue. However, we also 
say, we ought to have to provide certain services, many of which are no 
longer controversial, like emergency care and not gagging doctors from 
telling patients what they need, but primarily, the bill sets up a 
process so that if there is a dispute on a denial of care, that the 
patient has a process, a fair process through which they can go to 
appeal that, both internally and then to an external independent 
appeals process. We modeled our legislation after what was passed in 
Texas a number of years ago. The HMOs at that time said the sky would 
fall, premiums would skyrocket, that there would be a plethora of 
lawsuits. None of that has happened, as has been documented by 
statements by President Bush all during the Presidential campaign. Our 
bill is modeled after that.

  So we are coming down to this in terms of trying to get a resolution 
on this. What is the scope of the bill? We feel that everyone in the 
country should be covered with a floor of certain protections. We feel, 
however, that it was inappropriate and wrong for Congress 25 years ago 
to usurp from the States the ability to oversee medical judgment 
decisions by health plans. So if there is a negligent action that 
results in irreparable harm to the patient, then that would be dealt 
with on the State side, and I should point out that about 30 some 
States have already enacted significant tort reform in that.
  So what we are basically doing in this bill is codifying a decision 
that the Supreme Court has already made called P. Graham v. Hedrick 
which sets up that distinction. Contractual decisions stay on the 
Federal side in Federal court. It does not matter if a patient needs a 
liver transplant. It does not matter if it is medically necessary if in 
the contract it says, we do not provide liver transplants. That is a 
contractual item and would be handled on the Federal side. However, if 
the HMO has made a medical judgment-type decision that then results in 
an injury, then that is no longer a contractual issue. Now we are 
getting into the practice of medicine and the determination of medical 
necessity, and that is where then a patient can go through the appeals 
process, ultimately to an independent panel, and that panel's decision 
would be binding on the health plan. We think that is a fair 
resolution.
  Basically what we have done in the bill is we have done a new 
bifurcated Federal-State structure from what we did that passed the 
House where we simply said a medical judgment decision goes to the 
State and we remained silent on the provisions that stayed on the 
Federal side as it related to contract.
  We continue to feel that the employer protections in our bill are 
solid. There are about 300 endorsing organizations for the Norwood-
Dingell-Ganske bill that passed the House 2 years ago, and these 
organizations are supportive of the Ganske-Dingell bill now, the 
McCain-Edwards bill. All of these organizations have employees. The 
structure of these organizations is also one of an employer-employee 
relationship. They have all looked at the legal ramifications as has 
some of the leading ERISA law firms in the country, and the employer 
protections are solid. If an employer has not entered into the medical 
decision-making process by the health plan; let us say you are a small 
business in a west Texas town, and you have 10 employees and you 
provide health insurance to them and, by the way, the health plan or 
the HMO that you have chosen is their health plan too. Okay. If that 
HMO makes a decision that is medically negligent, and the employer, you 
the employer had nothing to do with that decision, you are not liable 
under our bill. Period, you are not liable.
  Mr. Speaker, I do not know employers who want to get involved in 
medical decision-making for their employees. Number one, their 
employees would consider that a violation of their privacy. Number two, 
the employers do not want to get anywhere near that, so they do not. 
And if they are not in there meddling, they are not liable under our 
bill. I do not know how many times we can say this. I do not know how 
many distinguished law professors around the country we can get to say 
that, yes, that is the truth. Under the plain meaning of the language 
of your statute, that is what it says. And then the business coalitions 
will then purchase full-page ads and say that it is not the way it is. 
For goodness sake. We have had some of the leading constitutional and 
ERISA scholars in the country look at that.
  Look, when I was in medical practice, just like a number of my 
colleagues, not only were we professionals treating patients, but we 
also ran a business. We have employees. Those employees get health 
care, usually covered through the practice. And I say to my colleagues, 
I do not know any physicians that enter into the medical decision-
making of their employees. That is between the employee and the HMO. 
They do not want to get anywhere near that, and they are protected, 
just like any other small businessperson would be. Some say, some of 
the businesses say, well, we have a self-insured plan. Maybe this will 
make us more liable. They looked at that down in Texas. Those self-
insured plans are run by third-party administrators, they do not 
micromanage like HMOs; their risk is very, very small, and when they 
ask their actuaries, what difference would this make in the premiums we 
should be charging, they get a minuscule amount that is about the 
equivalent of a Big Mac per month.

                              {time}  2130

  Mr. Speaker, I think we have a great bill. This bill has gone through 
a number of modifications in our attempt to take a step towards the 
opponents of our bill and address their concerns, but every time we do 
that, Mr. Speaker, the opponents to this take a step back.
  It is the proverbial old moving goal post. Finally, Mr. Speaker, as I 
am going to make an appeal to my colleagues to sign on to this bill, we 
have a lot of cosponsors, bipartisanship cosponsors in the House 
already.
  But there are a couple of things in this bill that should be 
particularly enticing to my Republican colleagues, because we have an 
extension of medical savings accounts in the bill that is in

[[Page H722]]

the House. We have 100 percent deductibility for the self-employed in 
this bill in the House.
  Those are things that Republicans have wanted for a long, long time, 
and the Democrats, who have negotiated in good faith, but may not be 
exactly where they are in a couple of those things or at least on the 
medical savings accounts issue, but in their spirit of cooperation and 
compromise, they said, all right, if we think it is important, they 
will accept it in the bill and they did.
  Mr. Speaker, I am going to close tonight coming back around to where 
I was before, and that I sincerely hope that Mr. Brian Lamb on C-SPAN 
is watching tonight. This is the only opportunity a number of us who 
are not members of leadership ever get to come to the floor of the 
House of Representatives and for anything other than a sound bite speak 
on an issue and try to express our ideas in some depth.
  Mr. Speaker, I see that we are now joined by a distinguished couple 
of colleagues from Texas. I am about done, but first I will yield to 
the gentleman from Texas.
  Mr. STENHOLM. Mr. Speaker, I thank the gentleman from Iowa (Mr. 
Ganske) for yielding to me and I would like to say that I have enjoyed 
listening to the gentleman's dissertation regarding the Patients' Bill 
of Rights. And as a Texan, I would say as an Iowan the gentleman has 
gotten it exactly right. And I do not understand either how some groups 
can continue to be as opposed as they say they are when the facts of 
the matter regarding lawsuits are exactly like the gentleman from Iowa 
(Mr. Ganske) has stated.
  I, for one, appreciate the gentleman's leadership on this issue, and 
we as cosponsors of the legislation will look forward to sooner, if not 
later, getting this legislation on the floor and passed and on the way 
to the Senate and on to the President.
  Mr. Speaker, I appreciate the gentleman's leadership on this issue.
  Mr. GANSKE. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Stenholm) for his comments.
  Mr. Speaker, I notice two other colleagues, the gentleman from Texas 
(Mr. Turner) and the gentleman from Texas (Mr. Sandlin) who have been 
stalwart in the Patients' Bill of Rights fight. The gentleman from 
Texas (Mr. Turner) in fact, worked on it as a State legislator.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Turner), if he 
would care to make a comment.
  Mr. TURNER. Mr. Speaker, I thank the gentleman from Iowa (Mr. 
Ganske). I want to commend the gentleman, first of all, on his 
leadership on this issue.
  The gentleman has truly been a courageous Member of this Congress to 
try to lead this House to adopting the Patients' Bill of Rights that 
all of us here have supported. It really represents, I think, the best 
opportunity for our new President to try to change the tone in 
Washington and to be able to move the Patients' Bill of Rights forward 
as the first piece of truly bipartisan effort.
  Mr. Speaker, I think it certainly is within our grasp, and I think 
that the efforts that the gentleman has made have blazed that trail. 
And as the gentleman mentioned, I was fortunate to be able to carry one 
of the first Patients' Bill of Rights in the country in Texas in 1996. 
And, of course, it was not until court rulings determined that our 
State protections really did not apply to all patients enrolled in 
managed care, that we had to deal with that here in Washington.
  Mr. Speaker, I thank the gentleman for his leadership on that issue.
  Mr. GANSKE. Mr. Speaker, I notice the gentleman from Texas (Mr. 
Sandlin) and I want to thank him for his great work that he has done on 
patient protection. The gentleman from Arkansas (Mr. Berry) has done a 
wonderful job on this issue, too.
  We have truly worked together in a bipartisan fashion, and I look 
forward to the day when we can all be together in a signing in the Rose 
Garden.

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