[Congressional Record Volume 149, Number 96 (Thursday, June 26, 2003)]
[House]
[Pages H5952-H5973]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 1, MEDICARE PRESCRIPTION DRUG AND
MODERNIZATION ACT OF 2003, AND H.R. 2596, HEALTH SAVINGS AND
AFFORDABILITY ACT OF 2003
Ms. PRYCE of Ohio. Mr. Speaker, by direction of the Committee on
Rules, I call up House Resolution 299 and ask for its immediate
consideration.
The Clerk read the resolution, as follows:
H. Res. 299
Resloved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (H.R. 1) to amend title
XVIII of the Social Security Act to provide for a voluntary
program for prescription drug coverage under the Medicare
Program, to modernize the Medicare Program, and for other
purposes. The bill shall be considered as a read for
amendment. The previous question shall be considered as
ordered on the bill and on any amendment thereto to final
passage without intervening motion except: (1) three hours of
debate on the bill equally divided among and controlled by
the chairmen and ranking minority members of the Committee on
Energy and Commerce and the Committee on Ways and Means; (2)
the amendment printed in the report of the Committee on Rules
accompanying this resolution, if offered by Representative
Rangel of New York or his designee, which shall be in order
without intervention of any point of order, shall be
considered as read, and shall be considered as read, and
shall be separately debatable for one hour equally divided
and controlled by the proponent and an opponent; and (3) one
motion to recommit with or without instructions.
Sec. 2. Upon the adoption of this resolution it shall be in
order on the legislative day of June 26 or June 27, 2003,
without intervention of any point of order to consider in the
House the bill (H.R. 2596) to amend the Internal Revenue Code
of 1986 to allow a deduction to individuals for amounts
contributed to health savings security accounts and health
savings accounts, to provide for the disposition of unused
health benefits in cafeteria plans and flexible spending
arrangements, and for other purposes. The bill shall be
considered as read for amendment. The previous question shall
be considered as ordered on the bill to final passage without
intervening motion except: (1) one hour of debate on the bill
equally divided and controlled by the chairman and ranking
minority member of the Committee on Ways and Means; and (2)
one motion to recommit.
Sec. 3. (a) In the engrossment of H.R. 1, the Clerk shall
await the disposition of H.R. 2596 under section 2.
(b) If H.R. 2596 is passed by the House, the Clerk shall--
(1) add the text of H.R. 2596 as new matter at the end of
H.R. 1;
(2) conform the title of H.R. 1 to reflect the addition of
the text of H.R. 2596 to the engrossment;
(3) assign appropriate designations to provisions within
the engrossment; and
(4) conform provisions for short titles within the
engrossment.
(c) Upon the addition of the text of H.R. 2596 to the
engrossment of H.R. 1, H.R. 2596 shall be laid on the table.
Sec. 4. During consideration of H.R. 1 and H.R. 2596
pursuant to this resolution, notwithstanding the operation of
the previous question, the Chair may postpone further
consideration of either bill to a time designated by the
Speaker.
Sec. 5. Upon the adoption of this resolution it shall be in
order, any rule of the House to the contrary notwithstanding,
to consider concurrent resolutions providing for adjournment
of the House and Senate during the month of July.
Sec. 6. The Committee on Appropriations may have until
midnight on Thursday, July 3, 2003, to file a report to
accompany a bill making appropriations for the Department of
defense for the fiscal year ending September 30, 2004, and
for other purposes.
The SPEAKER pro tempore. The gentlewoman from Ohio is recognized for
1 hour.
Ms. PRYCE of Ohio. Mr. Speaker, for purposes of debate only, I yield
the customary 30 minutes to the gentlewoman from New York (Ms.
Slaughter), pending which I yield myself such time as I may consume.
During consideration of this resolution, all time yielded is for the
purposes of debate only.
Mr. Speaker, House Resolution 299 is a multi-part rule providing for
the consideration of H.R. 1, the Medicare Prescription Drug and
Modernization Act of 2003, and H.R. 2596, the Health Savings and
Affordability Act of 2003.
This rule provides for consideration of H.R. 1 under a modified
closed rule, an appropriate rule for such a delicate, complex, and
historic piece of legislation. The rule provides for 3 hours of general
debate equally divided between the chairmen and ranking minority
members of the Committee on Energy and Commerce and the Committee on
Ways and Means. The rule waives all points of order against
consideration of H.R. 1.
After general debate it will be in order to consider an amendment
printed in the report accompanying this resolution, if offered, by the
gentleman from New York (Mr. Rangel) or his designee and debatable for
1 hour. All points of order are waived against the amendment. Finally,
the rule permits the minority to offer a motion to recommit to H.R. 1
with or without instructions.
Section 2 of this rule provides for the consideration of H.R. 2596,
the Health Savings and Affordability Act of 2003, either today, the
legislative day of June 26, or tomorrow, June 27, under a closed rule.
The rule provides 1 hour of general debate in the House equally divided
and controlled by the chairman and ranking minority member of the
Committee on Ways and Means. All points of order against the
consideration of H.R. 2596 are waived. Finally, the rule provides for
one motion to recommit with or without instructions.
{time} 1300
I would like to take a moment to clarify for my colleagues that upon
passage of both pieces of legislation, the text of H.R. 2596 shall be
added as a new matter at the end of H.R. 1. In simple terms, these two
bills will become one. However, this bill does not preclude either bill
from moving forward independently.
Finally, the remaining sections of this rule provide for some
housekeeping provisions and provisions which will allow this body to
move forward in the appropriations process.
Mr. Speaker, today is a historic day. For years now, seniors across
this country have consistently voiced to Congress the same major
concerns: the skyrocketing costs of prescription drugs. Their concerns
are not perceived; they are very, very real. Each year, a typical
senior pays approximately $1,300 on prescription drugs, filling about
22 prescriptions on average. Today, the House will consider a plan to
give all seniors a prescription drug benefit through Medicare.
In passing this bill, as I believe we will do before this day is
over, we will renew America's promise to our seniors, reduce the cost
of prescription drugs, and revolutionize medicine in the 21st century.
I would like to thank the gentleman from California (Chairman Thomas)
and the gentleman from Louisiana (Chairman Tauzin) for their exemplary
cooperation, their remarkable leadership, and inspiring vision they
have provided on this complex, yet very much-needed legislation. I
would like to take a moment just to give special thanks to them for
working so closely with me on a couple of provisions that will greatly
benefit cancer patients and hospitals across the country. Included in
this legislation is immediate Medicare coverage for oral anticancer
drugs through a demonstration project that will offer extraordinary
support to seniors who are fighting cancer. It will enable them to
afford the newest lifesaving medicines in the comfort of their own
homes, rather than be hooked up to chemotherapies by infusions in a
hospital or clinical setting.
I also commend the chairmen's interest and support in assisting
hospitals who serve a disproportionate number of uninsured and indigent
populations. Hospitals across this country, including many of our
Nation's children's hospitals, will be better able to serve their
patients with over $3 billion in additional funding. Finally, rural
hospitals are finally getting their fair share: $27.2 billion.
Since 1965, Medicare has provided a guarantee of health care coverage
for more than 40 million seniors. Today, our seniors are counting on
the stability, longevity, and integrity of this program for their
secure retirement. But if we do not act and pass this bill before us
today, the future of Medicare will be certain: certain bankruptcy. Our
inaction will have sealed the fate
[[Page H5953]]
for one of our Nation's most trusted programs.
So today, we will do two long-overdue things. First, we will
modernize Medicare to save it for future seniors; and, second, we will
provide the much-needed prescription drug coverage.
The prescription drug package the House is considering here today
will provide the same universal guaranteed Medicare health services as
those that currently exist. If you are 65 or older, you qualify for
Medicare, and you qualify for this benefit. It is that simple. And we
provide significant and immediate savings for seniors on their
medicines. Specifically, this plan provides Medicare beneficiaries with
a prescription drug discount card offering over 25 percent in savings,
catastrophic protections, giving seniors 100 percent coverage for out-
of-control drug costs beyond $3,500 year, and full assistance for our
neediest citizens.
Equally important, this rule makes in order a provision establishing
health savings accounts, a revolutionary tool, so that every American,
not just seniors, can set aside savings now for their medical expenses,
tax-free. With over 40 million uninsured, this is so important, and the
plan provides for a catch-up provision so that seniors can take
advantage and set aside more money more quickly.
Mr. Speaker, this is a remedy for what ails America's uninsured. Our
plan is designed for those people who might be shut out of work-based
coverage and offers all Americans, regardless of their income or age,
access to health coverage with no bureaucracy or costly mandates.
Finally, this package includes chronic care management for all
Medicare beneficiaries.
Mr. Speaker, one-third of Medicare beneficiaries have one or more
chronic illnesses. This provision will help better manage diseases,
reduce health care costs, and enhance health and quality of life.
So here we are at a major crossroad. Seniors continue to tell us that
adding a prescription drug benefit to Medicare is not some pie-in-the-
sky policy that they would merely prefer become law. No. The majority
of seniors are telling us that they cannot go another year without
help, without any assistance, without any help with their drug costs,
and without access to higher-quality health care.
Therefore, some questions need to be asked for those who will come
forward in the next few hours and oppose this package. Ask them: How is
this package not an improvement for our seniors who have no coverage
and are struggling to pay for their medications? And ask them: How is
the huge prescription drug savings that will result from this plan not
useful to seniors? Ask them: How is bringing Medicare into the 21st
century and saving it for future generations not wise for our children,
our grandchildren, and our great grandchildren?
Now, some of my colleagues will no doubt put forth $1 trillion, pie-
in-the-sky plans. These packages would bust any budget, Republican,
Democrat, or otherwise. As a matter of fact, the Democrat substitute
actually is larger than the sum of two budgets. The Democrat Spratt
budget had $528 billion for Medicare, and the Democrat Blue Dog budget
had $400 billion dedicated to Medicare. That is a total of $920
billion. But the Democrat substitute that they are offering today is
over $1 trillion, more than the combination of those two Democrat
budgets. Mr. Speaker, that is unacceptable.
Mr. Speaker, the lack of prescription drug coverage under Medicare is
exactly what age discrimination looks like in 2003. Seniors are the
last group of people who are forced to pay retail costs for their
medications and, Mr. Speaker, that should be enough of a violation of
civil rights to get even the ACLU involved.
I said just a moment ago that today is a historic day, and it is.
Today we apply a little common sense by recognizing that health care is
simply not what it was 30 years ago, and that Medicare is not what it
was 30 years ago. It must change to keep up. Today, we will take the
first steps in creating the next generation of quality health care, a
new era where prescription drugs make regular doctor visits less
frequent, where cutting-edge treatments make hospital stays nearly
obsolete in the future, and where lifesaving medications reduce
formerly deadly diseases to mere manageable symptoms within longer and
healthier lives.
Today I urge my colleagues to be bold, to be courageous, to show
leadership, and to take America's health care system into a new
frontier, a place where it has needed to go for far too long now. Time
is precious and so are our seniors. I urge this Congress to pass the
underlying rule and approve H.R. 1, the Medicare Improvement and
Prescription Drug Act of 2003.
Mr. Speaker, I reserve the balance of my time.
Ms. SLAUGHTER. Mr. Speaker, I thank the gentlewoman from Ohio for
yielding me the customary 30 minutes, and I yield myself such time as I
may consume.
(Ms. SLAUGHTER asked and was given permission to revise and extend
her remarks.)
Ms. SLAUGHTER. Mr. Speaker, this is a very sad day for most of us. A
program that has served America well and has given peace of mind and
good health care to seniors for over 40 years is under threat today;
and actually, what we know is going to be before us is the death of
Medicare.
One of the saddest parts about this bill today is that the Democrats
have no role in it. To all of my colleagues who showed up last night at
the Committee on Rules, or this morning, actually, at the Committee on
Rules with amendments that they thought that they could use to
strengthen the bill, I apologize to you that there is no possibility in
the world that you could do it. I hope that you did not hate yourself
this morning for all the sleep that you lost for nothing.
Mr. Speaker, this rule is an affront to the democratic process. The
underlying bill will harm every single one of the 40 million Americans
served by Medicare. At 1 a.m. this morning, with absolutely no
meaningful opportunity to review the almost 700-page prescription drug
legislation, the Committee on Rules met to consider the resolution now
before us. By now I should be used to it, but we cannot tolerate these
continual attacks on democracy. When you refuse to allow half this
House to speak and to give their amendments, you are cutting out half
of the population of the United States from any participation in the
legislation that goes on here. It defies reason and it defies common
sense that political expediency and newspaper headlines could force
this monumental legislation, probably the most monumental that any of
us will do in our tenure in the Congress of the United States, to force
it through the Chamber with little more than cursory consideration.
The other body, on the other hand, has spent over 2 weeks debating
similar legislation. In stark contrast, we meet when nobody is around,
up in the attic, as someone said today, and are permitted only 3 hours
to discuss the largest overhaul of Medicare in its history. The people
we represent would be disgusted if they understood how this issue is
being handled.
We are not naming a post office here. We are considering, as I said,
the most important change to Medicare since its creation. This decision
will affect so many people. It is no simple undertaking, and it
certainly deserves more debate than allowed by this rule.
To add even more confusion to the messy process, the Committee on
Rules incorporated the so-called Health Savings Account bill into the
rule for the Medicare overhaul legislation, so what we are doing here
are two rules. So-called health savings accounts would create a new tax
advantage, personal savings accounts, used to pay the out-of-pocket
medical expenses. At first glance, perhaps it sounds innocuous. But
when you look at the fine print, you see that it basically amounts to a
$72 billion tax cut over the next 10 years while the Federal deficit
continues to grow out of control. Even worse, it is a tax break with a
destructive purpose: to threaten the traditional employer-based health
care by actually encouraging companies to reduce their employees'
health coverage.
Mr. Speaker, perhaps the most egregious problem with the legislation
before us is it does nothing to address the skyrocketing prices of
prescription drugs. Oh, sure, they will tell us that we can import
drugs from Canada, but the fact of the matter is that an amendment
inserted into the Senate
[[Page H5954]]
bill by one of our Senators says that it cannot be done unless it is
certified by the Secretary of HHS, who has stated already that he will
not do it. Therefore, any debate today about being able to import drugs
is absolutely a farce.
The consumer price index on which Social Security cost-of-living
adjustments are based rose 98 percent, and the prescription drug costs
that are crippling older Americans rose even higher. Seniors on
Medicare are expected to spend $1.8 trillion on prescription drugs over
the next decade.
Today's Washington Post tells a story of Marie Urban of Cleveland.
After her housing and Medicare payment, she has $459 a month for
utilities, food, car insurance, taxes, and medication. She told The
Post that some months she has 87 cents left over. This is wrong. She
deserves better. A few years ago, as a temporary Band-Aid, I organized
a bus load of seniors to travel to Canada to purchase medications at
fractions of the prices charged in the American market. We had dozens
more people interested than we could accommodate, but those who went
saved anywhere from $100 to $650 on a 3-month supply of medication.
We are fortunate to live in an age when science provides the
medications that cure illness and improve the quality of life and
extend life. But the promise of the wonder drug is meaningless if you
cannot afford to buy it. The skyrocketing price of prescription drugs
is the number one concern of American seniors and, indeed, most
Americans. H.R. 1 does nothing to freeze or reduce the exorbitant cost
of prescription drugs. In fact, again, the idea of going to Canada and
handing it out with one hand and taking it away with the other is
something that the drug companies will be very happy about, because
they have fought in every possible venue to keep the reimportation of
drugs.
At the same time, we hoped that we might do what the Veterans
Administration has done with great success. By negotiating for the
people that they represent with the drug companies, they have been able
to save many of their veterans a great deal of money. Seniors fear this
bill is a rush to privatize Medicare. We saw the flop of
Medicare+Choice when many, many private insurance companies pulled out
completely on senior citizens, leaving many of them in parts of the
United States completely uncovered. Indeed, they have told us again,
they do not want to cover a prescription drug program. One hundred
percent of the people they cover will buy medicine. This is not what
they consider a good business proposition.
Forty years ago, Congress created the Medicare program because
private industry would not offer health insurance to older people.
Companies saw the older people as a threat to their profits. We should
have learned this lesson in the 1960s, because nothing has changed; and
now we are today taking away what is probably the most important issue
to senior citizens, will they be able to get health care.
{time} 1315
Don Young, who is the President of the Health Insurance Association
of Americans, quoted here often, has said, ``We caution Congress
against relying on drug only insurance as a mechanism to deliver a
benefit.''
Ira Loss, an analyst with Washington Analysis, said, ``The private
sector that is supposed to be excited about this isn't. It creates a
new benefit program built around insurance products that do not exist
and are likely to never exist.''
Mr. Speaker, this proposal would replace Medicare's guaranteed
coverage with what is essentially a voucher program to purchase private
insurance, assuming that there is an insurer willing to sell it to you.
But those who want the traditional fee-for-service Medicare will be
forced to pay higher premiums. We have no idea, for example, what Part
B would cost because it is not in the bill, which is intended to force
the beneficiaries out of traditional Medicare and into private
insurance.
Mr. Speaker, senior citizens do not want this legislation. We have
all received call after call and letter after letter beseeching us to
oppose this plan. They did not contact me because they need
prescription drug coverage. They called and wrote me because they know
this bill will not provide them with the help they desperately need.
According to the Consumers Union, the average Medicare user spends
$2,318 for prescription medicine. Under this plan, the out-of-pocket
drugs would rise to $2,954 for the average senior on Medicare. So this
program is a placebo, not a cure, legislation crafted to provide
political cover for the majority, not provide prescription drug
coverage for seniors. Some may argue that this is something better than
nothing, but it is only a start and, frankly, what we have in Medicare
has not been that bad. But as many of our constituents say, a bad bill
is worse than no bill.
Mr. Speaker, this bill that will raise premiums and reduce their
choices and dismantle Medicare is a very bad bill. I urge my colleagues
to oppose the rule.
Mr. Speaker, I yield such time as she may consume to the gentlewoman
from California (Ms. Woolsey).
(Ms. WOOLSEY asked and was given permission to revise and extend her
remarks.)
Ms. WOOLSEY. Mr. Speaker, this sham Republican bill fails to provide
women with the real prescription drug coverage they need and they
deserve.
Here we are, again, discussing ways to help seniors afford the
prescription drugs that they need. And once again, the majority insists
on a sham proposal that gives seniors nothing more than a false sense
of security.
My female colleagues and I would like to remind everyone that as we
debate proposals to add a prescription drug benefit to Medicare, the
decisions we make will overwhelmingly impact our mothers, grandmothers,
sisters, and aunts. Women are living longer than ever, and longer than
men--this is good news. However, the poverty that many women experience
during their final years is certainly not good news.
There are several reasons women's ``golden years'' are not so golden.
While most women have worked their entire lives, a good portion of this
work was not in the paid workforce. You don't earn a pension for time
spent caring for children or elderly parents.
When many of our mothers and grandmothers were in the workforce, they
were denied equal pay for equal work. Some worked only part time,
trying to balance the responsibilities of their jobs and their
families. As a result, they've made less over their lifetimes--and now
their monthly Social Security benefit is smaller. These women deserve
financial stability, and still, the Republican prescription drug
proposal denies them the security that comes with knowing that can
afford to pay for their medical care.
No one needs a drug benefit more than elderly women. But instead of a
real prescription drug benefit, all they are getting from the majority
are empty promises, a ``donut hole'' coverage gap, and increased
premiums for the services they already enjoy. Our mothers and
grandmothers deserve better. We can and we must do better. Oppose this
sham Republican plan, and support the Democratic alternative.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Linda T. Sanchez.)
(Ms. LINDA T. SANCHEZ of California asked and was given permission to
revise and extend her remarks.)
Ms. LINDA T. SANCHEZ of California. Mr. Speaker, this sham Republican
prescription bill provides elderly women with nothing more than a false
sense of security.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Solis).
(Ms. SOLIS asked and was given permission to revise and extend her
remarks.)
Ms. SOLIS. Mr. Speaker, this bill is a sham. It does not provide
adequate prescription drug benefit.
Este projecto de ley no ayudara a los ancionos. No ayudara ni a
nuestras madres ni a nuestras abuelitas.
(English translation of the above statement is as follows:)
It will not help our mothers, nor our grandmothers.
Mr. Speaker, I rise to call attention to the American women who will
be disproportionately impacted by Medicare reform. The reality we must
confront is that women simply live longer than men--about 19 years into
retirement, while men can expect to live 15 years. So although this
means we have longer to cherish our mothers and grandmothers, it also
means that women are more susceptible to multiple and chronic illness,
and require more long-term care needs.
It is no surprise then that women comprise the majority of Medicare.
In fact, we constitute 58 percent of the Medicare population at 65, and
71 percent at the age of 85. Yet even more crucial is the fact that
four out of five of America's elderly women are widowed and almost half
live out their days alone. Compound
[[Page H5955]]
this misfortune with the reality that these widowed women are four
times more likely, and a single or divorced woman are five times more
likely, to live in poverty after retirement than a married man.
America's elderly women, many of whom live alone and in poverty, have
higher out-of-pocket health care costs and are now being denied access
to a secure and responsible Medicare prescription drug plan under the
Republican Plan. Almost 8 out of 10 women on Medicare use prescription
drugs regularly, though most pay for these medications out-of-pocket.
Now we are telling these women, who already spend 20 percent more on
prescription drugs than their male counterparts, that they must
navigate the privatized ropes, and we can only hope, not guarantee,
that they will have affordable coverage and monthly premiums. Even
middle-class women who have made wise financial planning decisions will
quickly find that high drug costs may undermine any retirement security
they have worked hard to establish.
My district, which is predominately Latino, will be one of the
hardest hit by this new legislation. Latina women make up the largest
minority percentage (58 percent) on Medicare with incomes less than
$10,000. These minority women historically rely on public, rather than
private, health insurance. Now, we are stripping their only health
coverage security and implementing a new, privatized and completely
unmapable plan!
Have we not learned our lessons from Medicare+Choice that private
plans do not participate in many regions, that their premiums and
benefits vary greatly by geographic are, that participation by Medicare
HMO's has been unstable, and that private plans are not less costly
than traditional Medicare?
By 2025, Latinos are expected to comprise 18 percent of the elderly
population and they are continually encountering strategically placed
barriers that hinder their equal right to quality health care.
Let's not forget all the mothers, grandmothers, and sisters now and
in the future for whom Medicare represents a lifeline to a healthy
retirement. Who wants to tell the millions of hard working women who
take care of their families that once again, because of irresponsible
and unbalanced tax cuts, their health care and prescription drug needs
will be sacrificed?
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Harman).
(Ms. HARMAN asked and was given permission to revise and extend her
remarks.)
Ms. HARMAN. Mr. Speaker, I rise in opposition to the bill to end
Medicare as we know it, which will hurt our sisters, mothers, and
grandmothers.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Wisconsin (Ms. Baldwin).
(Ms. BALDWIN asked and was given permission to revise and extend her
remarks.)
Ms. BALDWIN. Mr. Speaker, I rise in opposition to this bill which
fails to provide women with the affordable and reliable Medicare
prescription drug coverage that they desperately need and deserve.
Mr. Speaker, I urge my colleagues to vote against this sham of a
bill. It seeks to privatize Medicare and does not provide a real,
guaranteed, affordable drug benefit that our seniors desperately need.
When I am home in Wisconsin, one of the issues I hear most about, in
the grocery store, on the street, at the airport baggage claim, or in
meetings from Monroe to Baraboo, is that seniors cannot afford to pay
their prescription drug coverage. Seniors send me receipts for their
drug bills and ask me how they are supposed to afford their rising drug
costs on a fixed budget.
The Republican drug bill on the floor today is not going to provide
seniors with the relief they deserve. Instead of providing a real,
affordable prescription drug benefit, this bill seeks to privatize the
Medicare program. It is my belief that privatization of Medicare is
unwarranted. Medicare has been a vital component of our Nation's health
care system since its creation in 1965. In fact, Medicare was
originally created because private insurance plans were simply not
providing health insurance to seniors and people with disabilities. For
nearly 40 years, Medicare has done the job that private insurers would
not--or could not--do.
Why then, would we rely on private insurers to provide a Medicare
prescription drug benefit to our Nation's seniors? This bill relies on
private insurers to provide a prescription drug benefit. Seniors would
have to join HMOs and private insurance plans to get the benefit. The
prices and benefits under this private coverage would vary from region
to region, so that a senior in Wisconsin would have to pay a different
premium than a senior in Florida. These geographic disparities are
simply unacceptable.
There are no assurances in this bill that prescription drugs would be
affordable. In fact, this bill takes no steps to stop or slow the
skyrocketing cost of prescription drugs. Instead, this bill provides
partial coverage of drug spending until $2,000 and then leaves seniors
high and dry. There is a huge gap in coverage where seniors may pay 100
percent out of pocket and continue paying premiums, until they reach a
high out-of-pocket cap. Half of all seniors will fall into this gaping
hole. I believe seniors deserve affordable drug coverage, and we should
not help some seniors cover their drug costs while leaving others out
in the cold.
Lastly, the Republican drug plan does not offer the same benefit to
everyone on Medicare. This plan calls for ``means-testing'' for
Medicare benefits, meaning seniors with higher incomes would have to
pay more money out-of-pocket before they reach the catastrophic limit.
This provision would fundamentally change the Medicare program. Since
its inception in 1965, the central promise of Medicare was that it
would provide a consistent benefit for everyone, and means-testing
would violate this promise.
I support the Democratic proposal that will be offered as an
amendment today. This proposal would add a new Part D in Medicare to
provide voluntary prescription drug coverage for all Medicare
beneficiaries. This proposal would provide the same benefits, premiums,
and cost sharing for all beneficiaries no matter where they live. It
would guarantee fair drug prices by giving the Secretary of the
Department of Health and Human Services the authority to use the
collective bargaining clout of all 40 million Medicare beneficiaries to
negotiate drug prices. The savings would then be passed on to seniors.
In addition, the Democratic proposal makes drugs more affordable by
allowing the safe reimportation of drugs from Canada and makes lower
cost generic drugs available more quickly. Unlike the Republican bill,
there are no gaps in coverage in the Democratic proposal. Coverage is
provided for any drug a senior's doctor provides. Seniors would be able
to choose where to fill their prescriptions and would not have to join
an HMO or private insurance plan to get drug coverage. This is the
proposal seniors have been asking for, not one full of complexities and
gaps in coverage like the Republican plan we will vote on shortly.
Today we are voting on a bill that is a sham. It is a sad mockery of
what seniors in our country deserve. Instead of providing a
comprehensive Medicare prescription drug benefit for America's seniors,
the Republicans have decided to make sure this bill suits the big drug
companies and leads down the road of privatizing Medicare. This is just
plain wrong for the retirees of the greatest generation, who worked
hard, lived through the depression, won a war, and raised their
families.
Seniors need a comprehensive prescription drug benefit that is
affordable and dependable for all--with no gaps or gimmicks in
coverage. The Republican proposal fails on all these counts, and I urge
my colleagues to vote against it.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Mrs. Capps).
(Mrs. CAPPS asked and was given permission to revise and extend her
remarks.)
Mrs. CAPPS. Mr. Speaker, I oppose this Republican prescription bill
because it provides elderly women with nothing more than a false sense
of security.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Watson).
(Ms. WATSON asked and was given permission to revise and extend her
remarks.)
Ms. WATSON. Mr. Speaker, I rise in opposition to this sham Republican
Medicare bill. That is why I wear my black arm band because it is the
death of Medicare and it does not provide the adequate prescription
drug coverage our mothers, grandmothers, sisters, and nieces deserve.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Mrs. Davis).
(Mrs. DAVIS of California asked and was given permission to revise
and extend her remarks.)
Mrs. DAVIS of California. Mr. Speaker, I oppose this unacceptable
bill that is particularly harmful to senior women.
Mr. Speaker, I rise to talk about older women and their need for a
real prescription drug benefit. The legislation we have before us
represents a hollow substitute for a bona fide Medicare prescription
drug benefit. Some will claim that the Republican Medicare reform
[[Page H5956]]
legislation provides a prescription drug benefit and declare success.
Well, Mr. Speaker, we aren't fooling anyone.
We aren't fooling Donna Koski, from San Diego, who cannot afford her
medication. She wrote to tell me, ``HMOs are no longer helping us with
the cost [of drugs]. I worked and paid taxes all my life, raised five
kids in California and now have five grandkids. I can't afford rent or
so many things that I once took for granted would be there when I
retired. What is to become of senior citizens [like me]?'' We aren't
fooling Sidney and Edith Horwitz, from La Jolla, who told me. ``Figure
out a way to give us drug benefits without joining a HMO. Deregulation
and outsourcing to private companies has been a travesty to
consumers.''
Mr. Speaker, my constituents want an affordable prescription drug
benefit that will be there when they need it. They do not want to
privatize Medicare. However, the bill we will discuss dismantles
Medicare and does nothing to lower prescription drug prices. This
proposal eliminates the security of traditional Medicare by requiring
it to compete with private plans in 2010. It would transform Medicare
from a defined benefit to a defined contribution program and ultimately
eliminate Medicare as we know it. Because, private Medicare plans tend
to aggressively recruit younger and healthier seniors, open competition
will mean rising out-of-pocket costs for the vast majority who would
choose the stable benefits and premiums of traditional Medicare. The
result of open competition will be the transformation of today's
universal, national risk pool into a multitude of regional pools
segmented by age, income, residence and health status. To many, this
transformation sounds more like a scheme than meaningful reform.
Our seniors need more stability and certainty than this--especially
older women who are counting on Congress to provide a real solution to
the rising cost of prescription drugs. Women, literally, are the face
of Medicare. They constitute 58 percent of the Medicare population at
65. They constitute 71 percent of the Medicare population at 85. Women
have a greater rate of health problems since they live longer. They
have lower incomes, which make access to affordable prescription drugs
more difficult. More than 1 in 3 women on Medicare (nearly 7 million)
lack prescription drug coverage.
The Republication Medicare reform plan will only perpetuate these
health care disparities. Where is the benefit for our seniors who are
living on a fixed income and cannot afford to pay out-of-pocket during
the coverage gap? Where is the benefit for the women who, because they
were stay-at-home mothers and did not earn a pension, cannot afford the
prescription drugs they desperately need?
For my constituents, the Republican proposal is not good enough. I
cannot support this legislation when I know we can do better. We are
doing more than providing prescription drugs, we are legislating the
future of Medicare.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Georgia (Ms. Majette).
(Ms. MAJETTE asked and was given permission to revise and extend her
remarks.)
Ms. MAJETTE. Mr. Speaker, I oppose this sham Republican Medicare bill
because it does not provide the adequate prescription drug coverage
that our mothers and grandmothers absolutely deserve.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from New York (Mrs. Maloney).
(Mrs. MALONEY asked and was given permission to revise and extend her
remarks.)
Mrs. MALONEY. Mr. Speaker, I oppose this Republican Medicare bill,
and I urge every woman, man, every American to read the fine print.
There are gaping holes. There are problems. I will put this into the
Record and I am totally opposed to this bill.
Mr. Speaker, the health of America's older women is at serious risk.
Whatever Medicare Prescription Drug bill we pass will have an enormous
impact on older women, both now and in the future, and women are
concerned.
More than half of Medicare recipients age 65 are women; by age 85, 71
percent are women. And most older women live on fixed incomes. Older
women tend to have more chronic health conditions than men, and eight
of ten women on Medicare use prescription drugs regularly.
In the face of these facts, the ``bait and switch'' tactics of the
Republican Medicare Prescription Drug bill are simply outrageous.
Seniors think we're giving them help with high cost drugs. They think
we're offering them supplemental insurance--guaranteed, cheaper and
permanent--to ease their burden of skyrocketing drug costs on fixed
incomes. But the Republican bill is a cruel trick. Seniors who are
sickest and taking expensive medications--mostly women on fixed
incomes--get a little bit of help with the first 2000 bucks of drug
expenses. But then they get the ``donut hole''--a big fat zero until
they pay a $3000 ransom to get more help with their drug bills.
The fiscal irresponsibility of the Republican bill is stunning and
illogical. Instead of putting the purchasing power of America's seniors
to work as a huge bargaining chip to lower prescription drug costs, the
Republicans prohibit the Secretary of HHS from negotiating for lower
drug prices on behalf of seniors. The Democrats believe prescription
drugs should be affordable for seniors--but our amendments to have the
Secretary negotiate on seniors' behalf were defeated.
The height of hypocrisy in the Republican bill is the fact that it
actually discourages employers from continuing to offer drug coverage
for retired seniors who have already paid health insurance premiums
throughout their working lives. The Congressional Budget Office
estimates that a third of employers will drop retiree drug benefit
coverage if the Republic bill becomes law.
Frankly, the Republican Medicare Prescription Drug bill is cruel.
This is not compassionate conservatism. It is blatant bias against
elderly, against women, and against the poor. It is the first step in
doing away with Medicare as an entitlement and it is the first step
toward dividing our elderly into the needy and those who can afford to
``buy out''. The purpose of Medicare was to help the elderly with
needed care as they age, and to do it with dignity and not on the basis
of ability to pay.
Prescription drug coverage would save money in the long term because
drug therapies can be substituted for more costly treatments like
hospitalization and surgery. But what seniors--men and women--need and
want is help that they can understand and can rely on, not the ``bait
and switch'' of the Republican plan.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Connecticut (Ms. DeLauro).
(Ms. DeLAURO asked and was given permission to revise and extend her
remarks.)
Ms. DeLAURO. Mr. Speaker, the Republican Medicare bill fails to
provide Americans with real prescription drug coverage, that which they
need and that which they deserve.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Illinois (Ms. Schakowsky).
(Ms. SCHAKOWSKY asked and was given permission to revise and extend
her remarks.)
Ms. SCHAKOWSKY. Mr. Speaker, I rise against the Republican bill that
kills Medicare and fails to provide affordable prescription coverage to
the elderly and people with disabilities.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Lee).
(Ms. LEE asked and was given permission to revise and extend her
remarks.)
Ms. LEE. Mr. Speaker, this bogus Republican prescription drug bill
will effectively dismantle and kill Medicare and leave millions of
seniors, especially our women, our mothers, our grandmothers behind.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from Minnesota (Ms. McCollum).
(Ms. McCOLLUM asked and was given permission to revise and extend her
remarks.)
Ms. McCOLLUM. Mr. Speaker, this Medicare bill fails to provide women
with real prescription drug coverage they need and deserve.
Ms. SLAUGHTER. Mr. Speaker, I reserve the balance of my time.
Ms. PRYCE of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman
from Kentucky (Mr. Fletcher) for some substantive remarks. Dr. Fletcher
is a member of the Committee on Energy and Commerce and also a member
of the medical profession, and we look forward to what he has to add to
this debate.
Mr. FLETCHER. Mr. Speaker, let me thank the gentlewoman from Ohio
(Ms. Pryce) for her leadership in chairing our majority conference as
well as her leadership on this issue and this rule.
Mr. Speaker, I find it interesting to see and observe the number of
people that have stood in line here to talk about this bill, even
though CBO estimates that 93 percent of our seniors will take advantage
of this bill. That means many of the sisters, mothers and family
members that these Members have just spoken about will take
[[Page H5957]]
advantage of this legislation. As a matter of fact, I would imagine if
we asked these Members how many of them take advantage of the Federal
Health Benefit Plan, that probably the majority of them, if not all of
them, choose to participate in that.
Now, we offer something here in this prescription drug bill that
gives them a similar choice, and yet for some reason they seem to
deride what we are doing.
This is the single most pressing health care issue facing our
country: providing prescription drugs for our seniors. This bill does
several things. One, it is a voluntary program. Two, it provides
something that is affordable, not only affordable for seniors but
affordable for taxpayers, and it is something that far exceeds anything
that has been looked at or has had a reasonable opportunity of being
passed that this Congress has ever put forth. It is flexible. It
provides choice and security. It provides a modernization of Medicare
that will address the concerns of prevention and chronic disease
management which are so needed in this country.
It also prevents a catastrophic illness from bankrupting a family.
Often a catastrophic illness can bankrupt a family, and we know of
families that have saved money their entire life and then one illness
in the family has bankrupted them. This bill absolutely prevents that
from happening due to the cost of prescription drugs.
We also find that it helps a number of low income seniors,
particularly women, and I am shocked that these Members would not stand
up and support this bill, because women are particularly affected. Many
women live on fixed incomes of Social Security and are having to choose
between food and medicine. I saw them as a physician. I saw them as
patients of mine. In Kentucky nearly 35 percent of Medicare
beneficiaries will qualify for low income assistance under this bill.
Mr. Speaker, not only that but in Kentucky, Medicare recipients are
spending 67 percent of their total prescription drug costs out-of-
pocket, which is the highest in the Nation.
Additionally, with this bill, they were talking about Democrats not
having input, but we had 30 hours of debate in the Committee on Energy
and Commerce. As a matter of fact, a Democratic colleague of mine, the
gentleman from Texas (Mr. Green) and I put forward an amendment for
diabetes screening. We passed that. It is part of this bill.
So I think this is a tremendously important piece of legislation.
Every senior will have reduced costs in the prescription drug expenses
that they pay because the Federal Government will negotiate a lower
price for these drugs. What we see here is an opportunity. We will
negotiate a lower price for the prescription drugs.
Mr. Speaker, I would hope Members would support this rule and that
Members would support this prescription drug bill.
Ms. SLAUGHTER. Mr. Speaker, we have so little time to try to make any
points here.
Mr. Speaker, I yield 2 minutes to the gentleman from Massachusetts
(Mr. McGovern), a member of Committee on Rules.
Mr. McGOVERN. Mr. Speaker, this is a sad day for this House and, more
importantly, it is a sad day for America's senior citizens.
This bill is a complex and controversial $400 billion Medicare
privatization plan that will affect the lives of 40 million senior
citizens. For 38 years Medicare has been there for our parents and our
grandparents, helping them live longer, more healthy lives. It is a
sacred promise with the elderly of this country and this House is about
to radically and fundamentally break that promise.
If that were not bad enough, the Republican leadership blocks out all
amendments and all but one substitute to this bill. For example, this
bill mandates for the first time a co-payment for senior citizens who
receive Medicare home health care. I have been fighting for years to
protect home health care from cuts, so I had an amendment before the
Committee on Rules around 4:30 this morning to eliminate that co-pay
because I think it is unfair and I think we should help seniors who use
home health care, not charge them more money. But like every single
other amendment, Democrat or Republican, my amendment was not made in
order.
The other body has spent the last 2 weeks, Mr. Speaker, debating,
discussing and amending their prescription drug bill. They seem to
recognize that this is a big deal. So how much time do we give our
seniors in this House? Not 2 weeks, not even 2 days. Three hours. What
a terrible disservice to the people I represent, the people we all
represent.
This bill ends Medicare as we know it and turns it into a convoluted,
complicated voucher program of HMOs and PPOs and shifting coverage. It
is a bill that leaves a huge gap in coverage, penalizing people for
getting sick. It is a bill that moves us towards privatizing Medicare
and leaves our seniors at the mercy of the insurance industry and the
big drug companies. It is a bill that only a CEO could love. Senior
citizens deserve a drug benefit within Medicare. They should not be
left at the mercy of the HMO accountants who are more concerned with
the bottom line and profit margins than with adequate health care.
Our substitute works like the rest of Medicare. It tackles the high
cost of drugs and it guarantees our seniors meaningful, consistent
prescription drug coverage. That is what our seniors deserve. I urge my
colleagues to vote no on the rule and yes on the Democratic substitute.
Ms. PRYCE of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from New Hampshire (Mr. Bradley).
Mr. BRADLEY of New Hampshire. Mr. Speaker, I rise today in support of
H.R. 1 and the rule that accompanies this important legislation, for
today we will begin to finally provide for a prescription drug benefit
under Medicare for America's senior citizens.
H.R. 1 will ease the financial burden placed on America's seniors,
improve access to the medications they need, and introduce market
measures that will curb future cost increases.
According to a recent study, the House plan, our plan, would reduce
the average overall cost of prescription drugs by 25 percent through
aggregating the purchasing power of seniors. In addition to these
overall savings, the plan provides significant and immediate savings
for seniors through provisions, including a prescription drug discount
card which would provide a 10 to 15 percent savings; significant front-
end coverage with a cost sharing agreement that has seniors paying 20
percent on the first $2,000 of drug costs after they pay a deductible
and a monthly membership fee. Beyond that it involves catastrophic
protection providing 100 percent coverage for out of control drug costs
beyond $3,500. And, lastly, and perhaps most importantly, assistance
for low income seniors, enabling those Medicare beneficiaries that have
income of 135 percent of the poverty line to receive full coverage on
their prescription drugs.
Mr. Speaker, the advancement of medical research and technology has
led to the development of new drugs that can dramatically reduce the
need for surgery, for hospitalization and for nursing home care.
{time} 1330
It is high time that we provide America's senior citizens with
improved access to these drugs at prices they can afford. I urge my
colleagues to support the rule and to support the legislation.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from
Ohio (Mr. Brown).
Mr. BROWN of Ohio. Mr. Speaker, I thank my friend from New York for
yielding me the time.
Mr. Speaker, we should reject this rule because H.R. 1 offers the
wrong vision for Medicare. H.R. 1 asks every Member a fundamental
question, what do you want Medicare to be? If you want Medicare
coverage that is guaranteed, dependable, universal and fair, you will
vote against H.R. 1. If you want Medicare to cover every senior
everywhere, you will vote against H.R. 1. If you want Medicare to offer
the same coverage to seniors on Park Avenue as seniors in Appalachian,
Ohio, you will vote against H.R. 1.
But Mr. Speaker, if you want Medicare to offer unreliable, selective,
discriminatory coverage, you will support H.R. 1. If you want Medicare
to offer seniors in Appalachian, Ohio, less coverage than seniors on
Park Avenue or no coverage at all, you will vote for H.R. 1. If you
want Medicare to offer
[[Page H5958]]
rural seniors coverage, but at three or four times the price, then you
will vote for H.R. 1. If you want a plan written by the drug companies
and by the insurance companies because of their huge contributions to
the Republican Party, if you want that, then you will vote for H.R. 1;
and if you want a bill that will force people who now have prescription
drug coverage, a bill that will force seniors who now have prescription
drug coverage to drop that coverage, then you will vote for H.R. 1.
The gentleman from New York (Mr. Rangel) and the gentleman from
Michigan (Mr. Dingell) will offer a substitute amendment with a
different version of Medicare. The Rangel-Dingell substitute
strengthens Medicare by adding a prescription drug benefit, no
unaffordable cost sharing, no gaps in coverage. The Rangel-Dingell
substitute would maintain Medicare's guaranteed coverage, remaining
faithful to the trust Medicare has earned from America's seniors.
The Rangel-Dingell substitute harnesses seniors' purchasing power to
demand better prices from the drug industry. My friend from Kentucky
had it all wrong when he said the Republican plan does that. The
Republican plan, because it was written by the drug companies, does
nothing to bring prices down.
Vote ``no'' on the rule. Vote ``no'' on H.R. 1. Vote ``yes'' on the
Rangel-Dingell substitute.
Ms. PRYCE of Ohio. Mr. Speaker, I am pleased to yield such time as he
may consume to the gentleman from California (Mr. Issa), my
distinguished colleague.
(Mr. ISSA asked and was given permission to revise and extend his
remarks.)
Mr. ISSA. Mr. Speaker, I support this bipartisan, Republican-led,
legendary, historic event that we are participating in here today.
Mr. Speaker, I rise today to comment Chairman Thomas, Chairman
Tauzin, and the House Republican leadership for their work on H.R. 1.
This landmark legislation will provide America's seniors with a
lifetime prescription drug benefit through Medicare. This new benefit
will mean permanent prescription drug access, lower drug costs and a
limit on catastrophic drug expenses for all beneficiaries.
I am especially pleased to see that this bill enacts meaningful
Medicare reforms that specifically affect California and my
constituents in the 49th Congressional District.
H.R. 1 includes language that allows the Secretary of Health and
Human Services to designate plans that serve special needs
beneficiaries as Specialized Medicare Advantage plans. This provision
enhances the development of more effective approaches to chronic
illness care by providing an opportunity for additional frail elderly
demonstrations to move into mainstream Medicare. One example of this
type of demonstration is the SCAN program, which currently serves over
50,000 Southern Californians--including 10,000 who live inside the 49th
Congressional District.
I also want to thank leadership for their work to ensure stable
funding in the Medicaid disproportionate share hospital (DSH) program.
H.R. 1 provides all states with a one time 20% increase in their DSH
allotments. This 20% increase means an additional $184 million in
Fiscal Year 2004 for California's safety net hospitals. This additional
funding will help ensure that services to the most vulnerable
populations remain available.
I believe that we must bring Medicare into the 21st century and that
no American should be denied needed prescription drugs because he or
she cannot afford them. I recognize that the lack of a prescription
drug benefit for our seniors signifies the fact that Medicare has
fallen behind the times. H.R. 1 is the best prescription drug benefit
plan for America and I urge my colleagues to support its passage.
Ms. PRYCE of Ohio. Mr. Speaker, I am pleased to yield such time as he
may consume to the gentleman from California (Mr. DREIER), my
distinguished colleague, the chairman of the Committee on Rules, who
led us through our hearing on this last night to the historic
conclusion today on the floor.
(Mr. DREIER asked and was given permission to revise and extend his
remarks.)
Mr. DREIER. Mr. Speaker, the first revision I would like to make to
my very good friend and the role that I play was leading us through
this morning as we did, in fact, as has been pointed out, beginning
late at night. We began late at night because we were all working
together to fashion a bill which I am convinced that at the end of the
day will enjoy bipartisan support in this House of Representatives.
It has been the gentleman from Illinois (Mr. Hastert), the Speaker,
who, as the author of this legislation, has been in the lead on not
only the issue of bringing about measures to strengthen and protect and
improve Medicare but also to put into place a very important expansion
of medical savings accounts, which I joined him in championing for
many, many years.
This is a historic day, as many as have said; and my colleague, the
gentlewoman from Ohio (Ms. Pryce), has been working diligently over the
last several days and weeks and months to get us here.
I mentioned the gentleman from Illinois (Speaker Hastert). There are
lots of other people, the gentleman from California (Mr. Thomas), the
chairman of the Committee on Ways and Means; the gentleman from
Louisiana (Mr. Tauzin), the chairman of the Committee on Energy and
Commerce; but I would like to talk about the Representatives who did at
12:50 this morning appear before the Committee on Rules.
The gentleman from Oregon (Mr. Walden) represented the Committee on
Energy and Commerce and did a wonderful job; but no one has been more
intimately involved in dealing with health care issues than the
gentlewoman from Connecticut (Mrs. Johnson), and I was very impressed
with the fact that she was able, in her presentation before the
Committee on Rules, over a 90-minute period, to deal with virtually
every question that came forward; and, Mr. Speaker, it was so apparent
that her grasp of this issue, coupled with her commitment to ensure
that our senior citizens finally have the opportunity for the first
time under the structure put in place for Medicare have access to
affordable prescription drugs; and, Mr. Speaker, it was very
interesting to note that while there was bipartisan praise for the
gentlewoman from Connecticut (Mrs. Johnson) as this hearing began at
12:50 this morning, the final panel that came before us at probably
about 4:30 or so, I cannot remember exactly what time it was, maybe
4:15 this morning, had a Democrat on the final panel praising the
gentlewoman from Connecticut (Mrs. Johnson), not necessarily agreeing
with everything that she said, but praising her for the fine work that
she has involved herself in on this issue.
I believe that as we look at what it is that we are trying to do here
there are so many very important and positive developments that have
taken place. I know my friend from Ohio has just mentioned the very
important issue of the disproportionate share of hospitals that provide
assistance under Medicaid. Increasing the level of funding for those
hospitals that are shouldering that responsibility has been one of the
challenges that the Los Angeles area, which I am honored to represent,
has faced; and we, I believe, are going to be able to help deal with
that.
At the same time, I have to say that in looking at some of the things
that have been said that were critical of this rule and of the measure,
first on the rule, Mr. Speaker, we have put into place what I believe
is a very fair rule. In the 107th Congress we all know that we dealt
with this issue, and there was no substitute made in order. So in this
Congress we have done that, but in bringing the health savings
accounts, which are a very important item, designed to provide
incentives for people to make choices and plan for their long-term
health care needs by bringing this measure in with our very important
Medicare package, what we have done is we have provided the minority
with three opportunities, the substitute and two opportunities to offer
motions to recommit, and there was no substitute offered on the other
and I suspect we would have made that. We conceivably could have had
four opportunities for the minority, if they had submitted those to us,
that would have been made in order; and we, as the majority, have
basically one opportunity and that is our bill.
I acknowledge that as members of the majority we have been able under
Speaker Hastert's leadership to put this package together; but anyone
who claims that we are not giving an opportunity to the minority for
their proposals to be considered is really wrong, and we have provided
the proposal which was submitted to us by the ranking minority member
of the Committee
[[Page H5959]]
on Ways and Means and ranking minority member on the Committee on
Energy and Commerce. So I believe we are going to, as this debate
proceeds, find that there are Democrats who will want to join with us;
and I congratulate them for understanding the fact that this is going
to be the first opportunity to truly provide access to affordable
prescription drugs to our senior citizens.
I will tell my colleagues, Mr. Speaker, in voting ``no'' on this
package, at the end of the day we will see Members saying no to our
attempt to put into place a program that will meet that very important
need. So I just want to say that I know there a lot of staff people who
have been involved in this, and I particularly want to express my
appreciation to the members of the Committee on Rules, very ably led
staff on our side by my friend Billy Pitts, and we on this committee
had members on both the Democratic and the Republican side who did meet
from 12:50 this morning until our filing of the rule by the gentlewoman
from Ohio (Ms. Pryce) and I at 6:20 this morning.
And the reason we did it is that this is such an important issue. The
reason we did it is that we want to make sure that we get this done for
the American people, and I am convinced that our chance to come
together has been made possible by all those who were involved in this,
and I thank my friend for yielding me the time.
Ms. SLAUGHTER. Mr. Speaker, I am pleased to yield such time as she
may consume to the gentlewoman from California (Ms. Pelosi), the
minority leader.
(Ms. PELOSI asked and was given permission to revise and extend her
remarks.)
Ms. PELOSI. Mr. Speaker, I thank the gentlewoman for yielding me the
time. I think this is a sham Republican Medicare bill which fails to
provide women with a real prescription drug benefit which they need and
they deserve.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from New York (Ms. Velazquez).
(Ms. VELAZQUEZ asked and was given permission to revise and extend
her remarks.)
Ms. VELAZQUEZ. Mr. Speaker, I think the sham Republican Medicare bill
fails to provide women with the real prescription drug coverage that
they need and deserve.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Ms. Waters).
(Ms. WATERS asked and was given permission to revise and extend her
remarks.)
Ms. WATERS. Mr. Speaker, I think this is a sham Republican
prescription bill because elderly women are dying from preventable
diseases. This is nothing more than a false sense of security.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from California (Mrs. Napolitano).
(Mrs. NAPOLITANO asked and was given permission to revise and extend
her remarks.)
Mrs. NAPOLITANO. Mr. Speaker, I think this is an unfinished
Republican Medicare bill because it does not provide the simple,
adequate prescription drug coverage for all our mothers, our sisters,
and our grandmothers.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from
California (Mrs. Capps).
(Mrs. CAPPS asked and was given permission to revise and extend her
remarks.)
Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding me the
time.
Mr. Speaker, I rise in opposition to this rule and to the Medicare
bill. The rule is unfair. The bill is unacceptable. It provides spotty
coverage that will not help seniors with their expensive medications,
and it reneges on a promise we have made to America's seniors and those
with disabilities by ending Medicare as we have known it.
I want to speak about a provision in the bill that still cuts, even
with yesterday's revisions, hundreds of millions of dollars for cancer
care. A cut like this will be devastating to seniors with cancer.
If this bill is passed, cancer centers will close, especially
satellite centers that are located close to where seniors live. Those
that remain open will admit fewer patients and lay off oncology nurses.
Medicare beneficiaries do pay too much for their oncology
medications. We all agree that we must fix this, but Medicare also pays
way too little for essential oncology services. The overpayments for
oncology drugs has been used to pay for treatments oncologists provide
to cancer patients. So we must fix both parts of this problem.
The bill fixes overpayment of drugs, but still cuts some $300 million
from cancer care to do it. The quality of cancer care will suffer.
The gentleman from Georgia (Mr. Norwood) and I submitted amendments
last night to fix both parts of this problem and protect the quality of
cancer care for all Americans, but these amendments were not made in
order; and now seniors will not only not get sufficient prescription
drug coverage but those with cancer, seniors with cancer, will see
their treatments jeopardized, thwarted, cut off. What will seniors with
cancer do?
I urge my colleagues to vote against the rule and against this bill.
Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
In response to the gentlewoman from California (Mrs. Capps), who we
both share an abiding concern about cancer patients and their
treatment, I would just like to set the record straight in that the
bill on the floor today increases oncology practice expenses by $190
million. That is 83 percent over their current payment, and it is 50
percent higher than any other specialty. It also includes an average
sales price plus 12 percent for 2 years. Now, that is $240 to $250
million on top of a $190 million increase in practice expenses.
In addition to that, we have provided for oral cancer therapies, the
new, upcoming way to treat cancer, so that chemotherapies are not the
only treatment that seniors can get. They can stay home and take a pill
in their own surroundings rather than go be hooked up to some infusion
device.
These are wonderful steps forward for the cancer community.
Mrs. CAPPS. Mr. Speaker, will the gentlewoman yield?
Ms. PRYCE of Ohio. I yield to the gentlewoman from California.
Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding, and we do
share a very strong interest in this issue, and we both also know that
oncology services involve more than the oncologist, and, yes, this bill
does raise from the terrible low cut that was originally in it some 12
percent; but it still leaves a huge vacuum for the services that are
provided by oncology nurses, the whole panoply of outpatient and clinic
setting services that patients who are receiving chemotherapy, which is
such a devastating treatment to go through, need in order to maintain.
It is really a life-and-death situation for people who receive a
diagnosis of cancer and then find out that they have to go to the
doctor and get their medication, and then they have to find some way to
have the services delivered because Medicare will not cover this wide
comprehensive care in a cancer center, and that is what we need to have
a full debate upon.
Ms. PRYCE of Ohio. Reclaiming my time, I disagree with the
gentlewoman's analysis of how it works. There is a provision that will
allow physicians to stockpile, if they prefer.
{time} 1345
But on to another issue, Mr. Speaker. There were statements made
earlier that there were no cost savings in this bill, by a former
speaker. There are cost savings. There is group purchasing and
insurance benefits, a 25 to 30 percent savings. There is a discount
card, 15 to 20 percent savings. There is a Medicare best price, $18
billion in savings. Average wholesale price reform, $15 billion in
savings. There is Hatch-Waxman reforms and reimportation reforms, all
generating savings. And that is how we are able to expand and generate
better treatment for seniors through the upcoming years.
Mr. Speaker, I reserve the balance of my time.
Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from
Rhode Island (Mr. Langevin).
[[Page H5960]]
Mr. LANGEVIN. Mr. Speaker, I rise in opposition to the proposed rule
providing for consideration of the Medicare Prescription Drug and
Modernization Act.
This rule restricts the House to 3 hours of debate on the largest
ever overhaul of a program that has been critical to the health of our
Nation's seniors for 38 years. Furthermore, the rule blocked dozens of
amendments, including one of my own, which could have resulted in
tremendous savings for seniors by opening the door for the Health and
Human Services Department to use the bulk purchasing power of America's
40 million Medicare beneficiaries to negotiate lower medication prices
for them.
As a result, Members are denied the opportunity to address many
disturbing provisions in this bill. To mention just a few, the failure
to address the rapidly rising cost of prescription drugs that will soon
render this benefit meaningless; the tremendous gaps in coverage that
will result in less help for those who need it most; and the provisions
that fundamentally alter the structure and entitlement of Medicare by
requiring the program to compete with private plans beginning in 2010.
Mr. Speaker, the list of Members' concerns with this bill goes on and
on and on. The other Chamber has been debating this bill for 2 weeks,
meanwhile the United States House of Representatives will have a mere 3
hours of debate on this bill that we are presented with. This is an
affront to democracy.
Ms. PRYCE of Ohio. Mr. Speaker, I continue to reserve the balance of
my time.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from
Oregon (Mr. DeFazio).
Mr. DeFAZIO. Mr. Speaker, I thank the gentlewoman for yielding me
this time.
We have heard a lot about the new benefits and protections that will
be afforded by this bill. Unfortunately, most of the benefits and
protections will not go to seniors in need, they will go to the
pharmaceutical and the insurance industry. This bill will do a good job
of protecting the monopoly profits and price gouging by the
pharmaceutical industry.
Perhaps the gentleman from Kentucky has not read or at least he
doesn't understand the bill. Section 1801 prohibits the Federal
Government, Medicare, from negotiating lower prices from the
pharmaceutical industry, a provision inserted at the behest of the
pharmaceutical industry to protect their profits. The VA negotiates
very successfully, and that would lower the cost of drugs much more
than the puny benefits in this bill at a cost of $400 billion. But, no,
that is prohibited in this legislation.
The bill does not allow the reimportation of U.S. manufactured drugs
from Canada because that would provide a greater benefit than the puny
benefits in this bill. Here are three drugs: Tamoxifen. If we could
just reimport, if Americans could just buy the drug by mail from
Canada, they would save 90 percent. But a couple with a $4,500 a year
drug bill will get a 22 percent benefit under this legislation. For
Vioxx, for arthritis, 52 percent if you could just buy it in Canada and
bring it back into this country. Under this bill, a 22 percent
reduction for seniors who pay $4,500 a year for drugs. And then
Xalatan, for glaucoma, a little closer, 33 percent from Canada, 22
percent under this bill.
So without any cost, without spending $400 billion and without
spending a penny, but impinging on the profits of the pharmaceutical
industry, we could provide much better benefits by negotiating or
allowing reimportation.
But it does not stop there. It also benefits the insurance industry.
It is going to drive seniors from Medicare into private insurance,
provide subsidies to private insurance to provide unspecified benefits
at a cost to be determined in the future when those benefits might
become available in the year 2006, and they can be withdrawn at any
time by those industries.
This is not the security our seniors deserve and it is outrageous
that this should be offered without any amendments being allowed to
this party.
Ms. PRYCE of Ohio. Mr. Speaker, I continue to reserve the balance of
my time.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Connecticut (Ms. DeLauro).
Ms. DeLAURO. Mr. Speaker, this House has sometimes risen to the
occasion on matters of great national importance; the first Gulf War,
September 11, when we came together to bind the Nation's wounds and
provide for the national security of the Nation. Unfortunately, this
legislation does not rise to the occasion. It does not deliver an
adequate prescription drug benefit or hold down the cost of drugs. What
it does do is open the door to the privatization of Medicare. It turns
it over to the HMOs, to the private insurance market which has dropped
over half of the Medicare enrollees in my State of Connecticut over the
last 4 years. And seniors have not forgotten.
This bill does nothing to contain costs. It prohibits the Secretary
of Health and Human Services from even engaging in negotiations with
the drug companies to lower prices. As a result, many seniors will pay
more than they do now and their premiums will rise as the cost of drugs
rises.
Throughout my time in Congress, the single most common concern I have
heard from seniors at the local stop-and-shops where I meet with them
every weekend is how expensive their prescription drug bills are.
Seniors know that they are being taken advantage of. They know they can
get drugs cheaper in Canada and overseas. And when seniors find out
that we are doing nothing to hold down the excessive profiteering of
the pharmaceutical companies, when they find out that their coverage
essentially stops during midsummer while they still have to pay the
premiums, they are going to feel betrayed. And they are being betrayed.
If we allow this bill to become law, we would be saying that
guaranteed health care for our seniors is no longer the obligation or
the responsibility of this government. I did not come to the Congress
to preside over the dismantling of Medicare. Our social contract with
our seniors must be honored, and I urge my colleagues to support a plan
that does that and not this Republican sham. Oppose the rule and oppose
the bill.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from
Tennessee (Mr. Cooper).
(Mr. COOPER asked and was given permission to revise and extend his
remarks.)
Mr. COOPER. Mr. Speaker, I thank the gentlewoman for yielding me this
time.
Mr. Speaker, this should be a great day for this country. We should
be on the verge of passing a real Medicare prescription drug benefit
for our seniors. But, unfortunately, we are not. The Republican
majority is rushing through a sham bill in this House in barely 24
hours. They would not let anybody see a copy of this bill until 11:50
p.m. last night. The Committee on Rules' deliberations began at 12:50
a.m. last night and lasted, as has been mentioned, until 4 a.m.
What are they afraid of? What are they hiding? And why would they not
allow amendments like the Dooley amendment to be offered on this floor?
It is my understanding in the other body that Senators Hagel, Ensign,
and Clinton will be offering the Dooley approach as a substitute to
that legislation. The other body has deliberated on this matter for
some 2 weeks in the full light of day so that all senior citizens
around this country, all families around this country, could pay
attention to the details of this legislation and judge for themselves
whether it is good medicine for the American people or not.
But not only is the Republican majority hiding the real substance of
this bill, they have failed to learn the lessons of past efforts of
this House to reform the health care system. Number one, health care
legislation that works must not be partisan. This bill is almost an
entirely Republican-only bill. That dooms it to failure from the start.
Second, real health care reform must not be overly complex. This is one
of the most complex bills that seniors could ever imagine facing. The
red tape is incredible. And, third, this bill should not be overly
burdensome to seniors, but it is. Watch out when your seniors back home
realize they have to pay $35 a month for a very questionable benefit.
[[Page H5961]]
There is a donut hole in coverage, and that is almost too complex to
explain in the 2 minutes I am allowed here, but this bill is so
inferior to the Dooley bill, which solves these problems in a simple,
clear and fair fashion. Under the Dooley bill, there is a zero monthly
premium.
Mr. Speaker, I urge a ``no'' vote on the previous question.
Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from
Illinois (Mr. Emanuel).
(Mr. EMANUEL asked and was given permission to revise and extend his
remarks.)
Mr. EMANUEL. Mr. Speaker, like the preceding speaker before me from
Tennessee, my good friend, the Dooley-Tauscher bill, I think, addresses
the right priorities, the right common values we have. It does not try
to end Medicare as we know it. It keeps Medicare, that has done so well
over 40 years, intact. And unlike the other bills, it lives within the
$400 billion frame. It is true to the principles that have held
Medicare true. It relies on part B of Medicare to deliver the benefit.
It does not try to privatize that benefit. It is a low-income benefit
for our seniors. But, most importantly, it is universal in its benefit.
Everybody would get it. There would be a minimum of a 25 to 30 percent
discount on drugs.
One of the biggest debates here is not only a benefit under Medicare
of prescription drugs, but it is making the drugs that our elderly need
every day when they go to the drugstore or their local pharmacy, making
those medications affordable. The benefit accounts for all drug
spending. That is the core principle here. It is a universal benefit.
So this is the right type of approach. The other day the Washington
Post endorsed it. And, today, in the other body, a bipartisan group of
Senators will be introducing it. I think it expresses our common values
and our common principles of what is true to our vision of what
Medicare should be, not what it should not be.
Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from
Florida (Mr. Davis).
Mr. DAVIS of Florida. Mr. Speaker, one of the things that we can all
agree upon here today is that there ought to be an open and honest
debate in our country and with our seniors as to exactly how to
accomplish writing a prescription drug benefit. There are Democrats
here who recognize that we have to live within the budget constraints
that have been forced upon us, and we are ready to take the first step,
even though it would not be the final step we would take. We are ready
to work with Republicans.
This bill that is being forced on the House of Representatives today
with a minimum amount of debate is a sham. There are many ways to
illustrate the point. Probably the best is the private insurance
companies who are being asked to provide this drug benefit are saying,
once again, we do not want to do it. We do not want your money. There
are not many people here in Washington who tell the government we do
not want your money. These private insurance companies do not want to
write this drug benefit. This bill is a sham.
The bill sets no details on premium, no details on the scope of the
coverage. What are seniors getting under this bill? They do not know
because we honestly do not know. The Dooley bill deserves a debate here
today. It represents a compromise between what the Senate and the House
is trying to do here and what the Democrats are proposing in the
substitute. We deserve to have a debate on the Dooley bill.
Mr. Speaker, the rule should be defeated, the motion should be
defeated, and we should debate the Dooley bill.
Ms. PRYCE of Ohio. Mr. Speaker, I reserve the balance of my time.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as he may consume to
the gentleman from Massachusetts (Mr. Tierney).
(Mr. TIERNEY asked and was given permission to revise and extend his
remarks.)
Mr. TIERNEY. Mr. Speaker, I rise in opposition to this bill, which is
not modernization of Medicare. It ends it, it does not mend it. And
there is no choice here for doctors, only for insurance companies. It
is going to put a lot of seniors who have good retirement plans back
into the Medicare system without the care and the prescription drugs
they need.
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. LaTourette). The Chair has an
announcement. As indicated by previous occupants of the Chair on June
27, 2002, and on March 24, 1995, although a unanimous consent request
to insert remarks in debate may comprise a simple declarative statement
of the Member's attitude toward the pending measure, it is improper for
a Member to embellish such a request with other oratory, and it can
become an imposition on the time of the Member who has yielded for that
purpose.
Ms. SLAUGHTER. Mr. Speaker, we will pay attention to that.
Mr. Speaker, I yield such time as she may consume to the gentlewoman
from Indiana (Ms. Carson).
(Ms. CARSON of Indiana asked and was given permission to revise and
extend her remarks.)
Ms. CARSON of Indiana. Mr. Speaker, I will be brief, and I appreciate
the opportunity to speak about how the Medicare bill fails to provide
women with the real prescription drug coverage that they need,
especially to senior women of this Nation.
Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from
Wisconsin (Mr. Kind).
(Mr. KIND asked and was given permission to revise and extend his
remarks.)
{time} 1400
Mr. KIND. Mr. Speaker, I rise in opposition to the rule, and
encourage my colleagues to vote ``no'' on the previous question so we
can have a real and honest debate today, and make in order the Dooley
substitute.
I, along with others in the New Democratic Coalition, have worked
long and hard to offer a viable alternative to the base bill. The bill
before us, unfortunately, will jeopardize the very sanctity of the
Medicare program. The Dooley bill, on the other hand, is simple,
progressive and affordable. It helps those seniors who needs the most
assistance, the low-income and those with high drug costs. It offers
zero premium payments; it is Medicare as seniors know it. The benefits
are integrated into Medicare part B, and every beneficiary gets a
guaranteed benefit for no additional premium.
Unlike the House and Senate Republican bills, this bill has no gap in
coverage, and it is fiscally responsible. It fits within the budget
resolution that was passed earlier this year.
Later today, it is my understanding that Senators Hagel and Clinton
and Ensign will be offering the same exact Dooley substitute on the
Senate floor. We should be allowed to debate the same measure today. I
urge a ``no'' vote on the previous question.
Ms. SLAUGHTER. Mr. Speaker, I yield 1 minute to the gentleman from
California (Mr. Thompson).
(Mr. THOMPSON of California asked and was given permission to revise
and extend his remarks.)
Mr. THOMPSON of California. Mr. Speaker, I rise today against this
rule. Members should have an opportunity to vote on an enhanced version
of the bipartisan Senate bill. That is the Blue Dog prescription drug
benefit bill. Unfortunately for seniors across this country, our
friends across the aisle have disallowed a debate on this better bill.
It is better because it has a guaranteed fall-back, which means if
seniors cannot get a PPO, they will have Medicare. It is better because
there are no premium supports, which means seniors are not going to be
penalize for staying in Medicare; and it is better because it does not
privatize Medicare. Medicare is an important program that has saved the
lives of many seniors, and an inclusion of a prescription drug benefit
deserves an open debate.
Mr. Speaker, I urge opposition to this rule so the Blue Dog proposal
can be debated and seniors can have the best coverage that we can
afford at this time.
Mr. Speaker, today I rise in opposition to the rule of the Republican
Medicare Prescription Drug Bill, H.R. 1. It serves only one purpose--
ensuring that the voices of several in the Democratic Party are never
heard on this critical issue.
I stand here on behalf of the Blue Dog Coalition--a group which
engaged in this debate by crafting a moderate, affordable prescription
drug alternative that would have appealed to Members on both sides of
the aisle. But this
[[Page H5962]]
body will never consider the Blue Dog substitute, because the Rules
Committee denied us the opportunity to debate our proposal and have a
vote on the House floor.
As you know, the Blue Dogs are a group of fiscally conservative
Democrats, who are committed--as a coalition--to the passage of a
prescription drug benefit that fits within our $400 billion budget
window. On Tuesday evening, the Coalition formally endorsed legislation
based upon the bipartisan Senate Medicare bill (S. 1).
The Senate has come together to develop a strong bipartisan benefit.
It is not perfect. But, in recent years, the perfect has become the
enemy of the good and, unfortunately, the perfect is out of our price
range. The Senate offers America's seniors a good benefit. It carries a
monthly premium of $35. A deductible of $275. A 50 percent cost-share
through the first $4500 of drug spending. And, it offers a catastrophic
benefit that kicks in after beneficiaries have spent $3700 out of
pocket. Further, it corrects a variety of inadequacies in our Medicare
reimbursement system for rural providers. And, it does all of this
without putting Medicare on the path to privatization. But, with a
score of $389 billion, there was some room for improvements. And, that
is just what the Blue Dog Coalition has done.
We have strengthened the rural provider package by accelerating the
start dates to 2004. And, we have improved the adjustments made to the
wage index labor share--dropping the labor share to 62 percent.
We have built upon the Senate's critically important fall-back
provisions. The fall-back means that seniors--such as those living in
rural areas without two or more plans providing service--will always
have access to a drug benefit. We have provided an additional layer of
stability for those seniors, by requiring the fall-back plans to
contract for two years as opposed to one.
We have included the Senate Generic drug amendment, which has been
scored by CBO as a cost-saver because it streamlines and clarifies the
process by which generic medications can be brought to market. This
will increase the amount of affordable medications available to all of
our seniors.
We have incorporated disclosure requirements, to ensure that our
plans are fully demonstrating how savings are passed on to our
beneficiaries.
We allow the Secretary to negotiate on behalf of all Medicare
beneficiaries for the best prices possible.
We permit the re-importation of medications from Canada, provided
that the Secretary certifies that such action would not jeopardize the
health and safety of the American public.
We allow Medicare to operate as the primary payor for all dually
eligible beneficiaries, lifting some of the financial burden off of the
shoulders of our states.
We allow a portion of employer contributions to be counted towards
the beneficiary out of pocket limits, encouraging our employers to
continue sponsoring retiree health plans.
And we are able to make these improvements within the confines of the
$400 billion budget allocation.
Unfortunately, the Congressional Budget Office was not able to
complete a score on our legislation prior to the convening of the Rules
Committee. However, the majority of the changes we have made to the
already-scored Senate bill were based upon Senate amendments that have
either been introduced and passed or are pending introduction. As such,
they have all been scored by CBO for their sponsoring offices. The
availability of that information has allowed the Blue Dogs to say with
certainty that this legislation fits within the $400 billion budget
window.
But, Members with questions about the Blue Dog substitute will never
have the opportunity to pose them because the rule has prevented all
debate on this alternative. Medicare is a complex program and the
debate on the addition of a new prescription drug benefit cannot be a
simple one. Voices should be heard, debate should be had, and all
options should be fully explored before one course of action is decided
upon. Unfortunately--to the detriment of this body and America's
seniors--that is not happening.
I urge my colleagues to oppose this rule, and in doing so allow the
House of Representatives to give this critical issue the open and
deliberate debate that it fully deserves.
Ms. PRYCE of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Georgia (Mr. Gingrey), another physician in our conference.
Mr. GINGREY. Mr. Speaker, I thank the gentlewoman from Ohio (Ms.
Pryce) for giving me an opportunity to speak on this issue. I rise in
favor of the rule and in favor of this bill.
I have delivered probably 5,000 or more babies over a 30-year medical
career; but I will be prouder today of this delivery that we are giving
to our seniors, that we have promised them for the last 2 years.
Finally today that delivery will occur. This will be the best delivery
that I have ever given because what we are talking about is not just a
prescription drug benefit; we are also talking about modernizing
Medicare so that it will not be going bankrupt by the year 2030.
With a prescription drug benefit, we will have an opportunity for our
seniors to avoid prolonged hospital stays and prolonged nursing home
stays, difficult expensive surgery. Let them take those medications
early in the disease process so that high blood pressure does not
result in a stroke or heart attack or so the diabetes they are
suffering with does not end up in them being a dialysis patient.
This is a good bill. This is a bill that our leadership is finally
going to give to our seniors; and I tell Members this is the day to do
it, and this is the finest delivery we can offer to our seniors.
Ms. SLAUGHTER. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I am sure the gentleman from Georgia (Mr. Gingrey) is
pleased that the Democrats tried to make the gentleman's amendment in
order last night.
Mr. Speaker, I yield 2 minutes to the gentlewoman from California
(Mrs. Tauscher).
Mrs. TAUSCHER. Mr. Speaker, I rise today to strongly urge my
colleagues to vote against the rule and to defeat the previous
question. This will allow us to debate a much more realistic and
fiscally responsible Medicare bill.
It is clear that the status quo is not working to make prescription
drugs affordable for seniors. It is also clear that our country's
economic situation does not give Congress a lot of options for solving
this growing problem. Under the Dooley-Tauscher plan, seniors do not
have to pay a premium, and the generous low-income benefit far exceeds
the one offered by the majority. For seniors whose income is 150
percent of the Federal poverty level, roughly equal to $13,400, they
will only have a 10 percent cost share.
Furthermore, any prescription drug plan needs to be part of Medicare,
which seniors like and trust. Our plan is managed by Medicare. The
benefit is integrated into Medicare part B, and every beneficiary gets
a guaranteed benefit at no additional cost. By leveraging the buying
power of all seniors, our plan allows every single person on Medicare
to benefit from immediate drug savings regardless of how many
prescriptions they are filling a month.
Finally, Mr. Speaker, our seniors need to be protected from
catastrophic drug costs. Seniors who have high drug costs will be able
to access the full benefit sooner because our plan focuses on the total
cost of the drug, not discounted price paid out of pocket. Our plan has
an extra safety net for those who really need it, people with total
drug costs of $4,000 a year.
Under our bill, companies that currently provide prescription drug
coverage to their retirees will have the incentive to continue doing so
because the Federal Government will assume the risk of drug coverage
once beneficiaries reach their deductible.
We need to be smart and realistic about how we can provide every
American senior with prescription drug coverage. Given the current
economic situation, our plan is the one that provides this coverage and
is fiscally achievable. I urge my colleagues to defeat the previous
question and support the Dooley-Tauscher substitute.
Ms. SLAUGHTER. Mr. Speaker, I yield such time as she may consume to
the gentlewoman from the Virgin Islands (Mrs. Christensen).
(Mrs. CHRISTENSEN asked and was given permission to revise and extend
her remarks.)
Mrs. CHRISTENSEN. Mr. Speaker, I rise in opposition to the sham
Republican Medicare bill which fails to provide women with the real
prescription drug coverage that they need and deserve, and undermines
the entire program.
Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Dooley).
Mr. DOOLEY of California. Mr. Speaker, I rise to ask that the
previous question be defeated so we can offer a real prescription drug
benefit to seniors. It is unfortunate that the bill being offered by
our Republican colleagues is one that seniors are going to find is so
complex that it is going to result in taxpayers displacing a lot of
[[Page H5963]]
private sector contributions which are already providing prescription
drug benefits.
Why in the world would we design a drug benefit program where we are
actually going to be trading taxpayer dollars for dollars that are
already being spent by corporations for their retirees?
There is a better alternative, and that is the bill we would like to
offer, that is, we take the $400 billion that President Bush has talked
about, roll it into Medicare part B, and use a drug card much like
President Bush has talked about which ensures that every senior will
have access to negotiated prices which ensures that they have 10 to 20
percent savings. We do this without an increase in premiums. We also
target seniors facing catastrophic health care costs by ensuring that
after they have purchased drugs that cost $4,000, that the Federal
Government will be there to pick up the vast majority of their drug
costs from that point on.
We also recognize that there are a lot of seniors in this country
that cannot afford the $4,000, so we provide a low-income benefit that
provides significant assistance to all those seniors who have incomes
less than 200 percent of poverty. This would ensure that 50 percent of
the seniors on Medicare today would have a subsidized low-income
benefit that would help provide them access to much-needed prescription
drugs.
It is time for this Congress to come together and say, if seniors
have a limited amount of resources, let us target those resources of
those seniors that are in greatest need. Those are the seniors with
very high drug costs and those seniors with the least ability to pay,
and the system should be simple.
The Republican plan that we are going to be considering on the floor
today provides seniors the benefit if they are low-income, but not if
they have $6,000 in assets or a car that is too valuable. We need a
plan that seniors can understand, that they do not need to be an
accountant to figure out; and that is what our alternative would
provide.
Ms. PRYCE of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Kentucky (Mr. Whitfield), a member of the Committee on Energy and
Commerce.
Mr. WHITFIELD. Mr. Speaker, today represents the culmination of 4 to
5 years of Congress' efforts to provide a prescription drug benefit for
senior citizens on Medicare. Two years ago, the House of
Representatives passed a prescription drug benefit for senior citizens.
Last year we did the same. The Senate did not do it the year before,
nor did they do it last year; but this year both the House and the
Senate will pass a prescription drug benefit.
This is a meaningful plan. It is going to provide basically free
medicines for any senior citizen on Medicare who is at 135 percent of
the poverty level and below. The only thing they will be expected to
pay is a small $2 copay for generic drugs and a small $5 copay for
name-brand drugs.
I have heard a lot of comments today about private insurance
companies are going to be involved in administering this plan. I think
it is important to recognize that today's Medicare plan uses private
insurance companies to handle all of the reimbursement charges for
Medicare. So we are not doing anything dramatically different in this
bill than what is being done today.
I would also say the fact that this bill would provide catastrophic
coverage for seniors is going to be a tremendous benefit. It will give
them the peace of mind to know that no matter how high their drug costs
may be, at some point the Federal Government will pay for all of it,
the taxpayers will pay for all of it. I would also say that this bill
provides an important rural health benefit package that is going to
benefit all of rural America. It also provides additional monies,
important monies that are needed for disproportionate share hospitals.
It will benefit every children's hospital in America today. All those
hospitals that provide care for people on Medicaid will receive
additional funds. I think this is an important bill, and I urge Members
to vote for the previous question and to adopt this new prescription
drug benefit for Medicare beneficiaries.
Ms. SLAUGHTER. Mr. Speaker, I yield myself the balance of my time.
Today, the House votes on the biggest change in Medicare in its 40-
year history, a change that will affect 40 million Americans; but the
Republican leaders have rigged the rules to prevent the House from
voting on serious alternatives offered by Republicans and Democrats
alike.
Mr. Speaker, I will call for a ``no'' vote on the previous question
in the hope that the House gets the chance to consider an additional
alternative that the Republican leaders fear. If the previous question
is defeated, I will offer an amendment to the rule that will make in
order the Dooley prescription drug alternative substitute. It makes all
senior citizens enrolled in Medicare part B eligible for prescription
drug assistance without increasing their premiums. Unlike the
Republican bill, it has no sickness penalty or doughnut hole that
seniors can fall through. Unlike the Republican bill, it does not
encourage companies to drop seniors' existing drug plans.
Let me make it clear that a ``no'' vote on the previous question will
not stop the consideration of H.R. 1. It will simply allow the House to
vote on the Dooley substitute. However, a ``yes'' vote on the previous
question will prevent the House from voting. I urge a ``no'' vote.
Mr. Speaker, I ask unanimous consent that the text of the amendment
be printed in the Record immediately prior to the vote on the previous
question.
The SPEAKER pro tempore (Mr. LaTourette). Is there objection to the
request of the gentlewoman from New York?
There was no objection.
Ms. SLAUGHTER. Mr. Speaker, I yield back the balance of my time.
Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, passing this plan is the right thing to do. It makes the
kind of commonsense changes to the health care system in this country
that the American public needs. Adding this Medicare benefit will renew
our promise to our seniors. It will reduce the cost of prescription
drugs, and it will revolutionize medicine for the 21st century. Seniors
deserve this assistance now. They deserved it yesterday. They deserved
it last week; and actually, they deserved it last year. It is time for
this body to act. I urge my colleagues to support this fair rule and
pass the needed reform today.
{time} 1415
The material previously referred to by Ms. Slaughter is as follows:
Previous Question for H. Res. 299--Rule on H.R. 1 and H.R. 2596
Medicare Prescription Drug and Modernization Act and Health Savings and
Affordability Act
In the first section of the resolution strike ``and (3)''
and insert the following:
``(3) the further amendment in the nature of a substitute
specified in section 7 of this resolution if offered by
Representative Doley of California or a designee, which shall
be in order without intervention of any point of order, shall
be considered as read, and shall be separately debatable for
60 minutes equally divided and controlled by the proponent
and an opponent; and (4)''
At the end of the resolution add the following new section:
``Sec. 7. The further amendment in the nature of a
substitute referred to in the first section of this
resolution is as follows:''
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare
Rx Now Act of 2003''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is
expressed in terms of an amendment to or repeal of a section
or other provision, the reference shall be considered to be
made to that section or other provision of the Social
Security Act.
(c) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE RX NOW
Sec. 100. Purpose.
Subtitle A--Part B Drug Benefit with High Deductible and No Premium
Sec. 101. Inclusion of high-deductible outpatient prescription drug
benefit under part B.
Sec. 102. Provision of benefits through medicare approved prescription
drug plans.
Subtitle B--Benefits for Low-income Beneficiaries
Sec. 111. Benefits for low-income beneficiaries.
[[Page H5964]]
Sec. 112. Improving enrollment process under medicaid.
TITLE II--RURAL HEALTH CARE IMPROVEMENTS
Sec. 201. Fairness in the medicare disproportionate share hospital
(DSH) adjustment for rural hospitals.
Sec. 202. Immediate establishment of uniform standardized amount in
rural and small urban areas.
Sec. 203. Establishment of essential rural hospital classification.
Sec. 204. More frequent update in weights used in hospital market
basket.
Sec. 205. Improvements to critical access hospital program.
Sec. 206. Redistribution of unused resident positions.
Sec. 207. Two-year extension of hold harmless provisions for small
rural hospitals and sole community hospitals under
prospective payment system for hospital outpatient
department services.
Sec. 208. Exclusion of certain rural health clinic and Federally
qualified health center services from the prospective
payment system for skilled nursing facilities.
Sec. 209. Recognition of attending nurse practitioners as attending
physicians to serve hospice patients.
Sec. 210. Improvement in payments to retain emergency capacity for
ambulance services in rural areas.
Sec. 211. Three-year increase for home health services furnished in a
rural area.
Sec. 212. Providing safe harbor for certain collaborative efforts that
benefit medically underserved populations.
Sec. 213. GAO study of geographic differences in payments for
physicians' services.
Sec. 214. Treatment of missing cost reporting periods for sole
community hospitals.
Sec. 215. Extension of telemedicine demonstration project.
Sec. 216. Adjustment to the medicare inpatient hospital PPS wage index
to revise the labor-related share of such index.
Sec. 217. Establishment of floor on geographic adjustments of payments
for physicians' services.
TITLE I--MEDICARE RX NOW
SEC. 100. PURPOSE.
The purpose of this title is to provide for outpatient
prescription drug benefits to medicare beneficiaries in the
following manner:
(1) Medicare beneficiaries enrolled under medicare part B
qualify for outpatient prescription drug benefits after an
annual deductible (initially set at $4,000) has been met.
This benefit is available without any additional premium.
(2) There are fixed dollar copayments for this coverage,
with the average of such copayments equal to 20 percent of
the benefits and the amount of the copayments varying
depending upon whether the drugs are generic, preferred
brand-name, or non-preferred brand-name drugs.
(3) The benefits are provided through medicare-approved
prescription drug plans. These plans may be current plans,
such as Medicare+Choice plans, employer-based retiree
coverage, medigap plans, State assistance programs, medicaid,
drug discount card plans, and other qualified plans (as
determined by the Secretary). All of these plans must offer,
in addition to the high-deductible coverage, discounts for
prescription drugs both while the annual deductible is being
satisfied and after it is satisfied.
(4) To assure access to medicare-approved prescription drug
plans for all medicare beneficiaries, the Secretary will
solicit bids for prescription drug discount plans that will
be available in all geographic regions to all medicare
beneficiaries.
(5) All pharmacies that comply with electronic claims
processing standards may provide drugs under the program.
(6) This title also provides for the availability of
additional benefits in the form of a waiver of the annual
deductible and reduced copayments, thereby providing
immediate entitlement to prescription drug benefits, for
medicare beneficiaries who have incomes under 200 percent of
the poverty line and who are not eligible for medicaid
prescription drug benefits.
Subtitle A--Part B Drug Benefit with High Deductible and No Premium
SEC. 101. INCLUSION OF HIGH-DEDUCTIBLE OUTPATIENT
PRESCRIPTION DRUG BENEFIT UNDER PART B.
(a) Coverage.--Section 1832(a) (42 U.S.C. 1395k(a)) is
amended--
(1) by striking ``and'' at the end of paragraph (1);
(2) by striking the period at the end of paragraph (2) and
inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(3) entitlement to have access to a prescription drug
plan that provides discounts on purchases for outpatient
prescription drugs and, effective beginning with 2006, for
payment made on his behalf (subject to the provisions of this
part) for high-deductible outpatient prescription drug
coverage under section 1845.''.
(b) Description of High-Deductible Prescription Drug
Benefit.--Title XVIII is amended by inserting after section
1844 the following new section:
``outpatient prescription drug coverage
``Sec. 1845. (a) High-Deductible Outpatient Prescription
Drug Coverage Defined.--
``(1) In general.--For purposes of this part, the term
`high-deductible outpatient prescription drug coverage' means
payment of--
``(A) expenses for covered outpatient prescription drugs
incurred in a year after the individual has incurred expenses
for such drugs in the year of an amount equal to the annual
deductible specified in paragraph (2); reduced by
``(B) cost-sharing described in paragraph (3).
For periods before 2006, such coverage shall consist of
access to discounts for prescription drugs under a medicare-
approved prescription drug plan.
``(2) Annual deductible.--
``(A) In general.--The annual deductible under this
paragraph--
``(i) for 2006 is equal to $4,000; and
``(ii) for a subsequent year is equal to the amount
specified in subparagraph (B) for that year, except that, if
the amount specified in such subparagraph is not a multiple
of $10, it shall be rounded to the nearest multiple of $10.
``(B) Inflationary adjustment.--The amount specified in
this subparagraph--
``(i) for 2006, is $4,000; or
``(ii) the amount specified in this subparagraph for a
subsequent year is the amount specified in this subparagraph
for the previous year increased by the annual percentage
increase in average per capita aggregate expenditures for
covered outpatient prescription drugs in the United States
for medicare beneficiaries, as determined by the Secretary
for the 12-month period ending in July of the previous year.
``(3) Cost-sharing.--
``(A) Three-tiered copayment structure.--Subject to the
succeeding provisions of this paragraph , in the case of a
covered outpatient drug that is dispensed in a year to an
eligible individual, the individual shall be responsible for
a copayment for the drug in an amount equal to the following
(or, if less, the price for the drug negotiated pursuant to
subsection (c)(5)):
``(i) Generic drugs.--In the case of a generic covered
outpatient drug, the base copayment amount specified in
accordance with subparagraph (B) for each prescription (as
defined by the Secretary) of such drug.
``(ii) Preferred brand name drugs.--In the case of a
preferred brand name covered outpatient drug, 4 times the
copayment amount applied under clause (i) for each
prescription (as so defined) of such drug.
``(iii) Nonpreferred brand name drug.--In the case of a
nonpreferred brand name covered outpatient drug, 150 percent
of the copayment amount applied under clause (ii) for each
prescription (as so defined) of such drug.
``(B) Establishment of base copayment amount consistent
with 80:20 benefit ratio.--For each year beginning with 2006
the Secretary shall establish a base copayment amount in a
manner consistent with the principle (subject to reasonable
rounding rules) that the ratio of the aggregate amount of
benefits provided under this section to the aggregate
copayments under this paragraph for each year should be
approximately equal to 80 to 20.
``(C) Discounts allowed for network pharmacies.--A
medicare-approved prescription drug plan may reduce
copayments for its designees below the level otherwise
provided under this paragraph, but in no case shall such a
reduction result in an increase in payments made by the
Secretary under this section to a plan.
``(D) Treatment of medically necessary nonpreferred
drugs.--A nonpreferred brand name drug shall be treated as a
preferred brand name drug under this paragraph if such
nonpreferred drug is determined (pursuant to procedures
established under subsection (c)(6)) to be medically
necessary.
``(E) Requirement for designation of preferred brand name
drugs.--Within each category of therapeutic-equivalent
covered outpatient prescription drugs (as defined by the
Secretary, in consultation with the Medicare Payment Advisory
Commission, each medicare-approved prescription drug plan
shall provide for the designation of at least one preferred
brand name covered outpatient drug.
``(4) Payment of benefits beyond deductible.--
``(A) In general.--There shall be paid from the Federal
Supplementary Medical Insurance Trust Fund, in the case of
each individual who is covered under the insurance program
established by this part and incurs expenses for covered
outpatient prescription drugs with respect to which benefits
are payable under this section, amounts equal to the amounts
provided under paragraph (1).
``(B) Counting of incurred expenses.--Expenses with respect
to covered outpatient prescription drugs under this section
shall--
``(i) be treated as incurred regardless of whether they are
reimbursed by a third-party payor;
``(ii) not be treated as incurred unless the expenses were
incurred during a period in which the individual was covered
under this part; and
``(iii) not be treated as incurred unless information
concerning the transaction giving rise to such expenses has
been electronically
[[Page H5965]]
transmitted by the pharmacy or other entity dispensing the
covered outpatient prescription drugs to the medicare-
approved prescription drug plan consistent with electronic
claims standards established under subsection (c)(3).''.
SEC. 102. PROVISION OF BENEFITS THROUGH MEDICARE APPROVED
PRESCRIPTION DRUG PLANS.
(a) In General.--Section 1845 of the Social Security Act,
as inserted by section 101(a), is further amended by adding
at the end the following:
``(b) Provision of Benefits Through a Medicare Approved
Prescription Drug Plan.--
``(1) In general.--In the case of an individual entitled to
benefits for high-deductible outpatient prescription drug
coverage under this section, the individual shall obtain such
benefits through a medicare-approved prescription drug plan
that is designated under this subsection.
``(2) Designation process.--The Secretary shall provide for
a process for designation of medicare-approved prescription
drug plans consistent with the following:
``(A) Frequency of designations.--The Secretary shall
permit individuals, on an annual basis and at such other
times during a year as the Secretary may specify, to change
the plan designated.
``(B) Dissemination of information.--The Secretary shall
provide for the dissemination of information on designation
of plans under this subsection. Such dissemination may be
coordinated with the dissemination of information on
Medicare+Choice plan selection under part C.
``(C) Default assignment.--In the case of an individual who
is enrolled under this part who has not otherwise designated
a medicare-approved prescription drug plan, the Secretary
shall assign the individual to an appropriate prescription
drug discount card plan serving the area in which the
individual resides.
``(D) Deemed designation.--The Secretary may deem an
individual who is enrolled in a medicare-approved
prescription drug plan described in subparagraph (A) through
(E) of subsection (c)(2) as having designated such plan, but
shall permit the individual to designate a prescription drug
discount card plan instead. The Secretary shall establish
rules in cases where an individual is enrolled in more than
one such plan.
``(3) Designee defined.--In this section, the term
`designee' means such an individual who makes such a
designation and, with respect to a plan, an individual who
has designated that plan under this subsection.
``(c) Medicare-Approved Prescription Drug Plans.--
``(1) In general.--For purposes of this part, the term
`medicare-approved prescription drug plan' means a health
plan or program described in paragraph (2) that--
``(A) beginning with 2006, provides at least high-
deductible outpatient prescription drug coverage to designees
of that plan or program;
``(B) meets the applicable requirements of paragraph (3)
and succeeding paragraphs of this subsection with respect to
such designees;
``(C) has entered into an agreement with the Secretary to
provide and exchange electronically such information as the
Secretary may require for the administration of the program
of benefits under this section; and
``(D) meets such additional requirements as the Secretary
may specify, including requiring the provision of appropriate
periodic audits.
``(2) Types of plans and programs that may qualify.--The
types of plans and programs that may qualify as a medicare-
approved prescription drug plan are the following:
``(A) A Medicare+Choice plan.
``(B) A group health plan, including a retirement health
benefits plan, that provides prescription drug coverage.
``(C) A State plan under title XIX.
``(D) A health benefits plan under the Federal employees'
health benefits program under chapter 89 of title 5, United
States Code.
``(E) A medicare supplemental policy.
``(F) State pharmaceutical assistance program.
``(G) A prescription drug discount card plan (described in
subsection (d)).
``(H) Any other prescription drug plan that is determined
to meet such requirements as the Secretary establishes.
``(3) Administration through card-based electronic
mechanism.--
``(A) Use of medicare prescription drug card.--Claims for
benefits under this section under a medicare-approved
prescription drug plan may only be made electronically
through the use of an electronic prescription card system (in
this paragraph referred to as the `system').
``(B) Standards for electronic prescription card system.--
The Secretary shall establish standards for the system,
including the following:
``(i) Cards.--Standards for claims cards to be used by
designees under the system.
``(ii) Coordination of electronic information.--Standards
for the real-time transmittal among pharmacies, medicare-
approved prescription drug plans, and the Secretary
(including an appropriate data clearinghouse operated by or
under contract with the Secretary) of information on expenses
incurred for covered outpatient prescription drugs by
designees.
``(iii) Confidentiality.--Standards that assure the
confidentiality of individually identifiable information of
designees and that are consistent with the regulations
promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
``(iv) Electronic transmittal of prescriptions.--
Prescriptions must be written and transmitted electronically
(other than by facsimile), except in emergency cases and
other exceptional circumstances recognized by the Secretary.
``(v) Provision of information to prescribing health care
professional.--The program provides for the electronic
transmittal to the prescribing health care professional of
information that includes--
``(I) information (to the extent available and feasible) on
the drug or drugs being prescribed for that patient and other
information relating to the medical history or condition of
the patient that may be relevant to the appropriate
prescription for that patient;
``(II) cost-effective alternatives (if any) for the use of
the drug prescribed; and
``(III) information on the drugs included in the applicable
formulary.
To the extent feasible, such program shall permit the
prescribing health care professional to provide (and be
provided) related information on an interactive, real-time
basis.
``(C) Standards.--
``(i) Development.--The Secretary shall provide for the
development of uniform standards relating to the electronic
prescription drug program described in subparagraph (B). Such
standards shall be compatible with standards established
under part C of title XI.
``(ii) Advisory task force.--In developing such standards
the Secretary shall establish a task force that includes
representatives of physicians, hospitals, pharmacies,
beneficiaries, pharmacy benefit managers, individuals with
expertise in information technology, and pharmacy benefit
experts of the Departments of Veterans Affairs and Defense
and other appropriate Federal agencies to provide
recommendations to the Administrator on such standards,
including recommendations relating to the following:
``(I) The range of available computerized prescribing
software and hardware and their costs to develop and
implement.
``(II) The extent to which such standards and systems
reduce medication errors and can be readily implemented by
physicians, pharmacies, and hospitals.
``(III) Efforts to develop uniform standards and a common
software platform for the secure electronic communication of
medication history, eligibility, benefit, and prescription
information.
``(IV) Efforts to develop and promote universal
connectivity and interoperability for the secure electronic
exchange of such information.
``(V) The cost of implementing such systems in the range of
hospital and physician office settings and pharmacies,
including hardware, software, and training costs.
``(VI) Implementation issues as they relate to part C of
title XI, and current Federal and State prescribing laws and
regulations and their impact on implementation of
computerized prescribing.
``(iii) Deadlines.--
``(I) The Secretary shall constitute the task force under
clause (ii) by not later than April 1, 2004.
``(II) Such task force shall submit recommendations to the
Secretary by not later than January 1, 2005.
``(III) The Secretary shall provide for the development and
promulgation, by not later than January 1, 2006, of national
standards relating to the electronic prescription drug
program described in clause (ii). Such standards shall be
issued by a standards organization accredited by the American
National Standards Institute (ANSI) and shall be compatible
with standards established under part C of title XI.
``(4) Acceptance of claims through all qualifying
pharmacies.--A medicare-approved prescription drug plan
shall--
``(A) permit the participation of any pharmacy that meets
terms and conditions that the plan has established;
``(B) provide for acceptance and process of claims for
designees from any pharmacy that meets standards the
Secretary has established under paragraph (3) to carry out
real-time transmittal of claims to such plans and that
provides for disclosure, in the case of dispensing of a brand
name drug to a designee, of information on the availability
of generic equivalents at reduced cost to the designee; and
``(C) permit enrollees to receive benefits (which may
include a 90-day supply of drugs or biologicals) through a
community pharmacy, rather than through mail order, with any
differential in cost paid by such enrollees.
``(5) Requirement to negotiate discounts and generic
equivalents.--A medicare-approved prescription drug plan
shall provide designees of the plan with the following:
``(A) Negotiated prices.--Access to negotiated prices
(including applicable discounts) used for payment for covered
outpatient drugs, regardless of the fact that no benefits or
only partial benefits may be payable with respect to such
drugs because of the application of the deductible under
subsection (a)(2) or copayment under subsection (a)(3) or
because the drugs are procured before January 1, 2006.
[[Page H5966]]
``(B) Generic equivalents.--Information on the availability
of generic equivalents at reduced cost to such designees.
``(6) Treatment of nonpreferred brand name drugs.--
``(A) Procedures regarding the determination of drugs that
are medically necessary.--
``(i) In general.--A medicare-approved prescription drug
plan shall have in place procedures on a case-by-case basis
to treat a nonpreferred brand name drug as a preferred brand
name drug for purposes of subsection (a) if the nonpreferred
brand name drug is determined--
``(I) to be not as effective for the designee in preventing
or slowing the deterioration of, or improving or maintaining,
the health of the individual; or
``(II) to have a significant adverse effect on the
individual.
``(ii) Requirement.--The procedures under clause (i) shall
require that determinations under such clause are based on
professional medical judgment, the medical condition of the
enrollee, and other medical evidence.
``(B) Procedures regarding appeal rights with respect to
denials of care.--Such a plan shall have in place procedures
to ensure a timely internal review (and timely independent
external review) for resolution of denials of coverage in
accordance with the medical exigencies of the case in
accordance with requirements established by the Secretary
that are comparable to such requirements for Medicare+Choice
organizations under part C and to ensure notice to designees
regarding such procedures. A designee shall have the further
right to an appeal of such a denial of coverage in the same
manner as is provided under section 1852(g)(5) in the case of
a failure to receive health services under a Medicare+Choice
plan.
``(7) Prompt payment of pharmacies for covered benefits.--
Medicare-approved prescription drug plans shall provide for
payment to qualifying pharmacies of benefits under subsection
(a)(4) promptly in accordance with rules no less generous
than the rules applicable under section 1842(c)(2)(B).
``(8) Education.--Medicare-approved prescription drug plans
shall apply methods to identify and educate providers,
pharmacists, and designees regarding--
``(A) instances or patterns concerning the unnecessary or
inappropriate prescribing or dispensing of covered outpatient
prescription drugs;
``(B) instances or patterns of substandard care;
``(C) potential adverse reactions to covered outpatient
prescription drugs;
``(D) inappropriate use of antibiotics;
``(E) appropriate use of generic products; and
``(F) the importance of using covered outpatient
prescription drugs in accordance with the instruction of
prescribing providers.
``(9) Not at financial risk.--The entity offering a
medicare-approved prescription drug plan shall not be at
financial risk for the provision of high-deductible
prescription drug coverage under the plan to designees, but
there shall be performance incentives (based on risk
corridors negotiated between the entity and the Secretary and
subject to audit) in relation to the administration of the
contract and the entity's ability to reduce costs through
appropriate incentive mechanisms.
``(10) Provision of data.--The entity offering such a plan
shall provide the Secretary with such information as is
required to make payments to the entity under this section.
``(d) Prescription Drug Discount Card Plans.--
``(1) Solicitation of bids.--The Secretary shall solicit
bids from entities to offer prescription drug discount card
plans to individuals enrolled under this part either
nationwide or in large geographic areas. The Secretary shall
award bids in a manner so that such plans are offered in all
areas of the United States. The Secretary may not award a
contract based on such a bid to an entity with respect to a
plan unless the entity and plan meet the applicable
requirements to be a medicare-approved prescription drug plan
under this section.
``(2) Limitation on benefits.--The entity offering a
prescription drug discount card plan shall not offer (or
charge for) benefits to designees of the plan in addition to
high-deductible prescription drug coverage, access to
negotiated prices, and other benefits required under this
section and, in the case of subsidy eligible individuals,
benefits under subsection (h).
``(e) Payment of Plans.--
``(1) In general.--The Secretary shall provide, in the
contract entered into between the Secretary and entities that
offer medicare-approved prescription drug plans, for payment
to the plans for high-deductible prescription drug coverage
offered through the plan, including expanded coverage for
low-income individuals under subsection (g) and taking into
account performance incentives described in paragraph (2). In
addition, in the case of prescription drug discount card
plans, the Secretary shall provide for payment of
administrative costs in carrying out the contract (taking
into account the performance incentives described in
paragraph (2)), based on rates negotiated between the
Secretary and the entity in the solicitation process under
subsection (d).
``(2) Incentives for cost and utilization management and
quality improvement.--The Secretary shall include in the
contract such financial or other performance incentives for
cost and utilization management and quality improvement as
the Secretary may deem appropriate.
``(f) Covered Outpatient Prescription Drugs Defined.--
``(1) In general.--Except as provided in this subsection,
for purposes of this section, the term `covered outpatient
prescription drug' means--
``(A) a drug that may be dispensed only upon a prescription
and that is described in subparagraph (A)(i) or (A)(ii) of
section 1927(k)(2); or
``(B) a biological product described in clauses (i) through
(iii) of subparagraph (B) of such section or insulin
described in subparagraph (C) of such section,
and such term includes a vaccine licensed under section 351
of the Public Health Service Act and any use of a covered
outpatient drug for a medically accepted indication (as
defined in section 1927(k)(6)).
``(2) Exclusions.--
``(A) In general.--Such term does not include drugs or
classes of drugs, or their medical uses, which may be
excluded from coverage or otherwise restricted under section
1927(d)(2), other than subparagraph (E) thereof (relating to
smoking cessation agents), or under section 1927(d)(3), as
the Secretary may specify and does not include such other
medicines, classes, and uses as the Secretary may specify
consistent with the goals of providing quality care and
containing costs under this section.
``(B) Avoidance of duplicate coverage.--A drug prescribed
for an individual that would otherwise be a covered
outpatient prescription drug under this section shall not be
so considered if payment for such drug is available under
part A or under this part (other than under this section).''.
(b) No Effect on Part B Premium.--
(1) In general.--Section 1839(a) (42 U.S.C. 1395r(a)) is
amended by adding at the end the following new paragraph:
``(5) Notwithstanding the previous provisions of this
subsection, in computing actuarial rates there shall not be
taken into account benefits and administrative costs that are
attributable to the prescription drug coverage provided under
section 1845.''.
(2) Special enrollment period; waiver of late enrollment
penalty.--
(A) Section 1837 (42 U.S.C. 1395p) is amended by adding at
the end the following new subsection:
``(k) There shall also be a general enrollment period
during the period beginning on July 1, 2005, and ending on
November 30, 2005.''.
(B) Section 1838(a) (42 U.S.C. 1395q(a)) is amended--
(i) by striking ``or'' at the end of paragraph (2);
(ii) by striking the period at the end of paragraph (3) and
inserting ``, or''; and
(iii) by adding at the end the following new paragraph:
``(4) in the case of an individual who enrolls pursuant to
subsection (k) of section 1837, January 1, 2006.''.
(C) Section 1839(b) (42 U.S.C. 1395r(b)) is amended by
inserting ``or a general enrollment period under section
1837(k)'' after ``not pursuant to a special enrollment period
under section 1837(i)(4)''.
(3) Government contribution.--Section 1844(a)(1) (42 U.S.C.
1395w(a)(1)) is amended--
(A) by striking ``plus'' at the end of subparagraph (A);
(B) by striking ``; plus'' at the end of subparagraph (B)
and inserting ``, plus''; and
(C) by adding at the end the following new subparagraph:
``(C) a Government contribution equal to the aggregate
amounts expended from the Trust Fund for benefits and
administrative expenses attributable to the prescription drug
coverage provided under section 1845; plus''.
(c) Medicare as Primary Payor.--Section 1862(b) (42 U.S.C.
1395y(b)) is amended by adding at the end the following new
paragraph:
``(7) Exception for outpatient prescription drug benefit.--
The previous provisions of this subsection shall not apply to
benefits provided under section 1845.''.
Subtitle B--Benefits for Low-income Beneficiaries
SEC. 111. BENEFITS FOR LOW-INCOME BENEFICIARIES.
(a) In General.--
(1) First dollar coverage.--Section 1845, as inserted by
section 101(b), is amended by adding at the end the following
new subsection:
``(g) First Dollar Coverage for Certain Low-Income
Individuals.--
``(1) In general.--In the case of a subsidy eligible
individual (as defined in paragraph (2)), this section shall
be applied as if the annual deductible were equal to zero
but, with respect to costs incurred before the amount of the
annual deductible otherwise applicable, the following
copayment amounts shall apply:
``(A) 10 percent copayment for individuals with incomes up
to 150 percent of poverty.--For subsidy eligible individuals
with income that does not exceed 150 percent of the poverty
line, the copayment amounts shall be the copayments amounts
specified in subsection (a)(3), which reflects an average
benefit percentage of 90 percent.
``(B) 50 percent copayment for individuals with incomes
above 150 percent of poverty.--For subsidy eligible
individuals with income that exceeds 150 percent of the
poverty line, the copayment amounts shall be
[[Page H5967]]
the copayments amounts specified in subsection (a)(3)
increased by 150 percent, which reflects an average benefit
percentage of 50 percent, but in no case shall such copayment
amount exceed the price negotiated for the drug involved.
``(2) Determination of eligibility.--
``(A) Subsidy eligible individual defined.--For purposes of
this section, subject to subparagraph (D), the term `subsidy
eligible individual' means an individual who--
``(i) is enrolled under this part;
``(ii) has income below 150 percent (or such higher
percent, not to exceed 200 percent, as a State may specify
under subparagraph (B)) of the Federal poverty line; and
``(iii) is not eligible for medical assistance with respect
to prescription drugs under title XIX.
For purposes of this section, an individual shall not be
treated as eligible for medical assistance with respect to
prescription drugs under title XIX (including under a waiver
under section 1115) only if, with respect to such assistance,
the individual is charged a copayment greater than a nominal
amount (as described in section 1916(a)(3)) and there is no
monthly or similar dollar limit established for the amount of
such assistance over any period of time.
``(B) Coverage of individuals with income up to 200 percent
of poverty at state option.--One of the 50 States or the
District of Columbia may, at its option and subject to
section 1935(c), specify a percent of income, that exceeds
150 percent but does not exceed 200 percent, that will apply
for purposes of this subsection to individuals residing in
the State.
``(C) Determinations.--The determination of whether an
individual residing in a State is a subsidy eligible
individual shall be determined under the State medicaid plan
for the State under section 1935(a) or by the Social Security
Administration. There are authorized to be appropriated to
the Social Security Administration such sums as may be
necessary for the determination of eligibility under this
subparagraph.
``(D) Income determinations.--For purposes of applying this
subsection--
``(i) income shall be determined in the manner no less
restrictive than the manner described in section
1905(p)(1)(B); and
``(ii) the term `Federal poverty line' means the official
poverty line (as defined by the Office of Management and
Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981)
applicable to a family of the size involved.
``(E) Treatment of territorial residents.--In the case of
an individual who is not a resident of the 50 States or the
District of Columbia, the individual is not eligible to be a
subsidy eligible individual but may be eligible for financial
assistance with prescription drug expenses under section
1935(f).
``(3) Administration of subsidy program.--The Secretary
shall provide a process whereby, in the case of an individual
who is determined to be a subsidy eligible individual and who
is enrolled in a medicare-approved prescription drug plan--
``(A) the Secretary provides for a notification of the
entity offering the plan that the individual is eligible for
a subsidy under paragraph (1);
``(B) such entity adjusts the benefits for prescription
drug coverage accordingly and submits to the Secretary
information on the amount of such benefits provided; and
``(C) the Secretary periodically and on a timely basis
reimburses the entity for the amount of such benefits
(including reasonable related administrative costs) that are
provided only because of the application of this subsection.
``(4) Relation to medicaid program.--
``(A) In general.--For provisions providing for eligibility
determinations, and additional financing, under the medicaid
program, see section 1935.
``(B) Coordination.--The Secretary shall develop and
implement a plan for the coordination of prescription drug
benefits under this part with the benefits provided under the
medicaid program under title XIX, with particular attention
to insuring coordination of payments and prevention of fraud
and abuse. In developing and implementing such plan, the
Secretary shall involve the States, the data processing
industry, pharmacists, and pharmaceutical manufacturers, and
other experts and representatives of low-income medicare
beneficiaries.''.
(2) Reduction in catastrophic copayments for low income
individuals.--Section 1845(a), as inserted by section 101(b),
is amended--
(A) in paragraph (3)(A), by inserting ``and paragraph (5)''
after ``Subject to the succeeding provisions of this
paragraph''; and
(B) by adding at the end the following new paragraph:
``(5) Reduction in copayments for low-income individuals to
10 percent.--In the case of a subsidy eligible individual
with income that does not exceed 150 percent of the poverty
line (as defined for purposes of subsection (g)), the
copayment otherwise applicable under paragraph (3) shall be
\1/2\ of the copayment amount otherwise applicable.''.
(b) Medicaid Amendments.--
(1) Determinations of eligibility for low-income
subsidies.--
(A) Requirement.--Section 1902(a) (42 U.S.C. 1396a(a)) is
amended--
(i) by striking ``and'' at the end of paragraph (64);
(ii) by striking the period at the end of paragraph (65)
and inserting ``; and''; and
(iii) by inserting after paragraph (65) the following new
paragraph:
``(66) provide for making eligibility determinations under
sections 1845(a)(5), 1845(g), and 1935(a).''.
(2) New section.--Title XIX of such Act is further
amended--
(A) by redesignating section 1935 as section 1936; and
(B) by inserting after section 1934 the following new
section:
``special provisions relating to medicare prescription drug benefit
``Sec. 1935. (a) Requirement for Making Eligibility
Determinations for Low-Income Subsidy.--
``(1) In general.--As a condition of its State plan under
this title under section 1902(a)(66) and receipt of any
Federal financial assistance under section 1903(a), a State
shall--
``(A) make determinations of eligibility for subsidies
under (and in accordance with) sections 1845(g) and
1845(a)(5);
``(B) inform the Secretary of such determinations in cases
in which such eligibility is established; and
``(C) otherwise provide the Secretary with such information
as may be required to carry out section 1845.
``(2) State option for coverage of additional low-income
individuals.--A State may elect under paragraph (2)(B) of
section 1845(g) to cover additional low-income medicare
beneficiaries under the prescription drug subsidy program
provided under such subsection, subject to contribution under
subsection (c).
``(b) Payments for Additional Administrative Costs.--
``(1) In general.--The amounts expended by a State in
carrying out subsection (a) are, subject to paragraph (2),
expenditures reimbursable under the appropriate paragraph of
section 1903(a); except that, notwithstanding any other
provision of such section, the applicable Federal matching
rates with respect to such expenditures under such section
shall be increased as follows (but in no case shall the rate
as so increased exceed 100 percent):
``(A) For expenditures attributable to costs incurred
during 2006, the otherwise applicable Federal matching rate
shall be increased by 10 percent of the percentage otherwise
payable (but for this subsection) by the State.
``(B)(i) For expenditures attributable to costs incurred
during 2007 and each subsequent year through 2013, the
otherwise applicable Federal matching rate shall be increased
by the applicable percent (as defined in clause (ii)) of the
percentage otherwise payable (but for this subsection) by the
State.
``(ii) For purposes of clause (i), the `applicable percent'
for--
``(I) 2007 is 20 percent; or
``(II) a subsequent year is the applicable percent under
this clause for the previous year increased by 10 percentage
points.
``(C) For expenditures attributable to costs incurred after
2013, the otherwise applicable Federal matching rate shall be
increased to 100 percent.
``(2) Coordination.--The State shall provide the Secretary
with such information as may be necessary to properly
allocate administrative expenditures described in paragraph
(1) that may otherwise be made for similar eligibility
determinations.
``(c) State Contribution at SCHIP Matching Rate Towards
Additional Low-Income Subsidies for Optional Subsidy Eligible
Individuals Covered Under State Option.--In the case of a
State that specifies a percent of income under section
1845(g)(2)(B) for a quarter, the amount of payment made to
the State under section 1903(a)(1) for the quarter shall be
reduced by the product of--
``(1) 100 percent less the enhanced FMAP described in
section 2105(b) for that State and quarter; and
``(2) the additional amount of payment made under section
1845 because of the application of such specification.''.
(b) Phased-In Federal Assumption of Medicaid Responsibility
for Cost-Sharing Subsidies for Dually Eligible Individuals.--
(1) In general.--Section 1903(a)(1) (42 U.S.C. 1396b(a)(1))
is amended by inserting before the semicolon the following:
``, reduced by the amount computed under section 1935(d)(1)
for the State and the quarter''.
(2) Amount described.--Section 1935, as inserted by
subsection (a)(2), is amended by adding at the end the
following new subsection:
``(d) Federal Assumption of Medicaid Prescription Drug
Costs for Dually-Eligible Beneficiaries.--
``(1) In general.--For purposes of section 1903(a)(1), for
a State that is one of the 50 States or the District of
Columbia for a calendar quarter in a year (beginning with
2006) the amount computed under this subsection is equal to
the sum of the product described in paragraph (3) plus the
product of the following:
``(A) Medicare benefits for medicaid eligibles.--The total
amount of payments made in the quarter because of the
operation of section 1845 that are attributable to
individuals who are residents of the State and are eligible
for medical assistance with respect to prescription drugs
under this title. For purposes of this subparagraph, an
individual shall not be treated as eligible for medical
assistance with respect to prescription drugs under title XIX
(including under a
[[Page H5968]]
waiver under section 1115) only if, with respect to such
assistance, the individual is charged a copayment greater
than a nominal amount (as described in section 1916(a)(3))
and there is no monthly or similar dollar limit established
for the amount of such assistance over any period of time.
``(B) State matching rate.--A proportion computed by
subtracting from 100 percent the Federal medical assistance
percentage (as defined in section 1905(b)) applicable to the
State and the quarter.
``(C) Phase-out proportion.--The phase-out proportion (as
defined in paragraph (2)) for the quarter.
``(2) Phase-out proportion.--For purposes of paragraph
(1)(C), the `phase-out proportion' for a calendar quarter
in--
``(A) 2006 is 90 percent;
``(B) a subsequent year before 2014, is the phase-out
proportion for calendar quarters in the previous year
decreased by 10 percentage points; or
``(C) a year after 2013 is 0 percent.
``(3) Product.--The product described in this paragraph for
a State for a calendar quarter is the State matching rate
described in paragraph (1)(B) for that State and quarter
multiplied by the additional expenditures made under section
1845 as a result of the following:
``(A) Reductions in catastrophic copayments.--The
application of subsection (a)(5) thereof.
``(B) First dollar coverage.--The application under
subsection (g) of reduced copayments amounts insofar as such
amounts are less than 25 percent of the amount of the price
otherwise negotiated for the drug involved.
(3) Medicaid providing wrap-around benefits.--Section 1935,
as so inserted and amended, is further amended by adding at
the end the following new subsection:
``(e) Medicaid as Secondary Payor.--In the case of an
individual who is entitled to benefits under part B of title
XVIII and is eligible for medical assistance with respect to
prescribed drugs under this title, medical assistance shall
continue to be provided under this title for prescribed drugs
to the extent payment is not made under such part B, without
regard to section 1902(n)(2).''.
(4) Clarifying amendments.--Section 1905(p)(3) (42 U.S.C.
1396d(p)(3)) is amended--
(A) in subparagraph (B), by inserting ``, but not including
any copayments under section 1845'' after ``section 1813'';
and
(B) in subparagraph (C), by inserting ``, but not including
any deductible under section 1845'' after ``section
1833(b)''..
(d) Treatment of Territories.--
(1) In general.--Section 1935 of such Act, as so inserted
and amended, is further amended--
(A) in subsection (a) in the matter preceding paragraph
(1), by inserting ``subject to subsection (f)'' after
``section 1903(a)'';
(B) in subsection (c)(1), by inserting ``subject to
subsection (f)'' after ``1903(a)(1)''; and
(C) by adding at the end the following new subsection:
``(f) Treatment of Territories.--
``(1) In general.--In the case of a State, other than the
50 States and the District of Columbia--
``(A) the previous provisions of this section shall not
apply to residents of such State; and
``(B) if the State establishes a plan described in
paragraph (2) (for providing medical assistance with respect
to the provision of prescription drugs to medicare
beneficiaries under section 1845(g)), the amount otherwise
determined under section 1108(f) (as increased under section
1108(g)) for the State shall be increased by the amount
specified in paragraph (3).
``(2) Plan.--The plan described in this paragraph is a plan
that--
``(A) provides medical assistance under section 1845(g)
with respect to the provision of covered outpatient drugs to
low-income medicare beneficiaries whose income does not
exceed an income level specified under the plan; and
``(B) assures that additional amounts received by the State
that are attributable to the operation of this subsection are
used only for such assistance.
``(3) Increased amount.--
``(A) In general.--The amount specified in this paragraph
for a State for a year is equal to the product of--
``(i) the aggregate amount specified in subparagraph (B);
and
``(ii) the amount specified in section 1108(g)(1) for that
State, divided by the sum of the amounts specified in such
section for all such States.
``(B) Aggregate amount.--The aggregate amount specified in
this subparagraph for--
``(i) 2006, is equal to $25,000,000; or
``(ii) a subsequent year, is equal to the aggregate amount
specified in this subparagraph for the previous year
increased by annual percentage increase specified in section
1845(a)(2)(B) for the year involved.
``(4) Report.--The Secretary shall submit to Congress a
report on the application of this subsection and may include
in the report such recommendations as the Secretary deems
appropriate.''.
(2) Conforming amendment.--Section 1108(f) (42 U.S.C.
1308(f)) is amended by inserting ``and section
1935(f)(1)(B)'' after ``Subject to subsection (g)''.
(e) Medicaid Reduction of Copayments for QMBs.--Section
1905(p)(3) (42 U.S.C. 1396d(p)(3)) is amended by adding at
the end the following new subparagraph:
``(E) The difference between the copayment amounts
established under sections 1845(g)(1)(A) and 1845(a)(5) for
covered outpatient drugs and the nominal copayment amounts
that would apply to such drugs if covered under this title,
pursuant to section 1916(a).''.
(f) Renegotiation of Pharmacy Plus Waivers.--In the case of
States which as of the date of the enactment of this Act have
entered into demonstration projects (popularly known as
pharmacy plus waivers) under section 1115 of the Social
Security Act under which the State is provided flexibility to
offer medical assistance for prescription drug coverage in
return for limitations on payments for certain optional
populations, the Secretary of Health and Human Services shall
renegotiate such projects in order to account for the
additional prescription drug benefits made available under
the amendments made by this title.
SEC. 112. IMPROVING ENROLLMENT PROCESS UNDER MEDICAID.
(a) Automatic Reenrollment Without Need To Reapply.--
(1) In general.--Section 1905(p) (42 U.S.C. 1396d(p)) is
amended--
(A) by redesignating paragraph (6) as paragraph (9); and
(B) by inserting after paragraph (5), the following new
paragraph:
``(6) In the case of an individual who has been determined
to qualify as a qualified medicare beneficiary or to be
eligible for benefits under section 1902(a)(10)(E)(iii), the
individual shall be deemed to continue to be so qualified or
eligible without the need for any annual or periodic
application unless and until the individual notifies the
State that the individual's eligibility conditions have
changed so that the individual is no longer so qualified or
eligible.''.
(2) Conforming amendment.--Section 1902(e)(8) (42 U.S.C.
1396a(e)(8)) is amended by striking the second sentence.
(b) Use of Simplified Application Process.--Such section
1905(p) is further amended by adding at the end the following
new paragraph:
``(7) A State shall permit individuals to apply to qualify
as a qualified medicare beneficiary or for benefits under
section 1902(a)(10)(E)(iii) through the use of the simplified
application form developed under section 1905(p)(5)(A) and
shall permit such an application to be made over the
telephone, the Internet, or by mail, without the need for an
interview in person by the applicant or a representative of
the applicant.''.
(c) Role of Social Security Offices.--
(1) Enrollment and provision of information at social
security offices.--Such section is further amended by adding
at the end the following new paragraph:
``(8) The Commissioner of Social Security shall provide,
through local offices of the Social Security Administration--
``(A) for the enrollment under State plans under this title
for appropriate medicare cost-sharing benefits for
individuals who qualify as a qualified medicare beneficiary
or for benefits under section 1902(a)(10)(E)(iii); and
``(B) for providing oral and written notice of the
availability of such benefits.''.
(2) Clarifying amendment.--Section 1902(a)(5) (42 U.S.C.
1396a(a)(5)) is amended by inserting ``as provided in section
1905(p)(10)'' before ``except''.
(d) Outstationing of State Eligibility Workers at SSA Field
Offices.--Section 1902(a)(55) (42 U.S.C. 1396a(a)(55)) is
amended--
(1) by striking ``subsection (a)(10)(A)(i)(IV),
(a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or
(a)(10)(A)(ii)(IX)'' and inserting ``paragraph
(10)(A)(i)(IV), (10)(A)(i)(VI), (10)(A)(i)(VII),
(10)(A)(ii)(IX), or (10)(E)''; and
(2) in subparagraph (A), by inserting ``and in the case of
applications of individuals for medical assistance under
paragraph (10)(E), at locations that include field offices of
the Social Security Administration''.
TITLE II--RURAL HEALTH CARE IMPROVEMENTS
SEC. 201. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE
HOSPITAL (DSH) ADJUSTMENT FOR RURAL HOSPITALS.
(a) Equalizing DSH Payment Amounts.--
(1) In general.--Section 1886(d)(5)(F)(vii) (42 U.S.C.
1395ww(d)(5)(F)(vii)) is amended by inserting ``, and, after
October 1, 2003, for any other hospital described in clause
(iv),'' after ``clause (iv)(I)'' in the matter preceding
subclause (I).
(2) Conforming amendments.--Section 1886(d)(5)(F) (42
U.S.C. 1395ww(d)(5)(F)) is amended--
(A) in clause (iv)--
(i) in subclause (II)--
(I) by inserting ``and before October 1, 2003,'' after
``April 1, 2001,''; and
(II) by inserting ``or, for discharges occurring on or
after October 1, 2003, is equal to the percent determined in
accordance with the applicable formula described in clause
(vii)'' after ``clause (xiii)'';
(ii) in subclause (III)--
(I) by inserting ``and before October 1, 2003,'' after
``April 1, 2001,''; and
(II) by inserting ``or, for discharges occurring on or
after October 1, 2003, is equal to the percent determined in
accordance with the applicable formula described in clause
(vii)'' after ``clause (xii)'';
(iii) in subclause (IV)--
(I) by inserting ``and before October 1, 2003,'' after
``April 1, 2001,''; and
(II) by inserting ``or, for discharges occurring on or
after October 1, 2003, is equal to the percent determined in
accordance with
[[Page H5969]]
the applicable formula described in clause (vii)'' after
``clause (x) or (xi)'';
(iv) in subclause (V)--
(I) by inserting ``and before October 1, 2003,'' after
``April 1, 2001,''; and
(II) by inserting ``or, for discharges occurring on or
after October 1, 2003, is equal to the percent determined in
accordance with the applicable formula described in clause
(vii)'' after ``clause (xi)''; and
(v) in subclause (VI)--
(I) by inserting ``and before October 1, 2003,'' after
``April 1, 2001,''; and
(II) by inserting ``or, for discharges occurring on or
after October 1, 2003, is equal to the percent determined in
accordance with the applicable formula described in clause
(vii)'' after ``clause (x)'';
(B) in clause (viii), by striking ``The formula'' and
inserting ``For discharges occurring before October 1, 2003,
the formula''; and
(C) in each of clauses (x), (xi), (xii), and (xiii), by
striking ``For purposes'' and inserting ``With respect to
discharges occurring before October 1, 2003, for purposes''.
(b) Effective Date.--The amendments made by this section
shall apply to discharges occurring on or after October 1,
2003.
SEC. 202. IMMEDIATE ESTABLISHMENT OF UNIFORM STANDARDIZED
AMOUNT IN RURAL AND SMALL URBAN AREAS.
(a) In General.--Section 1886(d)(3)(A) (42 U.S.C.
1395ww(d)(3)(A)) is amended--
(1) in clause (iv), by inserting ``and ending on or before
September 30, 2003,'' after ``October 1, 1995,''; and
(2) by redesignating clauses (v) and (vi) as clauses (vii)
and (viii), respectively, and inserting after clause (iv) the
following new clauses:
``(v) For discharges occurring in the fiscal year beginning
on October 1, 2003, the average standardized amount for
hospitals located in areas other than a large urban area
shall be equal to the average standardized amount for
hospitals located in a large urban area.''.
(b) Conforming Amendments.--
(1) Computing drg-specific rates.--Section 1886(d)(3)(D)
(42 U.S.C. 1395ww(d)(3)(D)) is amended--
(A) in the heading, by striking ``in different areas'';
(B) in the matter preceding clause (i), by striking ``,
each of'';
(C) in clause (i)--
(i) in the matter preceding subclause (I), by inserting
``for fiscal years before fiscal year 2004,'' before ``for
hospitals''; and
(ii) in subclause (II), by striking ``and'' after the
semicolon at the end;
(D) in clause (ii)--
(i) in the matter preceding subclause (I), by inserting
``for fiscal years before fiscal year 2004,'' before ``for
hospitals''; and
(ii) in subclause (II), by striking the period at the end
and inserting ``; and''; and
(E) by adding at the end the following new clause:
``(iii) for a fiscal year beginning after fiscal year 2003,
for hospitals located in all areas, to the product of--
``(I) the applicable standardized amount (computed under
subparagraph (A)), reduced under subparagraph (B), and
adjusted or reduced under subparagraph (C) for the fiscal
year; and
``(II) the weighting factor (determined under paragraph
(4)(B)) for that diagnosis-related group.''.
(2) Technical conforming sunset.--Section 1886(d)(3) (42
U.S.C. 1395ww(d)(3)) is amended--
(A) in the matter preceding subparagraph (A), by inserting
``, for fiscal years before fiscal year 1997,'' before ``a
regional adjusted DRG prospective payment rate''; and
(B) in subparagraph (D), in the matter preceding clause
(i), by inserting ``, for fiscal years before fiscal year
1997,'' before ``a regional DRG prospective payment rate for
each region,''.
SEC. 203. ESTABLISHMENT OF ESSENTIAL RURAL HOSPITAL
CLASSIFICATION.
(a) Classification.--Section 1861(mm) (42 U.S.C. 1395x(mm))
is amended--
(1) in the heading by adding ``Essential Rural Hospitals''
at the end; and
(2) by adding at the end the following new paragraphs:
``(4)(A) The term `essential rural hospital' means a
subsection (d) hospital (as defined in section 1886(d)(1)(B))
that is located in a rural area (as defined for purposes of
section 1886(d)), has more than 25 licensed acute care
inpatient beds, has applied to the Secretary for
classification as such a hospital, and with respect to which
the Secretary has determined that the closure of the hospital
would significantly diminish the ability of medicare
beneficiaries to obtain essential health care services.
``(B) The determination under subparagraph (A) shall be
based on the following criteria:
``(i) High proportion of medicare beneficiaries receiving
care from hospital.--(I) A high percentage of such
beneficiaries residing in the area of the hospital who are
hospitalized (during the most recent year for which complete
data are available) receive basic inpatient medical care at
the hospital.
``(II) For a hospital with more than 200 licensed beds, a
high percentage of such beneficiaries residing in such area
who are hospitalized (during such recent year) receive
specialized surgical inpatient care at the hospital.
``(III) Almost all physicians described in section
1861(r)(1) in such area have privileges at the hospital and
provide their inpatient services primarily at the hospital.
``(ii) Significant adverse impact in absence of hospital.--
If the hospital were to close--
``(I) there would be a significant amount of time needed
for residents to reach emergency treatment, resulting in a
potential significant harm to beneficiaries with critical
illnesses or injuries;
``(II) there would be an inability in the community to
stablize emergency cases for transfers to another acute care
setting, resulting in a potential for significant harm to
medicare beneficiaries; and
``(III) any other nearby hospital lacks the physical and
clinical capacity to take over the hospital's typical
admissions.
``(C) In making such determination, the Secretary may also
consider the following:
``(i) Free-standing ambulatory surgery centers, office-
based oncology care, and imaging center services are
insufficient in the hospital's area to handle the outpatient
care of the hospital.
``(ii) Beneficiaries in nearby areas would be adversely
affected if the hospital were to close as the hospital
provides specialized knowledge and services to a network of
smaller hospitals and critical access hospitals.
``(iii) Medicare beneficiaries would have difficulty in
accessing care if the hospital were to close as the hospital
provides significant subsidies to support ambulatory care in
local clinics, including mental health clinics and to support
post acute care.
``(iv) The hospital has a committment to provide graduate
medical education in a rural area.
``(C) Quality care.--The hospital inpatient score for
quality of care is not less than the median hospital score
for qualify of care for hospitals in the State, as
established under standards of the utilization and quality
control peer review organization under part B of title XI or
other quality standards recognized by the Secretary.
A hospital classified as an essential rural hospital may not
change such classification and a hospital so classified shall
not be treated as a sole community hospital, medicare
dependent hospital, or rural referral center for purposes of
section 1886.''.
(b) Payment Based on 102 Percent of Allowed Costs.--
(1) Inpatient hospital services.--Section 1886(d) (42
U.S.C. 1395ww(d)) is amended by adding at the end the
following:
``(11) In the case of a hospital classified as an essential
rural hospital under section 1861(mm)(4) for a cost reporting
period, the payment under this subsection for inpatient
hospital services for discharges occurring during the period
shall be based on 102 percent of the reasonable costs for
such services. Nothing in this paragraph shall be construed
as affecting the application or amount of deductibles or
copayments otherwise applicable to such services under part A
or as waiving any requirement for billing for such
services.''.
(2) Hospital outpatient services.--Section 1833(t)(13) (42
U.S.C. 1395l(t)(13)) is amended by adding at the end the
following new subparagraph:
``(B) Special rule for essential rural hospitals.--In the
case of a hospital classified as an essential rural hospital
under section 1861(mm)(4) for a cost reporting period, the
payment under this subsection for covered OPD services during
the period shall be based on 102 percent of the reasonable
costs for such services. Nothing in this subparagraph shall
be construed as affecting the application or amount of
deductibles or copayments otherwise applicable to such
services under this part or as waiving any requirement for
billing for such services.''.
(c) Effective Date.--The amendments made by this section
shall apply to cost reporting periods beginning on or after
October 1, 2004.
SEC. 204. MORE FREQUENT UPDATE IN WEIGHTS USED IN HOSPITAL
MARKET BASKET.
(a) More Frequent Updates in Weights.--After revising the
weights used in the hospital market basket under section
1886(b)(3)(B)(iii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(iii)) to reflect the most current data
available, the Secretary shall establish a frequency for
revising such weights, including the labor share, in such
market basket to reflect the most current data available more
frequently than once every 5 years.
(b) Report.--Not later than October 1, 2004, the Secretary
shall submit a report to Congress on the frequency
established under subsection (a), including an explanation of
the reasons for, and options considered, in determining such
frequency.
SEC. 205. IMPROVEMENTS TO CRITICAL ACCESS HOSPITAL PROGRAM.
(a) Increase in Payment Amounts.--
(1) In general.--Sections 1814(l), 1834(g)(1), and
1883(a)(3) (42 U.S.C. 1395f(l); 1395m(g)(1); 42 U.S.C.
1395tt(a)(3)) are each amended by inserting ``equal to 102
percent of'' before ``the reasonable costs''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to payments for services furnished during cost
reporting periods beginning on or after October 1, 2003.
(b) Coverage of Costs for Certain Emergency Room On-Call
Providers.--
(1) In general.--Section 1834(g)(5) (42 U.S.C. 1395m(g)(5))
is amended--
(A) in the heading--
(i) by inserting ``certain'' before ``emergency''; and
[[Page H5970]]
(ii) by striking ``physicians'' and inserting
``providers'';
(B) by striking ``emergency room physicians who are on-call
(as defined by the Secretary)'' and inserting ``physicians,
physician assistants, nurse practitioners, and clinical nurse
specialists who are on-call (as defined by the Secretary) to
provide emergency services''; and
(C) by striking ``physicians' services'' and inserting
``services covered under this title''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to costs incurred for services
provided on or after January 1, 2004.
(c) Modification of the Isolation Test for Cost-Based CAH
Ambulance Services.--
(1) In general.--Section 1834(l)(8) (42 U.S.C. 1395m(l)),
as added by section 205(a) of BIPA (114 Stat. 2763A-482), is
amended by adding at the end the following: ``The limitation
described in the matter following subparagraph (B) in the
previous sentence shall not apply if the ambulance services
are furnished by such a provider or supplier of ambulance
services who is a first responder to emergencies (as
determined by the Secretary).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to ambulances services furnished on or after the
first cost reporting period that begins after the date of the
enactment of this Act.
(d) Reinstatement of Periodic Interim Payment (PIP).--
(1) In general.--Section 1815(e)(2) (42 U.S.C. 1395g(e)(2))
is amended--
(A) in the matter before subparagraph (A), by inserting ``,
in the cases described in subparagraphs (A) through (D)''
after ``1986''; and
(B) by striking ``and'' at the end of subparagraph (C);
(C) by adding ``and'' at the end of subparagraph (D); and
(D) by inserting after subparagraph (D) the following new
subparagraph:
``(E) inpatient critical access hospital services;''.
(2) Development of alternative methods of periodic interim
payments.--With respect to periodic interim payments to
critical access hospitals for inpatient critical access
hospital services under section 1815(e)(2)(E) of the Social
Security Act, as added by paragraph (1), the Secretary shall
develop alternative methods for such payments that are based
on expenditures of the hospital.
(3) Reinstatement of pip.--The amendments made by paragraph
(1) shall apply to payments made on or after January 1, 2004.
(e) Condition for Application of Special Physician Payment
Adjustment.--
(1) In general.--Section 1834(g)(2) (42 U.S.C. 1395m(g)(2))
is amended by adding after and below subparagraph (B) the
following:
``The Secretary may not require, as a condition for applying
subparagraph (B) with respect to a critical access hospital,
that each physician providing professional services in the
hospital must assign billing rights with respect to such
services, except that such subparagraph shall not apply to
those physicians who have not assigned such billing
rights.''.
(2) Effective date.--The amendment made by paragraph (1)
shall be effective as if included in the enactment of section
403(d) of the Medicare, Medicaid, and SCHIP Balanced Budget
Refinement Act of 1999 (113 Stat. 1501A-371).
(f) Permitting CAHs To Allocate Swing Beds and Acute Care
Inpatient Beds Subject to a Total Limit of 25 Beds.--
(1) In general.--Section 1820(c)(2)(B)(iii) (42 U.S.C.
1395i-4(c)(2)(B)(iii)) is amended to read as follows:
``(iii) provides not more than a total of 25 extended care
service beds (pursuant to an agreement under subsection (f))
and acute care inpatient beds (meeting such standards as the
Secretary may establish) for providing inpatient care for a
period that does not exceed, as determined on an annual,
average basis, 96 hours per patient;''.
(2) Conforming amendment.--Section 1820(f) (42 U.S.C.
1395i-4(f)) is amended by striking ``and the number of beds
used at any time for acute care inpatient services does not
exceed 15 beds''.
(3) Effective date.--The amendments made by this subsection
shall with respect to designations made on or after October
1, 2004.
(g) Additional 5-Year Period of Funding for Grant
Program.--
(1) In general.--Section 1820(g) (42 U.S.C. 1395i-4(g)) is
amended by adding at the end the following new paragraph:
``(4) Funding.--
``(A) In general.--Subject to subparagraph (B), payment for
grants made under this subsection during fiscal years 2004
through 2008 shall be made from the Federal Hospital
Insurance Trust Fund.
``(B) Annual aggregate limitation.--In no case may the
amount of payment provided for under subparagraph (A) for a
fiscal year exceed $25,000,000.''.
(2) Conforming amendment.--Section 1820 (42 U.S.C. 1395i-4)
is amended by striking subsection (j).
SEC. 206. REDISTRIBUTION OF UNUSED RESIDENT POSITIONS.
(a) In General.--Section 1886(h)(4) (42 U.S.C.
1395ww(h)(4)) is amended--
(1) in subparagraph (F)(i), by inserting ``subject to
subparagraph (I),'' after ``October 1, 1997,'';
(2) in subparagraph (H)(i), by inserting ``subject to
subparagraph (I),'' after ``subparagraphs (F) and (G),''; and
(3) by adding at the end the following new subparagraph:
``(I) Redistribution of unused resident positions.--
``(i) Reduction in limit based on unused positions.--
``(I) In general.--If a hospital's resident level (as
defined in clause (iii)(I)) is less than the otherwise
applicable resident limit (as defined in clause (iii)(II))
for each of the reference periods (as defined in subclause
(II)), effective for cost reporting periods beginning on or
after January 1, 2004, the otherwise applicable resident
limit shall be reduced by 75 percent of the difference
between such limit and the reference resident level specified
in subclause (III) (or subclause (IV) if applicable).
``(II) Reference periods defined.--In this clause, the term
`reference periods' means, for a hospital, the 3 most recent
consecutive cost reporting periods of the hospital for which
cost reports have been settled (or, if not, submitted) on or
before September 30, 2002.
``(III) Reference resident level.--Subject to subclause
(IV), the reference resident level specified in this
subclause for a hospital is the highest resident level for
the hospital during any of the reference periods.
``(IV) Adjustment process.--Upon the timely request of a
hospital, the Secretary may adjust the reference resident
level for a hospital to be the resident level for the
hospital for the cost reporting period that includes July 1,
2003.
``(V) Affiliation.--With respect to hospitals which are
members of the same affiliated group (as defined by the
Secretary under subparagraph (H)(ii)), the provisions of this
section shall be applied with respect to such an affiliated
group by deeming the affiliated group to be a single
hospital.
``(ii) Redistribution.--
``(I) In general.--The Secretary is authorized to increase
the otherwise applicable resident limits for hospitals by an
aggregate number estimated by the Secretary that does not
exceed the aggregate reduction in such limits attributable to
clause (i) (without taking into account any adjustment under
subclause (IV) of such clause).
``(II) Effective date.--No increase under subclause (I)
shall be permitted or taken into account for a hospital for
any portion of a cost reporting period that occurs before
July 1, 2004, or before the date of the hospital's
application for an increase under this clause. No such
increase shall be permitted for a hospital unless the
hospital has applied to the Secretary for such increase by
December 31, 2005.
``(III) Considerations in redistribution.--In determining
for which hospitals the increase in the otherwise applicable
resident limit is provided under subclause (I), the Secretary
shall take into account the need for such an increase by
specialty and location involved, consistent with subclause
(IV).
``(IV) Priority for rural and small urban areas.--In
determining for which hospitals and residency training
programs an increase in the otherwise applicable resident
limit is provided under subclause (I), the Secretary shall
first distribute the increase to programs of hospitals
located in rural areas or in urban areas that are not large
urban areas (as defined for purposes of subsection (d)) on a
first-come-first-served basis (as determined by the
Secretary) based on a demonstration that the hospital will
fill the positions made available under this clause and not
to exceed an increase of 25 full-time equivalent positions
with respect to any hospital.
``(V) Application of locality adjusted national average per
resident amount.--With respect to additional residency
positions in a hospital attributable to the increase provided
under this clause, notwithstanding any other provision of
this subsection, the approved FTE resident amount is deemed
to be equal to the locality adjusted national average per
resident amount computed under subparagraph (E) for that
hospital.
``(VI) Construction.--Nothing in this clause shall be
construed as permitting the redistribution of reductions in
residency positions attributable to voluntary reduction
programs under paragraph (6) or as affecting the ability of a
hospital to establish new medical residency training programs
under subparagraph (H).
``(iii) Resident level and limit defined.--In this
subparagraph:
``(I) Resident level.--The term `resident level' means,
with respect to a hospital, the total number of full-time
equivalent residents, before the application of weighting
factors (as determined under this paragraph), in the fields
of allopathic and osteopathic medicine for the hospital.
``(II) Otherwise applicable resident limit.--The term
`otherwise applicable resident limit' means, with respect to
a hospital, the limit otherwise applicable under
subparagraphs (F)(i) and (H) on the resident level for the
hospital determined without regard to this subparagraph.''.
(b) Conforming Amendment to IME.--Section 1886(d)(5)(B)(v)
(42 U.S.C. 1395ww(d)(5)(B)(v)) is amended by adding at the
end the following: ``The provisions of subparagraph (I) of
subsection (h)(4) shall apply with respect to the first
sentece of this clause in the same manner as it applies with
[[Page H5971]]
respect to subparagraph (F) of such subsection.''.
(c) Report on Extension of Applications Under
Redistribution Program.--Not later than July 1, 2005, the
Secretary shall submit to Congress a report containing
recommendations regarding whether to extend the deadline for
applications for an increase in resident limits under section
1886(h)(4)(I)(ii)(II) of the Social Security Act (as added by
subsection (a)).
SEC. 207. TWO-YEAR EXTENSION OF HOLD HARMLESS PROVISIONS FOR
SMALL RURAL HOSPITALS AND SOLE COMMUNITY
HOSPITALS UNDER PROSPECTIVE PAYMENT SYSTEM FOR
HOSPITAL OUTPATIENT DEPARTMENT SERVICES.
(a) Hold Harmless Provisions.--
(1) In general.--Section 1833(t)(7)(D)(i) (42 U.S.C.
1395l(t)(7)(D)(i)) is amended--
(A) in the heading, by striking ``small'' and inserting
``certain'';
(B) by inserting ``or a sole community hospital (as defined
in section 1886(d)(5)(D)(iii)) located in a rural area''
after ``100 beds''; and
(C) by striking ``2004'' and inserting ``2006''.
(2) Effective date.--The amendment made by subsection
(a)(2) shall apply with respect to payment for OPD services
furnished on and after January 1, 2004.
(b) Study; Adjustment.--
(1) Study.--The Secretary shall conduct a study to
determine if, under the prospective payment system for
hospital outpatient department services under section 1833(t)
of the Social Security Act (42 U.S.C. 1395l(t)), costs
incurred by rural providers of services by ambulatory payment
classification groups (APCs) exceed those costs incurred by
urban providers of services.
(2) Adjustment.--Insofar as the Secretary determines under
paragraph (1) that costs incurred by rural providers exceed
those costs incurred by urban providers of services, the
Secretary shall provide for an appropriate adjustment under
such section 1833(t) to reflect those higher costs by January
1, 2005.
SEC. 208. EXCLUSION OF CERTAIN RURAL HEALTH CLINIC AND
FEDERALLY QUALIFIED HEALTH CENTER SERVICES FROM
THE PROSPECTIVE PAYMENT SYSTEM FOR SKILLED
NURSING FACILITIES.
(a) In General.--Section 1888(e)(2)(A) (42 U.S.C.
1395yy(e)(2)(A)) is amended--
(1) in clause (i)(II), by striking ``clauses (ii) and
(iii)'' and inserting ``clauses (ii), (iii), and (iv)''; and
(2) by adding at the end the following new clause:
``(iv) Exclusion of certain rural health clinic and
federally qualified health center services.--Services
described in this clause are--
``(I) rural health clinic services (as defined in paragraph
(1) of section 1861(aa)); and
``(II) Federally qualified health center services (as
defined in paragraph (3) of such section);
that would be described in clause (ii) if such services were
not furnished by an individual affiliated with a rural health
clinic or a Federally qualified health center.''.
(b) Certain Services Furnished by an Entity Jointly Owned
by Hospitals and Critical Access Hospitals.--For purposes of
applying section 411.15(p)-(3)(iii) of title 42 of the Code
of Federal Regulations, the Secretary shall treat an entity
that is 100 percent owned as a joint venture by 2 Medicare-
participating hospitals or critical access hospitals as a
Medicare-participating hospital or a critical access
hospital.
(c) Technical Amendments.--Sections 1842(b)(6)(E) and
1866(a)(1)(H)(ii) (42 U.S.C. 1395u(b)(6)(E);
1395cc(a)(1)(H)(ii)) are each amended by striking ``section
1888(e)(2)(A)(ii)'' and inserting ``clauses (ii), (iii), and
(iv) of section 1888(e)(2)(A)''.
(d) Effective Date.--The amendments made by subsection (a)
shall apply to services furnished on or after January 1,
2004.
SEC. 209. RECOGNITION OF ATTENDING NURSE PRACTITIONERS AS
ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.
(a) In General.--Section 1861(dd)(3)(B) (42 U.S.C.
1395x(dd)(3)(B)) is amended by inserting ``or nurse
practitioner (as defined in subsection (aa)(5))'' after ``the
physician (as defined in subsection (r)(1))''.
(b) Prohibition on Nurse Practitioner Certifying Need for
Hospice.--Section 1814(a)(7)(A)(i)(I) (42 U.S.C.
1395f(a)(7)(A)(i)(I)) is amended by inserting ``(which for
purposes of this subparagraph does not include a nurse
practitioner)'' after ``attending physician (as defined in
section 1861(dd)(3)(B))''.
SEC. 210. IMPROVEMENT IN PAYMENTS TO RETAIN EMERGENCY
CAPACITY FOR AMBULANCE SERVICES IN RURAL AREAS.
Section 1834(l) (42 U.S.C. 1395m(l)) is amended--
(1) by redesignating paragraph (8), as added by section
221(a) of BIPA (114 Stat. 2763A-486), as paragraph (9); and
(2) by adding at the end the following new paragraph:
``(10) Assistance for rural providers furnishing services
in low medicare population density areas.--
``(A) In general.--In the case of ground ambulance services
furnished on or after January 1, 2004, for which the
transportation originates in a qualified rural area (as
defined in subparagraph (B)), the Secretary shall provide for
an increase in the base rate of the fee schedule for mileage
for a trip established under this subsection. In establishing
such increase, the Secretary shall, based on the relationship
of cost and volume, estimate the average increase in cost per
trip for such services as compared with the cost per trip for
the average ambulance service.
``(B) Qualified rural area defined.--For purposes of
subparagraph (A), the term `qualified rural area' is a rural
area (as defined in section 1886(d)(2)(D)) with a population
density of medicare beneficiaries residing in the area that
is in the lowest three quartiles of all rural county
populations.''.
SEC. 211. THREE-YEAR INCREASE FOR HOME HEALTH SERVICES
FURNISHED IN A RURAL AREA.
(a) In General.--In the case of home health services
furnished in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act (42 U.S.C.
1395ww(d)(2)(D))) during 2004, 2005, and 2006, the Secretary
shall increase the payment amount otherwise made under
section 1895 of such Act (42 U.S.C. 1395fff ) for such
services by 5 percent.
(b) Waiving Budget Neutrality.--The Secretary shall not
reduce the standard prospective payment amount (or amounts)
under section 1895 of the Social Security Act (42 U.S.C.
1395fff ) applicable to home health services furnished during
a period to offset the increase in payments resulting from
the application of subsection (a).
SEC. 212. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE
EFFORTS THAT BENEFIT MEDICALLY UNDERSERVED
POPULATIONS.
(a) In General.--Section 1128B(b)(3) (42 U.S.C. 1320a-
7(b)(3)), as amended by section 101(b)(2), is amended--
(1) in subparagraph (F), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (G), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(H) any remuneration between a public or nonprofit
private health center entity described under clause (i) or
(ii) of section 1905(l)(2)(B) and any individual or entity
providing goods, items, services, donations or loans, or a
combination thereof, to such health center entity pursuant to
a contract, lease, grant, loan, or other agreement, if such
agreement contributes to the ability of the health center
entity to maintain or increase the availability, or enhance
the quality, of services provided to a medically underserved
population served by the health center entity.''.
(b) Rulemaking for Exception for Health Center Entity
Arrangements.--
(1) Establishment.--
(A) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
establish, on an expedited basis, standards relating to the
exception described in section 1128B(b)(3)(H) of the Social
Security Act, as added by subsection (a), for health center
entity arrangements to the antikickback penalties.
(B) Factors to consider.--The Secretary shall consider the
following factors, among others, in establishing standards
relating to the exception for health center entity
arrangements under subparagraph (A):
(i) Whether the arrangement between the health center
entity and the other party results in savings of Federal
grant funds or increased revenues to the health center
entity.
(ii) Whether the arrangement between the health center
entity and the other party restricts or limits a patient's
freedom of choice.
(iii) Whether the arrangement between the health center
entity and the other party protects a health care
professional's independent medical judgment regarding
medically appropriate treatment.
The Secretary may also include other standards and criteria
that are consistent with the intent of Congress in enacting
the exception established under this section.
(2) Interim final effect.--No later than 180 days after the
date of enactment of this Act, the Secretary shall publish a
rule in the Federal Register consistent with the factors
under paragraph (1)(B). Such rule shall be effective and
final immediately on an interim basis, subject to such change
and revision, after public notice and opportunity (for a
period of not more than 60 days) for public comment, as is
consistent with this subsection.
SEC. 213. GAO STUDY OF GEOGRAPHIC DIFFERENCES IN PAYMENTS FOR
PHYSICIANS' SERVICES.
(a) Study.--The Comptroller General of the United States
shall conduct a study of differences in payment amounts under
the physician fee schedule under section 1848 of the Social
Security Act (42 U.S.C. 1395w-4) for physicians' services in
different geographic areas. Such study shall include--
(1) an assessment of the validity of the geographic
adjustment factors used for each component of the fee
schedule;
(2) an evaluation of the measures used for such adjustment,
including the frequency of revisions; and
(3) an evaluation of the methods used to determine
professional liability insurance costs used in computing the
malpractice component, including a review of increases in
professional liability insurance premiums and variation in
such increases by State and physician specialty and methods
used to update the geographic cost of practice index and
relative weights for the malpractice component.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the
[[Page H5972]]
Comptroller General shall submit to Congress a report on the
study conducted under subsection (a). The report shall
include recommendations regarding the use of more current
data in computing geographic cost of practice indices as well
as the use of data directly representative of physicians'
costs (rather than proxy measures of such costs).
SEC. 214. TREATMENT OF MISSING COST REPORTING PERIODS FOR
SOLE COMMUNITY HOSPITALS.
(a) In General.--Section 1886(b)(3)(I) (42 U.S.C.
1395ww(b)(3)(I)) is amended by adding at the end the
following new clause:
``(iii) In no case shall a hospital be denied treatment as
a sole community hospital or payment (on the basis of a
target rate as such as a hospital) because data are
unavailable for any cost reporting period due to changes in
ownership, changes in fiscal intermediaries, or other
extraordinary circumstances, so long as data for at least one
applicable base cost reporting period is available.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to cost reporting periods beginning on or after
January 1, 2004.
SEC. 215. EXTENSION OF TELEMEDICINE DEMONSTRATION PROJECT.
Section 4207 of Balanced Budget Act of 1997 (Public Law
105-33) is amended--
(1) in subsection (a)(4), by striking ``4-year'' and
inserting ``8-year''; and
(2) in subsection (d)(3), by striking ``$30,000,000'' and
inserting ``$60,000,000''.
SEC. 216. ADJUSTMENT TO THE MEDICARE INPATIENT HOSPITAL PPS
WAGE INDEX TO REVISE THE LABOR-RELATED SHARE OF
SUCH INDEX.
(a) In General.--Section 1886(d)(3)(E) (42 U.S.C.
1395ww(d)(3)(E)) is amended--
(1) by striking ``wage levels.--The Secretary'' and
inserting ``wage levels.--
``(i) In general.--Except as provided in clause (ii), the
Secretary''; and
(2) by adding at the end the following new clause:
``(ii) Alternative proportion to be adjusted beginning in
fiscal year 2004.--
``(I) In general.--Except as provided in subclause (II),
for discharges occurring on or after October 1, 2003, the
Secretary shall substitute the `62 percent' for the
proportion described in the first sentence of clause (i).
``(II) Hold harmless for certain hospitals.--If the
application of subclause (I) would result in lower payments
to a hospital than would otherwise be made, then this
subparagraph shall be applied as if this clause had not been
enacted.''.
(b) Waiving Budget Neutrality.--Section 1886(d)(3)(E) (42
U.S.C. 1395ww(d)(3)(E)), as amended by subsection (a), is
amended by adding at the end of clause (i) the following new
sentence: ``The Secretary shall apply the previous sentence
for any period as if the amendments made by section 202(a) of
the Medicare Rx Now Act of 2003 had not been enacted.''.
SEC. 217. ESTABLISHMENT OF FLOOR ON GEOGRAPHIC ADJUSTMENTS OF
PAYMENTS FOR PHYSICIANS' SERVICES.
Section 1848(e)(1) (42 U.S.C. 1395w-4(e)(1)) is amended--
(1) in subparagraph (A), by striking ``subparagraphs (B)
and (C)'' and inserting ``subparagraphs (B), (C), (E), and
(F)''; and
(2) by adding at the end the following new subparagraphs:
``(E) Floor for work geographic indices.--
``(i) In general.--For purposes of payment for services
furnished on or after January 1, 2004, and before January 1,
2008, after calculating the work geographic indices in
subparagraph (A)(iii), the Secretary shall increase the work
geographic index to the work floor index for any locality for
which such geographic index is less than the work floor
index.
``(ii) Work floor index.--For purposes of clause (i), the
term `applicable floor index' means--
``(I) 0.980 with respect to services furnished during 2004;
and
``(II) 1.000 for services furnished during 2005, 2006, and
2007.
``(F) Floor for practice expense and malpractice geographic
indices.--For purposes of payment for services furnished on
or after January 1, 2005, and before January 1, 2008, after
calculating the practice expense and malpractice indices in
clauses (i) and (ii) of subparagraph (A) and in subparagraph
(B), the Secretary shall increase any such index to 1.00 for
any locality for which such index is less than 1.00.''.
Ms. PRYCE of Ohio. Mr. Speaker, I yield back the balance of my time,
and I move the previous question on the resolution.
The SPEAKER pro tempore (Mr. LaTourette). The question is on ordering
the previous question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. SLAUGHTER. Mr. Speaker, I object to the vote on the ground that a
quorum is not present and make the point of order that a quorum is not
present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
Pursuant to clauses 8 and 9 of rule XX, this 15-minute vote on
ordering the previous question will be followed by 5-minute votes on
adopting the resolution, if ordered, and on adopting House Resolution
297 which was debated earlier today.
The vote was taken by electronic device, and there were--yeas 226,
nays 203, not voting 6, as follows:
[Roll No. 321]
YEAS--226
Aderholt
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
DeMint
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
English
Everett
Feeney
Ferguson
Flake
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Gutknecht
Harris
Hart
Hastert
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Hyde
Isakson
Issa
Istook
Janklow
Jenkins
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Nethercutt
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NAYS--203
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Emerson
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Frost
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Hall
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Majette
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
[[Page H5973]]
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Snyder
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOT VOTING--6
Brown-Waite, Ginny
Cummings
Gephardt
Johnson (CT)
McInnis
Smith (WA)
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised that 2
minutes remain in this vote.
{time} 1436
Mr. Sandlin and Mr. Turner of Texas changed their vote from ``yea''
to ``nay.''
So the previous question was ordered.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore (Mr. LaTourette). The question is on the
resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Ms. SLAUGHTER. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This will be a 5-minute vote, followed by a
second 5-minute vote on the question of adoption of House Resolution
297 debated earlier today.
The vote was taken by electronic device, and there were--ayes 221,
noes 203, not voting 11, as follows:
[Roll No. 322]
AYES--221
Aderholt
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
DeMint
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Hall
Harris
Hart
Hastert
Hastings (WA)
Hayes
Hayworth
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Hyde
Isakson
Issa
Janklow
Jenkins
Johnson (CT)
Johnson (IL)
Johnson, Sam
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Nethercutt
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Young (AK)
Young (FL)
NOES--203
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Bartlett (MD)
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Flake
Ford
Frank (MA)
Frost
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Harman
Hastings (FL)
Hefley
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Majette
Maloney
Markey
Marshall
Matheson
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Snyder
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Toomey
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Waters
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOT VOTING--11
Carter
Gephardt
Gutknecht
Istook
Jones (NC)
Matsui
McInnis
Rush
Smith (WA)
Watson
Wolf
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised there
are 2 minutes remaining in this vote.
{time} 1444
So the resolution was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
The SPEAKER pro tempore. Pursuant to section 6 of House Resolution
299 and clause 1 of rule XXI, all points of order are reserved against
provisions contained in the bill making appropriations for the
Department of Defense for the fiscal year ending September 30, 2004,
and for other purposes.
____________________