[Congressional Record Volume 149, Number 128 (Wednesday, September 17, 2003)]
[House]
[Pages H8361-H8366]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MOTION TO INSTRUCT CONFEREES ON H.R. 1, MEDICARE PRESCRIPTION DRUG AND
MODERNIZATION ACT OF 2003
Mr. STENHOLM. Mr. Speaker, I offer a motion to instruct.
The SPEAKER pro tempore. The Clerk will report the motion.
The Clerk read as follows:
Mr. Stenholm moves that the managers on the part of the
House at the conference on the disagreeing votes of the two
Houses on the Senate amendment to the bill H.R. 1 be
instructed as follows:
(1) The House recede to the Senate on the provisions to
guarantee access to prescription drug coverage under section
1860D-13(e) of the Social Security Act, as added by section
101(a) of the Senate amendment.
(2) To reject the provisions of section 501 of the House
bill.
(3) The House recede to the Senate on the following
provisions of the Senate amendment to improve rural health
care:
(A) Section 403 (relating to inpatient hospital adjustment
for low volume hospitals).
(B) Section 404 (relating to medicare disproportionate
share adjustment for rural areas), but with the effective
date applicable under section 401(b) of the House bill.
(C) Section 404A (relating to MedPAC report on medicare
disproportionate share hospital adjustment payments).
(D) The following provisions of section 405 (relating to
critical access hospital improvements):
(i) Subsection (a), but with the effective date applicable
under section 405(f)(4) of the House bill.
(ii) Subsection (b), but with the effective date applicable
under section 405(c)(2) of the House bill.
(iii) Subsections (e), (f), and (g).
(E) Section 414 (relating to rural community hospital
demonstration program).
(F) Section 415 (relating to critical access hospital
improvement demonstration program).
(G) Section 417 (relating to treatment of certain entities
for purposes of payment under the medicare program).
(H) Section 420 (relating to conforming changes relating to
Federally qualified health centers).
(I) Section 420A (relating to increase for hospitals with
disproportionate indigent care revenues).
(J) Section 421 (relating to establishment of floor on
geographic adjustments of payments for physicians' services).
(K) Section 425 (relating to temporary increase for ground
ambulance services), but with the effective date applicable
under the amendment made by section 410(2) of the House bill.
(L) Section 426 (relating to appropriate coverage of air
ambulance services under ambulance fee schedule).
(M) Section 427 (relating to treatment of certain clinical
diagnostic laboratory tests furnished by a sole community
hospital).
(N) Section 428 (relating to improvement in rural health
clinic reimbursement).
(O) Section 444 (relating to GAO study of geographic
differences in payments for physicians' services).
(P) Section 450C (relating to authorization of
reimbursement for all medicare part B services furnished by
Indian hospitals and clinics).
(Q) Section 452 (relating to limitation on reduction in
area wage adjustment factors under the prospective payment
system for home health services).
(R) Section 455 (relating to MedPAC study on medicare
payments and efficiencies in the health care system).
(S) Section 459 (relating to increase in medicare payment
for certain home health services).
(T) Section 601 (Increase in medicaid DSH allotments for
fiscal years 2004 and 2005).
(4) The House insist upon the following provisions of the
House bill:
(A) Section 402 (relating to immediate establishment of
uniform standardized amount in rural and small urban areas).
(B) Section 403 (relating to establishment of essential
rural hospital classification).
(C) Subsections (a), (b), (d), and (e) of section 405
(relating to improvements to critical access hospital
program).
(D) Section 416 (relating to revision of labor-related
share of hospital inpatient pps wage index).
(E) Section 417 (relating to medicare incentive payment
program improvements).
(F) Section 504 (relating to wage index classification
reform).
(G) Section 601 (relating to revision of updates for
physician services).
(H) Section 1001 (relating to medicaid disproportionate
share hospital (DSH) payments).
Mr. STENHOLM (during the reading). Mr. Speaker, I ask unanimous
consent that the motion to instruct be considered as read and printed
in the Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the
gentleman from Texas (Mr. Stenholm) and the gentleman from Illinois
(Mr. Shimkus) each will control 30 minutes.
The Chair recognizes the gentleman from Texas (Mr. Stenholm).
Mr. STENHOLM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, all of us in this body have an enormous responsibility
to the American people as we put together a bill that will shape the
lives of 40 million current Medicare recipients and the millions more
that will be retiring in the near future. This bill will make changes
that will have profound effects on all Medicare beneficiaries and
particularly on the one in four who live in rural America. Rural
beneficiaries have different health care needs and delivery systems
than those living in urban areas and Congress has a responsibility to
pass a Medicare prescription drug reform bill that is responsive to
their needs.
The motion to instruct conferees that I am offering today will put
the House on record in support of a conference report that addresses
the unique challenges facing seniors and health care providers in rural
areas as much as possible. The motion would instruct conferees to agree
to the following:
Guaranteed prescription drug coverage through a Medicare fallback
option in areas where private drug plans are not available.
The best provisions improving Medicare payments to health care
providers in rural areas that were included in the Senate bill or the
House bill.
Reject the cut in payments to hospitals in the House bill which will
adversely affect hospitals in rural areas and undercut the benefits of
the rural health care improvements.
Rural beneficiaries have consistently had less access to Medicare
managed care plans. Since 2000, rural beneficiaries have been four
times more likely than urban beneficiaries to lack a private plan
option. This problem of low market penetration in rural areas by
private insurance plans may be even more pronounced for a drug-only
insurance plan. This motion would address this problem by calling on
the conferees to accept a guaranteed fallback plan be offered through
traditional Medicare that would be offered in areas where fewer than
two private plans have entered to ensure that all seniors have access
to this benefit.
The House bill does not include a fallback provision to ensure that
seniors have prescription drug coverage in areas where private plans
choose to not participate. Instead, the House bill allows the Secretary
to pay the drug-only plans whatever it takes to entice them to offer
plans. Because premiums for prescription drug coverage are based on
what the plans are paid, plans that take the bribe to participate may
have significantly higher premiums than those operating in more
competitive areas. With one in four seniors residing in rural areas, it
is extremely important that we not exclude rural seniors from having a
prescription drug benefit, which is a very real risk if we do not
provide a guaranteed fallback plan for seniors in areas where private
plans are not available. To deny seniors in rural America the
prescription
[[Page H8362]]
drug benefit option is to deny them access to quality health care.
The motion also calls on conferees to provide the strongest package
possible for rural health care by taking the best of the House and
Senate bills. Because of the very high proportion of elderly in rural
areas, Medicare is a very large and critical source of payment for
rural health care providers. Both the House and Senate bills would
provide many important improvements in payments to rural health care
providers. Unfortunately, there have been reports that assistance to
rural health care providers is being held hostage in conference
negotiations for leverage on other issues. This motion will send a
clear message that the health care needs of rural America should not be
used as leverage to advance an agenda on Medicare.
The House bill offers assistance to health care providers in rural
areas with one hand but takes away that assistance with the other hand
through a reduction in payments to hospitals, which will be
particularly harmful to rural hospitals. I am sure that all of us in
this body who have talked to our local hospitals as I have done have
heard about the challenges that our hospitals face, higher medical
malpractice premiums, an increase in the uninsured population, and
uncompensated care and cutbacks at the State and local levels. Reducing
payments to hospitals could jeopardize the financial life of rural
providers and undercut the benefits of the rural health care
improvements in the bill. The benefits of improving payments to rural
health care providers and increasing access to health care in rural
areas will be negated if the hospital in a rural community is forced to
close its doors. We must provide equal access to care for all Medicare
beneficiaries, regardless of where they live. A vote for this motion is
a vote to make sure that seniors and health care providers in rural
America are treated fairly by the current Medicare system and the new
prescription drug benefit.
Mr. Speaker, I reserve the balance of my time.
Mr. SHIMKUS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this motion would allow the Department of Health and
Human Services to offer a Medicare prescription drug plan. There is no
need for this type of government-run fallback because the House-passed
legislation already guarantees that every Medicare beneficiary will
have a choice of at least two Medicare prescription drug plans. My
colleague represents rural Texas. I represent rural Illinois. We know
that one of the problems in the past was Medicare plans leaving rural
areas. I think the benefit of what we have crafted is that it broadens
the scope of the region, so it brings in urban and suburban and rural
areas.
The motion also instructs conferees to recede to the Senate and
remove the hospital market basket update adjustment contained in the
House bill.
{time} 1615
I would note for my colleagues that we are not cutting hospital
reimbursement. We are reducing the increase they are going to receive.
According to the Medicare Payment Advisory Commission, MedPAC, the
nonpartisan panel of experts that advises Congress on Medicare policy,
hospitals make a 10 percent profit for Medicare inpatient services and
a 5 percent profit, on average, for all services provided to Medicare
patients. MedPAC unanimously advised Congress to increase payments by 3
percent, which is what the House bill does. This is often referred to
as market basket minus 0.4 percent.
Finally, this motion would instruct conferees to accept every rural
provider increase contained in both bills. This budget-busting motion
would mean the cost of the entire package would greatly exceed the $400
billion allocated under the budget resolution for Medicare prescription
drugs which would jeopardize our ever getting to a final bill.
Obviously, in our budget resolution we passed a bill for prescription
drugs at $400 billion. If we go above that amount, we will raise to a
point of order, and really we will have no resolution to this.
This motion is unnecessary. The House has already recognized the need
to ensure that rural Medicare providers are paid fairly. In fact, the
House-passed bill contains a $24.9 billion increase in payments to
rural providers which would help rural hospitals and physicians, among
others, continue to provide care to rural Americans. Let me just say
that again. I traveled all through the August break to many of the
rural hospitals. They do not have the numbers to be able to bring to
bear all the benefits; so they really need this increase, and this
rural increase of $24.9 billion is real dollars to rural hospitals, and
I know my colleague knows the need for an increase in rural hospital
coverage.
I would also note that conferees have reached agreement in a
bipartisan, bicameral basis on a number of issues that will be reopened
under this motion. Do we really want to tell the conferees to start
over all from scratch? I do not because we want to see success in this
Medicare prescription drug bill, and we want to finally get help to the
seniors who have asked for it.
Mr. Speaker, we should allow the conferees to work out the
differences between both bills. Since both Chambers have made a
significant commitment on helping rural providers, I have every
confidence that they will develop sound policy.
Mr. Speaker, I reserve the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield such time as he may consume to the
gentleman from Texas (Mr. Sandlin).
Mr. SANDLIN. Mr. Speaker, I thank the gentleman from Texas (Mr.
Stenholm) for yielding me this time, a real hero and champion of rural
health care, especially in west Texas.
Mr. Speaker, I join my colleagues in instructing the Medicare
prescription drug conferees to remember our Nation's 9.3 million rural
Medicare beneficiaries as they continue their critical deliberations.
The way this bill currently stands is nothing more than the old bait
and switch. The Republican leadership has used smoke and mirrors to
trick our seniors into thinking that they are getting a Medicare
prescription drug plan, when in reality they are forcing them to seek
medication from private insurance companies and HMOs that will set the
price and set the benefits. This HMO enrichment plan does not even
pretend to address the needs of rural America.
Mr. Speaker, as my colleagues know, over 80 percent of rural health
care beneficiaries today live in an area that insurance companies do
not and will not serve, and it is worse than that in my district. Not
one single insurance company in the United States of America has signed
up for the plan that is being proposed by our friends on the other side
of the aisle.
Just what has history shown us about what happens when insurance
companies get involved in Medicare? Medicare+Choice, the great managed
care experiment of our Nation's seniors, should have been named
Medicare Minus Choice. After all it has been a total disaster. Between
1998 and 2003, the number of Medicare+Choice plans dropped in the
United States by more than half. And in Texas, in our State, over
313,000 Medicare+Choice seniors have been dropped by insurance
companies since 1999 alone, dropped straight in the grease in Texas
because they do not want to serve rural America. Rural seniors do not
have access to private insurance plans, not the same as our urban
seniors, and knowing this, we must include a Government fallback option
for areas served by less than two plans. And there are no plans in east
Texas, no plans in rural America.
Mr. Speaker, we also need to eliminate the premium support provisions
in H.R. 1 that are scheduled to take place in 2010. It is
unconscionable to market this prescription drug bill as an equitable
bill and universal, when these folks who stay in traditional fee-for-
service Medicare will see significant premium increases under the
competition program. There is no competition in rural America, and
there is no service in rural America.
Rural seniors have not gotten a fair deal. On average, they are in
poorer health, have lower incomes, face higher out-of-pocket medical
spending than seniors in urban areas, and they are not addressed. They
need our help, and yet, all we are doing with this bill is compounding
the inequity rural seniors already endure.
I implore my colleagues to join me in instructing the Medicare
conferees to honor our rural seniors. Rural seniors need health care.
Rural seniors need our representation. The HMOs already have all that
covered.
[[Page H8363]]
Mr. SHIMKUS. Mr. Speaker, I yield myself such time as I may consume.
Let me just respond to my colleague. The private sector already does
manage the Medicare system. The private sector is already involved in
Medicare. They have been doing the job now. They can do it again. If we
mandate, as in our bill, that there would be two providers and, again,
expand the area of coverage from cities to suburbs out to the rural
areas, we will have coverage. I would remind folks $24.9 billion for
rural hospitals is real money.
Mr. SANDLIN. Mr. Speaker, will the gentleman yield?
Mr. SHIMKUS. I yield to the gentleman from Texas.
Mr. SANDLIN. Mr. Speaker, how can we assume that coverage would be
available in my district or in rural America when it is not available
now, and countrywide it is not available in 80 percent of rural
districts covered where we have Medicare-covered folks?
Mr. SHIMKUS. Mr. Speaker, reclaiming my time. Mr. Speaker, it is my
time.
The SPEAKER pro tempore (Mr. Linder). The gentleman from Illinois
(Mr. Shimkus) controls the time.
Mr. SHIMKUS. Mr. Speaker, reclaiming my time, it is because it is on
a county-by-county basis. What this Medicare bill does is set up at
least at a minimum two coverage areas that would cover the cities, the
suburban areas, and out to the rural areas. That way we bring in a
bigger pool. But I will also say again $24.9 billion to rural hospitals
we jeopardize if we go off in an opportunity to start instructing
conferees and distract from this debate.
Let me say one other thing about this legislation. I know my good
friends and colleagues are budget watchers, and the idea is that we
have a budget that has $400 billion for prescription drug benefit
coverage. Anything other than what we have going down the track would
probably be risen to a point of order because what they are going to do
is expand the cost structure.
Mr. Speaker, I ask unanimous consent that the gentleman from Texas
(Mr. Sam Johnson) be allowed to control the balance of my time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
I cannot believe we are arguing over this because there are some
misnomers here, I think. When they come up with this motion to
instruct, we are asking to accept the Senate's position on a
government-run prescription drug delivery structure, and the CBO has
estimated that that government-run provision will lead to higher prices
for beneficiaries and taxpayers in over $8 billion in higher costs.
That is a giveaway to the pharmaceutical industry.
This talk about seniors not having a benefit in rural areas is just
not right. Both CBO and CMS agree that numerous drug plans will be
available and more than 95 percent of the beneficiaries will
voluntarily sign up for the benefit. These nonpartisan actuaries have
no axe to grind and are in agreement on that point.
Furthermore, any action to approve the other body's position provides
unprecedented inflationary increases to hospitals and other health care
providers which will force the conference, as my colleague has said, to
exceed the $400 billion allocation in the budget resolution, thereby
jeopardizing the whole program. It will also undo bicameral, bipartisan
decisions that conferees have already resolved. The motion is
completely unnecessary because both bills already require prescription
drug plans to assume financial risk in delivering prescription benefits
to provide a fallback to guarantee all seniors have access to
prescription drug plans. It does not matter whether they live in a city
or in a country. Both CBO and CMS, as I said, agree that more than 95
percent of beneficiaries will voluntarily sign up.
Mr. Speaker, I reserve the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield myself 1 minute.
To respond to my friend from Texas, this is not a budget-busting
amendment. We fully expect the conferees to live within the $400
billion. We have a different idea of the prioritization than what the
majority party has, and we are just expressing that today. And also,
when the House has a chance to vote, Members on both sides can see
whether or not the priorities we believe are the most important should
be considered by the conferees. And also with the emphasis on
government-run, let me remind my friend from Texas that it is only if
the private system fails in rural America, will we have a return to a
Medicare plan. Only if it fails. We worry because of the past history
of private plans in rural America. We worry that they may not work, and
we think it would be irresponsible for us not to provide a fallback.
That is our opinion. It is not government- mandated, and these little
speech lines that keep flowing out, this is a different idea, a
different opinion, and we just expressed it today.
Mr. Speaker, I yield 4 minutes to the gentleman from Ohio (Mr.
Brown).
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman from Texas for
yielding me this time.
The premise behind the Stenholm motion is simple. One fourth of all
Medicare beneficiaries live in rural areas, and they are getting the
short end of the stick. Rural hospitals are closing, and there are not
enough rural hospitals to begin with. Twenty-five percent, as I said,
25 percent of all Medicare beneficiaries live in rural areas; 90
percent of all physician specialists practice in urban areas. Senior
and disabled Americans who need care simply are not getting it in time.
That is more than a problem. It is a tragedy. Because of the high
proportion of elderly in rural areas, Medicare plays a particularly
important role in those areas. Inadequate Medicare reimbursement means
inadequate access. There is no cushion. Our responsibility to rural
Medicare enrollees is the same as our responsibility to urban Medicare
enrollees. They paid in Medicare throughout their working years in
exchange for health care security during their retirement. It is the
covenant between the Government and its people.
Now that those people are retired, their health care should be
reliable. It should be affordable. It should be easily accessible. To
meet that responsibility, we need to pay rural providers enough to stay
in business. It is that simple.
Unfortunately, Mr. Speaker the House bill tries to have it both ways.
It invests in rural hospitals. That is good. Then it squeezes blood
from them by cutting reimbursement across the board. One cannot do it
both ways. It makes no sense, no sense, to undermine our own efforts to
help rural providers and by extension rural beneficiaries, the whole
point, by simultaneously increasing and then cutting hospital
reimbursement, not to mention the negative impact on urban and suburban
hospitals.
This motion, the Stenholm motion, simply instruct conferees to
eliminate the hospital cut. This motion instruct conferees to ensure
that no senior ends up without access to prescription drug benefits.
That is what this whole exercise is all about. H.R. 1 sets the stage
for two scenarios when it comes to areas traditionally underserved by
HMOs. Neither of those scenarios is acceptable from a public health
perspective or, as the gentleman from Texas (Mr. Stenholm) points out,
a fiscal perspective.
First, to lure an HMO to provide drug coverage in a rural or other
underserved area, in a sense this Congress bribes them. Knowing the
Federal Government is prepared to cover virtually all of an insurer's
risk in order to attract them to a rural area, I wonder how many
private plans will not hold out for this sweetheart deal? Of course
they will.
{time} 1630
Of course, they will. But if no plan takes the bait, then seniors in
that area just do not get drug coverage.
There are many provisions in H.R. 1 and S. 1 about which Members can
reasonably disagree, but do any of us really want to pass a bill that
plays that kind of game? The possibility that some seniors would not
have access or they will have to shower almost unlimited tax dollars on
HMOs to ensure that access, why would we ever think of going down that
road?
Fundamentally, the Stenholm motion instructs conferees to take the
best of both bills when it comes to bolstering access to care and
ensuring access to coverage in our Nation's rural
[[Page H8364]]
areas. It warns that the hospital cut included in H.R. 1 short-circuits
the bill's provider provision, rural provider provisions, and the
Federal fallback omitted from H.R. 1 is crucial if our goal truly is to
fill the drug coverage gap in Medicare.
Mr. Speaker, I urge my colleagues to vote for the Stenholm motion.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I am kind of getting worried about us wanting to spend
more money. It seems like every time I turn around, we do that. This
particular proposal spends more money. In fact, I think my colleagues
forget over there that we put in $27 billion extra for rural, just for
rural, and if you look at some of the statistics, Iowa, for instance,
has a 5.5 percent increase and plus-up on Medicaid. I think Iowa is
rural. Oklahoma has a 5.7 percent increase and a 5.9 percent increase
on Medicaid. I think that is rural, for the most part.
As I go through these notes, it seems to me that the States that you
call rural and are not getting anything, they are getting more. Montana
gets a 5.7 increase. It is impossible for me to figure out why you
think the rural areas are getting stiffed. South Dakota, 5.4 percent
increase; Tennessee, 5.3 percent, and so on. I can go on and on.
But the thing is that the Senate provision, or the provision, that
you are trying to affirm results in higher costs; and it is a complete
and utter giveaway. I think that it is time that we got a little bit of
fiscal responsibility in this House and stopped spending money.
Mr. Speaker, I reserve the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield 3\1/2\ minutes to the gentleman
from Iowa (Mr. Boswell).
(Mr. BOSWELL asked and was given permission to revise and extend his
remarks.)
Mr. BOSWELL. Mr. Speaker, I thank the gentleman for yielding me time.
Mr. Speaker, it is my pleasure to be here. This is a very dear thing
to people in my State. The gentleman made a reference to Iowa. I think
if you get into the print though, you will find out that we give the 5-
whatever percent, but then we take a piece of it back in the market
basket thing.
So what happens here? When we are in the last position, it is a bad
place to be. It is my understanding that no matter where you live, you
pay the same as we go into this. We pay the same, but we do not get the
same benefit.
This is doing us a lot of harm. We understand the impact this has on
the older folks. Everybody thinks that just applies to them, but it
applies to the whole community. When you cannot recruit doctors, you
cannot retain doctors; you cannot recruit nurses, you cannot retain
nurses; you cannot get technicians, you cannot retain them. You just go
right on down to the mess halls, as we used to say in the Army and the
Air Force. It affects the whole community, from the oldest to the
youngest. You cannot buy equipment. It does not cost any less in Iowa
and the rural areas than somewhere else. It is a very serious matter,
and it needs attention.
So I hope that this will be accepted, that we will instruct to go and
make sure that reimbursement rate is taken care of, and some equity,
fairness, will take place. It is unfair discrimination, pure and
simple, against States like mine, which rank last in the Nation in
reimbursement, and many other areas throughout the Nation.
I find out down in Texas, there are areas out there that are as bad
as we are. Yet overall, as we put all the numbers together, we go to
the bottom, a rate that is less than half what the top rate is in the
Nation. Something is awry. Something is wrong. We pay the same, but we
cannot have the same.
Wait a minute, this is the United States of America. If we all pay
the same, why do we not have the same treatment? That is not going on,
and here is a chance to make that right.
So I am very hopeful, I am very hopeful, that we will not pass up
this opportunity. We get to the underlying bill, the prescription drug
side, that is another argument, and it affects everybody across the
country. It does not affect just those of us getting a very bad shake
on the reimbursement rate for Medicare. It affects everybody. I think
we will keep that out in front of us for some time. I do not think that
is going to go away.
But this might be the chance, this might be the chance for some
parity, some equity, an opportunity to have some fairness when it comes
to Medicare reimbursement.
I hope that those that have the last say on this when it comes back
to us to either vote it up or vote it down will take this very, very
seriously and try to treat all Americans alike. We need fairness. We
pay the same, we ought to have the same result. It is a national
program; it is not just for individual areas.
It is kind of interesting, I would say to the gentleman from Texas
(Mr. Stenholm), talking to you and realizing out in some of the rural
areas in Texas, and I am sure it is the same in parts of your district
as well, that, no, it is not so. But, anyway, it certainly is in some
of the rural areas, and Texas is Texas.
Mr. Speaker, it is time for fairness. We are all Americans. We are 50
States, and we are not getting treated the same. Iowa would like to be
treated as everybody else. We do not want anything extra. Just treat us
the same. We stand up and pay the same; we ought to be treated the
same.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I will tell you what: let us correct the record. You did
get a market basket adjustment of minus 0.4 percent, but the number I
quoted you was the number at the end, which was a 5.5 percent increase.
That is 2.1 percent more than current law. That does not count the 5.5
percent increase in additional allotments for Medicaid. Iowa is not
being mistreated. When I hear talk about let us treat everybody equal,
I think of Canada and their socialist program of medicine, which has
not worked; and that is why Canadians come down here for medicine.
Mr. Speaker, I reserve the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield 2 minutes to the gentleman from
New Jersey (Mr. Pallone).
Mr. PALLONE. Mr. Speaker, I am just amazed when I listen to the
Republican side, because they are just so bent on the ideology of this,
and I think that the motion of the gentleman from Texas (Mr. Stenholm)
and what the Democrats are saying is look at this situation
practically.
If you listen to what the gentleman from Texas (Mr. Stenholm) has
said in the motion to instruct, it essentially says, look, we know
those of us who are in rural areas, I am not, but we know these HMOs
and these private plans are not working, for the most part, and if
someone tries to get their prescription drugs through an HMO or managed
care private plan, in many cases it is not going to be available, and
they are not going to have access to it.
It is the Republicans that basically are trying to impose an ideology
and saying we must privatize, we must go this route, this is no
alternative. All the gentleman from Texas (Mr. Stenholm) is saying is
in a situation where the HMOs or the private plans are not available,
we still have to guarantee drug coverage for those seniors in those
rural areas that cannot get it through these private HMOs or other
private plans. So let us have the Senate fallback that says you can get
your prescription drugs through traditional Medicare.
Now, I just do not understand why the Republicans keep insisting from
an ideological point of view, well, we cannot do that; you have to
privatize. They went so far as to suggest we have private contractors
that provide Medicare services now, but that is the Federal Government
as the ultimate insurer contract with some private company to provide
the service.
What you have done in this House bill is say that if you as an
individual cannot find a private plan, you are out of luck. All the
gentleman from Texas (Mr. Stenholm) is saying with this motion to
instruct is let us have a fallback. Let us have an alternative for
these people in rural areas when they cannot get the HMO to provide the
service. What could make more sense?
Mr. Speaker, it is the same thing as far as the reimbursement rate is
concerned. I heard the colleagues on the
[[Page H8365]]
Republican side say there is no cutback effectively in the
reimbursement rate. Certainly there is. Many of us went to meet with
the oncologists today, the cancer doctors; and they were talking about
the negative impact on cancer victims because of this reimbursement
rate. We have got to change that as well. Just follow the gentleman
from Texas (Mr. Stenholm). It is the practical way to do this, with
this motion.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I reserve the balance of my
time.
Mr. STENHOLM. Mr. Speaker, I yield 3 minutes to the gentleman from
Tennessee (Mr. Tanner).
(Mr. TANNER asked and was given permission to revise and extend his
remarks.)
Mr. TANNER. Mr. Speaker, I thank the gentleman for yielding me time.
Mr. Speaker, what we are talking about here is no less than a matter
of life and death. All of the medical technology in the world is not
going to help somebody who cannot access the system. When you are
talking about Tennessee, you are talking about 47 percent of the acute
care hospitals in rural Tennessee are losing money. In the House bill
you cut the market basket to those hospitals.
There is no way that one can deny the fact that somebody is going to
die needlessly because they do not have a hospital or an emergency
medical room within 50, 60 or 70 miles, simply because they live in a
rural area. You can argue about it, but there is no denying that it
will happen. Somebody will die in rural America, because if this House
bill goes through, you are going to see acute care hospitals in rural
areas close, not to mention the fact that there are people involved.
I think my friend, the gentleman from New Jersey (Mr. Pallone),
talked about the fallback provision. Because we live in a place where
you do not need a blinker signal on your car because the guy behind you
knows where you are going to turn off, we do not have a lot of choice.
And that is what we are talking about here. We are talking about life
and death in rural America.
You may not live in rural America; but you have a cousin, an aunt or
uncle, a brother, sister, or somebody that does; and these people are
going to be irreversibly adversely affected if we do not accept the
motion of the gentleman from Texas (Mr. Stenholm).
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, Tennessee is kind of an interesting State, because they
get a 5.3 percent increase; and it does not include six Tennessee
critical access hospitals which are rural which are paid exactly what
their costs are. Now, this bill is all-encompassing. It takes care of
people. It does not let people die, and it does not spend the Treasury
of the United States to zero.
Mr. Speaker, I reserve the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield 1 minute to the gentleman from
Texas (Mr. Rodriguez).
Mr. RODRIGUEZ. Mr. Speaker, let me first of all say that what we have
before us is two bills. Neither one is worth the paper they are written
on, and they are not going to respond to the issues that confront us.
The approach that the gentleman from Texas (Mr. Stenholm) is
providing is to try to look at what is best and try to make something
happen. The gentleman from Texas (Mr. Sam Johnson), I know he is from
Texas also, and I am from Texas, and I have counties that right now do
not have any access to any type of health care because they have chosen
to leave, they were not making the profits they wanted, and we are
having a rough time.
That bill is not going to be responsive. You are saying you are
concerned about being fiscally responsible. My God, you are taking
money from cancer, which is kind of robbing Peter to pay Paul. You are
taking money from people dying from cancer to try to fill another need.
We are here to tell you there are needs on both sides. That bill does
not meet those needs.
So one of the things we have to come to grips with is we have a
problem before us, and you are choosing not to deal with it directly,
and you are choosing to play games with Americans.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, let me just make a couple of observations. The
hospitals' payments include some of the payments for beneficiaries. It
is not just all hospital costs. I think that we have to consider the
fact that the United States Senate, which according to what this
proposal embodies, puts the government fully at risk.
{time} 1645
There is little incentive to control costs, and I think that the
provisions have to lead to higher prices for beneficiaries and
taxpayers, and it is a complete and utter giveaway. I think that we
have to defeat this motion.
Mr. Speaker, I yield back the balance of my time.
Mr. STENHOLM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this motion to instruct conferees is not a budget
buster. It is a red herring to suggest that we are going to bust the
budget at $400 million. I support that, and those of us who support
this resolution support that. It is a red herring.
One of the things my friend from Texas does not seem to want to
acknowledge is that there are many hospitals, as the gentleman from
Iowa (Mr. Boswell) pointed out, there are many hospitals that have not
enjoyed the increases that hospitals in the bigger towns have enjoyed
over the last 20 years. And when you have not gotten the increases that
some have gotten and you have gotten a lesser amount of reimbursement,
you are hurting. That is why we believe the Senate provisions are
fairer to those hospitals.
The gentleman is totally correct when he says they get less of an
increase, no one is getting cut; but when you have a baseline that is
too low, it is important that you get a chance to compete on a level
playing field with those hospitals who enjoy a little better situation.
We have argued for that for years, but unsuccessfully. Now we notice
that there is bipartisan support for acknowledging that rural hospitals
and many inner city hospitals have the same problem and that we should,
in fact, recognize and begin to correct that disparity.
Regarding the pharmaceutical benefits and the going back to a
government program, only if it fails will we go back to a Medicare
government program. But some of us, myself included, are very skeptical
that private businesses are going to be as interested in rural areas
with less people as they are in urban areas; and, therefore, a fall-
back is critical to us. But it does not do what the gentleman said it
did. It is only if it fails; only if it fails will we have a fall-back.
Now, in conclusion, it is difficult for me, and I will not miss the
opportunity to say that to be lectured by my friend from Texas on
fiscal responsibility, I say to the gentleman, that is a joke. For the
gentleman to have supported and continue to support the economic game
plan of his side of the aisle that has given us the largest deficits in
the history of our country, $689 billion and going up, and I know this
because my friend from Texas voted for the last bill that increased the
deficit another $12 billion. I did not, and I will get criticized. But
I think it is time for us to be fiscally responsible, but I find that
it is only when it is convenient. If it is a tax cut, it is great. But
if it is being fair to rural hospitals, that is a no-no.
As to the child tax credit, the debate that went on before this, let
me point out that every single dime of tax dollars that have been
collected on the Social Security system are being spent for current
operating expenses. Really, we are borrowing, in addition to that, $560
billion. Differentiating between Social Security taxes and income taxes
is a joke, a joke. Just because it was done for 40 years is no longer
reason for us to continue to do it.
But do not lecture me on fiscal responsibility. Do not let staff feed
the little notes in saying here is what it does and here is what it
does not, because this motion does not bust the $400 million budget. We
live within it. We only ask the conferees to make the changes. Yes, it
will be difficult. Yes, you cannot do what you want to do. You cannot
do the things that you want to do in total, but it is a reasonable
compromise; and that is what conferences between the House and the
Senate are all about. It is taking the differences and working them out
in a
[[Page H8366]]
very, very good and concise way. But do not lecture us on budget. Go
somewhere else. Argue the philosophical. That is a fair shot. The
gentleman and I philosophically disagree apparently on the direction
that this ought to be. That is a fair shot, and we will argue that. But
this amendment does not bust the budget. It offers some, we hope,
constructive suggestions; and I hope that the House will in an
overwhelming vote say to the conferees, we believe this has merit, take
a look at it, and let us pass it.
Mr. Speaker, this amendment is not what is important. It is what
comes back, because that is what is, in fact, going to be affecting
lives. And in rural areas, this is a critical difference from a
hospital's standpoint. If we cannot do what this amendment does, we are
going to continue to have real problems in rural areas, and anybody
that represents a rural area needs to take a good hard look and
hopefully join in support of this amendment.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Linder). Without objection, the previous
question is ordered on the motion.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to instruct
offered by the gentleman from Texas (Mr. Stenholm).
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. STENHOLM. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
order of the House of earlier today, further proceedings on this motion
will be postponed.
____________________