[Congressional Record Volume 149, Number 133 (Thursday, September 25, 2003)]
[House]
[Pages H8925-H8930]
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. SANDLIN. Mr. Speaker, I offer a motion to instruct.
The SPEAKER pro tempore. The Clerk will report the motion.
The Clerk read as follows:
Mr. Sandlin 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. SANDLIN (during the reading). Mr. Speaker, I ask unanimous
consent that the motion 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. Under clause 7 of rule XXII, the gentleman
from Texas (Mr. Sandlin) and the gentleman from Michigan (Mr. Camp)
each will control 30 minutes.
The Chair recognizes the gentleman from Texas (Mr. Sandlin).
Mr. SANDLIN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the way this bill currently stands is nothing more than
a
[[Page H8926]]
misrepresentation and a bait and switch. The leadership has used smoke
and mirrors to trick our seniors into thinking that they are getting a
Medicare prescription drug plan and into thinking that our hospitals
will be adequately reimbursed while, in reality, we are forcing our
seniors to seek medication from private insurance companies and HMOs
that will set the price and set the benefits and we are taking money
away from our hospitals.
Mr. Speaker, I rise to offer this motion to instruct the conferees on
H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003
and ask to remember our Nation's 9.3 million rural Medicare
beneficiaries as they continue their critical deliberations. The
legislation that I speak of today, as I mentioned, is much more than
simply a drug bill, it is a testament to our commitment to quality-of-
life issues for our Nation's seniors in our communities. Modern health
care today requires a comprehensive system that depends on access to
needed prescription drugs, certainly. It depends on physician care and
hospital treatment. All of those needs must be addressed. When access
is denied, treatment fails and people suffer. As H.R. 1 stands today,
our rural communities all across Texas and all across the Nation will
suffer.
Everyone here knows that our Nation's rural hospitals are desperately
in need of assistance. Over the past 25 years, Mr. Speaker, more than
470 hospitals across America have closed. That is unacceptable. That
impacts primarily rural America. This is very devastating for rural
citizens. Due to the fact that rural seniors have a lack of access to
preventive care, that causes them to have higher incidences of chronic
illnesses like heart disease, arthritis and things of that nature.
Medicare is a significant source of payment for rural health care
providers because of the higher proportion of seniors in rural areas.
We must provide the strongest reimbursement aid possible by taking the
best of the House and the best of the Senate bills. The House bill's
rural assistance provisions contradict each other by offering funding
through one avenue and slashing it through the market basket. This
measure, as proposed by the House, denies hospitals $12 billion of
desperately needed assistance, nearly $9 billion of which would go to
rural hospitals, the hospitals with the most challenge. In my home
State of Texas, over $420 million will be lost. That is all in the name
of fiscal responsibility. That is a false savings, Mr. Speaker, and it
is a savings that endangers the lives of Americans, especially in rural
America. This cost-saving measure certainly will not save hospitals but
it will cost them and their patients dearly.
{time} 1315
How much do we as a Congress expect our hospitals to endure? Our
rural hospitals are barely scraping by on what Medicare and Medicaid
already paid. In the name of patient safety, we ordered them to comply
with Federal mandate after Federal mandate from EMTALA to HIPPA but
then failed to grant the funding to ensure quality of care is provided.
Let me tell the Members here no one will expect care to be provided if
these hospitals close. It just will not be availability, and with that
elimination of care will follow a massive elimination of jobs critical
to our local economies and endangering our local families.
Rural seniors in hospitals are getting a raw deal here, Mr. Speaker.
We all know that. They are not looking for anything extra. They are
just looking for something equitable, something fair. Join with me and
do at least that much today for our hospitals, for our doctors, and for
our rural patients in rural communities.
Mr. Speaker, I reserve the balance of my time.
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
The Sandlin motion to instruct conferees is essentially the same as
the last two motions to instruct that have been defeated by the House
of Representatives. This motion, like the others, asks us to accept the
Senate's position of a government-run prescription delivery drug system
and structure. It would provide unprecedented and unnecessary
inflationary increases to providers and would undo the bicameral
decisions that the conferees have already resolved. Roughly a third of
the bill in question, H.R. 1, has been resolved by the Medicare
conference. This motion would reopen those issues that have already
been resolved in a bipartisan, bicameral fashion. This is the third
Congress that has attempted to enact a prescription drug benefit in
Medicare, and this motion would ensure that a prescription drug
Medicare bill never reaches the President's desk; and I urge a defeat
of this motion.
Mr. Speaker, I reserve the balance of my time.
Mr. SANDLIN. Mr. Speaker, I appreciate the gentleman's comments. I
yield such time as he may consume to the gentleman from Texas (Mr.
Lampson).
Mr. LAMPSON. Mr. Speaker, I thank the gentleman from Texas for
yielding me this time.
It is nice to be able to join on an issue as important as this and
one that does not deal with redistricting in Texas.
I do rise today in support of the Sandlin motion to instruct on
Medicare prescription drugs. This motion carries with it the efficacy
of protecting seniors and health care providers in rural areas. It was
not too many years before I came up here to Congress that I was serving
on a board called the Area Agency on Aging. It was a board where we
spent a great deal of our effort with senior citizens and the needs
that they had. Ultimately, they selected me to be a delegate to the
1995 White House Conference on Aging, and the goals that came from that
meeting of several thousand people gathered across the country had to
do with allowing seniors to live in independence and dignity, to make
sure they continued to have access to the programs that made such a
significant difference in their lives, Medicare and Social Security.
Since Medicare was enacted in 1965, it has truly provided health care
security to millions of America's seniors and people with disabilities.
Medicare is the binding commitment of a society to our most
vulnerable citizens and a commitment that America must always keep. One
segment of society that is neglected time and time again in Washington
is seniors living in rural communities, and I come here today to tell
the conferees that we have a real commitment to rural seniors.
Mr. Speaker, I represent a fairly diverse district. It consists both
of urban and rural areas, and therefore I have witnessed the
degradation of care for my constituents living in these rural years.
This Congress has a responsibility to represent all people throughout
the country and to provide guaranteed prescription coverage through a
Medicare fallback option in areas where private drug plans are not
available. We must ensure that cuts in payments to hospitals that were
included in the majority-offered House bill which adversely affect
hospitals in rural areas are not included in the conference report.
These cuts will serve to further undermine the ability of rural
hospitals and health care providers to ensure that adequate coverage is
offered in rural areas.
I cannot in good conscience allow this House to send to the
conference committee a bill which would leave our Nation's rural areas
in continued peril. I have pledged with my colleagues to work to
provide adequate health care to all Americans; and, frankly, this bill
as it currently exists imperils citizens living in rural areas.
HMOs and other private health plans have had a very poor record of
serving seniors living in rural areas. Indeed, according to the
government's own advisory board, the Medicare Payment Advisory
Commission, only 19 percent of rural Medicare beneficiaries have the
option of enrolling in a Medicare managed care plan in 2003. How can we
as a Congress participate in passing such a broad and affecting piece
of legislation without ensuring that the disparity between rural and
urban areas is abolished?
So the Sandlin motion to instruct will help to ensure that we do not
leave our rural citizens behind. I support this motion to instruct, and
I call on my colleagues here to join us and do exactly the same thing.
Mr. CAMP. Mr. Speaker, I reserve the balance of my time.
Mr. SANDLIN. Mr. Speaker, I yield myself such time as I may consume.
[[Page H8927]]
Mr. Speaker, one of the key problems with the House GOP Medicare
prescription bill is it fails to meet the needs of the one-fourth of
Medicare beneficiaries who live in rural areas. And someone who knows
that very well is the gentleman from Texas (Mr. Stenholm), my good
friend and colleague and a real champion of health care, especially out
in west Texas, and a very respected Member of the House.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Texas (Mr. Stenholm).
Mr. STENHOLM. Mr. Speaker, I thank the gentleman from Texas for
yielding me this time, and I thank him for bringing again this motion
to instruct to the floor of the House.
Some of our colleagues are asking why do this again. Listen carefully
to the rationale and the reasons of why we are doing it again. It is
critical to rural districts all over the United States. This is a
matter of life and death for 27 hospitals in my district. The issue is
fairness, and this is the third time that I have had to correct my
friends on the other side of the aisle for the red-herring approach
that they are talking about. No one is advocating a government-run
program unless by that they are suggesting that they are not in favor
of continuing Medicare. If they are in favor of letting Medicare go,
then they are correct; but I do not think the majority of the House is
talking about that.
Certainty we are not. And when they talk about budget issues, make it
very clear, we are proposing to live within the budgeted amount of $400
billion and not one penny more, period. But what we are saying is that
when we are looking at rural hospitals in particular, there are some
issues that the conferees need to listen to, and yes, one can make the
argument this is procedural, and I understand that, but when that
conference bill comes back on the floor and we are going to have to
vote on this issue, I am asking my colleagues, for example, in Kansas
1, 37 hospitals will lose $21,682,000; Georgia 11, six hospitals, $17
million; Texas 19, 18 hospitals, $39 million; Texas 23, 11 hospitals,
$11 million; Indiana 8, 13 hospitals, $28 million; North Carolina 8, 12
hospitals, $43 million; Minnesota 1, 15 hospitals, $45 million.
I can go on and on on this list. This is money that would not be
coming if the conferees come back and say market basket is not
applicable. And one can say, yes, this is a cut from a rate of
increase; but that is precisely what we are talking about in rural
areas. We have been cut and cut and cut to the point we cannot take any
more, and we have got to have some rationale and reasoning, some logic,
now in saying to rural areas, you must be treated fairly; and that is
what the best of both the House and the Senate bill does.
We are arguing about a philosophical direction, and with all due
respect, I do not agree with the direction that the majority wish to
take the conference, and I think a majority of this body does not. I
really do. That is why we will continue to come on this floor and
suggest to our colleagues who continue to vote against this motion to
instruct, take a good look, listen to their hospitals back home, listen
to what is being proposed and see how they will vote when that
conference committee completes its work and brings it back to the floor
of the House.
And everyone now I hope understands that the conference is in trouble
because we have some irreconcilable forces. It is kind of like the
Texas redistricting plan. We have got some folks not willing to give.
And when we have that, then we run the risk of doing nothing, and no
one wants to come out of this Congress by doing nothing. We have a
tremendous need of dealing with the cost of medicine, and there are
ways that we can do some great things to reducing the amount of cost of
health care to our senior citizens and to others, middle-income
America. But pay particular attention, and this is done for the benefit
of our colleagues, the conferees having to recognize that we have got
to come to an agreement with the Senate or otherwise nothing will
happen.
Again, I repeat, this is not a budget issue. We are just saying we
have a recommendation to the conferees of how they spend the money. We
are not talking about spending any more. And if you believe your
hospitals can do with less, continue to vote as you have been voting.
Do not instruct the conferees. But you had better start talking to them
because if the conferees insist on doing it the way they insist on
doing it, we risk the whole bill; and nobody wants to see that done.
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
Let me just say, Mr. Speaker, that under the Senate approach to the
Medicare prescription drug bill, one third of the beneficiaries will be
in a full government run fallback plan; and if the government is at
risk, the plan will have little incentive to control costs and would
simply process claims. And that is why the nonpartisan Congressional
Budget Office has estimated that the Senate provisions would lead to
higher prices for beneficiaries and taxpayers and result in over $8
billion in higher costs; and this would, I think, be an unacceptable
giveaway. The Congressional Budget Office, CBO, also estimates fewer
plans and therefore fewer choices for seniors under the Senate
proposal, and that would be because the full-risk plans would be
hesitant to compete against the government contractors.
And let me just say that the market basket adjustment is just a part
of the picture in terms of what is being done for providers in rural
America; and when we add in together the market basket update, the
standardized amounts, the labor share, the Medicare disproportionate-
share payment, we are seeing increases over current law in rural areas;
and most of those numbers do not include the increases for critical
access hospitals which are an important part of health care providing
in rural America.
So I would still urge my colleagues to defeat this motion to
instruct. We have a good process moving, and let us keep the process
going forward.
Mr. Speaker, I reserve the balance of my time.
Mr. SANDLIN. Mr. Speaker, I yield such time as he may consume to the
gentleman from the State of Tennessee (Mr. Tanner), a member of the
Committee on Ways and Means.
Mr. TANNER. Mr. Speaker, the $12 billion that CBO says the House bill
cuts from hospitals, $9 billion of that comes from hospitals serving
rural communities. As I said the other day when we were talking about
this approach, all the medical technology in the world is of no use to
me or anyone else if it is not accessible. Over 47 percent of the 134
acute care hospitals in Tennessee are losing money. A lot of these
hospitals are in rural areas that simply will not be able to remain
open with the market basket reduction, with the way this bill is
drafted, and with the demands that are being placed on them. Literally,
if one believes that accessibility to medical technology is as
important as the technology itself, and I cannot imagine anybody who
would argue that it is not, if they cannot get to a doctor or a
hospital with a heart attack in time, they are going to die. So it
really does not make sense to say this medical technology is important
in and of itself. There also has to be this accessibility issue to be
addressed, and this bill is not addressing this accessibility issue.
{time} 1330
That is why this motion to instruct is important.
But even if you do not believe that accessibility is a real goal that
we ought to strive for in America, you have got the equity argument
that the gentleman from Texas (Mr. Stenholm) made. Even if you say we
know it may not be fair, but that is just the way it is, what about all
of the jobs that are going be lost, jobs of dedicated medical
professionals that want to help people in rural America? They live
there voluntarily, they devote their productive years to curing and
helping people who are sick, and they go out the window as well when
these hospitals close.
I would just implore the House to look at the system of health care
delivery in our country and realize that this approach that the
majority is taking is shortchanging hospitals, rural hospitals, and,
more importantly, sick people all across this country, but particularly
in rural areas, and is that the kind of country we want to have? Is
that the kind of country we can be proud of? I think not.
Mr. Speaker, I would urge that this motion to instruct be approved
whenever we have a vote on it.
[[Page H8928]]
Mr. CAMP. Mr. Speaker, I reserve the balance of my time.
Mr. SANDLIN. Mr. Speaker, I yield such time as he may consume to the
gentleman from Arkansas (Mr. Ross), one of the people that really has a
good knowledge in the Congress about the issue of prescription drugs
due to the fact that he owns a pharmacy.
Mr. ROSS. Mr. Speaker, I thank the gentleman for yielding me time and
for offering up this motion to instruct conferees on the Medicare
prescription drug bill.
Mr. Speaker, let me tell you that, as the owner of a small-town
family pharmacy, one of the things that I see way too often is seniors
who walk through the doors of our pharmacy who cannot afford their
medicine or who cannot afford to take it properly.
I live in a small town, a town that lost its hospital back in 1995.
Our folks now go 16 miles down the road to the hospital in Hope,
Arkansas. Living in a small town, I see so many seniors that end up 16
miles down the road in the hospital running up a $25,000 or $50,000
Medicare bill, or requiring $250,000 worth of kidney dialysis, or
having a $50,000 leg amputation, simply because they cannot afford
their medicine or cannot afford to take it properly. This is America,
and we can do better than that by our seniors, America's greatest
generation.
There has been a lot of talk in Washington about trying to help our
seniors with the high cost of prescription drugs, but that is all we
have seen and that is all we have gotten, has been a lot of talk.
When I came to Congress in 2001, I thought if there was one issue
that would not be partisan, that would not divide us, but, rather,
would be a senior issue, this is not about Democrats or Republicans, or
at least it ought not be, it ought to be about our seniors, and I
thought if there was one issue that could bring us together, it would
be to do right by our seniors. But, instead, what we have had offered
up by the Republican leadership is a false hope and a false promise,
nothing more than Medicare fraud for our seniors.
There are several problems with this so-called Medicare prescription
drug bill. Number one, the fund that they want to cut funding for to
fund the prescription drug coverage for our seniors, the Republicans
want to cut funding to rural hospitals to the tune of $12 billion. We
have lost 470 rural hospitals in America in the last 25 years. As I
mentioned earlier, we lost the hospital in my hometown of Prescott,
Arkansas, in 1995, and I can tell you that is something I do not wish
on anyone. It is wrong to try and fund this Medicare prescription drug
benefit by shutting down rural hospitals.
Another problem with the bill is this bill is supposed to be about
helping our seniors. The problem is, it is not a seniors' bill, it is a
bill that has been written by the big drug manufacturers.
The drug manufacturers have more lobbyists in Washington, D.C., than
we have Members of Congress in the House and Senate combined, and their
fingerprints are all over this bill. The Republican leadership had the
nerve to put language in this bill that says that the Federal
Government shall be prohibited from negotiating with the big drug
manufacturers to bring down the high cost of medicine. That is in the
bill.
Another problem with the bill is privatizing the Medicare
prescription drug benefit. There is a very good reason why they want to
do this. You hear about how drugs are cheaper in other countries. They
are. It is because America is the only industrialized nation in the
world where people go without health insurance. That does not happen
anywhere else in the industrialized world.
There 41 million people in America without health insurance today;
8.5 million are children. Who are the rest of them? It is not the folks
that do not want to work. If you do not want to work, you get on
welfare and you get Medicaid.
We are talking about the people that are trying to do right and stay
off welfare, that are working the jobs with no benefits. But in other
countries that does not happen. In other countries the government says
to the big drug companies, you give us a discount if you want your drug
in our country, and they do.
I did a survey, Mr. Speaker, about a year ago, where I compared the
price paid by seniors in my Congressional District in Arkansas on the
five most commonly used brand name drugs with the price paid by seniors
in seven other countries. Guess what? Seniors in my district in
Arkansas pay, on average, 110 percent more than seniors pay in these
seven other countries.
So the drug manufacturers want to privatize this, because they know
if we have 40 million seniors under one plan, we, too, will demand
these kinds of discounts and rebates to help offset the costs of the
program. So they want to privatize it and have 100 different insurance
companies knocking on your momma's door, calling her on the phone,
sending her mail, all trying to sell her exactly the same policy.
Finally, the biggest problem with the bill is the benefit itself.
There is all this talk in Washington about helping our seniors with the
high cost of prescription drugs. What does the plan do?
Well, from day one you have got to pay at least a $35 monthly
premium, although no one can tell us exactly how much it will be. Then
you will have a $250 deductible. Then from $250 to $2,000, Medicare
will kick in at 80 percent of the cost of its medicine. That part
sounds pretty good. But when you get to $2,000, you have got to
continue to pay the $35 monthly premium. But, guess what? The senior is
back being forced to foot the entire bill from $2,000 up to $3,500. Pay
the premium, but get no help.
If seniors cannot afford the first $2,000 worth of medicine, tell me,
how in the world they are going to afford the next $1,500?
When you do the math on this, here is what it comes out to. All this
talk boils down to this. On the first $3,500 worth of medicine that
seniors need each year, Medicare is going to help them with $900 of it.
Seniors are still going to get stuck trying to pay $2,600 of the first
$3,500 worth of medicine. When you take the formula, and you almost
need a CPA to figure it out, and you factor in the premium, that is
what it amounts to.
Tell me this, $900 worth of help on a $3,500 drug bill, I do not know
about where you come from, but I can tell you, where I come from, that
is not going to help my struggling seniors to choose between their
medicine and their groceries and their rent and their light bill.
I am not going to rest until seniors can walk into the pharmacy of
their choice, pull out their Medicare card and be treated like they are
when they go to the doctor and to the hospital. I will continue to
fight, and that is exactly what we are doing in this motion to instruct
conferees on the Medicare prescription drug bill. I am going to
continue to fight until we get a plan that is voluntary, but
guaranteed, and made available to all seniors who have no help today,
while protecting those seniors who have help. I want to make sure that
this bill that passes this Congress will not shut down another rural
hospital.
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this is the third Congress where we have attempted to
pass a prescription drug bill. The bill that is in conference now
passed this House with a bipartisan vote. Finally, the other body has
acted and also has passed a prescription drug bill. That is why we are
in this meeting called a conference, to resolve the differences between
the two.
We have made tremendous bipartisan progress in that conference. One-
third of the bill, approximately, has been agreed to. This is the third
time this motion has been brought to try to divert time and attention
away from the progress that has been made in conference.
I think that if we are serious about trying to enact a prescription
drug benefit this year, if we are serious about getting a bill to the
President's desk, I think it would be important not to support this
motion. This would literally stop all of the progress that has been
made, not only in a bipartisan way between Republicans and Democrats,
but also between the House and Senate. As I say, this has been the
third Congress where we are very close. One-third of the bill has been
decided, great progress has been made. Let us let that progress
continue. Vote no on this motion.
Mr. Speaker, I reserve the balance of my time.
[[Page H8929]]
Mr. SANDLIN. Mr. Speaker, I yield 4 minutes to my good friend the
gentleman from Washington (Mr. McDermott).
Mr. McDERMOTT. Mr. Speaker, I want to thank my colleague from Texas
for yielding me time.
I am here to say you do not have to have a drawl to have this problem
in your State. There are 50 States where this is a problem. I was
walking across to my office building a minute ago, and I met a reporter
from a major newspaper here in the East who said to me, ``What is going
on in the Medicare conference?'' I said, ``I do not know. They are
talking.'' So he said, ``Well, what do you hear?'' I said, ``We do not
hear anything on the Democratic side. That is why we are out here every
day trying to instruct those people.''
I went to our Democratic House Member who is on that conference
committee and said, ``What is going on?'' He said, ``I do not know.
They are not having any meetings where they are discussing anything.''
Now, they have been telling us we are going to have this bill. But
this morning I was in the gym, and as I came out of the gym, I met one
of my Republican colleagues, and I said to him, ``What does this drug
thing look like? How does it look like it is coming?'' He said,
``Frankly, I hope it does not pass.'' I said, ``Really? Why?'' He said,
``Well, when they hang that doughnut hole around our neck in the next
election, we are going to be dead.''
You just heard my colleague from Arkansas describe the doughnut hole.
You have a $3,500 bill, and you get $900 in benefit, and you still have
to pay a $35 a month premium. It is a terrible bill, and the House bill
is based on the fact that they hope that the insurance companies will
put something together.
The reason we need the best of the Senate bill is at least they have
a fallback position which would allow the Federal Government to set one
up if the private sector cannot.
Now, the other thing my colleague pointed out and that needs to be
emphasized, this is so privatized that the House of Representatives
said that the United States Government, represented by the Secretary of
the Department of Health and Human Services, Tommy Thompson, cannot
negotiate lower prices on the basis of what is good for the American
people. He is absolutely, by law, prohibited from doing what is best
for the American people.
What kind of a plan is that? This is throw the folks into the arms of
the drug companies. They must have written every blessed word in it,
including that line.
They did not want the Secretary of Health and Human Services to sit
down on behalf of 40 million people, because they know what happened to
them when the Secretary of Veterans Affairs sat down on behalf of the
veterans, 5 million of them, and got a huge discount. They are afraid
that Mr. Thompson will negotiate something for them.
Now, we will hear, I am sure, something is going to pass this
Congress, whether it is any good or not will be for the people to
decide, because the Republicans know they cannot go home without
something. It better be worth something, or else they are going to pay
in the next election, because they have been promising, and they have
no excuse. They have the Presidency, they have the Senate, they have
the House, and if they cannot put a bill out that does what the people
need, they need to pay for it at the ballot box. That is what is being
set up.
We are instructing them the way to go if they want to do what is best
for the American people. But if they want to do what is best for PhRMA
and the drug companies, we will continue down this path, and no one
will know, until one day a bill pops out here, 1,000 pages, and we vote
on it, with nobody knowing what is in it.
{time} 1345
That will be wrong, and the payment will come at the ballot box.
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
I appreciate the gentleman's comments and the anecdotal nature of
them, but I do know that there was a 10 o'clock meeting this morning in
Dirksen 215 to brief the staff on the progress that has been made on
the Medicare bill and to go over issues and to discuss matters.
But this motion to instruct does not deal with the particulars of the
prescription drug benefit, as has been discussed. It really only would
provide for a government-run fallback in the plan. And both bills have
prescription drug plans that assume some financial risk. The difference
is they would ask the government to be the fallback on that, which
would really then allow for very little incentive to control costs and
would not really be the kind of benefit that would become available to
seniors and be effective.
So, again, I would urge a rejection of this motion to instruct on
that basis.
Mr. Speaker, I reserve the balance of my time.
Mr. SANDLIN. Mr. Speaker, I yield 3 minutes to the gentleman from
Texas (Mr. Turner), ranking member on the Committee on Homeland
Security.
Mr. TURNER of Texas. Mr. Speaker, I thank the gentleman from Texas,
my colleague, for yielding me this time on what is a very, very
important motion to instruct, and one that I would hope would be
received favorably by our Republican colleagues, because there are
provisions in this motion that I think are important to many of us,
particularly those of us who come from rural areas.
When we look at what this bill looked like as it left the House, as
my colleagues will recall, it only passed by one vote, and I think it
took over an hour to get that one vote after a little arm-twisting. So
this bill clearly was one that did not sail out of this House, and I
think that the provisions that are in it are important.
First of all, it is, I think, appropriate in this motion to ask that
the very best provisions of both the House and the Senate bill on
improving Medicare payments to health care providers in rural areas be
in the final conference report, because many of us in rural areas have
been hurt by some of the changes and cutbacks in Medicare funding. I
have people come into my office all the time from my district who are
administrators of hospitals, who tell us that they are having a hard
time keeping the doors open and pleading with us to try to provide
adequate reimbursement for Medicare services in our rural hospitals.
It is true that since 1998, 57 percent of the hospitals treating
Medicare patients in this country have lost money, and that is only the
beginning of the story. As we listen to the individual hospitals who
come and talk to us, they tell us that they may be closing the doors if
we do not do better in terms of Medicare reimbursements. So this is not
a partisan issue; this is a bipartisan issue that particularly affects
those of us in rural America. At a time when we are being called upon
to spend billions of dollars to reconstruct Iraq, we do not need to be
closing the doors of hospitals right here in America.
I also think the provision of the motion to reject any cuts that may
affect a rural hospital is an appropriate and similarly arguable
meritorious provision to have in this motion.
Finally, the guarantee that is in the Senate bill that there is a
fallback to a Medicare prescription drug plan if there are not two
plans offered by private companies in your area seems to only make
common sense. After all, most seniors in this country are happy with
Medicare; and they would be well pleased, as I have always been, in
advocating a prescription drug benefit under regular Medicare. But
because our Republican colleagues have insisted that we have a
privatization of Medicare in order to get a prescription drug benefit,
it seems only to make common sense that as we enter into that
experiment, if that is the direction the Republicans choose to lead us,
that we have some protection. After all, it is an experimental venture.
In my area we had cutbacks in Medicare offerings by private companies.
So I think this motion should be well received by both sides of the
aisle, and I hope it will be adopted.
Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, Medicare, of course, with regard to hospitals and
providers, reimburses, particularly hospitals, based on a system that
on average allows them to make a profit under Medicare. We are advised
in Congress by a nonpartisan group of panel experts called MEDPAC, or
the Medicare Payment Advisory Commission. And this
[[Page H8930]]
bill, as passed the House, follows their recommendation and their
advice to Congress, which they made unanimously, that Congress increase
payments by 3 percent, which is what this legislation does. We will be
spending billions and billions of dollars on Medicare. We are trying to
do it in a responsible way that follows the advice of the nonpartisan
experts that Congress has looked to in the past to help guide us in
these matters.
So again, I would say that there will be a tremendous amount in this
legislation for providers, particularly in rural areas. I represent a
rural area in Michigan. And just to give Iowa as an example, they will
ultimately receive a 5.5 percent increase in Medicare payments above
what they would have received under current law. Again, that does not
include the increases that they would receive for the 51 critical
access hospitals in Iowa. So there will still be, I think, a
significant help to make sure that there will be access to health care
in rural areas. It is a critical issue, and this legislation provides
for that.
Mr. Speaker, I yield back the balance of my time.
Mr. SANDLIN. Mr. Speaker, we have heard today about the problems in
this bill. It is important that we stand up for hospitals, for seniors,
and for rural America. For too long, America's rural hospitals have
received Medicare funding far below the amount paid for the same
service to their urban counterparts. Further, Medicare's base payment
and DSH payments are less for rural hospitals and include an arbitrary
cap. The results are very predictable. There has been an overall
Medicare operating margin of negative 2.9 percent, and that has had a
terrible impact on rural health care.
Let us stand up for our seniors. Let us stand up for rural hospitals.
Let us make sure that we have a prescription drug plan that is
guaranteed. We know the cost, we know what it covers, it is available,
and that does not have a doughnut hole. Let us work together. I am
urging my colleagues to support the motion to instruct conferees,
because the instructions in this motion are the very ones that are not
being worked out in a bipartisan way or in any way at all by the
conference committee.
The SPEAKER pro tempore (Mr. Simpson). All time for debate has
expired.
Without objection, the previous question is ordered on the motion to
instruct.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to instruct
offered by the gentleman from Texas (Mr. Sandlin).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. SANDLIN. 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, further
proceedings on this motion will be postponed.
____________________