[Congressional Record Volume 149, Number 148 (Tuesday, October 21, 2003)]
[House]
[Pages H9780-H9784]
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. BROWN of Ohio. Madam Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mr. Brown of Ohio 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 to reject the provisions of subtitle C of title II 
     of the House bill.

  The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the 
gentleman from Ohio (Mr. Brown) and the gentleman from Florida (Mr. 
Bilirakis) each will control 30 minutes.
  The Chair recognizes the gentleman from Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, my motion instructs the conferees working on the 
Medicare prescription drug coverage bill to abandon provisions in the 
House bill that would privatize Medicare by turning it into a private 
insurance voucher program. The public has asked this Congress and 
President Bush to supplement Medicare by adding prescription drug 
coverage to the Medicare benefits package.
  You may remember early this year, almost a year ago, President Bush 
proposed a prescription drug plan only if people left fee-for-service 
Medicare and went into a privatized plan. Clearly, the public rejected 
that. Even members of his own party said no to that. The American 
public has not asked this Congress, has not asked President Bush, to 
dissolve Medicare and replace it with a private insurance voucher 
program.
  The voucher provisions in the bill have nothing to do with 
prescription drug coverage. The voucher provisions do not supplement 
Medicare, the

[[Page H9781]]

voucher provisions destroy Medicare. They choke off funding for the 
program and force enrollees back into the private insurance market to 
try their luck.
  If you do not believe me, Madam Speaker, ask the bill's authors. Ask 
these questions:
  First, under the voucher provisions of H.R. 1, will every senior be 
guaranteed access to the same reliable health coverage, regardless of 
geographical location, regardless of a senior's income, regardless of 
health status? If the authors are honest, they know the answer is no.
  Two, will the Federal Government's financial commitment to Medicare 
automatically keep pace with the costs of the health care seniors need? 
If the authors of the bill are honest, the answer is no.
  Three, will the private health medical organizations, private HMOs 
which accept Medicare vouchers, will they be required to provide 
ongoing, reliable coverage to Medicare beneficiaries? In other words, 
will HMO cost-sharing and benefit levels be predictable year after 
year, will beneficiaries even be able to rely on the same plan being 
available next year and the year after? Again, if the authors are 
honest in answering that question, they will admit the answer is no.
  History also says that senior after senior in this country in State 
after State and district after district and plan after plan have seen 
their coverage drop as they are unceremoniously dumped from their 
Medicare HMO. Today, Medicare offers reliable medical coverage to 
seniors and disabled Americans, regardless of where they live, how much 
they earn, or their health status. Enrollees go to the doctor of their 
choice and the hospital of their choice.
  The insurance voucher provisions in H.R. 1 simply throw all that 
away. Under these provisions, seniors will be given a voucher to cover 
part of the cost of their health coverage. They will then be required 
to shop in the private insurance market, what they had to do before 
1965, before Medicare was available, shop in the private insurance 
market for whatever HMO happens to be in town that year.
  Over the last 4 years, HMOs participating in Medicare+Choice enrolled 
and then unceremoniously dropped 2.4 million Medicare beneficiaries. 
That means 2.4 million of our senior constituents got notice in October 
or November that, come January, they would have to find another place 
to deliver their health care.
  By undermining the existing Medicare program, by forcing seniors to 
pick and choose between and among private insurance plans, the voucher 
provisions in H.R. 1 would ensure that every Medicare beneficiary has 
an opportunity, an opportunity to be abandoned by their HMO.
  The core Medicare program, the program that would be replaced if the 
voucher provisions in H.R. 1 make it into the final prescription drug 
bill, the core Medicare program does not drop anyone, period. In fact, 
over the last 4 years, one of its most important roles has been to pick 
up the pieces when HMOs abandoned seniors and left town, to clean up 
after privatized Medicare+Choice HMO plans abandoned seniors. The fee-
for-service, traditional Medicare, has had to clean up afterwards.
  Under the voucher provisions in H.R. 1, the core Medicare program 
would itself be abandoned. Proponents of the voucher provisions, 
proponents of Medicare privatization, say that seniors deserve more 
choice. That is what we are going to hear today. That is what we have 
heard for years from my friends on the other side of the aisle, that 
seniors deserve more choice. That is why vouchers are such a good 
thing.
  But does anybody in this body really think retirees are clamoring for 
their choice of HMOs? Just like you and me, seniors want their choice 
of doctor, they want their choice of hospital. They do not want their 
choice of insurance companies. They do not want their choice of 
insurance agents. They do not want their choice of HMO brochures. They 
do not want their choice of enrolling in one fly-by-night HMO after 
another fly-by-night HMO has dropped them.
  Proponents of the voucher provisions claim that private HMOs operate 
more efficiently than the core Medicare program, so they say first of 
all you get more choice with an HMO, so you can choose among insurance 
company brochures and agents. They say you have more choice in HMOs. 
Then they try the second myth, and that is the myth that HMOs operate 
more efficiently than core Medicare.
  My Republican friends know that Medicare operates more efficiently 
than HMOs. HMO administrative costs, Madam Speaker, are actually five 
times higher than traditional Medicare. Private insurance premiums have 
consistently grown faster than the cost of providing Medicare, not just 
recently, but over the past 30 years since the time Medicare first 
existed.
  H.R. 1 will not reduce Medicare spending unless, and this, I guess, 
is their third point, unless the Federal Government caps its 
contribution to Medicare.
  So privatized Medicare HMOs are not more efficient, privatized 
Medicare HMOs do not give more choice, and privatized Medicare HMOs do 
not cost less, do not save the government more, unless government 
simply caps the money. In other words, unless seniors pay more out-of-
pocket.

                              {time}  1500

  That is the cost control mechanism in H.R. 1, seniors picking up more 
of the cost. That is not efficiency; that is betrayal of our senior 
constituents.
  The American public asked this Congress and this President to add a 
prescription drug benefit to Medicare, not to privatize and dismantle 
Medicare. This motion tells their conferees to keep their eye on the 
ball. The voucher provisions would undo 38 years of reliable cost-
effective health care for our Nation's retirees.
  I urge my colleagues, Madam Speaker, to take a stand on behalf of 
seniors, on behalf of disabled Americans, and on behalf of taxpayers 
who finance Medicare. If you want a Medicare program with a 
prescription drug benefit, you vote ``yes.'' If you want to privatize 
Medicare, if you want to cost-shift health care costs to seniors, if 
you want more HMOs and privatization of Medicare, then you vote ``no'' 
on this motion. It is an easy choice. Vote for the motion to instruct.
  Madam Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, a group of Members, both Republicans and Democrats, 
have been meeting for months in an attempt to reach a compromise on a 
very important and complicated subject, namely, Medicare reform or 
Medicare modernization.
  There are Members who care deeply about Medicare who have very 
different views about how to best strengthen and improve Medicare for 
future generations, which is why there are some substantial differences 
between the House and the Senate-passed Medicare prescription drug 
bills. That is why it has taken so long for this bipartisan group of 
negotiators to reconcile the differences between the two bills.
  However, Madam Speaker, I am pleased to report that this group is 
making substantial progress and that it is my sincere hope that we will 
get a conference report done this year and provide our seniors with a 
prescription drug benefit they need and deserve.
  Motions to instruct like this are not helpful; and, in fact, they 
hinder our ability to reach a compromise on Medicare prescription 
drugs. I honestly, and I mean this sincerely, do not believe that that 
is the goal of the author of this motion. And it certainly is not mine. 
I want a bill.
  The particular section the gentleman refers to is not without 
controversy. And that is why we are working through it in a bipartisan 
manner. However, the section that we are talking about, which would 
inject competition into the Medicare program and provide seniors with 
choices similar to those choices Members of Congress enjoy, is probably 
the most misunderstood provision in the House-passed bill, and the most 
mischaracterized, I might add.
  Let me attempt to clarify some of the issues that are often 
misunderstood surrounding so-called FEHBP-style competition. First, 
H.R. 1 contains no changes, no changes to the basic entitlement to 
Medicare. The traditional Medicare program will continue to be

[[Page H9782]]

available to all seniors throughout the country and will continue to 
pay providers in the same way as today. However, it is an undisputed 
fact that we need to reform Medicare to ensure that it is around for 
future generations.
  Social Security, Medicare, and Medicaid currently comprise more than 
40 percent of the Federal budget. By 2030 the General Accounting Office 
estimates that these three programs could consume 75 percent of the 
Federal budget if no changes are made. In addition, the Medicare part A 
trust fund is scheduled to go insolvent in 2026 while the Medicare part 
B trust fund will require increases in Medicare part B premiums to 
remain solvent, increases that are much higher than the 13.5 percent 
increase Medicare beneficiaries will see in 2004.
  So reforms must be made to ensure that Medicare continues to exist 
for future generations. As we add a $400 billion drug benefit to a 
program that already has $13 trillion in unfunded liabilities, we must 
also enact real reforms that will place the program in a sound 
financial footing for the future. The provision in the House-passed 
bill attempts to do that. Is it the best way to go? I do not know. I do 
not know. But that is why members of the conference committee are 
working on the provisions and the issue right now.
  I would urge Members to allow the process to work its will and to not 
support the motion to instruct which, while nonbinding, would do more 
harm than good.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 5 minutes to the gentleman 
from Washington (Mr. McDermott), who has been a leader in health care 
in the Committee on Ways and Means.
  Mr. McDERMOTT. Mr. Speaker, in order to think about Medicare, you 
have to think about us all being in the same boat. Right now we made a 
decision a long time ago that all seniors will be in the same boat, we 
would get the same benefits, we would have the same amount we would put 
into it no matter where you lived, or how old you were, or whatever 
your medical condition was, what color you were, what State you lived 
in, how much money you had. It did not make any difference; we were all 
in the boat.
  Now the Republicans have said we are going to blow the bottom out of 
the boat. They have done that with tax cuts, and they set up a 
situation in 2010 where it is going to be absolute chaos in this body 
over how we fund anything because of the bottom having been blown out 
of the boat when we made these tax cuts recently.
  Their answer to the seniors of this country is, well, we are going to 
give you all the same life ring. You can just take this life ring and 
go out and do the best you can with it.
  Now, I sat on the Medicare commission for a year and heard this issue 
debated. What we have today is a program where all senior citizens get 
the same guaranteed set of benefits, no matter who you are, where you 
are, or anything. And what is attempted to be done in this bill is to 
say that in 2010 we are going to take away those guaranteed benefits 
and we are just going to give you a life ring of a voucher for $5,500.
  Now, I could just take my own example. I am 65. My mother is 93. So 
you are going to give us each the same life ring? Now, do you think for 
one moment, any Member of this Congress, do you think that my mother 
and I could go out and get a benefit package of the same size for the 
same cost? I mean, who has not bought any insurance? We all know from 
our government employees insurance thing that you have got to pay more 
if you are older, if you have got kids, or you have got some pre-
existing condition or whatever. Well, to send me and my mother out with 
the same amount of money is basically what we are going to say to 40 
million people on Medicare. You have got to go out there and find an 
insurance company that wants you.
  Now, I do not know how many of you have dealt with somebody who is in 
their 90s. Some of them are doing pretty well, some are doing a little 
less well, some are in real trouble. But to say to them that on an 
individual basis we are going to throw you out of the life boat and 
here is your life ring and good luck, I hope you make it to good 
health, it simply does not make any humane sense.
  Leaving people, they say, well, we are not going to do that until 
2010. What are you worried about? People are going to wake up in 2010 
and say what in the world was the legislature, the Congress, thinking 
in 2003 when they set this mess up? Many of us may not be here. And 
there will be a whole new bunch here trying to put back together what 
we destroyed today, what we take away from seniors, which is security 
of health care.
  I have not spent a dime on my mother. Nobody in this room has spent a 
dime on their parents because the medical plan under Medicare has taken 
care of them. Now, I paid my taxes, of course, and we all paid our 
taxes. That is what the lifeboat is all about, is we all pay our taxes 
and those in it that need it. And what is being proposed in this bill 
that is now in conference is that in 2010 we take away the lifeboat.
  This motion by the gentleman from Ohio (Mr. Brown) simply says we do 
not want to take Medicare apart and destroy the life boat in which we 
all sit. We do not want to put every senior citizen out there on their 
own. Dealing with insurance companies, my God, we have all dealt with 
insurance companies. We have dealt with automobile insurance companies 
and casualty insurance companies and all these insurance companies. You 
know what they do to you individually. There is no individual market 
today. If you are under 65 and you try and buy insurance, you have an 
awful time because of the prices they charge you.
  The value of Medicare is that we put everybody together, we share the 
risk. And most of us hope we never take a dime out of this program. It 
is an insurance program, surely, but it is also one that we do not want 
to take advantage of. And to say to people, well, why do you not go buy 
your own and see if you can make a little money on the side simply 
makes no sense.
  I urge this entire House to vote for the gentleman from Ohio's (Mr. 
Brown) resolution.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, there is no intent, never has been any intent to take 
that life boat away in the year 2010. The programs that we are talking 
about are strictly voluntary. And that choice will be available in 2010 
as it is today. And anybody who would say otherwise either does not 
know what is included in the legislation or else they are ignoring it.
  Mr. Speaker, I yield such time as he might consume to the gentleman 
from New Jersey (Mr. Ferguson).
  Mr. FERGUSON. Mr. Speaker, we spoke before about the reforms in H.R. 
1 which are similar to some provisions of the Federal Employee Health 
Benefits program. I want to address that for a moment. The FEHBP-style 
reforms in H.R. 1 seek to place the traditional Medicare program on a 
level playing field with private plans. Only by creating this type of 
competition within Medicare can we hope to bend the growth curve and 
place Medicare on a sound financial footing for the future.
  These reforms make no changes to the basic entitlement to Medicare. 
The traditional Medicare program will continue to be available to all 
seniors throughout the country. These reforms simply provide incentives 
for seniors to choose the most cost-efficient form of care in areas in 
which a vibrant private plan market exists.
  This type of competition can only be triggered in areas in which two 
or more private plans are in operation, where they have a certain level 
of enrollment and meet certain market penetration requirements. In 
areas where these conditions are not met, nothing changes after 2010. 
In areas in which these conditions are met, the traditional Medicare 
program is compared directly to private plans in the market, and 
seniors will have incentives to choose the most cost-efficient form of 
care in their area.
  Reforms must be made to ensure that Medicare continues to exist for 
future generations. As we add a $400 billion drug benefit to a program 
that already has a $13 trillion unfunded liability, we must also enact 
real reforms that will place the program on a sound financial footing 
for the future.
  Now, some of my colleagues on the other side of the aisle have had 
some concerns. They have continued to claim that traditional Medicare 
is

[[Page H9783]]

more efficient than private plans. And, if that is the case, then they 
have nothing to fear from the FEHBP-style reforms that are in H.R. 1. 
If Medicare truly is more efficient than private plans, then 
beneficiaries in competitive areas who remain in traditional fee-for-
service will see their premiums decrease.
  In these reforms we want to provide incentives for beneficiaries to 
choose the most cost-efficient form of care. If traditional Medicare is 
the most efficient form of care in the area, then beneficiaries will be 
given incentives to remain in traditional Medicare through premium 
decreases. If, however, private plans can deliver Medicare services 
more efficiently than the traditional program, then we want 
beneficiaries to have the incentives to join private plans.
  These reforms are necessary to bring Medicare costs under control and 
ensure the long-term viability of the program.
  And, now, before I just close and urge my colleagues to vote ``no'' 
on this motion to instruct because it is unnecessary, the sponsor of 
this motion, my friend, the gentleman from Ohio (Mr. Brown), had asked 
some questions earlier. I just want to reassure him, because I know he 
is very concerned, and thus the reason he raised these questions.

                              {time}  1515

  The first question was, under H.R. 1 will the entitlement to Medicare 
continue? The answer to my friend from Ohio is yes. Traditional 
Medicare will continue to be available to all seniors in all parts of 
the country.
  The second question the gentleman from Ohio (Mr. Brown) raised was, 
will government contributions keep pace with the cost of health care? 
The answer to my friend is yes. Government payments to providers in the 
traditional program will continue the same way that they do today.
  The third question my friend from Ohio raised was, will private plans 
be required to provide reliable benefits and cost sharing? The answer 
again to my friend is yes. Plans must be reviewed and approved by CMS. 
CMS, the very agency that runs Medicare today, will also be running 
these programs in the future. If you can trust them now, you can trust 
them in the future.
  Mr. Speaker, I urge my colleagues to vote no on this motion.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from California (Mr. Cardoza).
  Mr. CARDOZA. Mr. Speaker, I rise today in support of the motion by my 
colleague from Ohio.
  As a Representative of a rural area in California, I must voice 
strong opposition to any provision in the Medicare conference that 
would put my seniors at risk of higher premiums and reduced quality of 
care as this so-called premium support would do.
  The House plan includes provisions that would for all intents and 
purposes, I believe, could spell the demise of Medicare system as we 
know it.
  In the year 2010 Medicare beneficiaries would be given something 
similar to a voucher that they could use to purchase health care 
services in what the majority would have you believe would be better 
than the Medicare system provides.
  The move creates a defined contribution system in one that for 
decades has been a defined benefit. Just trying to explain it to my 
constituents at home has been a trying experience. Medicare has always 
been a program that you are eligible to receive at age 65. In the 
current program, once you reach that golden age, you know exactly what 
you are going to receive and exactly what services you are going to be 
covered with.
  Premium support creates a situation where seniors will receive a 
benefit determined by their health, by where they live, or by what they 
are willing to risk.
  Why do we not put our resources, Mr. Speaker, into crafting a 
Medicare bill that will actually help those who need the assistance? 
Why do we not close the doughnut hole? Why do we not give our hospitals 
the basic funding levels that they need to survive? Why do we not give 
seniors a prescription drug benefit that they can understand?
  I predict that if we pass this measure with the provisions that are 
in it currently, we will be acting upon a repeal within months. 
Privatizing Medicare is not the answer.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I would say to the gentleman that we learned of the 
doughnut hole from the Democratic plan in the last Congress. And I also 
would join the previous speaker in voicing strong opposition to any 
legislation which would adversely effect my senior constituents. I, 
obviously, do not feel that this legislation would do that. And I would 
again ask the Members to vote against the motion to instruct.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Texas (Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, I wanted to speak for just a minute on why 
the Federal Employee Health Benefit Plan style reforms are needed in 
Medicare.
  As the chairman as pointed out so eloquently, spending on Medicare is 
projected to nearly double over the next decade, just as the baby 
boomers begin to retire. Social Security, Medicare and Medicaid 
currently comprise more than 40 percent of the Federal budget; but by 
2030, the Government Accounting Office estimates that these three 
programs could constitute 75 percent of the Federal budget if no 
changes are made. Truly, that would be blowing out the bottom of the 
boat, to borrow a metaphor from the gentleman from Seattle.
  This level of entitlement spending is unsustainable and will crowd 
out other essential functions of government. Reforms must be made to 
ensure that Medicare continues to exist for future generations. And 
after all, that is what this debates is all about, ensuring that 
Medicare is going to be there for future generations. As we add a $400 
billion drug benefit to a program that already has $13 trillion in 
unfunded liabilities, we must enact real reforms that will place the 
program on sound financial footing for the future.
  To modernize Medicare and ensure its long-term fiscal viability, H.R. 
1 includes incentives for beneficiaries to choose the health care 
system that provides services in the most efficient manner. Even with 
these competitive reforms, seniors retain complete freedom to choose a 
private plan or remain in the traditional fee-for-service program.
  H.R. 1 contains no changes to the basic entitlement of Medicare. The 
traditional Medicare program will continue to be available to all 
seniors throughout the country and will continue to pay providers in 
the same way as today.
  Again, I must correct the gentleman from Seattle in that this is not 
a voucher proposal; but these competitive reforms are needed to put 
Medicare on a sound financial footing for the future. Any changes to 
the premiums of the fee-for-service beneficiaries will also be phased 
in over a 5-year period.
  Finally, I would close with just echoing what the chairman so 
eloquently stated in that motions to instruct are generally not 
helpful.
  Mr. Speaker, I urge my colleagues to vote no on the motion to 
instruct.
  Mr. BILIRAKIS. Mr. Speaker, I do not have any further requests for 
time, and I yield back the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself the balance of my 
time.
  Mr. Speaker, I have heard my friends on the other side of the aisle 
talk about, particularly the gentleman from New Jersey (Mr. Ferguson) 
talk about that privatized HMOs are so efficient. And I hear that over 
and over and over. Just because they are private business, that they 
must be extraordinarily efficient, that they must do such better work 
than the government could do. But my friend from New Jersey also knows 
that, in fact, Medicare, traditional fee-for-service Medicare has one-
fifth the administrative costs as a privatized HMO, as an insurance 
company, as a health care plan that he is talking about.
  I would like to give one reason why and just read a couple of 
statistics and then ask for my colleagues' ``yes'' vote on this motion 
to instruct.
  In the year 2000, the Inspector General documented that in a survey 
of Medicare+Choice, privatized Medicare, plans, that they tried to bill 
taxpayers for $116 million in inappropriate administrative costs. Now, 
this is one of the reasons that private insurance is so

[[Page H9784]]

much more administratively cumbersome and wasteful than is traditional 
Medicare. The private insurance industry tried to bill the government 
$250,000 for a meeting with foods, gifts and alcohol; $190,000 for a 
sales award meeting in Puerto Rico; $157,000 for a company's 150th 
anniversary party; $100,000 for sporting events and theater tickets; 
$69,000 for holiday parties; $37,000 for wine and gift tickets; $1 
million in lobbying, they have got their monies worth there, that is 
for sure; $25,000 for a stadium luxury box. That was in 2000.
  In 2001, the Inspector General again looked at $97 million and asked 
for billed charges from private insurance interests to the government: 
$284,000 in entertainment costs like stadium skyboxes, sporting events; 
$90,000 for golf club memberships; $30,000 for a Christmas party; 
$3,400 for cost of alcohol at various functions.
  Mr. Speaker, the fact is that traditional Medicare works. It works 
because it gives full choice of physician, choice of provider, choice 
of hospital; not choice, as private insurance does, not the choice 
among insurance agents and insurance HMO brochures.
  Traditional fee-for-service Medicare works because it is reliable. It 
will always be there. You will not find yourself unceremoniously 
dropped like 2.4 million seniors have been for Medicare HMOs. 
Ultimately, traditional Medicare is more efficient than these private 
insurance plans with huge salaries, huge bonuses, huge stock benefits 
and wasteful extraneous spending as I just outlined. I ask my 
colleagues to vote ``yes'' on the motion to instruct.
  The SPEAKER pro tempore (Mr. Culberson). 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 Ohio (Mr. Brown).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. BROWN of Ohio. 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 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________