[Congressional Record Volume 149, Number 159 (Wednesday, November 5, 2003)]
[House]
[Pages H10438-H10443]
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

  Mrs. CAPPS. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mrs. Capps of California 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. To reject the provisions of Subtitle C of title II of 
     the House bill.
       2. To reject the provisions of section 231 of the Senate 
     amendment.
       3. Within the scope of the conference, to increase payments 
     for physician services by an amount equal to the amount of 
     savings attributable to the rejection of the aforementioned 
     provisions.
       4. To insist upon section 601 of the House bill.

  Mrs. CAPPS (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 
gentlewoman from California?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to clause 7 of rule XX, the 
gentlewoman from California (Mrs. Capps)

[[Page H10439]]

and the gentleman from Florida (Mr. Bilirakis) each will control 30 
minutes.
  The Chair recognizes the gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, my motion would do three things. It would instruct 
conferees to drop privatization language from both the Senate and the 
House bills. It would direct any savings derived from dropping these 
provisions to pay for increased physician fees, and finally, the 
conferees on the Medicare bill would be instructed to protect the 
language in the House bill that provides for a small increase in 
Medicare payments to doctors for the next 2 years.
  Essentially, this motion would tell the conferees to reject an 
untried proposal that would jeopardize Medicare and, instead, spend our 
precious resources to make sure that our doctors will be able to see 
their patients.
  Mr. Speaker, in 1965, we established Medicare because the private 
insurance industry demonstrated that it could not provide affordable 
access to needed health care for seniors. I recognize the power of the 
market, but in trying to provide for the health care to senior 
citizens, this market falls short.
  Our recent experience with Medicare+Choice just shows how true that 
is. Just 2 weeks ago in Ventura County, California, two private plans 
serving seniors pulled out, leaving these seniors with no more HMO 
service. Covering Medicare beneficiaries is too expensive for private 
plans to justify to their investors, and this is especially true in 
rural areas where the low population and the short number of providers 
has proved too high a hurdle for private plans, but in spite of this 
experience, proven now over many years, the House bill would turn 
Medicare into such a voucher program.
  The Senate bill would simply pay HMOs more per beneficiary than 
traditional fee-for-service Medicare costs. Basically, it would bribe 
them to take care of these patients, but if these plans cannot provide 
the same care as Medicare for less, why would we want to pay them more? 
Why not just stick with traditional Medicare? This idea is a waste of 
money, and both approaches would drive premiums for Medicare 
beneficiaries way up.
  The chief actuary of Medicare estimates that under the House bill, 
premiums would rise by 25 percent under this provision. This would 
force many beneficiaries to join HMOs and other plans since they could 
not afford to stay in traditional Medicare any longer, and so these 
provisions would end the Medicare program that has worked now for 
nearly 40 years, the Medicare program in which our seniors have such 
great faith.
  Medicare under this plan will be replaced with the program where the 
health insurance industry itself decides how much a senior will pay and 
what kind of care they will get, and a senior's cost-sharing and 
premiums would no doubt change from one area to the next and perhaps 
from 1 year to the next.
  Seniors have paid their payroll taxes all their lives. They were 
promised that Medicare would provide them with health care no matter 
where they lived, and now, they see that some in this place are trying 
to change the rules of the game on them.
  AARP is strongly opposed to these kinds of changes, and so is the 
National Committee to Preserve Social Security and Medicare. These 
organizations are devoted to protecting America's seniors, and they 
believe that this is a mistake. They think these resources should be 
put to better use, and so do I.
  I think instead of finding new and faster ways to funnel money to 
private health insurance plans, we should be shoring up the providers 
who actually treat and provide health care to our constituents, our 
physicians. In my District and all across this country, doctors were 
stunned to see a 4 percent cut announced for next year. This latest cut 
comes on top of the 5.4 percent cut in 2002. The net result of these 
cuts would put doctors' reimbursements at 8 percent below their 2001 
levels, and it would represent the fifth reduction since 1991.

  Payments between 1991 and 2004 will have fallen 19 percent behind 
inflation in practice costs even using Medicare's own conservative 
estimates.
  These cuts are indefensible.
  We are already having a hard time keeping enough doctors and other 
health care providers to care for the public in many areas of the 
country.
  A number of surveys have indicated physicians increasingly are 
limiting how many Medicare patients they see and that more will be 
forced to do so if payments are cut again.
  Medicare cuts have ripple effects into non-Medicare health care, 
because it makes it harder for health care institutions and for rural 
areas to attract and keep their doctors.
  We simply cannot afford another round of cuts.
  So this motion would also instruct the conferees to protect the 
language in the House bill that would give doctors a 1.5 increase in 
payments for the next 2 years. Though this is a small increase, it is 
much better than the cut physicians were facing.
  The motion would also direct conferees to take the money that would 
have been spent on privatization to be spent on increasing these 
physician fees.
  This motion is a very simple choice. Do we want to pay the HMOs more 
money so they may or may not cover our constituents, or would we rather 
put that money to use ensuring that there are enough doctors, the true 
professionals, who treat America's seniors and those with disabilities?
  I urge my colleagues to choose our doctors and their patients over 
the insurance industry. I urge them to support this motion and make 
clear where they stand.
  Finally, Mr. Speaker, I just want to note how unfair this entire 
conference process has been. The ranking members of the committees of 
jurisdiction, members of the conference and Representatives of hundreds 
of thousands of Americans are not even allowed in the room to be heard 
on this bill. The voice of the minority is a very important part of our 
public debate.
  This exclusionary, undemocratic process that disenfranchises more 
than 100 million Americans is all too common up here.
  Comprehensive and controversial changes like this bill cannot be 
sustained without the broad bipartisan support that this bill lacks.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I appear to be the only speaker on this 
side. I do not know how many speakers the gentlewoman has.
  Mrs. CAPPS. Is the gentleman reserving the balance of his time at the 
moment?
  Mr. BILIRAKIS. Mr. Speaker, what I would like to do is reserve the 
balance of our time and be the last speaker, just before the 
gentlewoman's closing.
  Mrs. CAPPS. That is very fine.
  Mr. Speaker, I yield 4 minutes to the gentleman from Ohio (Mr. 
Brown), the ranking member of the Subcommittee on Health on the 
Committee on Energy and Commerce.
  Mr. BROWN of Ohio. Mr. Speaker, I appreciate the work that my friend 
from California (Mrs. Capps) does on all kinds of Medicare issues, from 
what she has done today with the nursing shortage to intercity 
hospitals and everything in between.
  I also support and appreciate the good work that the gentleman from 
Florida (Mr. Bilirakis) has done on a whole host of Medicare issues, 
and I know from working with the gentleman from Florida (Mr. Bilirakis) 
of his personal support for Medicare, his belief in Medicare. 
Unfortunately, though, the beliefs of my friend on the other side of 
the aisle does not always play out in support for Medicare by some 
other members of the Republican conference.
  I remember hearing the gentleman from California (Mr. Thomas), the 
chairman of Ways and Means, the principal player on this conference 
committee that the gentlewoman from California (Mrs. Capps) talked 
about, more than 50 percent of American people, Senate and House, are 
simply not allowed in the House. More than 50 percent of the Senate, 48 
percent of the people represented by House Members, but the gentleman 
from California (Mr. Thomas) has said he wants to end Medicare as we 
know it.
  All we have got to do really is look back on the history of this 
program, and while the gentleman from Florida (Mr. Bilirakis) does 
indeed care about

[[Page H10440]]

Medicare, wants to continue to make it work, wants to preserve it, so 
many of his fellow Members, including people in the White House, simply 
do not.
  The President, some months ago, said that he wants to do a 
prescription drug benefit, but he said if you want a prescription drug 
benefit, you have got to get out of Medicare, and you have got to let 
the insurance industry do it.

                              {time}  2015

  That has really been the thrust from President Bush to the gentleman 
from California (Mr. Thomas) to Speaker Gingrich a few years ago, to 
back in 1965, Republicans really wanted this system turned over to the 
insurance companies. Privatize Medicare and give it to the insurance 
industry. Go back to 1965, out of roughly 200 Republican Members of the 
House and Senate, only 23 voted for the creation of Medicare. Gerald 
Ford in 1965, a future President, voted against it. Congressman Dole, 
future Senator Dole, Republican Presidential candidate, voted against 
it. Senator Strom Thurmond voted against the creation of Medicare. 
Congressman Donald Rumsfeld in 1965, later Secretary of Defense and the 
architect of this plan, I put in quotation marks, of the rebuilding of 
Iraq, voted against this creation of Medicare.
  Then in 1995, the first time Republicans had an opportunity to do 
something about Medicare, the Republicans under Speaker Gingrich tried 
to cut it by $270 billion in order to give a tax cut to the most 
privileged Americans, the same old story. Speaker Gingrich said in 
October 1995 that he hoped Medicare would wither on the vine.
  Senator Dole in October 1995 said, that I was in there fighting 
against the creation of Medicare because we did not believe in it. The 
next year he was a Republican candidate for President.
  Dick Armey, sometime later, said about Medicare, in a free capitalist 
country, we would not have a socialist program like Medicare. And a 
Republican Congressman from Georgia recently said, I heard in the 
Committee on Rules, said that Medicare is a Soviet-style program.
  They are free to think what they want about Medicare, and the more 
power to them. If they do not like Medicare, that is their business, 
but do not come on the floor like so many Republicans have, and I 
accept the gentleman from Florida (Mr. Bilirakis) because he believes 
in this program, but so many Republicans come to the floor and say I 
believe in Medicare. I have a mother and father, and I care about them, 
and I care about Medicare. Sure, they care about their mother and 
father, but they simply do not much like Medicare. They want to 
privatize it and end it as we know it. They want to turn it over to the 
insurance companies.
  Mr. Speaker, that is why the motion to instruct by the gentlewoman 
from California (Mrs. Capps) is so important to send a message to the 
conference committee and to send a message to the American people that 
Medicare works and we do not want it turned over to the private 
insurance industry.
  Mrs. CAPPS. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Cardoza).
  Mr. CARDOZA. Mr. Speaker, I rise in support of this motion by the 
gentlewoman from California (Mrs. Capps), who has done fantastic work 
in this area.
  This motion instructs the Medicare conference committee to reject the 
controversial and risky privatization scheme of premium support and 
reallocate that money to increase the payment to physicians who care 
for Medicare beneficiaries.
  Let me first discuss the issue of premium support and why I am 
concerned that this scheme could potentially dismantle the program of 
Medicare. I am concerned about subjecting a proven health care delivery 
system like Medicare to the uncertainty of the private market. I am 
especially hesitant about the system that relies on HMOs to provide 
this service to our seniors.
  In my home area of Merced County, there is not one Medicare+Choice 
plan that my constituents can participate in. HMOs have made it 
abundantly clear that serving the rural areas and serving rural America 
is not profitable; and, therefore, they have pulled out of those 
regions in a mass exodus. Now the House bill relies on these private 
plans to provide services for Medicare beneficiaries. It just does not 
make sense.
  Additionally, since its inception, Medicare has been a defined 
benefit system for which seniors pay a guaranteed premium each month 
and receive a guaranteed benefit.
  In the House Medicare proposal, seniors' health care costs would be 
subsidized in the form of a voucher which they could then use to buy 
coverage in the private market. Their benefits can vary widely. Their 
choice of doctors can be restricted. Some services may not be covered, 
and so and so forth.
  In theory, this system is supposed to cut costs by introducing 
competition into a Federal entitlement program. Unfortunately, all this 
plan really does is pass the costs of health care on to our 
constituents.
  The basic foundation of Medicare is that we are all in this together 
and that everyone shares the risk. With premium support, the risk stays 
in the Medicare pool while healthy beneficiaries are picked off by 
private insurance companies in order to make a profit.
  Seniors do not want this. They do want their choice of doctor, they 
do want a choice of hospital, and most importantly, they want to be 
able to afford their health care. So let us not take a gamble with our 
seniors. Let us use the money that we will save by striking this 
provision and put it toward something more tangible. If we increase 
payments to doctors who see Medicare patients, we will ensure that they 
continue to offer the highest quality care and not be forced to drop 
Medicare patients because the system cannot cover the basic cost of 
their treatment.
  Mr. Speaker, physicians are being forced out of providing services to 
Medicare patients at an alarming rate. In fact, CMS just announced they 
would be imposing a 4.5 percent reduction in physicians' Medicare 
reimbursements effective January 2004. This is a disservice to our 
Nation's doctors and to our seniors. I urge a ``yes'' vote on this 
motion.
  Mrs. CAPPS. Mr. Speaker, I yield 4 minutes to the gentleman from 
Oregon (Mr. DeFazio), whose rural district has faced the experience of 
having insurance companies up and leave.
  Mr. DeFAZIO. Mr. Speaker, I thank the gentlewoman for her leadership 
on this issue.
  It is a funny thing here, we are being told that the Republicans want 
to inject competition into the insurance market. Well, if they really 
want to do that, why do they not support my bill to lift the antitrust 
exemption from the insurance industry? The only industries in America 
exempt from antitrust law who can and do get together in private 
resorts on an annual basis to collude, to fix prices and red line out a 
whole bunch of potential clients is the insurance industry and, of 
course, professional sports. These are the only industries in America 
in a country of capitalism and competition who are exempt from any 
restriction on collusion.
  Now we are going to throw our seniors onto the tender mercies of this 
collusive, anticompetitive industry. Oh, that is great. My seniors 
already had this experience. We had Medicare+Choice, HMOs. Oh, this is 
going to be great. You are going to get more benefits than under fee-
for-service. Well, the companies were not able to collude and set the 
prices quite high enough to satisfy their profits, so they up and left 
with very little notice. My seniors were left in the cold.
  Now what we are going to do is not only recreate that structure which 
has already failed the seniors of America once, to throw them on the 
mercies of an anticompetitive and collusive industry that does not give 
a darn about them, but now we are going to jigger it even a little more 
so it can destroy the Medicare fee-for-service plan, to which my 
seniors returned when they were screwed by the insurance industry. That 
is right; they were screwed. Suddenly you do not have an HMO plan any 
more, tough luck, we do not care. They could at least go back to 
Medicare fee-for-service.
  But under this plan, it is beautiful. They are not going to have that 
option anymore because it is going to undermine the fee-for-service 
plans. It is a little thing called adverse selection. We are going to 
let the private, anticompetitive, collusive insurance industry cherry-
pick the people they want

[[Page H10441]]

to cover for as long as they might want to cover them. You can get a 
policy for a year; but if you get sick, next year we are not going to 
renew your policy. That is the way this industry works.
  Mr. Speaker, Members need to talk to their constituents. It is 
happening to people who are young, people with small businesses. 
Someone gets sick, we cannot renew your policy. Or we can renew your 
policy, only there is a 400 percent increase in premiums. That is what 
they are going to do to seniors because this thing is even more 
dastardly because it is going to destroy the core problem because we 
will leave the oldest, the sickest, and the ones that the collusive 
insurance industry does not want to cover over here in the Medicare 
fee-for-service, and make them pay more for it. We are going to make 
them pay more for it.
  So this is a great option for seniors. Either the collusive industry 
that does not want to cover people who are sick or incurring costs will 
offer you a deal, or you can go back over here to Medicare which we 
have undermined and jacked the premiums up dramatically. That is the 
so-called choice in competition that the Republicans are offering the 
seniors of America.
  Mr. Speaker, this is just an incredible travesty for this House and 
for the people's Representatives to even pretend that this somehow is 
going to improve coverage for our seniors.
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Maine (Mr. Allen).
  Mr. ALLEN. Mr. Speaker, I thank the gentlewoman for yielding me this 
time.
  I come here tonight in order to urge the House to support the 
gentlewoman's motion. It is absolutely clear that the Republican bills, 
both in the House and the Senate, do encourage people to move away from 
traditional fee-for-service Medicare. As the gentleman from Ohio (Mr. 
Brown) said earlier, when asked on a television program about the 
damage that these proposals might do to traditional Medicare, the 
gentleman from California (Mr. Thomas), the Chair of the Committee on 
Ways and Means said, ``I certainly hope so'' when asked if it would 
destroy Medicare as we know it.
  But let us look back at what is happening in the State of Maine. In 
Maine today there is no private sector health insurance for people on 
Medicare. It is all Medicare fee-for-service. So when people in 
Washington say we are going to change your health care system, we are 
going to move people out of traditional fee-for-service into insurance 
company coverage, well, they are going to have trouble persuading 
people from Maine that makes any sense.
  I speak from personal experience. Both of my parents passed away in 
the last couple of years. But before they did, in their mid-to-late 
eighties, they spent 1 year on a plan called Golden Care, a wraparound 
private insurance plan that included Medicare. It was not golden; it 
was a nightmare because the insurance company did what insurance 
companies do: deny coverage. My mother would go to the doctor. She 
thought she had authorization, and it would come back and the claim 
would be denied. That is what insurance companies do. We cannot let 
that happen to seniors on Medicare.
  My chief of staff has a father who spent most of the last 10 days in 
the hospital. He had a very serious heart problem. He was in for one 
test after another test. He was in overnight. His situation on more 
than one night was extremely grave. At one point, finally, after a week 
in the hospital with round-the-clock care, he looked up at his wife and 
he said, thank God for Medicare. Thank God for Medicare.
  What the Republican bills are doing is making sure that Medicare as 
we know it gradually withers on the vine and that it is replaced by 
your friendly insurance company.
  I do not have a single constituent in Maine who has ever come to me 
and said I am ready to give up the choice of doctors and hospitals 
under Medicare, but what I really want is a choice of insurance plans. 
Send me those brochures, those insurance plans, that is what seniors 
want at 85 years old. I do not think so. Save Medicare, support the 
motion.

                              {time}  2030

  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I thank the gentleman from Ohio, particularly for his 
kind remarks. I rise in opposition to the motion to instruct offered by 
the gentlewoman from California (Mrs. Capps). This is just the latest, 
I think, in a long line of motions to instruct that hurt our ability to 
finish our Medicare bill and provide prescription drugs to seniors. I 
am going to focus my remarks principally on the comments made of saving 
money from taking money away from the H.R. 1 program, if you will, and 
putting it into providers.
  I have been a tireless advocate of fixing the formula that the 
Centers for Medicare and Medicaid Services uses to annually update 
Medicare payments to physicians. In fact, I introduced a bill in late 
2001 that would have prevented that 5.4 percent cut in physician 
reimbursements under Medicare that went into effect in 2002. I believe 
the gentlewoman was supportive as were others. Physicians were slated 
to receive another cut, this time of 4.4 percent, were it not for 
congressional action that corrected flawed data in the update formula 
and provided physicians with a 1.6 percent update for 2003.
  However, persistent flaws in the update formula mean that physicians 
are looking at negative updates next year and through 2007, and this 
motion to instruct does not fix that. It makes no sense, and the others 
have said it, it makes no sense that we would be cutting payments to 
our Nation's doctors at the same time that their costs are rising.
  That is why the House bill contains provisions, and if this bill goes 
down, those provisions will not be applicable and the increases that we 
are all talking about would not take place.
  That is why the House bill contains provisions that will ensure that 
physicians will see their reimbursements under Medicare, rather than 
cut by 4.4 percent, would be increased by 1.5 percent in fiscal years 
2004 and 2005. This will provide Congress with the time that it needs 
to make long-term reforms to the Medicare physician payment update 
formula so that physicians can count on predictable, rational payments 
from Medicare. It will also avoid a major physician access problem for 
Medicare beneficiaries.
  I would note, Mr. Speaker, that a number of organizations 
representing America's physicians, including the American Medical 
Association, the American Osteopathic Association and the Alliance of 
Specialty Medicine all strongly support the House bill. I would quote 
from an October 30, 2003, letter from the American Medical Association. 
I believe the minority is aware of this. The last few lines basically 
say:
  Pending Medicare payment cuts must be addressed now, not in 2010, 
which is basically what the instructions go to, and the flawed payment 
formula must be addressed through replacement of the formula. Simply 
attempting to transfer dollars from patients to physicians through some 
ambiguous, unspecified mechanism, as is intended under the Capps motion 
to instruct, would not change the flawed Medicare payment formula, and 
thus would not ensure long-term access for Medicare patients.
  I received another letter dated the same date, October 30, from the 
American Osteopathic Association. It starts out:
  On behalf of the 52,000 osteopathic physicians represented by the 
American Osteopathic Association, I write to thank you for your efforts 
to reform and improve the Medicare program. The AOA applauds the 
consistent effort by the committee and their staffs to finalize a 
legislative compromise that will improve the health care of millions of 
Medicare beneficiaries. We encourage the committee to complete work on 
the pending conference report, enabling both Chambers to approve the 
legislation before the end of the year.
  In the next paragraph it finishes up by saying:
  Additionally, section 601 of the bill includes reforms that reduce 
the future economic volatility of the physician payment formula. These 
provisions have strong bipartisan, bicameral support. We urge their 
inclusion in the final conference report.
  It goes on the next page:
  Given budget constraints, the AOA understands that a long-term 
solution

[[Page H10442]]

for the physician payment issue could not be included in this 
legislation, and I add to that my own comment, unfortunately. However, 
we believe strongly that section 601 provides short-term relief that 
will allow physicians to continue participating in the Medicare 
program, preventing an increase in access problems for Medicare 
beneficiaries. Furthermore it provides Congress ample time to develop 
and implement long-term reforms of the Medicare physician payment. I 
would add parenthetically, in my own words, that I would hope we could 
work together with the minority to fix that terrible, terrible, unfair 
formula.
  We received another letter from the Alliance of Specialty Medicine 
basically saying the same sort of thing in a different way. It is 
signed by the American Academy of Dermatology Association, American 
Association of Neurological Surgeons/Congress of Neurological Surgeons, 
American Association of Orthopedic Surgeons, American College of 
Cardiology, American College of Emergency Physicians, American College 
of Radiology Association, American Gastroenterological Association, 
American Society for Clinical Pathology, American Society for 
Therapeutic Radiology and Oncology. American Society for Cataract and 
Refractive Surgery, American Urological Association, National 
Association of Spine Specialists, Society of Thoracic Surgeons.
  Mr. Speaker, I would also note, and I hate to put it this way, but if 
my friends really would like to help America's physicians and, yes, I 
appreciate the fact that they are on our side in terms of trying to 
have an increase rather than that great, terrible decrease, then I 
would recommend that they support, or at least favorably, objectively, 
open-mindedly look at the balanced liability reform like H.R. 5, which 
is the HEALTH Act. The gentlewoman from California voted against this 
legislation. I do not question that she wants to help the providers. I 
certainly do not. But those people who voted against this legislation, 
I would like to think they basically did so with a closed mind which 
America's doctors so desperately, desperately need.
  I have heard a number of charges that Congress is considering handing 
Medicare over to the HMOs. That is not what the House did at all in the 
Medicare reform bill that we passed.
  What the House did do was to improve the Medicare+Choice program and 
set up a new system. It has been said that people have been dealt 
unfairly by virtue of losing their HMO because they moved out. That has 
happened in my district in Florida, too. I have reprimanded and I have 
admonished as far as that is concerned but, my gosh, if that is the 
case, then those programs apparently were liked. They were liked by the 
particular patients. They are distressed because they have been taken 
away. Their Representatives are standing on the floor of the House here 
and complaining that they have been taken away. So there must be some 
good to them. I am not sure that I would have recommended any of them 
to my parents, but that is my personal choice.
  What the House did do was to improve the Medicare+Choice program and 
set up a new system that will encourage regional plans to offer seniors 
another choice besides traditional Medicare. It is my hope that this 
will extend new choices to folks in rural areas who have not had a 
choice in Medicare before.
  I talked to the gentlewoman from Florida (Ms. Corrine Brown) on the 
floor of the House during our last series of votes. We talked about 
this. I said, what we're basically saying is let's be open-minded. 
Let's be objective. Let's take a look at new ideas. They may not be any 
good. There may be some good to them, there may be some bad to them, 
but let's be open-minded. That is basically what I was pleading. That 
is what we are trying to do in the conference. We are going back and 
forth. It is a bipartisan thing.
  I remember one of the most important gentlemen, the longest in 
seniority in the House basically calling a particular piece of 
legislation he introduced bipartisan when there was one Republican who 
cosponsored that legislation. So he called it bipartisan. We have two 
Senators in these gatherings. That is pretty darn bipartisan, I would 
say even more so bipartisan. But what the House did not do, and I would 
never support, and I very much appreciate the gentleman from Ohio 
making those comments, is force seniors to leave traditional Medicare. 
I feel very strongly about that. There are a lot of lengthy, sometimes 
heated discussions taking place regarding that. Any statements that 
characterize the House bill in any other way are, I say without any 
hesitation, 100 percent false.
  I would have voted, Mr. Speaker, in the mid-sixties, I like to think 
I would have if I had been in the House at that time, to establish the 
concept of Medicare. My parents, along with so many others, took 
advantage of it. They are both gone now. I certainly look forward to 
retiring one of these days and taking advantage of it. I am concerned 
that it be a viable system, it is a system that is hurting right now, 
but be a viable system.
  The reality that we are all facing and that many folks here in 
Congress seem to not want to address is that reforms must be made to 
ensure that Medicare continues to exist. It is a great program. There 
is no question about it. In my opinion it is. I say that. I do not 
hesitate. There are faults in it. It has got to be reformed. Anything 
that has been in effect for something like 40 years has got to be 
looked at again and possibly some changes made. We have got to ensure 
that Medicare continues to exist for future generations. As we add a 
$400 billion benefit, a $400 billion drug benefit to a program that 
already has, we forget this, do we not, $13 trillion in unfunded 
liabilities, we have got to take a serious look at how we can place the 
program on a sound financial footing for the future.
  The House and the Senate did take different approaches in trying to 
meet this goal. We are currently working through those differences, but 
I want to emphasize and what I do want to emphasize, and really 
emphasize, is that none of those options involve forcing any senior to 
ever leave traditional Medicare.
  Conferees are working around the clock, almost literally around the 
clock. We meet again tomorrow. We will meet Monday and Tuesday, on 
Veterans Day. My veterans back home will not be happy to hear that, but 
we will be up here meeting Monday, and we will be meeting on Tuesday 
and there is a possibility, a very strong probability, we may not have 
any votes in the House next week, but the conferees will be here as we 
were during the last few days when we did not have any votes for 3 days 
during the particular week.
  We are trying to reach a compromise on this issue. I am hopeful that 
we will emerge with a conference report that will add a new 
prescription drug benefit that will be available to all Medicare 
beneficiaries but be voluntary, provide seniors with new choices under 
Medicare and reimburse our health care providers, including physicians, 
fairly, so that beneficiaries will continue to have access to high 
quality care.
  Mr. Speaker, the gentlewoman means well, and we have worked well 
together in the past, but I submit that this motion to instruct will 
not help us to meet that goal. I urge my colleagues to oppose it.
  Mr. Speaker, I yield back the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  I want to thank my colleague from Florida. I do appreciate his 
discussion about the importance of supporting our physicians and our 
Medicare providers. I have noticed his leadership in the past of 
restoring the cuts that have been coming with a steady drumbeat since 
1997, really, and have gone to the bone in terms of their ability to 
stay, delivering Medicare to our seniors and our citizens with 
disabilities. I support his efforts to do that as well.
  That is what this motion to instruct conferees is all about. It is 
about the ability to keep that 1.5 percent that is already in the 
underlying bill and to perfect the bill, to make it something that we 
can support in a bipartisan fashion, by taking the funding that would 
be used for the privatization that would be used to subsidize the 
insurance companies to deliver Medicare services, amounting to $6 
billion, and put that funding right away instead to the providers who 
need this kind of support.
  Mr. BILIRAKIS. Mr. Speaker, will the gentlewoman yield?

[[Page H10443]]

  Mrs. CAPPS. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. That $6 billion, as I understand it, is in the Senate 
version. There is no money contemplated in terms of a cost in the House 
version. But in any case I do not disagree with her on this $6 billion.
  Mrs. CAPPS. We are assuming the Senate bill will have some play in 
the discussion that is perhaps going on in the conference committee at 
the moment, and that is where we would urge the attention of the 
conferees to be put, that there is funding that has been set aside in 
the Senate bill that would make quite a difference in Medicare 
providers being able to stay, particularly in rural areas to continue 
to deliver the service.
  I have seen the statement of the AMA and the osteopaths on this 
motion to instruct, and I need to say clearly for the Record that these 
letters do not describe correctly my motion to instruct. My motion to 
instruct supports the AMA position on physician fees. This motion 
explicitly supports the provision in the House bill that provides 
immediate assistance to doctors. In no way does it delay or support a 
delay in fixing the physician fee problem. Despite what the AMA and 
other groups have said, this motion does not delay permanent actions on 
fixing the sustainable growth rate. This motion does not address a 
long-term fix, but neither does the House bill.
  The reason the House bill does not have a long-term fix is because it 
is very expensive. My motion would prevent the conference from spending 
money on risky privatization schemes when that money should be used to 
help finance a long-term solution to the physician fee problem. I 
believe the AMA must have been reading a different motion. Their 
statement says we are taking money from patients to give it to 
physicians. It could not be further from the truth.

                              {time}  2045

  Section 231 of the Senate bill has the Federal Government paying 
private plans, not patients. I frankly think that patients would be 
better served if that money went to their own doctor than to bribe some 
private plan to pay for their services or to play in the field.
  I am disappointed that the AMA has so inaccurately described my 
motion, and I hope this is an inadvertent mistake. I have work very 
closely with the AMA and other professional groups on the problem of 
physician fees; and recently I brought Tom Scully, the administrator of 
Medicare, to a meeting of doctors in my district. The motion I am 
offering today is designed to respond to the concerns that they raised 
in that meeting with Administrator Scully. The AMA is wrong about what 
my motion does, and their position does not reflect the position of 
doctors in my district.
  In addition, I wanted to address the gentleman's comments about 
leaving traditional Medicare in place. This House bill, which we have 
dealt with in the House before, will lead to rising Medicare part B 
costs because it would leave the sicker patients in traditional 
Medicare, while healthier seniors will go to HMOs. We have seen this in 
the Medicare+Choice plans, and we will certainly see it in a plan such 
as is proposed in this underlying bill. This is going to lead to much 
higher premiums for those who remain in Medicare. Seniors who do not 
want to join an HMO will be forced to because their premiums will be to 
expensive.
  Mr. Speaker, this is a clear and very simple choice. On the one hand, 
we have HMOs and the insurance industry. On the other hand, we have the 
doctors who administer care, who know how to do this every day under 
Medicare, and their patients. The House and Senate bills seek to impose 
an untried and unnecessary privatization scheme onto Medicare. They 
will overpay HMOs in a bribe to get them to cover beneficiaries. These 
provisions would force seniors into private plans and drive up the 
premiums on those who stay in traditional Medicare. It would mean that 
seniors in different parts of the country would be paying different 
amounts for the same care. Instead of jeopardizing the Medicare system 
in this way, we could be ensuring that Medicare beneficiaries could see 
their doctors by making sure that they are reimbursed appropriately.
  Support this motion to instruct to be sure that conferees support 
doctors over HMOs and protect our constituents from ill conceived 
changes.
  So that is the motion to instruct conferees that we have proposed and 
that we hope will be passed in this House of Representatives so that 
the conferees will take seriously these recommendations to improve the 
underlying Medicare bill and make it something that could receive 
bipartisan support in the House of Representatives.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Pearce). 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 gentlewoman from California (Mrs. Capps).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mrs. CAPPS. 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 are postponed.

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