[Congressional Record Volume 149, Number 167 (Tuesday, November 18, 2003)]
[House]
[Pages H11493-H11500]
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

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

       Ms. Berkley 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 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.

  Ms. BERKLEY (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 Nevada?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the 
gentlewoman from Nevada (Ms. Berkley) and the gentlewoman from New 
Mexico (Mrs. Wilson) each will control 30 minutes.
  The Chair recognizes the gentlewoman from Nevada (Ms. Berkley).


                             General Leave

  Ms. BERKLEY. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on this motion to instruct.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Nevada?
  There was no objection.
  Ms. BERKLEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise to offer a motion to instruct the conferees on 
the Medicare Prescription Drug Bill to provide a much needed payment 
update to physicians for the next 2 years.
  I represent Las Vegas, which is home to the fastest growing seniors 
population in the United States. In my community, we are facing a 
health care crisis. The rapid growth of southern Nevada has put a 
strain on the health care system, and many doctors face a tough choice 
when it comes to treating Medicare patients because reimbursements are 
not keeping up with the costs of practicing medicine. In addition to 
staffing costs and utilities and rent, malpractice insurance for 
doctors in my community has skyrocketed anywhere from 150 to 400 
percent.
  We rely on our doctors to treat more than 150,000 seniors under the 
local Medicare system; but with the cost of doing business so high and 
the demands for their services at a premium, in many instances our 
doctors cannot afford to see new Medicare patients. We used to talk 
about the quality of health care, but the situation is becoming so bad 
that we are no longer talking about the level of treatment the patient 
receives, but whether or not they will receive any treatment at all.
  My community is struggling to attract enough medical professionals to 
address the health care needs of our ever-expanding population. But how 
can we expect more doctors to see more Medicare patients if we continue 
to cut payments to doctors under Medicare? If we do not act soon, there 
will be another 4.5 percent reduction in reimbursements to physicians 
who are treating those who depend on their physicians' care the most, 
our seniors.
  If we allow this to happen, the result will be a loss of $17 million 
in payments to physicians in my State of Nevada alone. The time is long 
past due that we increase these payments which have limited medical 
providers from expanding the number of patients receiving care. I have 
heard from doctors in Las Vegas who say they want to treat Medicare 
patients, but they are being forced to choose between taking on new 
Medicare patients or keeping the lights on in their offices and their 
practices solvent.
  According to the AMA, since 1991 the cost of practicing medicine has 
gone up by more than 33 percent, but payments have grown less than 10 
percent. For years doctors have provided important tests for seniors 
for cholesterol, depression, blood pressure, vision, and hearing 
impairment without any reimbursements from Medicare.
  Medicare reimbursements for primary care are inadequate, and in 
January they will be too low for many doctors to continue to serve 
Medicare patients. Just last year, doctors' payments were cut by 5.4 
percent; and if we allow them to be cut once again, this will be the 
fifth reduction since 1991 and would place doctors' reimbursements 8 
percent below 2001 levels. It does not make any sense to be cutting 
payments to doctors when the

[[Page H11494]]

costs of practicing medicine are on the rise.
  Our doctors simply cannot afford to take any more cuts. Already one-
quarter of the family physicians across the Nation are saying they can 
not accept any new Medicare patients. Who knows how many more will 
choose to do the same in January when they are told their 
reimbursements have been slashed once again?
  As a Nation we must provide our doctors with the means to treat and 
provide health care to our citizens. This motion would instruct the 
conferees to protect the language in the House version of the 
Prescription Drug Bill that would reverse the cut to our physicians 
while providing a 1.5 percent increase in payments for the next 2 
years. To fund the increase in payments to our doctors, this motion 
strikes funding for privatization provisions in the Prescription Drug 
Bill.
  The Centers for Medicare and Medicaid Services estimated that under a 
privatized Medicare, premiums would skyrocket for the seniors who 
choose to stay in traditional Medicare. I am concerned that by 
increasing the premiums of traditional Medicare, many patients would be 
forced into HMOs and other private plans. This 1.5 percent increase 
will give doctors nationwide enough to continue to treat seniors on 
Medicare, and it will give Congress time to develop and permanently fix 
this flawed system that shortchanges doctors and continues to restrict 
the ability of seniors to access health care services.
  I ask my colleagues to work with me to fix the Medicare physician 
reimbursements formula which currently threatens to destabilize the 
Medicare program. Seniors rely on their doctors and the medicines they 
need to stay healthy. Seniors have waited too long for a prescription 
drug benefit in Medicare and relief from high prescription drug costs. 
We must work together for a drug benefit that prevents seniors from 
risking their health by cutting pills in half or having to choose 
between paying for medicine and paying for their rent, their 
electricity or even the purchase of their food.
  For 4 decades this Nation promised that Medicare would provide health 
care for all seniors. It is a program that ensures these hardworking 
older Americans who have paid taxes and have paid into the system will 
have health care coverage.
  I urge my colleagues to vote for this motion to allow our 
constituents to continue to choose what doctors they see, what 
hospitals they are treated in, and to continue to access the highest 
quality of care.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, it is a little bit hard for me to understand why we are 
going to vote on this motion to instruct or why my colleague from 
Nevada has offered it, because the conference committee on the Medicare 
bill has already agreed that we are not going to have the provisions in 
there that she is worried about that we are going to adjust the 
physician payments.
  In fact, the American Medical Association has written to us asking us 
to strongly oppose the Berkley motion to instruct and urges the 
conference to pass the pending Medicare conference report. So, in fact, 
I think the problem that the gentlewoman has addressed or has 
identified here has already been addressed in the conference report to 
the satisfaction of physicians nationwide. Perhaps to explain this a 
little bit more fully we will turn to a physician.
  Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. 
Burgess), who is an OB-GYN and he has worked very hard on issues 
related to health care.
  Mr. BURGESS. Mr. Speaker, I thank the gentlewoman from New Mexico 
(Mrs. Wilson) for yielding me time.
  Mr. Speaker, I confess to being a little bit mystified as to why we 
are here tonight with a motion to instruct conferees when the 
conference report appears to have been decided; but I am just a simple 
country doctor, and I do not always understand the ways of Congress.
  But the motion to instruct as I understand it would strip out 
important competitive provisions in the Medicare conference report and 
redirect funds allegedly towards reimbursement of physicians. The 
conference committee has reportedly included a provision that will 
provide physicians with positive updates in 2004 and 2005. That is not 
a permanent solution. It does provide Congress with the time it needs 
to make long-term substantive changes to the Medicare physician payment 
formula. It will also ensure that Medicare beneficiaries continue to 
access high-quality health care.
  That is why the American Medical Association, the American 
Osteopathic Association, and the Alliance of Specialty Medicine all 
strongly support the House Medicare bill.
  I am aware the supporters of the motion are attempting to portray 
this as a choice between HMOs or doctors; and this is false and the 
authors know it is false. However, do not take my word for it. Listen 
to what the AMA has to say about this motion: ``Simply attempting to 
transfer dollars from patients to physicians through some ambiguous, 
unspecified mechanism, as is intended under the motion to instruct, 
would not change the flawed Medicare payment formula and thus would not 
ensure long-term access for Medicare patients.''
  As mentioned before, the House bill increased reimbursements for 
physicians and is supported by the physician community. It also 
provides seniors with more choices under Medicare and attempts to make 
some long-term competitive reforms so that Medicare is available and on 
sound financial footing for generations to come.
  Mr. Speaker, Medicare spends $247 billion a year as it stands. The 
gentlewoman that offered the motion to instruct is from Nevada and, of 
course, Nevada has had a serious problem with liability in recent 
years. In fact, a study by Kessler in 1996 showed that with two 
diagnostic codes, $50 billion a year could be saved in Medicare if we 
did not have to bear the costs of defensive medicine in this country. 
That $50 billion would more than fund the $40 billion a year with which 
we are seeking to add a prescription drug benefit.
  The House-passed Medicare bill does not ever require that Medicare 
beneficiaries leave traditional Medicare. I might add that we will have 
a new out-patient drug prescription drug benefit available to 
beneficiaries. Anyone who says otherwise either does not understand the 
legislation or does not care to talk about the facts.
  This is an irrelevant motion introduced only to score political 
points. I urge Members to recognize it for what it is and to vote 
against the motion.
  Ms. BERKLEY. Mr. Speaker, I yield 10 minutes to the gentleman from 
Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentlewoman from Nevada 
(Ms. Berkley) for her leadership on health care issues and for her 
advocacy on behalf of seniors, especially in Nevada, and around the 
country.
  Mr. Speaker, I normally when speaking on the House floor do not quote 
from a television show, but I would like to start this evening with 
several of my colleagues. The gentlewoman from Ohio (Mrs. Capps), the 
gentleman from Rhode Island (Mr. Kennedy) and maybe some others, maybe 
the gentleman from New Jersey (Mr. Pallone) and the gentleman from 
Massachusetts (Mr. Delahunt) are going to speak on this too.
  I am quoting from Al Hunt on ``Capital Gang.'' If you have seen that 
show, those people watching, you know he does something called the 
``Outrage of the Week.'' He says: ``Now for the outrages of the week. 
The American Association of Retired Persons, the largest lobby for the 
elderly, is on the verge of selling out many seniors on the Medicare 
bill.'' This is a commentator saying this, not me. ``The legislation as 
it now stands would deny 4 million retirees coverage they currently 
get, would give sweeping new powers to HMOs over the traditional one 
for Medicare,'' basically a $12 billion pay-off to the insurance 
companies, ``and would gut a measure approved by both Houses to 
facilitate importation of cheaper prescription drugs from Canada,'' 
from countries that charge two and three and four times what the drug 
companies do in this country.
  ``The AARP Washington lobbyists apparently care more about their own 
influence than what they can do for struggling seniors.''

[[Page H11495]]

  Mr. Speaker, we should not be surprised by this. Let me share some 
comments, some articles written about AARP which most of us in 
Washington know is one of the largest insurance companies in the 
country.
  In Newsday 3 years ago, ``Critics say AARP, which formally unveiled 
its new headquarters building in downtown Washington last month, has 
softened its earlier militancy because it is preoccupied with its 
profit-making enterprise, including $100 million in earnings from the 
sale of insurance.''

                              {time}  2200

  The Denver Post wrote not too long ago, ``AARP receives more than 
$100 million in revenue from health insurers.''
  Newsday wrote, ``Critics suggest that AARP's substantial profits from 
the sales of insurance policies, drug company advertising,''--no 
surprise there either considering they sold out to the drug industry on 
this one,--``drug company advertising in its magazines, and investment 
schemes conflict with its interests on behalf of seniors. AARP 
President William Novelli acknowledged complaints from members that 
AARP has been too timid in the political battles to defend Medicare and 
Social Security. He conceded that AARP has pulled its punches since 
right-wing groups and Members of Congress criticized it.''
  Capital News Service wrote, ``AARP's pharmacy service,''--its 
connection to the drug industry, think about that,--``is part of its 
insurance sales operation which generated $101 million in revenue last 
year, 17 percent of the organization's total budget.'' No wonder they 
are there for this bill that enhances the profits of the drug industry, 
$150 billion it enhances their profits and gives a $12 billion blank 
check to the HMOs in this country.
  Milwaukee Journal says, ``AARP receives millions of dollars from 
UnitedHealthcare, a national health insurance firm based in 
Minnesota.''
  Now, Mr. Speaker, in the last minute or two before yielding to my 
friends, I want to mention that Mr. Novelli, who is the head of AARP, 
who did the negotiations, these tough-minded negotiations with the drug 
companies and the insurance companies, Mr. Novelli wrote the preface to 
Newt Gingrich's book on how to reform Medicare.
  Newt Gingrich is the guy that first thing after Medicare passed in 
1965, only 12 Republicans voted for it. Bob Dole voted no. Donald 
Rumsfeld voted no. Strom Thurmond voted no. All kinds of Republicans 
voted no. In those days, Republicans did not like Medicare. They say 
they do now, but then Newt Gingrich, when the Republicans finally took 
control of the House in 1995, the first thing Newt Gingrich did was cut 
$250 billion from Medicare to do what? Guess. To pay for a tax cut for 
the richest people in the country. Same old story.
  Mr. Novelli has decided he is buying in. The head of AARP writes the 
preface to Newt Gingrich's book on how to privatize Medicare, the same 
Newt Gingrich that said: If I have my way, Medicare's going to wither 
on the vine. The same Newt Gingrich that said that.
  Mr. Novelli writes, ``Newt's ideas,'' and they are on a first-name 
basis obviously as much time as they spent together trying to dismantle 
Medicare, ``Newt's ideas are influencing how we at AARP are thinking 
about our national role in health promotion and disease prevention and 
in our advocating for system change.'' If only his 40 million members 
knew that he was in league with Newt Gingrich to try to privatize 
Medicare; that he, Mr. Novelli, was in league with the drug industry 
which will gain $150 billion, billion with a B, that is twice what we 
are spending in Iraq, $150 billion to the drug industry and a $12 
billion insurance payout to the insurance companies. That is like 1,000 
times more than Halliburton is still paying Dick Cheney, the Vice 
President of the United States.
  These things are pretty incredible, Mr. Speaker, when we think about 
the money that AARP is going to make from this bill. They are going to 
get in line behind the drug companies and the insurance companies with 
their hand out.
  Mrs. CAPPS. Mr. Speaker, will the gentleman yield?
  Mr. BROWN of Ohio. I yield to the gentlewoman from California.
  Mrs. CAPPS. Mr. Speaker, I thank my friend the gentleman from Ohio 
(Mr. Brown) for yielding to me.
  I want, first of all, to acknowledge this motion to instruct 
conferees and thank my colleague from Nevada. It is very appropriate 
that this motion be submitted at this time as we are aware that the 
conferees on the Medicare modernization bill are meeting, but some news 
has been trickling out, even though to my knowledge there are Members 
only on one side of the aisle attending that conference report from the 
House of Representatives, and so it is just bits and pieces of news 
that come.
  I am thankful that my colleague from Ohio mentioned the fact that 
AARP has endorsed this legislation which we really have not seen yet, 
but they must know some things about it, and I just want to say to my 
colleague that I sent Mr. Novelli a letter today resigning my 
membership, withdrawing my membership from AARP. I remember so clearly 
members from the organization from the Washington office coming to my 
office to tell me in very strong language this summer about the four 
principles that they were high bound must be in a prescription 
medication bill, a Medicare modernization bill, including defined 
benefits, including no means testing, including other standards, all of 
which are fast disappearing from the legislation as it is being 
prepared to bring to the floor for a conference vote before we adjourn 
here.
  As this discussion goes on, I cannot get out of my mind the faces of 
the seniors in my district, several meetings over the past several 
weeks that I have had with them, seniors who signed up for 
Medicare+Choice, that partnership between the private sector, the HMOs, 
the insurance companies and Medicare, a volunteer program, voluntary 
program that they signed up for to help pay their prescription 
medications. In my congressional district which is, a lot of parts of 
it are rural, one after another of these HMOs after raising their 
premiums, after raising their copays, have left. In parts of my 
district, there is no choice for seniors but straight Medicare or 
medigap programs, and in other areas, there is one program just hanging 
on by a thread.
  So the high cap program, the part of Medicare that provides a 
voluntary counseling service, had gathered seniors together to explain 
to them why they got this letter from the HMOs saying that they were 
going to withdraw from the area, not serve them any longer, confuse 
seniors in their eighties, many of them with health conditions. They 
were frightened. They were frustrated, and they do not want this 
legislation. They know very well what happens when we begin the 
process, which this bill most certainly will do, to take us into 
privatizing of Medicare, exactly what the former speaker, Mr. Gingrich, 
had in mind when he became Speaker of the House in the last decade.
  This bill, the House bill and the Senate bill which are now being 
reconciled, are trying to impose an untried and really unnecessary 
privatization scheme. Medicare works. The piece that needs to be 
modernized is the prescription benefit. Privatizing Medicare will, 
contrary to what someone from the other side of the aisle said, will 
not give seniors that backup, because it will force and by bribing the 
HMOs, by putting money up front to the HMOs, which this motion to 
instruct seeks to remove, by bribing the HMOs to come into an area, the 
folks who are left with Medicare, straight Medicare will be the older 
and the sicker seniors, because those HMOs will raise their rates. They 
will raise their premiums, they will cherry pick, and only the sick 
seniors, the old seniors who have the highest costs will be left with 
straight Medicare. That is not a choice and that is going to happen. It 
will be happening before the end of this decade if this bill is passed 
and goes into effect.
  This is something our seniors know very well, and the seniors who 
have contacted my office today in response to my removing myself from 
AARP are thankful that we are speaking up because they know that this 
is something that will not benefit them.
  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.
  I think all of us agree that Medicare is one of the most successful 
health

[[Page H11496]]

care programs in the history of this country, and I think all of us 
have a right to be proud of what we are about to accomplish here 
because we have been elected to make a difference. All of us come here 
to make a difference on things that matter to the people that we serve, 
and a large number of national organizations, including the AARP and 
the American Medical Association, the hospital association, have all 
endorsed what we are about to accomplish.
  I am very pleased to welcome this evening the other doctor from the 
State of Georgia (Mr. Gingrey) to explain further what this bill is 
going to do for Americans.
  Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from Georgia 
(Mr. Gingrey).
  Mr. GINGREY. Mr. Speaker, I thank the gentlewoman from New Mexico for 
yielding time to me.
  Mr. Speaker, there they go again. They do not like the message so 
they start trashing, trashing the messenger, and in this case, the 
messenger just happens to be 35 million seniors who are members of the 
AARP. Excuse me, 35 million less one. The gentlewoman from California 
just told us that she resigned.
  This is a solution, Mr. Speaker, in desperate need of a problem. The 
motion to instruct conferees, like so many that the minority has 
offered before, serves no useful purpose in this debate. They are 
simply political tools used in a desperate attempt to divert attention 
away from the fact that the Republican House will in a matter of days 
deliver, it will deliver on its commitment to providing seniors with 
access to meaningful, affordable and comprehensive prescription drug 
coverage.
  Mr. Speaker, I support properly reimbursing physicians. The House 
bill did that and so does the bipartisan Medicare conference agreement 
which is why it is supported by a number of medical societies, 
including the American Medical Association.
  Listen to what they say: ``The American Medical Association strongly 
supports passage of the Medicare prescription drug conference report, 
which currently includes historic and critical provisions for improving 
choice and access for Medicare seniors and disabled patients. In 
addition,'' Mr. Speaker, ``in addition, the conference report would 
halt 2 years of impending Medicare payment cuts to physicians and other 
health professionals and replace them with payment increases of at 
least 1.5 percent per year. Because the Medicare conference report 
includes these critical provisions for improving choice and access, the 
AMA strongly opposes the Berkley motion to instruct and urges Congress 
to pass the pending Medicare conference report before they adjourn.''
  If the gentlewoman from Nevada is serious about wanting to help our 
Nation's providers, our physician providers, and I trust that she is, I 
would urge her to reconsider her opposition to medical liability reform 
legislation such as H.R. 5, the HEALTH Act, the tort reform bill, a 
bill that was strongly supported by both the AMA and the Nevada Medical 
Association. The other body has not acted yet, so the gentlewoman will 
have yet another chance to truly support physician providers.
  Mr. Speaker, I strongly support the bipartisan Medicare conference 
agreement, and we will soon consider this on the House floor. This 
motion to instruct no longer serves any purpose. Indeed, the provisions 
related to Medicare competition that the gentlewoman references in her 
motion are not even part of the final conference committee agreement.
  I urge my colleagues to join me in rejecting this motion to instruct 
and supporting the final Medicare conference agreement.
  Ms. BERKLEY. Mr. Speaker, I yield 5 minutes to the gentleman from 
Rhode Island (Mr. Kennedy).
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I want to thank the 
gentlewoman from Nevada for offering this motion, and I reject those 
who would call it political.
  Yes, believe it or not, we are in a political body, and yes, believe 
it or not, we live in a democracy where we are Representatives of the 
people, and we represent those folks the best we can. The gentlewoman 
from Nevada is doing her job in highlighting the fact that the 
Republican conference report on the Medicare bill is a sham.
  If this was about prescription drug coverage, we would have it all 
done. There is no disagreement from anyone about the fact that 
prescription drug coverage ought to be passed. We are talking about 
$400 of prescription drug coverage for seniors. It would be done 
tonight. We could have it on the President's desk. There would not be 
one person against it other than those who are dead set against any 
kind of Medicare improvement whatsoever.
  The problem the gentlewoman has accurately identified is that this 
premium support plan that is essentially part of their reform is 
untenable. It is untenable because the nature of senior citizens, their 
high risk of needing health care, is such that, guess what, we needed 
the Medicare program because when we relied on the private sector, the 
private sector was not there.

                              {time}  2215

  That is why we have the Medicare program, for those who do not 
understand what we are talking about tonight. We have the Medicare 
program because when left to the private sector, they did not cover 
seniors because they were too high risk.
  So what do the Republicans propose? They propose going back to the 
days before we passed Medicare, where we left the seniors' health care 
to private insurers. Now, what are private insurers going to do? Guess 
what, they are going to have to figure out a way to make a profit. How 
do you make a profit with risk insurance when you have someone as high 
risk as a senior citizen? Well, if you are smart about your insurance 
practices, you try to avoid the risk. That is the whole nature of 
insurance, to avoid risk.
  I hope I am not telling anyone anything new, but that is the nature 
of insurance. So you avoid risk, and that means avoid the sickest 
seniors. Avoid the seniors who will cost the most. And there will be no 
argument from the other side on this because it flies in the face of 
the for-profit nature of the HMO companies that they are about to turn 
our Medicare system over to.
  So you avoid all the seniors that are costing you, you take the 
seniors that do not require much health care and you want to sign them 
up. And then what do you do? What happens to all those seniors that are 
not signed up? Oh, you propose to leave them in the traditional 
Medicare program, but will increase the premiums of part B on the 
traditional Medicare program to cover the increased cost that the 
Medicare program will incur. And the Republicans put a provision in the 
Medicare program saying that if it should exceed certain cost 
guidelines, then we will have to come back to Congress to figure out 
what to do.
  Well, guess what is going to happen then? At that point you will say, 
well, we are going to have to dismantle Medicare because, guess what, 
it just is not working. Well, you are setting it up not to work. You 
are underfunding it. And if my colleagues do not believe anything I am 
saying, just understand this. Who is in favor of this bill? The 
pharmaceutical industry. Why are they in favor of this bill? Because it 
does not do what needs to be done to take on the pharmaceutical 
industry and say you need to give in this matter.
  Thirty percent profit rates for the pharmaceutical industries are too 
much when our seniors are barely able to make it buying the 
prescription drugs they need and affording them the health and other 
things they might need in terms of housing and food and the like. The 
pharmaceutical companies like the Republican bill.
  Who else likes the Republican bill? Guess what, the insurance 
companies like the Republican bill. And as the gentleman from Texas 
(Mr. DeLay) has said before, and the gentleman from California (Mr. 
Thomas), the chairman of the committee, and so we do not misunderstand 
their intentions, because they said it very clearly, and here is the 
chairman of the committee: ``To those who say that the House bill ends 
Medicare as we know it, our answer is: we certainly hope so.''
  Well, my friends, if senior citizens are comfortable with the fact 
that the future of Medicare is in the hands of those who believe in the 
private sector, then so be it.
  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.

[[Page H11497]]

  Sometimes I feel here like we are looking through the looking glass, 
like in the Alice in Wonderland book. Sometimes things people say do 
not make any sense to me at all. I do not understand how can people say 
we have underfunded, when we are just about to add $400 billion in new 
benefits to Medicare.
  When Medicare was started back in 1965, medicine was only 1 percent 
of the cost of health care. We did not have the miracle medicines that 
we have today. Cancer, the diagnosis of cancer in 1965, was a death 
sentence. Today, people survive it because of medicine. And yet we have 
a system under Medicare that will pay for a diabetic to go into the 
hospital and have their foot amputated but will not pay $29.95 a month 
for the Glucophage to control blood sugar.
  That is why so many seniors in New Mexico have opted for something 
called Medicare+Choice, because that is the only thing in Medicare that 
has given them something of a prescription drug benefit. Now, this is 
my card as a Member of Congress. I am actually a member of an HMO, like 
a whole lot of New Mexicans. It is very common in New Mexico. Forty 
percent of seniors in New Mexico take advantage of these kinds of plans 
because it has given them some choice and some options, when Medicare 
has not given them that choice before.
  What we are adding to Medicare this week is a guaranteed benefit not 
just for people who are fortunate enough to live in Albuquerque, New 
Mexico, but for everybody else who has not had that opportunity: a 
guaranteed benefit under Medicare to add prescription drugs. That 
reduces the cost of medicine for everybody, and that gives people 
choices and options.
  I think people want choices. If you are in Santa Rosa, New Mexico, 
maybe you want to get your prescription drugs by mail order. My family, 
we like to get it at the pharmacy, at the Journal Center at Loveless, 
just because that is convenient for us; but seniors should have those 
choices.
  The other thing I think is important to seniors is that this is 
voluntary. If there is a senior, and I know a lot of veterans who are 
already covered by the VA or folks who have earned their health 
benefits through employment and they have great retiree plans, they do 
not have to sign up for this if they do not want to. But for those who 
do not have that coverage now, they will have the opportunity to get 
prescription drugs through Medicare.
  Now, why does all this matter? I mean, we talk here about deductibles 
and donuts and all these kind of things; but I had somebody call my 
office recently, her name is Bertha Griego, and she is a wonderful lady 
who is 74 years old. She has lived all her life in New Mexico, and she 
talks with affection about the 1929 Model T her dad had driving around 
the dirt roads of New Mexico. She is a wonderful lady. And like most of 
our parents and grandparents, she has a growing list of ailments. Some 
of them are serious; some of them are just annoying. But prescription 
drugs have allowed her to live a relatively healthy life in her senior 
years.
  Last year, she paid $1,700 for the whole year just in copayments for 
her medicine. She is on a fixed income. Her husband, Robert, also has 
medical bills; and he gets Social Security. He has a small pension. All 
together they earn about $16,000 a year. Well, when you pay the 
groceries and the light bill and the heating bill, the checking account 
gets a little short by the end of the month. And that happened 
recently.
  Mrs. Griego ran out of money in the checking account 7 days before 
the next check came in. She also ran out of Lovexil, which is a 
medicine she takes for her thyroid problem. The pharmacist told her if 
she did not buy her medicine in the next 7 days, she would get a little 
groggy and tired in the meantime. And that is what happened. But Mrs. 
Griego could not get her pills until she had her check.
  In New Mexico, 52 percent of seniors are low income, including Bertha 
and Robert. When we pass this legislation, and we get this program in 
place, Bertha and Robert will not have to wait for the next Social 
Security check to come in to buy their medicine. And that is why this 
matters. That is why we have a responsibility to do what we can with 
what we have from where we are and start making a difference for the 
problems that affect the people we care so much about.
  Mr. Speaker, I reserve the balance of my time.
  Ms. BERKLEY. Mr. Speaker, I yield 30 seconds to the gentleman from 
Rhode Island (Mr. Kennedy).
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank the gentlewoman for 
yielding me this time, just a couple of seconds to respond to the 
gentlewoman from New Mexico.
  The fact of her being so passionate about seniors I do not question 
whatsoever, but if she was truly interested in helping those low-income 
people, then how come her votes and those of her colleagues repeatedly 
have cut the very programs on behalf of the people that she says she is 
trying to help? Instead, her party votes to cut taxes for the richest 1 
percent of our population, those with incomes over $350,000, by nearly 
$2 trillion. And two-thirds of that goes to the wealthiest 1 percent.
  And I might add that when they are done with this Medicare bill, they 
are going to give all the money they cut; they are going to add to 
special interest money for those with HMOs and those with 
pharmaceutical interests. And do not take my word for it; just look at 
the Wall Street Journal. The HMOs and the pharmaceutical companies are 
jumping up and down thanking the gentlewoman from New Mexico for giving 
them a gift.
  Ms. BERKLEY. Mr. Speaker, I yield 3 minutes to the gentleman from New 
Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I have a great deal of respect for the 
gentlewoman from New Mexico, and also the gentleman from Georgia, but I 
have to say I feel like I am listening to Alice in Wonderland when I 
listen to what the two of them are saying about this Medicare 
conference report that we are about to vote on in a few days.
  The gentlewoman said that Medicare is very successful, and she 
pointed out that we are adding $400 billion to the program. But I would 
ask a very simple question: If it is so successful, why do we not just 
add it as a drug benefit and give the seniors the $400 billion for 
their prescription drugs?
  That is what the Democrats proposed. We said, right now you have part 
B where you pay so much, I think it is about $50 a month for your 
doctor's care, a $100 deductible, 80 percent of the cost paid for by 
the Federal Government, and 20 percent copay. That is what the 
Democrats proposed. We said, do the same thing with prescription drugs: 
have the seniors pay $25 for a premium, a $100 deductible, 80 percent 
of the cost paid for by the Federal Government, 20 percent copay up to 
a certain amount, and then it becomes catastrophic. But that is not 
what the Republicans did.
  The reason that the gentlewoman from Las Vegas is proposing this 
motion is because she does not want to give money to the HMOs. She does 
not want to force seniors to have to go to an HMO to get their 
prescription drugs. She says, let us give this money in this case to 
the doctors or let us give it to the seniors in some way so they 
benefit from it.
  I totally agree with the gentlewoman that we need to provide 
prescription drug coverage and preventive care for seniors, but then 
why are the Republicans giving away money to the HMOs? Why are they 
forcing seniors to go to an HMO to get their prescription drug 
coverage? Sure, if someone wants to join an HMO, like in my State, some 
people do get their drug coverage, I have no problem with that; and I 
know the gentlewoman does not. But this forces the seniors into the 
HMO. My colleagues are saying they have to join an HMO in order to get 
the prescription drug coverage. And that is not fair. That is not 
choice. That is not voluntary.
  Now, the gentleman from Georgia, said, well, we are providing with 
this Medicare agreement meaningful, affordable, and comprehensive 
coverage. That is simply not the case. First of all, seniors are being 
forced into an HMO. The Republicans are privatizing Medicare in the 
long run. But think about this benefit that you are giving the senior 
citizens. First of all, we do not even know what the premium is, so it 
may not be affordable at all. There is no set premium. We know that the 
deductible is $275, not $100, like it is for part B. And then there is, 
in fact, as the gentlewoman mentioned, this huge donut hole when you do 
not get any

[[Page H11498]]

coverage at all. So the seniors in the long run are going to be paying 
more out, in my opinion, than they are going to get back.
  Now, yes, this is a voluntary program. But what good is it if nobody 
sees fit to sign up for it because they will be forced into an HMO or 
they will have to pay so much money out of pocket that they do not get 
a meaningful, affordable, or comprehensive benefit the way the 
gentleman from Georgia described? None of that is the case here.
  Finally, why can we not have real competition? Let us have the 
Medicare administrator negotiate price reduction. That is not in this 
bill either.

                              {time}  2230

  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, this bill does not force anybody to join an HMO, but 
seniors have the right to choose to get their medicine from managed 
care if they want to. Or if they want to, they can choose a stand-alone 
prescription drug plan or they can have it integrated with a fee-for-
service plan that works for them.
  People choose different ways to get their health care. My family has 
made our choice, and we are comfortable with why we make those choices 
for a lot of reasons, but we should have enough variety in this new 
system so we do not have a one-size-fits-all system, and that seniors 
have the right to choose, whether it is a stand-alone prescription drug 
program, a mail order program, added to fee-for-service, or rolled into 
a managed care plan, if that is what citizens want, that is what we 
have tried to do.
  I have to say, in the end, this program is being supported by a 
pretty broad array of organizations who see it for what it is, a very 
good step towards providing prescription drugs to seniors in this 
country.
  Mr. Speaker, I reserve the balance of my time.
  Ms. BERKLEY. Mr. Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Woolsey).
  Ms. WOOLSEY. Mr. Speaker, I thank the gentlewoman for yielding me 
this time.
  Mr. Speaker, I would like the gentleman from Georgia to know he is 
going to have to continue doing the math and subtraction because the 
gentlewoman from California (Mrs. Capps) is not alone in resigning her 
membership today. I resigned mine, and I also circulated a letter here 
on the House floor, and within 30 minutes I had over 50 Members sign a 
letter to Mr. Novelli saying they were resigning their membership 
because of his change in his positions with AARP determining that it is 
more important to protect their insurance industry and their own 
insurance company than protecting the membership of AARP.
  I want Members to know each time one of us announces that we have 
resigned and our constituents hear of it, we get calls back saying oh, 
I am resigning, too. I want to tell Members when the seniors in this 
country catch on to what the other side of the aisle are doing to them, 
they are going to want to resign.
  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I am not old enough to join AARP, but since they have 
become such a big part of this debate, I want to read what they have 
said. It is not an unqualified endorsement. I have never seen the 
perfect bill yet in this job, but it is a pretty good bill. I think the 
AARP came to that conclusion. I would like to enter their statement 
into the Record, but maybe reading some parts will explain where they 
are coming from. It is dated November 17, 2003, AARP endorses Medicare 
prescription drug bill, and this is directly from them.
  ``AARP today announced its strong endorsement of the prescription 
drug bill offered by the conference committee and will work vigorously 
for its passage.
  ``AARP believes that millions of older Americans and their families 
will be helped by this legislation. Though far from perfect, the bill 
represents an historic breakthrough, an important milestone in the 
Nation's commitment to strengthen and expand health security for its 
citizens at a time when it is sorely needed.
  ``The bill will provide prescription drug coverage at little cost to 
those who need it most: People with low incomes, including those who 
depend on Social Security for all or most of their income. It will 
provide substantial relief for those with very high drug costs, and 
will provide modest relief for millions more. It also provides a 
substantial increase in protections for retiree benefits and maintains 
fairness by upholding the health benefit protections of the Age 
Discrimination and Employment Act.
  ``AARP is pleased by the improvements made to the conference report 
in recent days. A new structure called ``premium support'' which 
required competition between traditional Medicare and private plans was 
downsized to a limited test starting in 2010, which has significant 
protections for those in traditional Medicare. The government will 
provide coverage in areas where private plans fail to offer coverage. 
The integrity of Medicare will be protected.
  ``An unprecedented $88 billion will encourage employers to maintain 
existing health retiree benefits. The legislation will help speed 
generic drugs to market and add important new preventive and chronic 
care management services. Finally, this legislation protects poor 
seniors from future soaring prescription drug costs.
  ``AARP is launching a national grassroots, advertising and 
information campaign this week to explain the legislation and urge 
bipartisan support for its passage.''
  Sometimes we get the kind of lukewarm endorsement around here that 
Members just pull a sentence or two of. This is not one of them. This 
is unqualified support from an organization that is not known for 
supporting Republican provisions in bills, frankly. And I think we got 
to this point because we put aside partisanship and politics and 
focused on making a difference for the people that we came here to 
serve.
  I think we have a right to be proud of what this body and this 
Congress as a whole is about to achieve this week. I welcome and 
commend the AARP for setting aside its traditional focus on sometimes 
which party Members are in and focusing on policy and not on politics.

             AARP Endorses Medicare Prescription Drug Bill

       AARP today announced its strong endorsement of the 
     prescription drug bill offered by the conference committee 
     and will work vigorously for its passage.
       AARP believes that millions of older Americans and their 
     families will be helped by this legislation. Though far from 
     perfect, the bill represents a historic breakthrough and 
     important milestone in the nation's commitment to strengthen 
     and expand health security for its citizens at a time when it 
     is sorely needed.
       The bill will provide prescription drug coverage at little 
     cost to those who need it most: people with low incomes, 
     including those who depend on Social Security for all or most 
     of their income. It will provide substantial relief for those 
     with very high drug costs, and will provide modest relief for 
     millions more. It also provides a substantial increase in 
     protections for retiree benefits and maintains fairness by 
     upholding the health benefit protections of the Age 
     Discrimination and Employment Act.
       AARP is pleased by the improvements made to the conference 
     report in recent days. A new structure called ``premium 
     support'' which required competition between traditional 
     Medicare and private plans was downsized to a limited test 
     starting in 2010, which has significant protections for those 
     in traditional Medicare. The government will provide coverage 
     in areas where private plans fail to offer coverage. The 
     integrity of Medicare will be protected.
       An unprecedented $88 billion will encourage employers to 
     maintain existing health retiree benefits. The legislation 
     will help speed generic drugs to market and add important new 
     preventive and chronic care management services. Finally, 
     this legislation protects poor seniors from future soaring 
     prescription drug costs.
       AARP is launching a national grassroots, advertising and 
     information campaign this week to explain the legislation and 
     urge bipartisan support for its passage.

  Mr. Speaker, I reserve the balance of my time.
  Ms. BERKLEY. Mr. Speaker, I yield myself such time as I may consume.
  I am absolutely astounded by the continued nonsensical talk about 
bipartisanship when the Democrats were not even allowed in the room 
when the decisions were made, when consumer groups were excluded, when 
there was absolutely no interaction of bipartisanship on this bill, and 
I dare say that we have not even seen the legislation yet in its 
completed form because it has

[[Page H11499]]

yet to come from the House leadership so all of us can review this. So 
this bipartisan discussion is nonsense.
  Mr. Speaker, I yield 2 minutes to the gentleman from Oregon (Mr. 
DeFazio) to enlighten all of us.
  Mr. DeFAZIO. Mr. Speaker, the gentlewoman from New Mexico (Mrs. 
Wilson) mentioned the VA. I assume she is aware as a veteran that the 
VA negotiates on behalf of all of America's veterans, and they have 
negotiated prices and the extortionate cost of pharmaceuticals of about 
60 percent. That is how we can afford to give them very inexpensive 
medications with a very small copayment.
  Those are similar to the reductions in Canada, about 50-60 percent, 
but the Republicans have prohibited in this legislation that the 
government should negotiate on behalf of the 40 million people in 
Medicare any reduction in the price of pharmaceuticals at the behest of 
the pharmaceutical industry. This bill also prohibits the importation 
of drugs from Canada. They say, no, it does not do that, we are going 
to give the authority of the Secretary of HHS to reimport the drugs, 
but guess what he has already said, he will not do it because they are 
not safe. But, in fact, arguably drugs, U.S. manufactured, FDA-approved 
drugs are safer when they come back from Canada because their supply 
chain is left corrupt in Canada because it is controlled by the 
government and because they negotiate 50-60 percent reductions in the 
price.
  The gentlewoman talks about competition. Guess what, the insurance 
industry who the gentlewoman wants to subsidize with $20 billion is 
exempt from antitrust law. They can throw out any senior at any time. 
We may get a 1-year plan from a company, but it is like every other 
form of insurance in America today, file one claim, next year you are 
back in the Medicare fee-for-service plan where the premiums have gone 
up because the industry has cherry picked people out until they need 
the service. They will give them a service grudgingly until the end of 
year until they can cut them off.
  The people in my district know HMOs, they know them really well. The 
HMOs pulled out. They said we are not making enough money in southern 
Oregon, we are pulling out of southern Oregon, and they did. Now, there 
are no options. So we are going to put people back into the plans and 
the graces of the private insurance industry, after giving them a $20 
billion subsidy without subjecting them to antitrust law and exempting 
them from any negotiation by the government to reduce the price of 
pharmaceuticals. This is a giveaway to the pharmaceutical industry, 
plain and simple.
  Mrs. WILSON of New Mexico. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, it is true the VA does negotiate very hard to get low 
costs for veterans in their system; and the reason and the way they do 
that is the same way we are going to see under these new plans because 
it is kind of like when Americans go down to Costco or Price Club, when 
buying in bulk, consumers are going to get a better price.
  Mr. DeFAZIO. Mr. Speaker, will the gentlewoman yield?
  Mrs. WILSON of New Mexico. I yield to the gentleman from Oregon.
  Mr. DeFAZIO. Mr. Speaker, I would ask the gentlewoman just to 
clarify, is the VA part of the government and are we prohibiting the 
rest of the government from negotiating on behalf of seniors?
  Mrs. WILSON of New Mexico. Mr. Speaker, reclaiming my time, I would 
be happy to answer the gentleman's question in my own way here.
  The VA does negotiate low prices because they have the leverage of 
having a lot of people who use the medicine. That is the same concept 
we are applying here, that there are large groups of people who can get 
a better price and get lower costs because they do it together. There 
is a group rate, just like we do if we go into Denny's with a large 
party, diners get a group rate and a lower cost.
  The estimates are that the cost of medicine will go down between 15-
25 percent, and we do not say that there has to be a Medicaid price. 
The companies can negotiate a low price, as low as they can get, and we 
give them leverage to do so. I think that is the way to go. And I think 
that guaranteed benefit is the way to go in this program.
  Mr. Speaker, in closing, we are about this week to pass historic 
legislation that has been a long time in coming. This House has passed 
Medicare prescription drug bills twice before, but this is the first 
time that the Senate has also passed something and we can meet together 
in the middle. Contrary to the protestations by some of my colleagues, 
there actually were Democrats in the room, Senator Baucus and Senator 
Breaux have both signed onto this approach, and without their support, 
we would not be passing this bill. I think that is important.
  I think it is important to set some of those partisan things aside 
and try to get things done, recognizing that it is not perfect, but we 
are getting something done for the people who need it. It is voluntary. 
It gives people choices. It gives the most help to those who are low 
income and those who have high medicine costs because they are very 
sick. For the first time in Medicare, we are going to really focus on 
chronic disease management so that we improve the quality of life of 
seniors in addition to extending the length of life.
  The biggest problem in Medicare today is that not enough seniors can 
afford life-saving medicine. We need to add this prescription drug 
benefit to Medicare.
  I told Members about a lady in my district and there is another one I 
met who is a great grandmother. Her name is Ella May Naser. She is 
older than Medicare. She is about to be 98 years old, and she is still 
sharp as a tack. She is on her own now, but in August of every year she 
has to change her health care plan from one Medicare+Choice system to 
another because she only gets about $685 a month, and at some point the 
prescription drug benefit runs out in her plans. She has one medicine 
to control her high blood pressure, another to prevent degenerative 
bone disease, and another one for glaucoma. She has family that helps 
her sort all of these things out and try to make sure that her plans 
cover what she needs because they know she will stop taking her 
medicine if she does not have the money to pay for it.
  This plan will help people like her. That is why we are doing this. 
That is why we have to set aside the little differences in order to 
accomplish the big things that people send us here to do.
  Mr. Speaker, I yield back the balance of my time.
  Ms. BERKLEY. Mr. Speaker, I yield 45 seconds to the gentleman from 
Massachusetts (Mr. Delahunt).
  Mr. DELAHUNT. Mr. Speaker, I think it is important that we note as a 
matter of record that where the gentlewoman from New Mexico (Mrs. 
Wilson) indicated there were two Democrats that were present at the 
conference, and the gentlewoman I understand served on that conference. 
The gentlewoman is aware that the gentleman from New York (Mr. Rangel), 
the gentleman from Michigan (Mr. Dingell), and the gentleman from 
Arkansas (Mr. Berry) were appointed by the leadership to serve in that 
conference and were denied access.

                              {time}  2245

  There was no input from the Democratic Party in this House into this 
particular conference.
  Ms. BERKLEY. Mr. Speaker, I yield myself the balance of my time.
  I have always believed in providing a prescription medication benefit 
under the Medicare system. It makes no sense to me that we have a 
Medicare system that allows seniors to see a doctor, the doctor 
prescribes the least expensive, most cost-effective way of dealing with 
illness, which is prescription medication. Many of the seniors in my 
district and throughout the United States cannot afford the 
prescription medication that the doctor prescribes. Being a doctor's 
wife and having a stepdaughter who is a third-year medical student, I 
do not need to be lectured by the other side of how the effect of these 
Medicare reimbursements are affecting doctors because I know firsthand 
and personal what it is doing. I know that the doctors are suffering 
and that there is a real crisis in health care and that our doctors 
need to be appropriately reimbursed for the Medicare patients that they 
see.
  But what I am opposed to is privatizing the Medicare system, and

[[Page H11500]]

that is what this legislation does. Make no mistake about it, this 
legislation, rather than being a prescription drug plan, rather than 
being a Medicare reimbursement plan for doctors, what this is is the 
first step in privatizing Medicare, and that would be a disaster for 
our seniors.
  I urge my colleagues to vote for this motion. My motion addresses the 
concern of the doctors across the country and ensures that Medicare 
patients can have access to their doctors by providing these doctors 
with a 1.5 percent increase in physician payments over the next 2 
years. I ask my colleagues to protect our citizens and not have them 
investing in risky and untested privatization schemes and to put the 
necessary funding in the prescription drug bill to fairly reimburse our 
doctors who administer the necessary care to Medicare patients. Instead 
of putting the Medicare system in jeopardy, we should protect our 
constituents' access to care. This motion fixes this problem for 
another 2 years, but I implore my colleagues that in the future we must 
work together to address a permanent fix for the formula.
  I urge my colleagues to support our doctors and their patients and 
vote ``yes'' on this motion to instruct.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Rogers of Alabama). 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 gentlewoman from Nevada (Ms. Berkley).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. BERKLEY. 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.

                          ____________________