[Congressional Record Volume 149, Number 168 (Wednesday, November 19, 2003)]
[House]
[Pages H11598-H11605]
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. HOOLEY of Oregon. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:
       Ms. Hooley of Oregon 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.

  The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the 
gentlewoman from Oregon (Ms. Hooley) and the gentleman from Florida 
(Mr. Foley) each will control 30 minutes.
  The Chair recognizes the gentlewoman from Oregon (Ms. Hooley).

                              {time}  1915

  Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I stand here in the well of the people's House today to 
offer a motion to instruct the conferees of the Medicare prescription 
drug bill to provide a much-needed payment update to physicians for the 
next 2 years and eliminate provisions that would privatize Medicare.
  Right now, as we speak, doctors are faced with the tough choices of 
treating patients, old friends and new patients alike, or turning them 
away since the reimbursements under the Medicare program have not kept 
pace

[[Page H11599]]

with the costs of practicing medicine. This is not an argument about 
the quality of health care; it is about the ability to receive health 
care at all. This is a particular problem in rural areas like those 
that make up part of my district in Oregon.
  The decisions that we make on this bill will have a disproportionate 
impact on the ability of millions of Americans to have access to health 
care. We cannot enable more doctors to see more Medicare patients if we 
continue cutting payments to doctors. If we do not act soon, there will 
be another 4.5 percent reduction in reimbursements to physicians who 
are treating those who count on their care the most, our seniors. That 
4.5 percent cut represents a loss of $20 million to my State alone. The 
overall costs are staggering, and the damage to the health of American 
seniors will be as well.
  For a State with historically low Medicare reimbursements like 
Oregon, the impact is even greater. According to the AMA, the cost of 
practicing medicine has gone up by more than one-third since 1991. Over 
the same period of time, the rise in Medicare payments has been less 
than 10 percent. Just last year, doctor payments were cut by 5.4 
percent; and if we allow those further cuts to take effect, this would 
be the fifth time in 12 years that rates have been cut. If cut, the 
level would drop to nearly 8 percent below the 2001 level.
  My doctors tell me their costs have not dropped by 8 percent, and I 
suspect that doctors across the country would agree. It makes no sense 
whatsoever to cut payments when the costs of practicing medicine are on 
the rise. Doctors simply cannot afford to take more cuts. I am worried 
whether we are going to have a Medicare system by the cuts we are 
asking doctors to take. Already one-quarter of family physicians across 
the Nation are saying they cannot accept any new Medicare patients. Who 
knows how many more will choose to do the same in January when they are 
told reimbursements have been slashed again.
  As a Nation, we must provide our doctors with a 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 to payments for the next 2 
years.
  To fund the increases in payments to our doctors, this motion strikes 
funding for privatization provisions in the underlying prescription 
drug bill. The Centers for Medicare and Medicaid Services estimates 
that under a privatized Medicare, premiums would skyrocket for seniors 
who choose to stay in traditional Medicare. I am concerned that by 
increasing the premiums of traditional Medicare many beneficiaries 
would be forced into HMOs and other private plans.
  This small, but critical, increase will give doctors nationwide the 
wherewithal to continue treating seniors on Medicare, and it will give 
Congress time to develop a permanent fix for 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 this Medicare physician 
reimbursement formula which currently threatens to destabilize the 
Medicare program. Seniors rely on their doctors and the medicines they 
need to stay healthy. They have waited too long for a prescription drug 
benefit in Medicare and relief from the high cost of prescription 
drugs. 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 or paying their rent, electricity, or 
buying food.
  For 4 decades this Nation promised that Medicare would provide health 
care for all seniors. Medicare ensures these hard-working older 
Americans who have paid taxes and paid into the system that they have 
health care coverage. I urge my colleagues to vote for this motion to 
allow our constituents to continue to have access to high-quality care.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am thrilled to be on the floor talking about Medicare 
tonight and certainly thrilled I have a chance to answer some of the 
comments made by the gentlewoman from Oregon (Ms. Hooley).
  In my district in Florida, I have the fifth largest Medicare eligible 
population of 435 congressional districts. This is not an issue I take 
lightly. I would suggest some of our colleagues read the actual bill 
because what they are asking us to do tonight in their amendment is 
exactly why we are focused on some of the reforms in the very Medicare 
package we are talking about.
  A physician update, an increase in payment, is in the bill the House 
Republicans have authored and sent to this floor and now is in 
conference. There was a mention that there was a fee cut last year of 
5.4 percent. I would like to correct the record. As a member of the 
Committee on Ways and Means who fought to increase physician 
reimbursement, not only did we eliminate the cut a year ago; we 
actually increased by 1.5 percent in this bill. In Oregon we have a 1.5 
percent update in 2004 and in 2005. We have a 5 percent bonus for those 
working in rural Oregon to make certain that they are able to see the 
patients because of the limited access and limited number of 
physicians. So there is a 16 percent increase in the bill we are 
talking about today.
  Let me also take some exception when it is discussed about this FEHBP 
competitive-style model for a minute. My district is typical of most 
districts in the country. In fact, in Florida I represent eight 
counties: Palm Beach County, St. Lucie, Okeechobee, Glades, Hendry, 
Martin, and Charlotte. It goes from the east coast on the Atlantic to 
the west, ending at the Gulf of Mexico. There is almost every 
demographic mix one can imagine, people moving from the north and east 
coast; and what they have said to me in town hall after town hall, I 
want choices like Members of Congress have. They say they want choices 
like we have in our health care delivery system, and I reach for my 
wallet because I know somewhere in here is my Federal health benefit 
plan; and I get a range of options to choose from, whether I want a 
higher deductible, higher copayment, whether I want a fee-for-service 
or PPO or a managed care plan.
  Seniors in my district are smart enough to know they are able to make 
choices. The Democrats have been down the street burning AARP cards 
this afternoon. Rather than engaging in constructive debate on how to 
fix the most important plan for seniors in this country, they are 
invoking memories of Jane Fonda burning things in city streets around 
our country and screaming that AARP has sold them out.
  A month ago AARP was, as I was told by some of my colleagues on the 
other side of the aisle, the gold standard of senior lobbying 
organizations, and I tend to agree. I meet with AARP in my district in 
order to have a dialogue to see if we can meet some common ground and 
common objective. So when AARP indicated that they were supporting our 
Medicare bill, it was not only refreshing that we were engaged in a 
bipartisan, constructive conversation, but we were actually modernizing 
Medicare.
  So to eliminate the competitive model in the Medicare plan we are 
discussing undermines the very notion of what the gentlewoman from 
Oregon (Ms. Hooley) is debating on the floor today. The update for 
physicians is in the bill.
  Let me also say another thing that is troubling me because I have 
been somewhat perplexed by this insistence by the other side of the 
aisle that the trouble with this bill is we do not get after those 
nasty drug companies.
  We do not just let our citizens run across the border and buy drugs 
from Canada. I just finished a TV interview with one of my colleagues 
talking about the cost of drugs in America and the cost of drugs in 
Canada, but let me talk about a more critical concern of mine.
  In my district in my county in Florida, the first case of anthrax 
poisoning occurred in Palm Beach County, Florida, the death of a man 
who worked for the National Inquirer because he contracted anthrax 
through the mail that was sent to the National Inquirer.
  Why do I bring that up and why do I raise the anthrax attacks and the 
fear

[[Page H11600]]

it invoked in Florida? Because one of the concerns that we have all 
indicated is we want cheaper prescription drug prices for our seniors, 
but we wanted a protected chain of custody to make certain that the 
drugs we are getting for our seniors are not tainted.
  Let me read this headline from the National Journal Group American 
Health Line. It says that Florida laws to prevent the sale of 
counterfeit or diluted prescription drugs in the State are too weak, 
according to a report issued Tuesday. The Miami Herald reports the 
report found that as many as 55 of the 1,458 prescription drug 
wholesalers licensed in Florida sell counterfeit or diluted medications 
or treatments illegally imported into the United States. The Office of 
the Attorney General said the questionable medicines for some 
wholesalers have reached pharmacies, but the extent of the problem is 
not known.
  So I continue to hear these bottles of pills rattling on the other 
side of the aisle saying just let us have our chance to be in the 
debate, and we will get Americans cheaper drugs from Canada. Well, the 
first person that dies from an anthrax-laced medication or the first 
person that receives phony or altered cancer drugs and dies because 
they did not receive the proper dosage, the first person who has a 
catastrophic incident because somehow that cheaper drug that my 
colleagues have suggested they will bring to our States has harmed a 
citizen, I cannot wait to watch the rush for the exit by each of those 
who have been rattling these pill bottles saying that was not my idea, 
I certainly did not want any part of it.
  So let us debate Medicare and let us debate it on the floor, not in 
the AARP lobby, not in the newspapers, and not on TV, but for seniors 
like my parents and in the memory of my grandmother, whose one wish was 
that Social Security and Medicare would sustain her for her life. The 
one check she would wait for was Social Security, and the one thing she 
wanted more than ever was not to be a burden on her children or 
grandchildren. She wanted to be self-sustaining. It is in her memory I 
have worked 9 years on Medicare and want to make certain this proposal 
works. So I reject this motion.
  We will continue to have discussions on it, but the things that have 
been raised in this motion today on H.R. 1 are just not accurate. They 
just do not apply. If they read the bill, they will see that physicians 
are getting compensated properly. They will see the competitive model 
is not going to undermine Medicare. It has no effect on entitlement. 
There is continued entitlement to defined benefits under current law. 
There is continued access to traditional FFS Medicare through the fee-
for-service Medicare throughout the country, and all payments to plans, 
including traditional fee-for-service Medicare based on the demographic 
and health risks of employees. We have provisions in this bill that 
deal with most of the problems raised.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1930

  Ms. HOOLEY of Oregon. Mr. Speaker, I yield 7 minutes to the gentleman 
from Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentlewoman from Oregon 
(Ms. Hooley) for yielding time and thank her for her leadership on this 
Medicare issue and her leadership on health care issues generally.
  Mr. Speaker, I heard my friend from Florida not once, not twice, not 
three times, maybe not even four times, maybe five, six times say, 
``You should just read the bill.'' That is the problem. As bad as the 
Medicare bill is, the process is even worse. We would like to read the 
bill. We cannot find it. The reason we cannot find the bill is the bill 
was, first of all, written by the prescription drug companies, by the 
insurance companies, in private, similar to how Vice President Cheney 
wrote the energy bill, Vice President Cheney who still receives $3,000 
a week from an oil company as part of his pay, but these bills have 
been written in secret.
  The prescription drug bill has been written by the insurance 
industry, by the drug industry. At the conference committee when the 
House and Senate were trying to work together to write a bill, no House 
Democrats were allowed in the room. No House Democrats were allowed to 
look at the bill, to discuss the bill, to debate the bill or to offer 
amendments. When I hear my friend from Florida sort of gratuitously say 
we should read the bill, we would like that opportunity.
  The problem with this prescription drug issue, it is not really a 
prescription drug bill. We could have passed a prescription drug bill, 
take $400 billion and distributed it to seniors who need drug coverage. 
We could have done that cooperatively, bipartisanly in a day or two, 
but what this bill really is, it is a Medicare privatization bill. When 
you think about this, and I have been a ranking Democrat on the 
Subcommittee on Health for 4, 5, 6 years, I have been on that committee 
for more years than that and watched sort of how the Republicans look 
at this Medicare issue. They all say, my mom's on Medicare, my 
grandfather's on Medicare, I like the program. Ultimately, when you 
look at what Republicans do in Medicare and you look at the history of 
the Republican Party with Medicare, the problem is they simply do not 
like Medicare. You can say, well, that's not true.
  Let us do a little bit of history. When Congress passed the 
legislation to create Medicare, President Johnson signed the bill in 
July of 1965 creating this program that now insures 39 million 
Americans. At that moment, half of American seniors had no health 
insurance. The other half did, but it was clearly a big problem. Lyndon 
Johnson signed this bill. The fact is only 13 Republicans in the whole 
House of Representatives supported the bill to create Medicare. Gerald 
Ford, a Member of the House, opposed it. Bob Michel, the Republican 
leader, opposed it. John Rhodes, another Republican leader, opposed it. 
Bob Dole opposed it. Senator Strom Thurmond opposed it. Donald Rumsfeld 
voted against the creation of Medicare. They simply did not like the 
idea of a government program. They wanted to continue to let these 
seniors be out in the market, be in the private market. If they could 
get insurance good; if they could not, that was just too bad. They 
should have thought of that and made more money or whatever the reason. 
Nothing much happened to change Medicare except it worked, from 1965 
until 1995. Then the first time Republicans had a chance, the first 
time Republicans were in the majority in 1995, right out of the box 
Newt Gingrich tried to privatize Medicare. He tried to cut $250 billion 
from Medicare to pay for a tax break for the most privileged people in 
society, just like they do now. He immediately tried to privatize 
Medicare. Fortunately, President Clinton stopped that. Fortunately, 
other Members of this Congress stood up and fought it and stopped it.
  Speaker Gingrich, in 1995, bragging in a meeting of the American 
Conservative Union, said, We don't get rid of Medicare right away. We 
don't think it's politically smart. We think the right way is to go 
through a transition, but we know it's going to wither on the vine. 
That is what Speaker Gingrich wanted to do. He wanted to privatize it.
  Bob Dole, then a Senator, then a Presidential candidate, Bob Dole 
bragged that he was in the arena trying to fight Medicare, trying to 
fight its creation 30 years earlier.
  It is pretty clear that Republicans in 1965 voted against the 
creation of Medicare, including one future President, one future 
Presidential candidate and other leading Republicans. Then in 1995, 
when they had a chance, they immediately tried to privatize Medicare 
and cut its funding. In fact, AARP president Bill Novelli, who has 
gotten sort of famous this week in his sellout to the drug companies 
and the insurance interests, Bill Novelli wrote the preface in Newt 
Gingrich's health care book, his health care privatization book. He 
called Newt a big-idea person. The Republican majority has continued to 
rally behind Newt Gingrich's call for Medicare privatization. John 
Linder told the House Rules Committee last year that Medicare was a 
Soviet-style program. Dick Armey, majority leader of the House of 
Representatives last year, said, in a free society we wouldn't want to 
have Medicare. Former Congressman Rick Santorum says the traditional 
Medicare program has to be phased out. And Bill Thomas, working with 
the drug industry and the insurance industry in writing this Medicare 
privatization bill, told a reporter, to those who say that this bill 
would end Medicare as we know it, our answer is, we certainly hope so.

[[Page H11601]]

  The conference bill does that. It would end Medicare as we know it, 
because Republicans would rather throw money at a private failure 
rather than continue support for a public success.
  Mr. Speaker, Medicare has worked for seniors in this country. We need 
to add a prescription drug benefit inside Medicare, not turn this 
program over to the insurance interests who are getting a $20 billion 
taxpayer gift once this bill is signed into law if it passes, and we do 
not want to turn this program over to the drug industry who will profit 
140 billion additional dollars under this bill.
  Mr. Speaker, my Republican friends, it is an honest debate. They 
simply do not like Medicare. They do not believe there should be a 
government program called Medicare. They think the insurance industry 
and the drug industry ought to do this. That is their view. Mr. 
Speaker, I hope that enough Members rally around because it is clear 
that seniors in this country want to protect Medicare. They do not want 
it privatized. They want a public health system that works for 
everybody and treats everybody the same.
  Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
  It is indeed appropriate that there be a doctor in the House sitting 
in the well presiding as we discuss this important project, a doctor 
who happens to be a Republican. The notion that we want to destroy 
Medicare is patently false. It is interesting, I am on the Committee on 
Ways and Means, so this is something we deal with quite frequently, how 
many letters I get urging us to increase the fee payments to 
Medicare+Choice organizations, Blue Cross and Blue Shield of New 
Jersey, Blue Cross and Blue Shield of Florida. From my colleagues on 
the other side of the aisle who somehow find those Medicare+Choice, 
which are popular with their constituents, we should increase 
reimbursements to those plans. But if they listened to the argument 
they just made about privatization, then those Medicare+Choice panels 
would not even operate. They would not even exist.
  So it seems like there is a number of Members here that seem to trust 
the private health insurance industry when it suits the political goals 
of allowing their constituents to have access to prescription drugs, to 
eyeglasses, to other remedial services, that is okay. That is not 
really privatization. That is kind of a sort of an experiment, I guess. 
But that is in fact what is happening today. There are managed care 
plans that President Clinton supported and endorsed and increased 
funding for, community health care organizations, a number of things 
that we have done in our communities to make certain health care is 
delivered.

  We know they are losing the debate when they have to bring up Newt 
Gingrich on the floor and rather than talk about substantive debate 
here, many of us have read the bill numerous times because we had it on 
the floor, we all had a vote, I think nine Democrats joined us in 
supporting that bill. I know it was not in its entirety. I am sure 
there are some new additions, some new conference report language, some 
different things, but we are not talking about whole new territory 
here, we are not going over new ground. But I would caution when we 
start accusing the entirety of the Republican Party as being opposed to 
Medicare that that is somewhat of a hurtful statement to this Member 
because I take seriously the responsibility I have representing 
seniors, I take seriously the fact that my parents are on Medicare, 
enrolled in Medicare, my father is suffering today with cancer who is 
being treated by great physicians in Palm Beach County who are being 
reimbursed by Medicare, who seem to be not only caring for him, but 
obviously thrilled with their work and happy with the reimbursements 
being offered.
  The current Medicare system is a sickness model. I am hopeful that 
the party on the other side of the aisle comes back to the roots of 
Claude Pepper from Florida and Lyndon Johnson who would have recognized 
a fabulous program but one that needs to reflect today's technologies.
  In our bill we have wellness incentives to look for dietetic 
screenings to see if we can prolong the life of someone suffering from 
diabetes. Medicare today will reimburse to amputate your limb, they 
will watch you go blind, they will put you on dialysis, but we will not 
reimburse a dietician to come in and see if we can properly construct a 
diet to minimize the onset of the disease. That is a plan that they 
want to sit here and defend? New technologies that can indicate a 
cancer in the body early and detect it and cause, hopefully, the cure 
of that cancer. Cardiovascular screening that I have worked on with 
Senator Bob Graham from Florida.
  This Medicare bill we are bringing to the floor has a lot more to 
offer than some of the criticism would indicate. But I still have to 
snicker when I see a group of people standing outside of AARP burning 
cards. It harkens back to an earlier day. I just somewhat humorously 
look at how quickly they turn on that organization whom they held in 
such high esteem up to 48 hours ago and now is being vilified here on 
the floor. We are happy AARP weighed in. They said it was a first step. 
They did not say this was a panacea, nor did any Member of this body 
ever suggest that this is the last thing we will ever do on Medicare. 
We will learn as we go along, we will add, we will try and increase the 
opportunities for preventive health care, we will increase 
reimbursement to hospitals in every Members' district, a bill that I 
authored. We are doing the drug discount card, another provision that I 
authored that will be in this bill. I think we are on the right track.
  Mr. Speaker, I reserve the balance of my time.
  Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may 
consume.
  Just a reminder, I think that everybody on the floor of the House, 
all Members from both the Republican and Democratic Party, would be 
happy to see those changes, that in fact they would not pay for 
amputation of a leg or an arm and would pay for diabetes treatment 
along the way.
  Mr. Speaker, I yield 5 minutes to the gentleman from New Jersey (Mr. 
Pallone) who has been working on health care issues the entire time he 
has been in Congress.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for 
yielding me the time and her remarks.
  I listened to what the gentleman from Florida said, and I have to 
say, I know he is well-intentioned. I certainly do not mean to imply 
that he is not well-intentioned, but the problem is that the ideology 
of the Republicans is getting in the way of what works practically. I 
am afraid that the ideology, even though they may not intend it, 
ultimately, will destroy Medicare.
  The gentleman from Florida talked about Lyndon Johnson and the 
origins of Medicare. I do not want to go through all that again, but we 
must remember that the reason that President Johnson and the Democrats 
primarily put Medicare into place in the sixties was because the 
private market did not work. Seniors were not able to go out and get 
insurance in the private market, and so that is why the government had 
to set up a program to insure the senior citizens. That is the bottom 
line. Practically speaking, I do not really have an ideology. I do not 
care if it is a government program versus a private program, but the 
bottom line is that the government program, the Medicare program, works 
and it works because you have this large pool that all the seniors are 
members of, and the private market has essentially told us in many 
cases that they are not going to provide the type of health insurance 
that many of the Republicans have talked about.
  The gentleman says that Democrats are against HMOs. I do not have a 
problem with HMOs and managed care. He mentioned my home State of New 
Jersey. Sure, lots of seniors sign up for HMOs in New Jersey. But the 
problem is that the HMOs have increasingly dropped the seniors. 
Something like 80,000 to 100,000 New Jersey seniors in the last few 
years have been dropped by HMOs. All we are saying, as Democrats, is we 
do not want seniors to be forced into managed care, forced into HMOs in 
order to get a drug benefit. That is what the gentleman is doing. That 
is what the Republicans are doing with this bill. Essentially, the only 
way practically speaking that you are going to be able to get a drug 
benefit is if you join an HMO, and then you lose your choice of 
doctors. That is not fair.

[[Page H11602]]

If you really cared about Medicare, and you wanted to just expand it 
and include a prescription drug benefit to deal with preventive care, 
then all you have to do is what the Democrats have said all along, add 
the drug benefit to traditional Medicare. We have talked about that. We 
have said just like you have part B now for your doctor bills, where 
you pay about a $50 a month premium, you have a $100 deductible for 
your first doctor's visit and after that the Federal Government pays 80 
percent of the cost and you pay 20 percent up to a certain amount when 
the Federal Government pays the whole thing. We advocated and we voted 
on a substitute to this awful Republican bill. We had a Democratic 
substitute that did exactly the same. You paid $25 a month, the first 
$100 deductible on your drug bills you have to pay, and after that 80 
percent is paid for by the Federal Government, 20 percent by you, up to 
a certain amount, and then the Federal Government pays 100 percent. If 
you really liked traditional Medicare and wanted to keep it going the 
way it is, then you would not have any problem doing just that. Take 
whatever pot of money you have and add a prescription drug benefit to 
traditional Medicare. But that is not what you do. The Republicans 
basically want to privatize, and they force people to go into an HMO to 
get the drug benefit.

                              {time}  1945

  The gentlewoman's motion here is very simple. Basically, she is 
saying do not give extra money to the HMOs and the private insurers 
because we know that they cannot compete with the regular Medicare 
program. Do not give them the windfall and extra money in order to make 
them participate in this plan. Take that money and give it, as she 
said, to the doctors to increase their reimbursement rate. Whether we 
give it to the doctors or whomever we give it to, the bottom line is 
that we should not be giving windfall dollars to HMOs and private 
insurers so that they have extra money to compete with the traditional 
Medicare fee-for-service.
  If my colleagues feel that there needs to be competition and that 
HMOs should be out there as an option, or other private insurance 
options should be out there, then let them compete in a traditional 
way. Do not give them all this extra money and say, Here is some extra 
money, so you come into the market, because then we do not have fair 
competition. We do not have fair competition at all. We are giving them 
extra money, and what we are going to ultimately do is to make it 
impossible for people to stay in traditional Medicare.
  The thing that really bothers me the most is that they keep 
mentioning on the Republican side all the different groups that support 
this Republican Medicare bill. They mention AARP, they mention the AMA, 
they mention the drug companies, PhARMA or whatever. The reason that 
all these different groups support this bill is because they are all 
getting a piece of the action. In other words, the doctors are getting 
an increased reimbursement rate, so of course they think it is a great 
bill. AARP is an insurance company. They are going to sell insurance, 
so they think it is a great idea. And the drug companies love it 
because they have a clause in here that says that the Secretary of 
Health and Human Services, the Medicare administrator, cannot negotiate 
price reductions, so they are happy because they can continue to charge 
higher price, increasing prices.
  So all these different special interest groups, they are all very 
happy; but the Medicare recipient, the senior, is the one that suffers 
because they are not being given an adequate benefit. Not only are you 
telling them that they have to join an HMO, but they are going to have 
to pay more out in their out-of-pocket in order to get any kind of drug 
benefit.
  If we look at the way this thing is structured, the deductible is 
$275, not $100. 275. The cost sharing, basically the Federal Government 
pays 75 percent of the cost but only up to $2,200 a year. After that 
there is a doughnut hole and the senior has to pay out of pocket up to 
$5,044. So what we are going to see here with these seniors is there is 
no set premium. So the HMO is going to come in and say they are going 
to charge them, who knows, $75 a month, $80 a month. The sky is the 
limit. There is no set premium; 275 deductible, between $2,200 and 
$5,000 out of pocket. They get nothing from the Federal Government. 
There is no reason for anybody to sign up for this thing because they 
are not getting a benefit. They have to lose their choice of doctors. 
They get a lousy benefit that is not even worth having. Meanwhile, all 
the special interests, the HMOs, get all this windfall in terms of 
dollars.
  Mr. GEORGE MILLER of California. Mr. Speaker, will the gentleman 
yield?
  Mr. PALLONE. I yield to the gentleman from California.
  Mr. GEORGE MILLER of California. Mr. Speaker, the gentleman is 
correct here. Assuming the $35 premium, in fact, out of the first 
$5,000 of benefit, they have to pay $4,020 out of pocket.
  Mr. PALLONE. Absolutely.
  Mr. GEORGE MILLER of California. Mr. Speaker, I guess maybe some 
people in America think that is a drug benefit, but that is not going 
to provide. Out of the first $5,000, they pay $4,020 out of their 
pocket and they get $1,000 in benefit.
  Mr. PALLONE. Right. Reclaiming my time, Mr. Speaker, that is assuming 
that the benefit is $35.
  Mr. GEORGE MILLER of California. That is assuming it is $35, but 
nothing in the law requires it to be $35.
  Mr. PALLONE. Absolutely not.
  Mr. FOLEY. Mr. Speaker, I reserve the balance of my time.
  Ms. HOOLEY of Oregon. Mr. Speaker, I yield 4 minutes to the gentleman 
from Florida (Mr. Hastings).
  Mr. HASTINGS of Florida. Mr. Speaker, I thank the distinguished 
gentlewoman from Oregon for yielding me this time, and I appreciate her 
so very much for her bringing this motion.
  It is most regrettable that we are in this dispute in the manner that 
we are because in many respects it comes from a lack of communication 
between the two respective sides.
  Mr. Speaker, it gives me great pleasure to support the gentlewoman 
from Oregon's (Ms. Hooley) measure.
  Since 1965 Medicare has been a vital instrument in ensuring quality 
health care to America's elderly and disabled. Like my friend from 
Florida, my mother is on Medicare, and like my friend from Florida, my 
mother is desperately ill. The real truth of the matter is if it were 
not for Medicare, I would not be able to sustain my mother's present 
care.
  Medicare's 40 million beneficiaries use thousands of different health 
care products and services furnished by over 1 million providers in 
hundreds of markets nationwide. However, today a great number of people 
in this House seek to dismantle Medicare with a fool's gold of a bill 
titled the Medicare Prescription Drug and Modernization Act.
  Despite my Democratic colleague's best efforts to make this an 
inclusive and comprehensive process, one that addresses the real 
concerns of America's seniors and disabled, we are shut out from 
negotiations. My friend on the other side from Florida, and he is my 
friend, may have seen this bill. But I serve on the Committee on Rules. 
We have not met on it for it has not been filed, and we will not see it 
until maybe an hour before we go to the Committee on Rules on this 
measure.
  The bill does not ensure affordable prescription drugs because of the 
arbitrary budget cap pushed by the administration. H.R. 1 has high 
deductibles and does not guarantee an affordable premium. In addition, 
the Medicare Prescription Drug and Modernization Act creates large 
coverage gaps with many seniors being required to pay high premiums 
even when they do not receive benefits. Let me tell the Members about 
one guy that is from Myakka City, Florida, Mr. Coldao, a Vietnam 
veteran-turned-farmer who cannot afford health coverage and now faces 
losing the little that he has because drug companies flee rural areas 
in search of bigger profits.
  Approving this bill may not guarantee a destitute future for those of 
us that are Members of Congress, but it will guarantee a destitute 
future for those seniors who do not and have not served in this body.
  Mr. Speaker, simply put, this bill should be wrapped around a toilet 
paper holder and stuck in one of the Capitol's bathrooms. It is that 
bad. It is poison for this country. It stinks.
  And now I want to tell my friend about this AARP. I am a member of 
that organization until yesterday. And

[[Page H11603]]

I did not go to AARP and burn my card. I sent to its director notice 
that I resigned, and let me tell the gentleman why. Because I never 
received a mumbling word from anybody at AARP asking me, one of the 35 
million members, what I think about this particular measure. I did not 
receive a questionnaire from them, and I ask my friend from Florida, 
are all seniors being treated equally under the Republican plan that he 
has seen and Democrats have not? What are the effects on Medicaid in 
the State of Florida and in the State of Oregon and this Nation as it 
pertains to the poor? And most importantly, here come the baby boomers. 
Baby boomers, get ready. Get ready to go bust under this plan.
  Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
  Of course I respect very much my colleague from Florida, and I 
appreciate his words tonight. I do want to at least add that at the 
current program we have on Medicare, just to correct any record, there 
is zero prescription drug coverage in Medicare. So for the very seniors 
they are talking about tonight, the veterans they are talking about 
tonight, citizens watching us tonight, they have zero coverage from 
Medicare for prescription drugs. Yes, there is a $275 deductible, and 
there is a monthly premium. The average American spends about $2,000 on 
drug costs annually. Under our plan they will probably save anywhere 
from $900 to $1,100 that will now be provided through Medicare to them. 
So anyone who is spending money on drugs today with this bill will have 
a benefit.
  The drug discount card that I authored along with Senator Hagel that 
is now part of this global bill includes for low-income families a $600 
credit much like their ATM card that they can use at drug stores to not 
only achieve a discount off the retail price of the pharmaceutical but 
also have money to purchase and back up that purchase.
  So, yes, I am pleased with the progress we are making. I am pleased 
that we have things in this bill to provide new remedies for situations 
for ailing seniors, and I am encouraged by the fact that we have been 
able to increase reimbursements to hospitals, increase reimbursements 
to physicians. We are able to do some of the diagnostic tests necessary 
to improve and enhance the quality of life. So I feel very comfortable, 
as we continue the debate, that more changes probably can be made if we 
deal in a constructive fashion.
  Mr. PALLONE. Mr. Speaker, will the gentleman yield?
  Mr. FOLEY. I yield to the gentleman from New Jersey.
  Mr. PALLONE. Mr. Speaker, again I have not seen the bill because it 
has not been given to the Democrats, but my understanding is that the 
Medicare program that the gentleman has talked about, the comprehensive 
program, is not effective until the year 2006.
  Could the gentleman explain to me, if it is true that all these 
problems are out there and all these changes need to be made to 
Medicare, why the Republicans are going to wait until the year 2006 to 
have this program kick in?
  Mr. FOLEY. Mr. Speaker, reclaiming my time, actually 6 months from 
enactment, we will start with a discount card that will provide an 
immediate $600 in the plan. A number of the wellness provisions we are 
talking about will become instantaneous, the increase to physicians, 
the increase to hospitals, the increase to managed care.
  Mr. PALLONE. But generally, Mr. Speaker, it does not kick in until 
2006.
  Mr. FOLEY. Mr. Speaker, reclaiming my time, there will be a number of 
things that will take place up until 2006. The big fundamental 
prescription drug will be 2006, the gentleman is correct. Because we 
have to get plans up and running. We have to implement the delivery 
system. We have to get plans concurrent. We have to do the 
pharmacology. So there are a number of things that will require some 
time.
  Mr. PALLONE. Mr. Speaker, the gentleman does not think that could be 
done by next year?
  Mr. FOLEY. Maybe. That may be possible as we move forward. With some 
cooperation, we may be able to actually expedite the time frame. That 
is this gentleman's wish. The sooner, the better. But within 6 months 
of enactment, we will have the first phase of this. We will have a 
number of the components already implemented. As to the prescription 
drug plan, I think our leadership will move more quickly than 2006.
  Mr. Speaker, I reserve the balance of my time.
  Ms. HOOLEY of Oregon. Mr. Speaker, I yield 3\1/2\ minutes to the 
gentlewoman from California (Ms. Lee).
  Ms. LEE. Mr. Speaker, I thank my colleague for yielding me this time 
and also for this motion to instruct and for her tremendous leadership 
on this issue.
  This bill of course we have yet to see but have heard a lot about 
what will essentially privatize Medicare. Not only will the bill begin 
to dismantle a program that has worked for over 30 years; it does 
fatten the pockets of the pharmaceutical and the private insurance 
industry donors, leaves over 9 million rural Medicare beneficiaries 
with no access to affordable prescription drugs, and really does pit 
seniors one against the other based on their income through means 
testing.
  I hope we say no to this Republican bill. Under this bill, 
Republicans have eliminated Federal Medicaid funding to fill in the 
gaps in the Medicare drug benefit, disproportionately affecting rural 
beneficiaries who are 20 percent more likely to have incomes below 150 
percent of poverty level. This means that up to 1.7 million 
beneficiaries could have their current drug coverage reduced.
  Under this bill new, untested private insurers are authorized to 
provide a prescription drug benefit. Under this bill Republicans cap 
Medicare spending for the traditional programs and also for private 
plans, of course shifting the greater risk and cost to our senior 
citizens. It does not make any sense to provide a $12 billion slush 
fund to keep private insurers in Medicare, which is really 
anticompetitive. It is costly and it is unfair to seniors.

                              {time}  2000

  Also, as I understand it, under this bill, Republicans leave seniors 
who spend between $2,200 and $3,500 for prescription drugs without any 
cost assistance or sharing for Medicare. And again, not having seen the 
bill, but from what we hear, under this bill, and of course the 
administration and the Republican leadership have weakened all of the 
measures to control the costs of these drugs; policies to promote 
access to generic drugs and reimportation of U.S.-made drugs which, of 
course, we passed in this House, those provisions have either been 
watered down or just totally disregarded.
  To put it simply, a senior who receives $2,200 worth of drugs in a 
year will pay about $420 in premiums, $275 deductibles, and $481, which 
is about 25 percent of drug costs from $276 to $2,200. So the total 
cost is somewhere between $1,700 and $2,200 in drugs.
  Also, with this gap or what we call the ``doughnut hole,'' the 
Republicans have left that in this bill, of course. Seniors whose drug 
costs fall above $2,200 and $3,500 will pay 100 percent of the cost. 
Seniors with $3,500 in annual drug costs will pay too much.
  Mr. Speaker, this is really the beginning of the end of Medicare as 
we know it. This is an attempt really to dismantle Medicare. We cannot 
allow that. We must stand up for our constituents. We must stand up for 
our senior citizens and provide a prescription drug benefit which is 
helpful, not which is harmful. This bill is not comprehensive, I guess. 
I mean we have not seen it, but from what we hear, it is terrible and 
it is very incomplete.
  So I think we need to be honest with our senior citizens. It does 
privatize Medicare. It does begin to dismantle Medicare. It is much too 
costly for our senior citizens to buy drugs which are already too 
expensive.
  Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
  It is almost comical on the floor for people who claim they have 
never seen this bill, they know every aspect of it and can criticize it 
with great flourish and abundance.
  We just heard about the rural health care network, and I absolutely 
represent a lot of rural communities. Mr. Speaker, $30 billion 
additionally to fund rural health. Standardized amount for payments. A 
labor share to help with the labor index in rural communities. The 
disproportionate share program is increased in our bill. Low-

[[Page H11604]]

volume hospitals receive additional payments based on their discharges. 
Critical-access hospitals have additional benefits. A wage index. 
Graduate medical education programs. Sole-community hospitals qualify 
based on some data.
  These are all incorporated in this new Medicare reform proposal that 
will benefit constituents in the gentlewoman from California's 
district.
  Bonus payments for physician, an increased 5 percent add-on if you 
are in the rural component. Clinics pay separately for professional 
services. Rural health care clinics, federally qualified. Low-volume 
rural ambulance, targets higher payments for ambulances in rural 
communities. Home health care adds an additional 5 percent.
  So these are all funded by our program, including community health 
centers.
  Now, it came up about the $2,200, the doughnut that they continue to 
describe. The median recipient on Medicare uses approximately $2,000 
annually in drug utilization costs. That is why we came up with the 
$2,200 to cover the majority of Americans. After $3,600 of drug 
expenditures, we then pick up 95 percent of the tab for the 
catastrophically ill.
  Now, what the Democrats fail to continue to mention, and I wish they 
would put their price tag alongside their lofty ideas, is to give drugs 
to every senior in an unlimited amount without payment, without 
copayment, without deductible, would be about $900 billion, almost $1 
trillion. Please, somebody on the other side, advise me where that 
money comes from, and I will be willing to listen to their proposal.
  But in the abstract and failing to offer concrete solutions, they 
criticize a bill that has been worked on by the Committee on Ways and 
Means. They should contact some of their Democratic colleagues who 
serve on the committee with me. They are probably not happy with every 
aspect of the bill, but they have seen it. We have debated it. We have 
discussed it. This bill has been around for about 4\1/2\ years, no 
shocks, no nuances, no changes. It has all been part of the debate. 
Yes, they may object to portions of it, but to claim that somehow we 
just popped this bill up in the middle of the night belies the 4\1/2\ 
years I have been on the committee working on this and shows little of 
the knowledge of the very important components that provide relief to a 
number of their constituents, Democrat, Republican, and Independent 
alike.
  Mr. Speaker, I reserve the balance of my time.
  Ms. HOOLEY of Oregon. Mr. Speaker, I yield 3 minutes to the gentleman 
from California (Mr. George Miller).
  Mr. GEORGE MILLER of California. Mr. Speaker, I thank the gentlewoman 
for offering this motion and for yielding me this time.
  I just want to say, following up what my colleague, the gentleman 
from Florida (Mr. Hastings) said, and that is that unfortunately, we 
now see people who are offering themselves as so-called honest brokers 
who set up thresholds and tests as to whether this would be a good bill 
for senior citizens; whether or not this would provide the kind of drug 
benefit that senior citizens should have and that they need to match 
the cost of the drugs that they now have to pay the prices that they 
have to pay, we now see that that organization, AARP, was in the bag 
all of the time. They were not there representing their members, they 
were not there representing senior citizens; they were there 
representing themselves as an insurance company. Now, we see that under 
the provisions of the bill, they stand to do billions of dollars in 
business. They do about $100 million in business now, selling Medigap 
insurance policies, but now they want to get into the pharmaceutical 
business.
  So they were not an objective observer of this process. They were not 
there as guardians; they were there as special interests with a special 
seat at the table. So special that the Republican administration gave 
them a number of contracts over the last couple of years from the 
Department of Labor and other agencies in this Federal Government, and 
now all of a sudden we find out they took a dive on the bill. They did 
not talk to their Members and say, what should we do. The beltway 
lobbyists, speaking from their own interests, made a decision to 
support this bill to the extent now that all day long we have been 
watching on the news as people have been turning in their membership in 
AARP, people have been resigning from the organization. I have a letter 
here from their legislative chairman in Raleigh, North Carolina who 
says that he is resigning because they were never asked about this. And 
the fact that they would support a bill as they understand it with the 
level of benefits, with the privatization of Medicare, they want out. 
They are resigning. That was supposedly the honest broker that was 
going between the sides and discussing the merits of this program.
  This bill is one thing and one thing only: it is to provide 
protection to the big pharmaceutical industry. This bill does nothing 
about price. You can have your discount cards, but it is discounted off 
an inflated price, and it specifically prohibits the Secretary of 
Health and Human Services from negotiating price. When asked about why 
this is in the provision in a meeting today, one of the authors of the 
bill said because that is the way big PhRMA wanted it. Well, big PhRMA 
got their way and Mr. Middle America, they got hosed in this operation.
  We cannot negotiate like Wal-Mart. We cannot negotiate like Costo. We 
cannot negotiate like the Veterans' Administration. No. They get to set 
the price and then somehow we are going to give you a discount off an 
inflated price. So they did not do anything about price there; all they 
did was protect the profits of the pharmaceutical industry, and if the 
seniors get a benefit, they will be lucky. Out of the first $5,000, 
they will pay $4,000. That is not the benefit that the AARP should be 
fighting for.
  Mr. FOLEY. Mr. Speaker, I yield myself such time as I may consume.
  I would just ask Members who are so comfortable with the insurance 
provided to them through Blue Cross Blue Shield, it is a PPO, it is 
made out to me, it is a government-wide benefit plan that has a retail 
pharmacy carrier; it has a mail order if I want; there is a customer 
service number; I can use it at most hospitals for admission and 
medical doctors. But surprisingly, it is not the Federal Government, it 
is Blue Cross and Blue Shield. So if this is so onerous and a disaster 
waiting to happen, then maybe my colleagues ought to turn in their 
card. I think they probably would not go without the coverage, and that 
is what my constituents have been asking for: give me what you have. 
Let me have choices. Let me have options. Let me decide for myself.
  Now, they may be outraged at AARP, but up until last week they were 
always throwing it in our faces that this was the legitimate group that 
negotiated for seniors, and now all of a sudden they have racked up 
this alleged racketeering, mob-style pharmaceutical alliance with big 
PhRMA. It is just interesting, when they change their viewpoint and 
decide to support something we are doing, this is evil incarnate. A 
week ago they were the gold standard of senior care and consideration; 
today we are going to burn our cards.
  So I ask my colleagues to be the judge: is it politics, or is it 
process? Is it results, or is it claiming credit? As a Member of the 
Committee on Ways and Means, yes, there is a lot more I would like to 
do to this bill. But part of the process I have learned is compromise, 
negotiation, and meaningful steps forward to make results achievable 
for citizens, the people that pay our salary that send us to work.
  When I go home after reviewing this bill and looking at its contents, 
I know in my heart I can look at seniors, whether they live in Lake 
Worth, Port St. Lucie, Punta Gorda, Okeechobee; whether they are 
wealthy or poor, whatever their ethnic background, whatever their 
family composition, that I will be able to look them in the eye and 
say, this is a better program than it was last month and last year.
  Mr. Speaker, with that I know the hour is late, and I sincerely 
appreciate, as I have worked with the gentlewoman from Oregon on a 
number of issues, and we care deeply about health care; we share common 
objectives and common goals. But I think the characterization of this 
bill is overstated in its demagoguery. I think if we look at what is 
being provided and the full range of services, people should come

[[Page H11605]]

away from this bill knowing this is an important, critical first step 
to providing prescription drug coverage for our seniors. Today, at this 
hour, seniors have absolutely zero coverage by the Federal Government 
for prescription drugs.
  If there is any indication that what we are about to embark on by 
those who suggest this is not a benefit, then they have not read the 
calculation. Just do the math along with me. From $3,600 to $5,000, the 
example used by the gentleman from California, if you spent $5,000, you 
are only paying $900; well, do the math. From $3,600 to $5,000 is 
$1,400. Your obligation is a 5 percent copay of that. So it does not 
take rocket science to figure out that is $70. That means you have 
$1,330 of a benefit there alone. If you take the front end, if you take 
the front end and you look at the deductible and the $2,200 amount, you 
are talking about roughly $900 to $1,100. So if you add those two 
together, there is about $2,430 of benefit for a person that spends 
$5,000, not counting the $600 and the discount card, plus the discounts 
achieved. So if we reflect on all of those numbers and you hear these 
numbers thrown around, get out a calculator, we will supply the 
numbers. It is not that difficult.
  My final statement will be to those who say our seniors do not 
understand enough of what they are doing to be able to figure these new 
processes or new bills out. Well, do my colleagues know what? The 
generation I am talking about managed their way through the depression, 
they survived World War II, they taught us how to ride our bikes and 
drive our cars. They raised us. They fought wars. They have been able 
to succeed in life on their own without the Federal Government dumbing 
them down and acting like they cannot make choices.
  The Medicare bill we are about to bring to this floor represents 
significant, important, fundamental change. It represents increasing 
opportunity to gain wellness care. It represents prescription drug 
coverage for the first time in this Nation's history.
  The Congress was controlled by the Democrats in 1965, when Medicare 
was introduced, to 1995 when the Republicans took over and, in that 
span of time, no prescription drugs were added. So I ask the basic 
question. I have been working on it since I came to Congress in 1995. 
We finally have a product on the floor in 2003, a lot later than I 
would have liked to, but under our majority, with President Bush and 
the Senate majority in Republican hands, we are about to embark on a 
wellness Medicare program for the 21st century.

                              {time}  2015

  So I appreciate the time of the gentlewoman from Oregon (Ms. Hooley), 
and I appreciate the House's indulgence.
  Mr. Speaker, I yield back the balance of my time.
  Ms. HOOLEY of Oregon. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, the gentleman from Florida (Mr. Foley) and I have worked 
on many issues together. I guess I would like to offer today to work on 
another issue. Oregon happens to be a very low reimbursement State 
because we have been very efficient in our health care. I am glad that 
Florida has a high reimbursement rate. I would just like to be there 
with them. And our State, because it is a low reimbursement State, I 
have areas in my district where doctors are filled. Because they lose 
money every time they take a Medicare patient, they do not want to take 
anymore. It is not because they do not want to provide the service; it 
is that they cannot afford to do it. They cannot afford to have 100 
percent of their clients Medicare clients because, again, of the 
reimbursement level.
  I urge my colleagues to vote for this motion to direct the millions 
that the House bill uses for privatization to improving Medicare 
payments for physicians. Physicians cannot deliver 21st-century 
medicine to our seniors with payment rates that do not cover the cost 
of their care.
  My motion would address the concerns of doctors across the country 
and ensure that they are able to treat Medicare patients. Instead of 
putting the Medicare system in jeopardy through risky and untested 
privatization schemes, we should protect our constituents' access to 
care.
  I urge my colleagues to support our doctors and their patients and to 
vote ``yes'' on the motion to instruct.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Hensarling). 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 Oregon (Ms. Hooley).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. HOOLEY of Oregon. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________