[Congressional Record Volume 149, Number 169 (Thursday, November 20, 2003)]
[House]
[Pages H11845-H11853]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




MOTION TO INSTRUCT CONFEREES ON H.R. 1, MEDICARE PRESCRIPTION DRUG AND 
                       MODERNIZATION ACT OF 2003

  Mr. INSLEE. Mr. Speaker, I offer a motion to instruct.
  The Clerk read as follows:
       Mr. Inslee 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 by 
     an amount equal to the amount of savings attributable to the 
     rejection of the aforementioned provisions to--
       (A) raise the average standardized amount for hospitals in 
     rural and other urban areas to the level of the rate for 
     those in larger urban areas; and
       (B) to raise the physicians' work geographic index for any 
     locality in which such index is less than 1.0 to a work 
     geographic index of 1.0.
       (4) To insist upon section 601 of the House bill.

  The SPEAKER pro tempore (Mr. Ose). Pursuant to clause 7 of rule XXII, 
the gentleman from Washington (Mr. Inslee) and the gentleman from 
Florida (Mr. Bilirakis) each will control 30 minutes.
  The Chair recognizes the gentleman from Washington (Mr. Inslee).
  (Mr. INSLEE asked and was given permission to revise and extend his 
remarks.)
  Mr. INSLEE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, we are bringing a motion today on this most important of 
issues in an effort to give seniors what they deserve, which is a real 
guaranteed prescription drug benefit under Medicare. Unfortunately, 
unless we pass this motion, or some equivalent motion, the generation 
that fulfilled their duties on Iwo Jima, that is The Greatest 
Generation, will not get a first class double-A rated guaranteed 
prescription drug benefit under Medicaid. They will get something 
approaching the flimflam that they have had for so long from the United 
States Congress.
  Mr. Speaker, we are here to offer a motion which will boldly instruct 
the conferees to cure both a sin of commission and a sin of omission in 
their plan. Now, let me address those sins of commission and omissions.
  First, there are multiple sins of omission from the proposal of the 
conferees we have heard to date, one of which is their abject and total 
failure to do anything for America's senior citizens to restrict the 
incredible rise in drug prices they have been experiencing. And, Mr. 
Speaker, certain other motions will address that issue. But it is 
amazing to me that at the moment in time when our seniors are yelling, 
and justifiably so, about the incredible rise in their drug prices, 
that not only does this conference report refuse to do anything 
affirmative about it, it has actually shackled Uncle Sam from doing 
anything about it and from negotiating better drug prices. That is a 
sin of omission that other motions have dealt with.
  Mr. Speaker, this motion deals with two other fundamental ones that 
need to be remedied. One is to prevent this conference report from 
driving a dagger through the heart of Medicare by privatizing this 
entire system, which this conference report would result in as sure as 
God made little green apples. And it would do so slowly but surely by 
this nefarious plan to force every single senior citizen to either 
accept a privatized system in the morass of the insurance industry, or 
to accept essentially higher premiums and less coverage. That is a sin 
of commission.
  But there is a sin of omission as well that our motion would cure, 
and that is the fact that we are not providing adequate reimbursement 
to physicians, to providers, to nurses, to physical therapists, to 
oncologists who treat our senior citizens. And as a result of these low 
payments, as a result of these low payments now in the State of 
Washington, over 50 percent of the physicians are no longer taking new 
Medicare patients. Why not? They cannot afford to under the 
reimbursement rates. And are we fixing this problem in this bill? No.
  Over 50 percent of the people in the State of Washington now go to 
try to get their physicians and they are not being accepted. And, 
frankly, a prescription drug benefit that does not solve this problem 
is not going to be a solution to the problem. It does no good to have a 
prescription drug benefit if you cannot get into a physician to have a 
prescription written for you. Half the doctors in the State cannot 
afford to do it right now, because under the Republican plan, in order 
to fund the tax cuts for Enron, we are adopting measures to screw down 
Medicare and to screw down benefits over the long term under the 
Medicare system.
  Now, there is a tricky little effort that slowly but surely will 
accomplish former Representative Newt Gingrich's great dream, which is 
to see Medicare wither on the vine. And it will accomplish it by saying 
a few years out from now, people who want to stay in the Medicare 
system to get a guaranteed benefit would be forced either to go into a 
privatized system at the whim of the insurance industry or accept less

[[Page H11846]]

effective coverage from Medicare. How do I know that? Well, I know that 
because the experts in the field have evaluated it.
  Let me just quote two fellows. Henry Aarons of The Brookings 
Institution, and CBO Director Robert Reischauer, two people who 
essentially were the originators of the idea of premium support, 
because in the right circumstances perhaps it would have some 
justification. They said the GOP plan could result in Medicare 
experiencing a ``death spiral,'' and said that it is too risky to 
adopt. And the reason they said that is that the authors of this plan, 
the people who have been trying to shrink Medicare since it started in 
the 1960s, and who actually tried to prevent it from starting in the 
first place, know that under their plan what will happen is that 
private insurance companies will cherry pick the healthiest among 
Americans. And as they cherry pick the healthiest Americans, they will 
leave the sick in Medicare, who will have to pay higher premiums under 
this nefarious proposal.
  Mr. Speaker, this motion will instruct the conferees to come back 
without that provision, without that little thing that is the poison in 
this little trap for our senior citizens. That is why we have people 
calling every single office in Congress urging us not to adopt this for 
our senior citizens, because they are not going to be snookered by this 
plan.
  Mr. Speaker, I yield 3 minutes to the gentleman from Washington (Mr. 
McDermott), who is a great physician from Seattle.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, I only want to make two points. The 
reason that this is a bad bill is that it does not take into account 
what is in the common good. The idea of Medicare is that everybody pays 
into the pot and then, if God forbid you get sick, you take money out 
to pay for your health care. Everybody in the United States who is over 
65 is covered. Everybody gets the same benefits. It does not make any 
difference where you live, Alabama, Arizona, or wherever, you get the 
same benefits. And what this bill does is change the basic concept.
  What this bill says is we are going to guarantee that you have enough 
money individually as Americans to go out and buy your own bill. Now, 
everybody who is 65 and older in this country is not in the same health 
status, and they are going to get different coverage depending on their 
health status, depending on where they live, and how much money it 
costs in their area. Everybody is going to get something different. And 
the fairness in this program will be gone. Now, that is the first thing 
that is wrong with this; that we have taken away the idea of a common 
good, where we take care of each other.
  Now, they will say, oh, but you can stay in the old Medicare program. 
Let me tell you what is wrong with that. What they say is that the old 
Medicare program has to compete with these private insurance companies. 
So if you do not want to take your voucher and go out to a private 
insurance company, you can stay in the old Medicare program. Now, we 
have already heard my colleague, the gentleman from Washington (Mr. 
Inslee) say that the insurance companies, in meeting the enrollment 
criteria for their program, they will find some way to figure out where 
the healthy old people are. They are not going after the 95-year-old 
mother that I have living in a retirement home in Seattle. They will 
not be going and recruiting her to get into their health care plans. 
They want to leave her over here with this bunch.
  Now, what will happen is the old and the sick will be over here and 
the young and the healthy will be on this side. And, of course, the 
costs will be less over here. So if this side has to compete with that 
side, and the costs are higher, they are going to stick the ones who 
stay in the old health care, in the old Medicare, with higher premiums. 
So not only is my mother not going to have the same benefits, she is 
going to get a higher premium. I, because I am younger and in better 
shape than she is, will be on this side, and I will get a deal with 
some insurance company, and I will do much better than my mother.
  Is that fair? Is that what we want to do? Do we want to separate out 
the healthy old people from the sick old people and say to the sick 
ones, well, you are kind of on your own, folks. Hope it works out. Hope 
you have some kids to pick up the difference. Because my mother has 
four kids to help her, but not everybody has four kids to help them. So 
you are setting up a situation where you are saying to grandma, here is 
your voucher, good luck.
  Vote ``no'' tomorrow.
  Mr. Speaker, I want to talk about the Medicare bill that we will soon 
consider. This is one of the most important bills in the 16 years I 
have been in the Congress because we are dealing with an issue that is 
about the question of what is in the common good.
  The way Medicare works is, everyone pays money into the pot, and if 
someone gets sick, then their health care is paid for. So the only 
people who cost money are those who get sick and need health care.
  Nobody wants to get sick, but it's good to know that Medicare is 
there to take care of us.
  But if we allow this Medicare plan to go into effect, the Republicans 
would change Medicare into a voucher system, where seniors pay private 
insurance companies to provide them with health care coverage.
  And if we use private, for-profit health insurance, we--the 
government and the taxpayers--are going to pay them money every single 
month to ``cover'' our seniors, but not necessarily to provide health 
care. Because if somebody does not get sick or use health care, the 
insurance company keeps the money. So the insurance company has every 
reason to not provide health care and every reason to want to get only 
the healthiest among us in their plan.
  And that will leave us in the situation where we're paying insurance 
companies to do little, and they will leave the oldest and sickest 
Medicare beneficiaries in the traditional Medicare plan.
  Now, it gets even worse. Because the Republicans want the oldest and 
the sickest to pay more. They want traditional Medicare to ``compete'' 
with these private insurance companies based on their costs. But we 
know the insurance companies will get the cheapest people into their 
plans. They'll advertise at health clubs, at the top of the stairs. 
They've done this before; they're good at it.
  So for those who stay in traditional Medicare, their premiums will go 
up because the insurance companies will only target and recruit the 
people who wouldn't use health care. The Republicans will let the 
insurance companies take just who they want and leave the most 
vulnerable amongst us on their own.
  We already know this will happen, because this is exactly what 
happened before. Back in 1997, we set up this big program, ``Medicare 
plus Choice''. The Republicans believed then, as they do now, that it 
would be better to break Medicare up into private managed care plans--
to put everyone in an HMO. They said it would be cheaper, and better.
  Well, we know what happened. Every year since the Medicare Plus 
Choice plans came into existence, they have pulled out and left seniors 
scrambling back into traditional Medicare. In 1999, there were about 7 
million people in these M+C plans. Now there are about 4.6 million 
people in these plans. So nearly 3 million seniors have already been 
abandoned by these private plans.
  But the plans were happy to take our money first.
  We know the private plans take the healthiest seniors, and we know 
that these people would be cheaper to insure if they stayed in 
traditional Medicare.
  We know that these very healthy seniors are 16 percent less costly. 
These are the healthy people the private plans are trying to get. And 
the insurance companies are making money on them, hand over fist. They 
are either making a ton of money for doing nothing, or they are so 
inefficient that they are losing this 16-percentage point spread. 
Either way, they aren't very good for us.
  In their new plan, the Republicans throw even more money to the 
insurance companies. The insurance companies will be paid even more per 
person then they already get, probably 10 t0 15 percent more. And we 
know how these plans operate, they will do their best to get the 
healthy folks in, the ones they can make money on.
  And for those who want to stay in traditional Medicare, the price per 
person is going to go up, so they are going to raise the premium on 
anybody who stays in the regular program. This is not thinking about 
the common good. It is wrong, it is un-American, and it is undermining 
the whole concept of Medicare.
  Republicans have tried for many years to shift Medicare away from a 
program of real benefits to a voucher program. This time around, the 
Republicans call this a ``demonstration project,'' they say it will 
just be a test. But it could involve 6 million or more seniors, and 
could be expanded to cover the whole country after six years. And this 
``demonstration'' is not something you can volunteer for, or decide not 
to do--if they pick your city,

[[Page H11847]]

you're in, whether you like it or not, you're a guinea pig.
  Don't be fooled. This is not an experiment, this is not a test--this 
is the first step towards privatizing Medicare, pushing all our seniors 
into the private market and telling them to make it on their own. This 
is not insurance, this is throwing them to the wolves.
  The Republican plan to use the promise of much-needed prescription 
drug coverage in order to push their agenda of privatizing Medicare is 
just wrong. We can't do this to our seniors. We can't just give them 
all a voucher and say, ``good luck finding coverage, good luck finding 
something you can afford.''
  And, just in case you're wondering if this is all, here are a few 
more things wrong with their Medicare bill:
  1. Millions of seniors will lose their existing--and better--
retirement benefits. Companies will use Medicare providing a drug 
benefit as an opportunity to eliminate coverage they currently provide 
for their retirees. At least 2 million Medicare beneficiaries will lose 
their current benefit, which is almost certainly better than the scant 
coverage provided under this plan. This will make these beneficiaries 
worse off.
  2. The drug coverage provided is weak and inconsistent. Seniors will 
pay a premium of at least $35 a month, and many will pay more into the 
program than they will get back.
  The Republican plan contains a large coverage gap--after $2,200 in 
total costs, there is no coverage until a senior has paid $3,600 out of 
pocket, and purchased $5,044 worth of prescription drugs.
  This means that of the first $5,000 a person spends, only $1,000 of 
it will come from their insurance. They will pay $4,000 of it on their 
own. This is not much of a benefit.
  This means that seniors who spend more than $180 per month on 
medications will have many months in the year when they pay 100% of 
their drug costs but will still pay a premium every month.
  Seniors will only be eligible for drug coverage through private 
insurance companies that will have wide latitude in setting premiums 
and deductibles.
  Private insurance companies will also be able to make decisions about 
which drugs are covered, as well as which pharmacies seniors can use.
  3. This bill is designed to protect an increase drug companies' and 
insurance companies' profits.
  The pharmaceutical industry will reap about $140 billion in profits 
over eight years if this bill becomes law.
  The bill explicitly prohibits the Secretary of Health and Human 
Services from negotiating lower drug prices on behalf of America's 40 
million Medicare beneficiaries.
  And, the bill does not allow Americans to import drugs from countries 
where prices are lower.
  Insurance companies receive tens of billions of dollars in subsidies 
to take Medicare's business.
  We take the risk and the insurance companies take the profits. If 
insurance companies lose money on Medicare, this bill says we, the 
government, will pay for it.
  4. Their ``Cost-containment'' measure is designed to hurt Medicare 
beneficiaries and providers. Under their plan, Medicare's financing 
will be unstable and under assault. If general tax revenues account for 
more than 45 percent of Medicare spending, Congress would have to 
consider cost-control measures. We know this will probably happen by 
2016, or even earlier. Congress could reduce benefits, increase 
beneficiary premiums, raise payroll taxes or reduce payments to 
providers.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume, and I rise in opposition to the motion to instruct offered by 
the gentleman from Washington (Mr. Inslee).
  Mr. Speaker, I would say at the outset, through the Chair, that the 
only air of omission is that the gentleman's party was in charge so 
very many years did not see fit to decide that prescription drugs were 
necessary for our poor seniors. Now, all of a sudden, when the 
Republicans are doing it, they are taking issue with it.
  This motion to instruct, Mr. Speaker, no longer serves any purpose, 
no longer serves any purpose, since a bipartisan group of Medicare 
conferees has already reached, as the gentleman knows, reached an 
agreement that will greatly improve the Medicare program, and most 
notably through the addition of a long-awaited prescription drug 
benefit.

                              {time}  1915

  In fact, I can assure the gentleman from Washington (Mr. Inslee) that 
the provisions he seeks to strike in his motion to instruct were not 
included in the bipartisan Medicare conference agreement.
  Additionally, the three positions that the gentleman is advocating, 
insuring that all hospitals receive the large urban standardized rate, 
that there be a floor on the work component on the physician fee 
schedule, and that the conference report include increases in 
reimbursements to physicians, are all already in the conference report.
  I have led the opposition to a number of motions to instruct Medicare 
conferees over the past couple of months; and in doing so, I 
continually urge my colleagues to allow the bipartisan negotiations 
that I was a part of to play out. As Members know, these negotiations 
have run their course, and the result is a bipartisan agreement that is 
endorsed by a number of organizations, including the AARP.
  That is why this motion no longer has any meaning, Mr. Speaker. It 
seeks to strike provisions not included in the final agreement and 
direct these nonexistent funds towards provider-payment increases that 
are already included in a bipartisan Medicare conference agreement.
  In fact, the American Medical Association has strongly opposed 
previous motions to instruct that attempt to move money from patients 
to providers. In fact, the AMA forwarded me a statement earlier this 
week in response to a motion which took place, I believe, a couple of 
nights ago to instruct that said it strongly opposes the Berkley motion 
to instruct and urges Congress to pass the pending Medicare conference 
report before we adjourn.
  I support reimbursing physicians and hospitals fairly for the 
valuable services they provide. I have been particularly passionate 
about fixing the formula that the Centers for Medicare and Medicaid use 
to annually update Medicare physician payments. In fact, I introduced a 
bill in late 2001, I believe it was jointly with the ranking member of 
my Subcommittee on Health, the gentleman from Ohio (Mr. Brown), that 
would have prevented the 5.4 percent cut in physician reimbursements 
under Medicare that went into effect in 2002.
  Physicians were slated to receive another cut, this time a 4.4 
percent, if not for congressional action that corrected flawed data in 
the update formula and provided physicians with a 1.6 percent update 
for 2003.
  However, persistent flaws in the update formula mean that physicians 
are looking at a 4.5 percent cut next year and further negative updates 
through 2007. It makes no sense, does it, that we would be cutting 
payments to our Nation's doctors at the same time their costs are 
rising. That is why the bipartisan Medicare conference agreement 
contains provisions that will ensure that physicians see their 
reimbursements under Medicare increased by 1.5 percent in fiscal years 
2004 and 2005. Rather than the 4.5 percent cut, we are talking about a 
1.5 percent increase, a 5.9 percent swing.
  This will provide Congress with the time that it needs to make long-
term reforms to the Medicare physician payment update formula so that 
physicians can count on predictable, rational payments from Medicare; 
and it will also avoid a major physician access problem for Medicare 
beneficiaries.
  I would note that a number of organizations representing America's 
health care providers, including the American Medical Association, the 
American Osteopathic Organization, the American Hospital Association, 
and the Federation of American Hospitals, all strongly support the 
bipartisan Medicare conference agreement.
  Mr. Speaker, over the past few months, I have had to listen to an 
awful lot of rhetoric about how Congress was privatizing Medicare or 
implementing a voucher system or handing Medicare over to the HMOs. 
That was not true then, and it certainly is not true now. What the 
bipartisan Medicare conference agreement does do is improve the 
Medicare+Choice program and set up a new system that will encourage 
regional plans to offer seniors another choice besides traditional 
Medicare.
  It is a voluntary thing. Seniors can choose to retain traditional 
Medicare, something that they are accustomed to, something I would 
recommend to my parents if they were still alive, retain it and then go 
ahead and purchase a private drug prescription plan to add to it. It is 
my hope that this will extend new choices to folks in rural areas who 
have not had a choice in Medicare before.

[[Page H11848]]

  The bipartisan Medicare conference agreement also includes a limited 
pilot project that will test a new system that could help put Medicare 
on sound financial footing for future generations. It is a pilot 
program. I think conferees came to a solid compromise. It is 
bipartisan, and it will help us fulfill our promise to America's 
seniors, and that is why I am so pleased that AARP strongly endorsed 
this agreement.
  I can attest to the gentleman that a bipartisan group of conferees 
worked around the clock to reach this compromise. Soon Congress, I 
suppose tomorrow, will vote on a conference report that will add a new 
prescription drug benefit that will be available to all Medicare 
beneficiaries and that will provide seniors with new choices under 
Medicare and will reimburse our health care providers, including 
physicians, fairly so that beneficiaries will continue to have access 
to high-quality care; and I would also throw in at this point that 
under this bipartisan Medicare conference agreement, as under the 
original House-passed bill, seniors retain complete freedom to choose a 
private plan or to remain, as I have already said, in the traditional 
fee-for-service program. Medicare will continue to offer every 
beneficiary access to Medicare's defined benefit.
  I hope Members will join me in supporting the conference report 
tomorrow and rejecting this motion to instruct which is meaningless 
because the conference agreement has already taken place.
  Mr. Speaker, I reserve the balance of my time.
  Mr. INSLEE. Mr. Speaker, I yield 1 minute to the gentleman from Ohio 
(Mr. Strickland).
  Mr. STRICKLAND. Mr. Speaker, I would just like to take a moment and 
direct a question to the gentleman from Florida (Mr. Bilirakis). The 
gentleman has said over and over in his statement that this was a 
bipartisan conference report. I ask a question: Was any House 
Democratic Member included in the conference negotiations? Were any of 
the Democrats included in the conference negotiations?
  Mr. BILIRAKIS. Mr. Speaker, will the gentleman yield?
  Mr. STRICKLAND. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Speaker, every House Democratic Member who showed 
an interest in having a piece of legislation rather than an issue in 
November was invited into this coalition. It was bipartisan because 
there were two Democratic Senators who did have enough dedication who 
wanted to have a bill who were invited to participate, and I am here to 
tell Members that their comments and their recommendations probably 
took up 50 percent of the time over a period of months.
  Mr. STRICKLAND. But the gentleman from Florida knows that our 
appointed conferees were the gentleman from New York (Mr. Rangel), the 
gentleman from Michigan (Mr. Dingell), and the gentleman from Arkansas 
(Mr. Berry), and those three individuals were not included in the 
negotiations. I do not understand how the gentleman can stand and say 
to the American people that this was a bipartisan effort. It was not. 
Our Members were shut out of these negotiations.
  Mr. INSLEE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Wisconsin (Mr. Kind).
  Mr. KIND. Mr. Speaker, I thank the gentleman from Washington (Mr. 
Inslee) for yielding me time on this important motion. I commend the 
gentleman for this motion and for his efforts on the prescription drug 
bill that we have before us tomorrow.
  This motion speaks to a fundamental problem that has existed in rural 
America in particular for many, many years; and coming from western 
Wisconsin, the Third Congressional District that I represent, I have 
devoted a lot of my time to try to deal with the inadequacies of 
Medicare reimbursement that have adversely affected my rural hospitals.
  This motion would ask for raising the average standardized amount for 
hospitals in rural areas, as well as raise the physicians' work 
geographic index. Why is this important? Well, rural hospitals have 
been suffering for a long time. Sixty percent of the rural hospitals in 
my district and throughout the country are not receiving adequate 
Medicare reimbursement to cover the costs of treating Medicare 
recipients. Over the last 25 years, we have lost 475 rural hospitals 
which have gone out of business, partly due to the fact of the 
inadequacy of the Medicare reimbursement formula.
  On average, my rural hospitals receive about 25 percent less than the 
average Medicare reimbursement throughout the country. This is a 
serious issue that needs serious attention.
  The bill before us tomorrow I feel has a very good provider aspect 
with it, but the provider aspect is paid for. There are offsets found 
in the budget in order to pay for that. One of the chief concerns I 
have with the Medicare bill that is going to come before us tomorrow is 
there is no cost containment, and these costs are going to explode in 
future years. As a way of dealing with the rising prices of 
prescription drugs, one is allowing generics to enter the market on a 
competitive basis when the patents on brand-names expire. Another is to 
allow the Federal Government to negotiate prices with the 
pharmaceutical companies, even though there is specific language in 
this bill that specifically prohibits any price negotiation. Finally, 
is to allow the reimportation of FDA-approved drugs in a country like 
Canada back into the United States, something that many of my seniors 
in Wisconsin are already doing.
  Mr. Speaker, if we are concerned about the costs of this bill, we 
would implement these practical measures. The easiest thing to do in 
the world of politics is to pass a bill we do not pay for and stick it 
to our kids and our grandchildren in future years, and that is exactly 
going to be the outcome of this bill tomorrow if we do not come to 
grips with the cost factor of rising medications.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself 1 minutes.
  Mr. Speaker, to respond to the gentleman's statements, the regulatory 
reform portion of this bill, the electronic prescribing portion of this 
bill, the medication therapy management portion of this bill, and many 
of the provider issues were worked out on a bipartisan basis by all of 
the staffs, even prior to the conference. They were not discussed as 
part of the conference because they were already worked out. I just 
wanted to point that out.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Georgia (Mr. Gingrey).
  Mr. GINGREY. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, once again we are debating a motion to instruct Medicare 
conferees. I find it odd that we are doing so after a bipartisan group 
of Medicare conferees has reached an agreement that has been strongly 
endorsed by numerous organizations, including AARP and 35 million 
seniors.
  This motion to instruct conferees, as the gentleman from Florida (Mr. 
Bilirakis) said, like so many that the minority has offered before, 
serves no useful purpose in this debate. It is a solution in desperate 
search of a problem. 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 on its commitment 
to providing seniors with access to meaningful, affordable, and 
comprehensive prescription drug coverage.
  Mr. Speaker, I support properly reimbursing physicians and hospitals. 
The House bill does that, as does the bipartisan Medicare conference 
agreement, which is why it is supported by a number of organizations, 
including the American Medical Association, the American Hospital 
Association, and the Federation of American Hospitals.
  I also believe it is a false choice to suggest that we need to choose 
between properly reimbursing providers and finding a way to ensure 
Medicare's long-term financial viability, because this bill does both. 
The AMA agrees with me, and here are some of its thoughts on a motion 
that was offered earlier this week by the gentlewoman from Nevada (Ms. 
Berkley).

                              {time}  1930

  ``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.

[[Page H11849]]

  ``In addition, the conference report would halt 2 years of impending 
Medicare payment cuts to physicians and other health professionals and 
replace these cuts 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.''
  Let me just say this, Mr. Speaker. If the gentleman from Washington 
is serious about wanting to help our Nation's providers, let me suggest 
and urge to him to reconsider his opposition to medical liability 
reform legislation, tort reform, such as H.R. 5, the HEALTH Act, a bill 
that was strongly supported by the American Medical Association. Mr. 
Speaker, I am sure that the physicians in the State of Washington would 
be very appreciative of that support.
  While we should all be pleased about the fact that we are about to 
provide our seniors with Medicare prescription drug coverage, I would 
note for my colleagues that spending on Medicare is projected to nearly 
double over the next decade just as our baby boomers begin to retire. 
Social Security, Medicare and Medicaid currently comprise more than 40 
percent of the Federal budget. By the year 2030, the General Accounting 
Office estimates that these three programs, once again Social Security, 
Medicare and Medicaid, could consume 75 percent of the Federal budget 
if we make no changes and we keep Medicare as we know it. This level of 
entitlement spending is unsustainable and it will crowd out other 
essential functions of government. Reforms must be made to ensure that 
Medicare continues to exist for future generations, the children and 
the grandchildren that the gentleman from Washington was talking about. 
As we add a $400 billion drug benefit to a program that already has $13 
trillion in unfunded liabilities, we must enact real reforms that will 
place the program on sound financial footing for the future.
  To modernize Medicare and ensure its long-term fiscal viability, the 
bipartisan Medicare conference agreement will provide for a limited 
pilot project that will help test to see if the competitive reforms 
included in the House bill will help to ensure the long-term viability 
of this program. Under the bipartisan Medicare conference agreement as 
under the original House-passed bill, seniors retain complete freedom 
to choose a private plan or remain in the traditional as we know it 
fee-for-service program. Medicare will continue to offer every 
beneficiary with access to Medicare's defined benefit.
  Mr. Speaker, I strongly support the bipartisan Medicare conference 
agreement which we will soon consider on the House floor. This motion 
to instruct no longer serves any purpose and the gentleman from 
Washington knows that. Indeed, the provisions relating to Medicare 
competition that the gentleman references in his motion are not even 
part of the final conference report.
  I urge my colleagues to join me in rejecting this motion to instruct 
and supporting in a bipartisan fashion the final Medicare conference 
agreement.
  Mr. INSLEE. Mr. Speaker, I yield myself such time as I may consume.
  I appreciate the gentleman's advice, but we take it with not great 
credence from a group that have run us up into a $500 billion deficit 
because of their fiscal irresponsibility. So I appreciate the 
gentleman's advice, but I do not think it is going to have a lot of 
sway with the American people from a group that has given us the 
largest deficits in the universe's history.
  Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from Ohio (Mr. 
Brown).
  Mr. BROWN of Ohio. I thank the gentleman from Washington for yielding 
time.
  Mr. Speaker, night after night we come down here. We talk about 
Medicare. I hear my friends on the other side of the aisle over and 
over say that of course they care about Medicare, that they believe in 
it. I know the gentleman from Florida (Mr. Bilirakis) does, because I 
have worked with him regularly. But I also know that his leadership 
does not. All you have got to do is look at the Republican history of 
Medicare. In 1965, when Medicare came in front of the United States 
Congress, when the creation of Medicare happened and President Johnson 
signed it, July 1965, only 13 out of 140 Republicans in this body voted 
to create Medicare. The other 127 voted no. Gerald Ford voted no; Bob 
Michel voted no; John Rhodes voted no; Bob Dole voted no; Senator Strom 
Thurmond voted no; and Donald Rumsfeld voted no.
  The first time in these years since 1965 when the Republicans 
actually could weaken Medicare, they tried to. Newt Gingrich, the new 
Speaker of the House in 1995, the first thing he did was proposed to 
cut $270 billion from Medicare in order to give a tax cut to the most 
privileged people in this society. Speaker Gingrich said, ``We don't 
want to get rid of Medicare in round one because we don't think that's 
politically smart, but we believe it's going to wither on the vine.''
  Bob Dole, who had been around 30 years earlier to try to defeat 
Medicare, bragged to a conservative group in 1996, ``I was there 
fighting the fight trying to stop Medicare from happening.'' They are 
not the only ones. John Linder told the House Rules Committee he did 
not like Medicare because it was a Soviet-style program. Dick Armey, 
former majority leader, said he did not like Medicare. He said, ``It's 
something you wouldn't have in a free society.'' And Bill Novelli, the 
AARP CEO, wrote a preface to Newt Gingrich's book calling him a big 
idea person because of his efforts to privatize Medicare. Bill Novelli, 
making $700,000 a year working for the insurance company that we call 
AARP. AARP has made, according to the Milwaukee Journal and Capital 
News Services, literally $100 million a year from insurance sales, that 
organization. Sure they endorse this bill because that organization is 
going to make tons of money in the insurance business.
  But the fact is my friends on the other side of the aisle simply do 
not like Medicare. They voted against its creation and every single 
time they have had a chance, they have done what they could to cripple 
it. They cut its funding, they try to privatize it, they take options 
away from seniors, all in the name of choice.
  Mr. Speaker, the Inslee motion makes sense. Support the Inslee motion 
to instruct.
  Mr. BILIRAKIS. Mr. Speaker, I yield such time as he may consume to 
the gentleman from Texas (Mr. Burgess).
  Mr. BURGESS. I thank the gentleman for yielding me this time.
  Mr. Speaker, once again this was a bad motion earlier this week, it 
was a bad motion last week, it is a bad motion this week, and now it is 
irrelevant. It is irrelevant because the Medicare conferees have come 
to an agreement on these provisions. In fact, the final conference 
agreement does not even contain the Medicare competition provisions 
referenced in this motion.
  The Medicare conference agreement has been endorsed by a number of 
organizations that would be directly affected by this motion to 
instruct conferees, such as AARP, the American Medical Association, and 
the American Hospital Association. So while the minority continues to 
try to score political points, and in fact they are just trying to 
scare people, the House is on the cusp of delivering a Medicare 
prescription drug bill to our Nation's seniors.
  However, in the best interest of today's debate, let me describe what 
this motion intended to accomplish. It directs conferees to strip out 
important competitive reforms in the House and Senate-passed Medicare 
bills and redirect the funds toward increasing reimbursements for 
physicians and hospitals. This House certainly understands the 
importance of properly reimbursing physicians. That is why, unlike the 
Senate, the House included a provision that will provide physicians 
with positive payment updates in 2004 and 2005. This provision is 
included in the bipartisan Medicare conference agreement. While this is 
not a permanent solution, Mr. Speaker, it will provide Congress with 
the time it needs to make long-term, substantive changes to the 
Medicare physician payment update formula.
  The bipartisan Medicare conference agreement also increases 
reimbursements for physicians practicing in rural areas as part of the 
most robust

[[Page H11850]]

Medicare rural package this Congress has ever considered. Finally, the 
conference agreement will ensure that all hospitals receive the large 
urban standardized rate which means billions of dollars in additional 
funding for our Nation's hospitals.
  Mr. Speaker, it is not lost on me that the supporters of this motion 
are attempting to portray this as a choice between HMOs or doctors. It 
is a false choice and they know it.
  One of the aspects of the conference report that will be presented 
later this week that I find particularly attractive is the enactment of 
health savings accounts, a far cry from yesterday's HMOs. But do not 
take my word for it. We were very fortunate today to have the 
president-elect of the American Medical Association here on Capitol 
Hill, Dr. John Nelson, an OB-GYN like the gentleman from Georgia (Mr. 
Gingrey) and myself. The American Medical Association last week when 
this motion to instruct was offered yet one more time said they 
strongly support the passage of the Medicare prescription drug 
conference report which currently includes historic and critical 
provisions for improving choice and access to America's seniors and 
America's disabled.
  In addition to increasing Medicare reimbursements to our Nation's 
physicians, the bipartisan Medicare conference agreement also provides 
seniors with more choices under Medicare and will begin to test some 
long-term competitive reforms that will ensure that Medicare is 
available and on sound financial footing for generations to come. That 
is an important point. Let me stress it. Ensure that Medicare is on 
sound financial footing for generations to come. I want to emphasize 
that neither the bipartisan Medicare conference agreement nor the 
House-passed Medicare bill would ever require that Medicare 
beneficiaries leave traditional Medicare.
  A traditional Medicare will have a new patient prescription drug 
benefit available to its beneficiaries. Anyone who says otherwise 
either does not understand this legislation or prefers to avoid the 
facts.
  Medicare conferees have worked through some very difficult issues. We 
owe them all a debt of gratitude for what they have done. They have 
produced a consensus agreement that this House will vote on later this 
week. The time to offer irrelevant, meaningless motions to instruct is 
over. The time to provide America's seniors with a Medicare 
prescription drug benefit is now. I urge my colleagues to vote ``no'' 
on the motion to instruct.
  Mr. INSLEE. Mr. Speaker, I yield myself such time as I may consume.
  When this premium support kicks in, no senior in America will have 
any choice about the matter. You will be subject to a provision that 
you will have to pay more money out of pocket when the HMOs take the 
healthy people into the private sector and leave the rest of our senior 
citizens in the more expensive Medicare pool. The group that said that 
last July was the AARP which said it will require beneficiaries to pay 
even more out of pocket. One hundred percent of Medicare recipients 
will be subject to this provision. You have no choice whatsoever. And 
everybody in this Chamber knows it.
  Mr. Speaker, I yield 2 minutes to the gentleman from Ohio (Mr. Ryan).
  Mr. RYAN of Ohio. Mr. Speaker, I have noticed as I sat here tonight 
and throughout this debate some contradictions in the arguments from 
the other side which has not been unusual in my short time here. We 
hear a lot about privatization. We hear a lot about how the free 
markets need to work. But I am a little confused when we want to free-
trade pharmaceuticals. The same day we were sitting here passing free 
trade agreements with Singapore and Chile, we refused to free trade 
pharmaceuticals with Canada, to lower the prices here. The same day. 
Actually, it was early into the next morning. I am wondering where all 
the capitalists and free traders were for that vote. Now, we have 
pharmacy benefit managers who for the private insurance companies will 
be allowed to negotiate down the drug prices. But we are tying the 
hands of the Secretary of Health and Human Services and explicitly say 
he is not allowed to negotiate lower drug prices.
  These are complete contradictions in the argument. We hear about 
smaller government and free trade is great and we need the private 
markets to work, we need to be able to allow the free markets to work, 
and they are not working because they are not allowed to work if 
somehow they are going to improve this program and allow the government 
to be able to run a program that will benefit all of the seniors who 
will be eligible. People think they are going to wake up and get a 
Christmas gift this year, and they are going to find out in the end 
they are going to get coal in their stockings.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself 1 minute to respond to a 
point just made by the gentleman from Washington regarding premium 
support because that was the point. I am reading from the AARP 
endorsement, this insurance company as it was referred to a few minutes 
ago:
  AARP is pleased by the improvements made to the conference report in 
recent days. A new structure called premium support--their words--which 
required competition between traditional Medicare and private plans was 
downsized to a limited test starting in 2010 which has significant 
protections--their words--significant protections for those in 
traditional Medicare.
  I should think they would know at least as much about this as many of 
you gentlemen over there do. The government will provide coverage in 
areas where private plans fail to offer coverage. The integrity of 
Medicare will be protected.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Kentucky (Mr. Whitfield).

                              {time}  1945

  Mr. WHITFIELD. Mr. Speaker, I am glad that we are having this debate 
this evening on such an important topic as Medicare. It is quite 
obvious that this bill is not an ideal bill. There are shortcomings in 
this bill. But this Congress for 5 or 6 years has been having 
discussions about providing a prescription drug benefit for senior 
citizens, and that is precisely what this legislation does.
  The previous speaker talked about the importance of being able to 
reimport drugs from Canada. If we pass this bill, those seniors who 
need it most are not going to have to be concerned about the cost of 
medicine because if they want to, and the option is theirs, they do not 
have to, they can stay with the Medicare program they have today; but 
if they want to, they can come into this program, and if their income 
is 135 percent of the poverty level and below, they do not have to pay 
a monthly premium to participate. They do not have to pay any 
deductible to participate, and their only out-go would be a $1 co-pay 
for a generic drug, a $3 co-pay for a brand-name drug, and they can 
reimport all the drugs they want to; and it is not going to be less 
than that. So they are going to be better off under this program than 
they would be worrying about reimportation of drugs from Canada.
  If they are 135 percent of the poverty level and higher, instead of 
paying a $1 co-pay, they are going to pay a $2 co-pay. Instead of 
paying a $3 co-pay for brand names, they are going to pay a $5 co-pay 
for brand names. And I can tell the Members, the 35 counties that I 
represent in rural western Kentucky, the senior citizens there are 
going to be delighted with this bill because most of them are going to 
be able to walk away and not pay a premium, not pay a deductible, but 
have a prescription drug program that they can afford. It is not the 
ideal bill. There are some shortcomings. There is no question about 
that.
  I would also like to make this comment about this argument about 
privatization, which I think is frequently used to scare senior 
citizens, and I understand that. We all like to play that game. But I 
think it is important to know that under the existing Medicare program 
that has been in effect for all these years, HCFA already contracts 
with private companies in all 12 regions of this country to administer 
the program. So we are already dealing with private companies. There is 
nothing unusual about that. But it does sound good if they want to try 
to scare senior citizens. But overall I think this bill is a good 
beginning.
  And I would make one other comment, although I certainly do not agree 
with Newt Gingrich on everything, but

[[Page H11851]]

people always talk about his comment of letting it wither on the vine. 
He was not talking about Medicare as a program. He was talking about 
HCFA, the entity that administers Medicare; and if people talk to any 
health care provider in this country, whether it be a physician, 
hospital, whatever, they will complain and express concern about the 
bureaucracy at HCFA on reimbursements, on all sorts of issues. I have 
had more than one town meeting in my district with health care 
providers complaining about the bureaucracy at HCFA. Obviously, HCFA is 
trying to do a good job, but Newt Gingrich's comment was simply about 
trying to modernize it to provide a better program, more efficient 
program, more productive program with a faster reimbursement for health 
care providers.
  So, Mr. Speaker, I know it has been a difficult chore, and I know 
that the Democrats on the other side have contributed to this program. 
They have worked to help us devise a program that is a good starting 
point, and I think this is a good starting point, and I think the thing 
that really tells the story about this program, about this bill that we 
probably will be voting on tomorrow, is that the AARP, which is the 
premier senior citizen association in the country, is now endorsing 
this bill, it is my understanding. So I hope that we will vote against 
the gentleman from Washington's motion to instruct, and I hope that 
tomorrow we can pass this bill and provide our seniors with a 
prescription drug bill that they will be able to afford.
  Mr. INSLEE. Mr. Speaker, I yield myself such time as I may consume.
  AARP, that is the organization that also endorsed the catastrophic 
drug plan some time ago, that, when seniors found what was in it, 
rampaged and forced this Congress to repeal it. And, yes, seniors are 
concerned about this, and that is why they are calling us by the score 
in every one of our offices, and no doubt in yours too, because they 
understand when we tried to do this privatization experiment in the 
State of Washington for these profit-driven insurances companies that 
come in, tens of thousands of people without coverage were left without 
coverage when they left a year and a half later. It did not work. It is 
an experiment that already failed, and we are doing it again because 
people want to have Medicare wither on the vine.
  Mr. Speaker, I yield 2 minutes to the gentleman from New Mexico (Mr. 
Udall).
  (Mr. UDALL of New Mexico asked and was given permission to revise and 
extend his remarks.)
  Mr. UDALL of New Mexico. Mr. Speaker, I thank the gentleman from 
Washington (Mr. Inslee) for his leadership on this motion to instruct, 
and it is badly needed because we can see from the other side how the 
deceptions flow out. We are hearing over and over here again about a 
bipartisan conference. The fact of the matter is, and they know it, 
that we were locked out of the conference. Absolutely unprecedented. 
Democrats locked out and a secret agreement crafted, which we most of 
us have not even seen yet. We have not seen it. But it is going to be 
rammed through despite the fact it is supposed to sit on the table here 
for 3 days at a minimum for us to study.
  But this is a bad bill. It is a bad bill for seniors, and it is a bad 
bill for the future of Medicare. The key thing that a prescription drug 
bill should do is get control of the cost. This bill does not get 
control of costs in any respect. In fact, it has a prohibition in the 
bill that specifically says the Department of Health and Social 
Services, the agency that runs Medicare, cannot negotiate with the drug 
companies. I will bet the drug companies love that provision.
  Also the House of Representatives passed a reimportation provision. 
Reimportation allows us in the United States to bring in the cheaper 
drugs where they are safely manufactured. But they did not want that in 
the bill; so they junked that also. So there is nothing in this bill to 
control costs, and we are headed down a road of creating a program 
which is going to bankrupt our grandchildren.
  The only way, the only way we are going to get control of costs is 
allow the government, allow the government to negotiate. With that, let 
me urge all my colleagues to support the very wise motion of the 
gentleman from Washington (Mr. Inslee).
  Mr. Speaker, I rise today with great disappointment in the conference 
agreement that has been brought to the floor. I sincerely hoped that 
the bill that passed the House in July would have been moderated with 
provisions included in the other Chamber's bill.
  Unfortunately, instead of considering legislation today that would 
have modernized the Medicare program to provide prescription drug cost 
relief and coverage for seniors throughout this great Nation, we have 
this agreement that is geared toward dismantling one of the most 
successful government programs ever implemented. Instead of considering 
legislation to modernize the Medicare formulas to fix the inequities 
between rural and urban areas, we are considering an agreement that 
wraps these crucial fixes in with a prescription drug benefit that is 
designed to achieve the ideologically extreme goal of privatizing 
Medicare.
  I will certainly admit that the provider package included in this 
agreement is excellent. For years doctors, hospital administrators, and 
other health care providers have suffered under the unfair Medicare 
formulas that severely hampered their ability to provide care to 
Medicare beneficiaries. The labor share revision, the geographic 
physician payment adjustment, equalizing the Medicare disproportionate 
share payments, increasing home health services furnished in rural 
areas, critical access hospital improvements--these are all incredibly 
important provisions that I strongly support in order to help 
strengthen the health care system in rural areas. The physician fee 
formula update is another provision that is incredibly important. 
Without this fix, physicians will have no other choice but to stop 
seeing Medicare beneficiaries, which will lead to the total breakdown 
of a system that is already badly strained to its limits.
  I recognize the importance of these provisions. I understand the 
difficulties that those in the health care industry are facing. I 
understand the difficulties seniors are facing in trying to purchase 
and pay for their medications. That is why I have cosponsored 
legislation to fix the disproportionate share provisions, I have 
cosponsored legislation to fix the Medicare physician payment updates, 
I have written letters supporting these provisions and urging Chairman 
Thomas to include these rural fixes in the legislation, I have written 
a letter to conferees asking them to retain these provisions, and, when 
this bill passed in July, I voted in favor of the Democratic 
alternative that not only included stronger rural provisions than those 
included in the Majority's bill, but also contained a real prescription 
drug benefit--not a benefit engineered to bring about the demise of the 
Medicare program.
  Let's be clear about what our goal was supposed to be. We were 
supposed to create a new prescription drug benefit in Medicare. That's 
what we were supposed to be doing with this important legislation.
  Unfortunately, we are doing much more than that, and a lot of it is 
terrible. We were supposed to be reducing the costs of drugs for 
seniors. Yet this plan prohibits the federal government from using its 
clout to force down the price of medicine.
  We were supposed to help seniors keep their current drug coverage if 
they are fortunate enough to have it. Yet this plan may force up to 
three million seniors out of their current employer-based plans.
  We were supposed to be strengthening the Medicare program by adding a 
voluntary benefit for prescription drug coverage. Yet this plan, under 
the guise of a premium support demonstration, weakens the Medicare 
program by forcing beneficiaries to pay more for Medicare if they don't 
give up their doctor and join an HMO.
  We were supposed to help low-income seniors who get additional 
assistance from Medicaid afford their prescriptions. Yet this plan not 
only forces 6 million low-income seniors to pay more for their 
medications, but also imposes an unfair assets test that disqualifies 
seniors if they have modest savings.
  We were supposed to be providing a prescription drug benefit that 
would ease the cost and emotional burden seniors face in dealing with 
medication purchases. Yet this plan leaves millions of seniors without 
drug coverage for part of the year due to the $2800 gap in coverage.
  Mr. Speaker, I am extremely disappointed with this agreement. I am 
disappointed because what should have been a straightforward approach 
took a wrong-turn along the way. I think this is a terrible way to 
spend $400 billion dollars on a supposed prescription drug benefit, and 
I will be forced to vote against this measure. I urge my colleagues to 
reject this shameless assault on Medicare.
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mr. INSLEE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)

[[Page H11852]]

  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentleman from Washington for yielding me this time, and I thank the 
gentleman from Florida (Mr. Bilirakis) as well.
  There are several points that I think are very important this 
evening. I have heard the words, and I guess it was not ridiculous, but 
I heard the fact that this is an outdated motion, it is unnecessary, it 
is without timeliness. I beg to differ with my colleagues. If we can do 
anything to educate the American public and our colleagues who may not 
be here this evening about the failures and the fallacies of the 
legislation that we might see tomorrow, Mr. Speaker, if we could pass a 
real guaranteed Medicare prescription drug benefit and as well provide 
for our private hospitals and our doctors, this legislation would be 
passed 435 to zero. If we could actually do what we have debated and 
argued for almost 10 years through the Clinton administration and now 
the Bush administration, there would be no need to have a motion to 
instruct.
  But, Mr. Speaker, I stand here tonight because there is little time 
to educate our colleagues as well as the American public because 
tomorrow we will have 632 pages that will never have been read and that 
will be forced down our throats and we will be asked to vote for 
something that truly will destroy Medicare as we know it.
  We will be asked to give $12 billion to the HMOs without any 
explanation. We will be asked to tell the government that they cannot 
negotiate lower pharmaceutical prices, drug prices, for the Medicare 
program. What an outrage. We will be telling the government to spend 
all the money that is needed and not require it to get the best deal. 
We will not be giving the hospitals, all of the hospitals, the kind of 
moneys that they need as it relates to reimbursement. We will not be 
doing what the gentleman from Washington (Mr. Inslee) has asked for 
identification payment.
  We will, in fact, not allow seniors to reimport drugs where they have 
been doing it all along. And in actuality, to my good friends at AARP, 
and I consider them my good friends, I thought it was called now the 
``American Association of Rich People,'' I would say to them the reason 
why they have 35 million members is because in 1965 President Johnson 
passed Medicare to give an extended life to those seniors who are now 
living.
  So what this bill will do tomorrow when we vote on it is it will 
eliminate the sickest of our seniors, the oldest of our seniors, and 
the calculation is that by 2006 those seniors will be dead. So we will 
not to have to worry about them.
  This is a bad bill; and to the American public, no matter how long we 
are on this floor, I thank the gentleman from Washington (Mr. Inslee) 
for his leadership. We are educating 35 million AARP members. We will 
tell them the truth that this is a bad bill and the only reason they 
are still alive to have an AARP card is because we passed Medicare in 
1965.
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mr. INSLEE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Ohio (Mr. Strickland).
  Mr. STRICKLAND. Mr. Speaker, I thank my friend for yielding me this 
time.
  I continue to object to my friends on the other side referring to 
this as a bipartisan bill. They know that no Democratic Member of this 
House was allowed to participate in the negotiations.
  And it is your bill, and you are going to have to live with it. The 
gentleman from Michigan (Mr. Dingell), the gentleman from New York (Mr. 
Rangel), the gentleman from Arkansas (Mr. Berry), our representatives, 
were shut out; and you ought to recognize that. I think it is 
intellectually dishonest to refer to it as a bipartisan bill.
  This bill was written by the pharmaceutical companies. Let me give 
the Members an example of why I say that. Two days ago, Secretary 
Thompson and the two Senators that participated, the Democratic 
Senators, met with the Blue Dogs in this House; and in that meeting 
they were asked why there is specific language in this bill that 
prohibits the Secretary from negotiating cheaper prices for our senior 
citizens. And one of those seniors spoke up and said it is in there 
because PhRMA insisted that it be in there.

                              {time}  2000

  Think of that. I hope the American people are paying attention, 
because this bill was written for and by the pharmaceutical companies 
and, sadly, my friends on the Republican side are supporting it, and 
they are going to have to live with it. I have gotten over 100 calls in 
my office today; only two of them have been in support of this flawed 
bill.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I would remind the gentleman through the Chair that I am 
not sure what his definition of bipartisanship is, but a few years ago, 
we had a tort reform bill on the floor, and the most elderly Member in 
terms of service of this House had the bill on that side. He had one 
Republican cosponsor of that bill and continually, continually harped 
on it being bipartisan, bipartisan, bipartisan. I should think that two 
United States Senators, two United States Senators, I think one, maybe 
both ranking members of the appropriate committees, two out of 12 would 
be considered every bit as bipartisan as one out of 435.
  I would also, additionally, remind the gentleman through the Chair 
that in addition to the other areas that I said that have been worked 
out on a bipartisan basis by all of the staffs, there were the Hatch-
Waxman reforms and the reimportation and whatnot, and the gentleman 
from Michigan's (Mr. Dingell) staffers were at every one of certainly 
the Hatch-Waxman reforms and the reimportations, as I understand it.
  The point was made regarding the catastrophic. If memory serves me 
correctly, I believe I voted for that bill. How many of us, 400-some of 
us did. It turned out to have been the wrong thing to do, but 400 some. 
Bipartisan? My colleagues better believe it. I would suggest that if 
the gentleman were here at that time, he probably would have been part 
of the 400 and some that voted for that particular bill. That was a 
mandatory thing. This is voluntary. That was mandating on these people. 
This is voluntary.
  I would just finish up my comments, Mr. Speaker, by reminding the 
people over there through the Chair of the AARP endorsement. 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 and 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. It will provide modest relief for 
millions more.
  It also provides a substantial increase in protections, protections 
for retiree benefits and maintains fairness by upholding the health 
benefit protections of the Age Discrimination and Employment Act.
  The gentleman from Ohio who most recently spoke talked about some 
sort of a meeting which was held with PhRMA. I really do not know about 
that. I do not deny it took place. But I will tell my colleagues that 
there was a meeting held in the last couple of days where AARP appeared 
with the two Democratic Senators, and they wrote many of the provisions 
of this bill. I would not call this an AARP bill, I would not call this 
a Republican bill nor a Democratic bill. It is a bipartisan bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. INSLEE. Mr. Speaker, I yield myself such time as I may consume.
  We have tremendous respect for the gentleman from Florida (Mr. 
Bilirakis). But what we are saying is the seniors of the greatest 
generation simply deserve better than this bill, and we ought to be 
capable of doing better, so that we do not have a bill that is too 
little and too late, we believe both.
  Mr. BILIRAKIS. Mr. Speaker, will the gentleman yield?
  Mr. INSLEE. I yield to the gentleman from Florida.

[[Page H11853]]

  Mr. BILIRAKIS. Mr. Speaker, I agree with the gentleman, they deserve 
better. I agree with the gentleman, it is not perfect. But I would 
simply say to the gentleman that it will help an awful lot of seniors 
in the meantime. In the meantime, it will help a lot of seniors. The 
alternative is zero.
  Mr. INSLEE. Mr. Speaker, reclaiming my time, we believe the 
alternative is a real Medicare prescription drug plan which we 
Democrats have offered and voted for.
  Mr. Speaker, I yield 2 minutes to the gentlewoman from Ohio (Mrs. 
Jones).
  Mrs. JONES of Ohio. Mr. Speaker, I too have a lot of respect for the 
gentleman from Florida (Mr. Bilirakis), and he has been very helpful in 
letting the issue of uterine fibroid research be heard, and I thank him 
for that.
  But I have to differ with him on a few things, and one of those would 
be we are discussing this prescription drug benefit like it is going to 
happen tomorrow. I want seniors, if the bill passes, to understand it 
will not happen until 2006, so we are clear on that.
  Mr. Speaker, I had a town hall meeting for my seniors and what they 
said to me is, they wanted a prescription drug benefit that would be 
fair, that would be guaranteed, and that would be affordable. I have 
been talking and talking about how I want it to be fair, guaranteed, 
and affordable and, as I review this bill, it is not that.
  I am here talking on a motion to instruct because as a new member of 
the Committee on Ways and Means, I thought that my ranking member would 
have a chance to be in the meeting. Now, the reality is, the Democratic 
House Members were not included. We went to a meeting with the 
chairman, the gentleman from California (Mr. Thomas), and he said, only 
those who are Members of the willing, or however the heck he described 
it, get to come to the private meetings of the conference committee. 
Our conference folks would get invited to the official meetings of the 
conference, but they would not be invited to the meetings where things 
that were accomplished in this bill were included.
  History taught me that there is a Senate and then there is a House of 
Representatives and, true, those two Senators sat down with the 
Republicans, and they call it bipartisan, but they are not my Senators. 
We stand up as Members of the House, and we are entitled to participate 
in the process.
  Mr. Speaker, I had Tom Scully in my district because I am truly 
concerned about what is happening in health care, and he came in and 
talked to my hospitals, and my colleagues heard what the hospitals 
said, and they got more money. And the doctors sat with Tom Scully, and 
my colleagues heard what they said, and they got more money.
  My son Mervin is 20 years old and he uses the term, ``I ain't mad.'' 
And I ``ain't mad'' at the hospitals that they got money to be able to 
provide services. And I ``ain't mad'' at the doctors because I thought 
they should be paid more. But I am mad because my seniors are not 
getting what I thought they were entitled to, which is a guaranteed, 
affordable benefit. There is a gap in coverage, there are all kinds of 
things. I am running out of time, but I am here to speak on behalf of 
the 11th Congressional District. I ain't voting for this bill, and I 
ain't mad.
  Mr. BILIRAKIS. Mr. Speaker, the gentleman has the right to close, as 
I understand it. I have no further speakers, so I yield back the 
balance of my time.
  Mr. INSLEE. Mr. Speaker, I yield myself the remaining time.
  I want to express my respect for the leadership of the gentleman from 
Florida (Mr. Bilirakis) on organ donation issues, which is an important 
matter as well. We appreciate his leadership of trying to improve the 
access of organs in organ transplant procedures. So we agree on quite a 
number of issues.
  But I think we agree on a goal perhaps and not a direction in that he 
has indicated that he believes seniors do deserve better. And we 
believe seniors, in the bottom line of this debate, deserve better than 
this proposal for a couple of fundamental reasons. Reason number 1: 
this short-term, extremely modest potential benefit that may 
potentially help a few seniors includes the seeds of destruction 
potentially of the very foundation of their health care that this 
Nation has come to embrace since the early 1960s, and that is Medicare. 
In the premium support provision, which sounds like innocuous language 
that is in the bill, it is in the bill, and we all agree on that; it 
will be in bill. We do not know what page, because nobody has read 
this. It is going to be hundreds of pages and nobody will have read 
this probably until we are forced to vote on it less than 24 hours 
after the bill is passed; but nonetheless, that little innocuous 
provision carries the potential of the seeds of destruction of the 
guarantee of the Medicare program.
  The reason I say that is it will, ultimately, foist on every senior, 
whether they want it or not, if it is implemented, under this bill, to 
face a situation where they will have to pay more and have less 
coverage than those in the private plans. And since the private 
insurance companies are extremely adept at marketing, they can have all 
kinds of bells and whistles to lure the healthiest people into their 
population, leaving the sickest in Medicare, those most in need of 
security and peace of mind, leaving their premiums to skyrocket and 
Medicare to go into a death spiral, as the analysts have predicted.
  I am getting to a certain age; I am not as old as my dad and mom who 
I love dearly, but I think aging is tough enough. American seniors 
should not have to worry about the loss of the guarantee of Medicare. 
We should pass a Medicare prescription drug program that we have 
suggested on this side of the aisle, and work with my Republican 
colleagues to pass a true bipartisan bill.
  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 gentleman from Washington (Mr. Inslee).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BILIRAKIS. 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.

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