[Congressional Record Volume 149, Number 169 (Thursday, November 20, 2003)]
[House]
[Pages H11862-H11868]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  2130
                         THE HEALTH CARE CRISIS

  The SPEAKER pro tempore (Mr. Bradley of New Hampshire). Under the 
Speaker's announced policy of January 7, 2003, the gentleman from 
Maryland (Mr. Cummings) is recognized for 60 minutes as the designee of 
the minority leader.


                             General Leave

  Mr. CUMMINGS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on the subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Maryland?
  There was no objection.
  Mr. CUMMINGS. Mr. Speaker, I rise this evening with my fellow members 
of the Congressional Black Caucus to address the health care crisis in 
America. While millions of Americans lack adequate health insurance, 
the rights of the uninsured continue to increase. In addition, the cost 
of prescription medication is placing an enormous financial burden on 
consumers. And our seniors, many of whom are living on fixed wages, are 
in desperate need of relief.
  Mr. Speaker, the late Senator and former Vice President, Hubert 
Humphrey, once said, `` . . . the moral test of government is how it 
treats those in the dawn of life, the children; those in the twilight 
of life, the elderly; and those in the shadows of life, the sick, the 
needy, and the handicapped.'' As a Nation we have failed that test on 
all three counts.
  Currently, my colleagues on the other side of the aisle are offering 
a bill to overhaul the Federal Medicare program under the guise of a 
much-needed prescription drug benefit for this Nation's seniors. This 
bill, if passed, would cost our children over $400 billion. Mr. 
Speaker, I say it will cost our children because the government is 
currently operating in a deficit. We simply do not have the money. 
Therefore, it is the younger generations and those yet unborn who will 
have to shoulder the financial burden required by this legislation.
  Mr. Speaker, let us not be mistaken. Every dollar being spent worth 
saving or improving one's quality of life is a dollar well worth 
spending. However, this bill directs billions of dollars towards 
enhancing the financial well-being of corporations at the expense of 
the physical well-being of those who need it the most.
  This Nation's seniors have practically begged us, as their 
congressional representatives, to work together in drafting a 
comprehensive bill that would provide prescription drug coverage and 
enhance the current Medicare program. Quite frankly, this bill is an 
inadequate response to their plea.
  Let me boil it down to the very basics. The Medicare conference 
agreement prohibits the Secretary of Health and Human Services from 
negotiating lower drug prices on behalf of the 40 million Medicare 
beneficiaries. In other words, this legislation says that the Secretary 
of Health and Human Services cannot negotiate lower prices although we 
have millions of Medicare beneficiaries buying medicines or obtaining 
medicines from these pharmaceuticals.
  This proposed legislation also creates a gap of $2,844 that would be 
impossible for lower-income seniors to bridge and disallows lower-
income seniors the ability to receive coverage under both Medicare and 
Medicaid. And further, Mr. Speaker, the bill could have disastrous 
effects on my home State of Maryland. 59,640 Maryland Medicare 
beneficiaries could lose their retiree health benefits and 75,800 
Maryland Medicaid beneficiaries could pay more for the prescription 
drugs that they need. Mr. Speaker, that is simply unacceptable. We can 
and we must do better for our seniors.
  The Congressional Black Caucus is extremely concerned about the 
health care needs of the 26 million people of every color that we 
represent. Therefore, providing affordable, high-quality health care 
for every American is a top priority. And I emphasize the fact that the 
Congressional Black Caucus represents not only African American people 
but we represent people of all colors. As a matter of fact, many of our

[[Page H11863]]

districts do not have a majority African American population, and we 
have consistently found that we have spoken for Americans who are 
merely feeling as if they have no voice in this Chamber.
  Some have said that we have been the conscience of the Congress. I 
would submit that we have been the conscience of this Nation. To this 
end, the Congressional Black Caucus, the Asian Pacific American Caucus, 
the Hispanic Caucus, and the Native American Caucus introduced the 
Healthcare Equality and Accountability Act of 2003. This comprehensive 
and ambitious legislation will improve the lives and livelihoods of all 
Americans and signifies a historic milestones towards providing equal 
access to affordable and quality health care.
  The gentlewoman from the Virgin Islands (Mrs. Christensen), who will 
be addressing us a little bit later, played a very significant role in 
leading the Black Caucus and the other caucuses to create this very 
important legislation.
  Mr. Speaker, let me say why it is so important to communities of 
color that this Congress create an affordable prescription drug benefit 
under Medicare and work to pass the Healthcare Equality and 
Accountability Act. The state of health care within communities of 
color is particularly disturbing. According to a recent report released 
by the National Urban League, ``African Americans are more likely to be 
among Medicare's lower-income beneficiaries . . . 65 percent of African 
American beneficiaries fall below 200 percent of the poverty level and 
33 percent have incomes that actually fall below the poverty level 
itself.''
  Minorities are also disproportionately among the uninsured, 
representing more than half of all uninsured Americans. Hispanic 
Americans, 35 percent; Native Americans, 27 percent; African Americans, 
20 percent; and Asian-Pacific Islanders, 19 percent. All have 
substantially higher uninsured rates than white Americans, which is 12 
percent. Conversely, the health care needs of minority Americans are 
often greater than those of nonminorities. Our communities 
disproportionately suffer from numerous chronic diseases: diabetes, 
heart disease and stroke, and many forms of cancer.
  Racial and ethnic minorities are also more likely to receive unequal 
treatment than white Americans. According to the National Academies' 
Institute of Medicine Report of 2002, racial and ethnic minorities tend 
to receive inferior care in comparison to white Americans even when 
insurance status, income, age, and severity of conditions are 
comparable.
  Communities of color are less likely to receive preventative care and 
face a greater risk of misdiagnosis, inadequate treatment, and even 
premature death. The state of health care in minority communities is 
nothing short of alarming.

  Mr. Speaker, consider the following statistics: The death rates from 
heart disease among African American adults is 29 percent higher than 
white adults, and the death rate from stroke is 40 percent higher. 
Compared with whites, Native Americans are 2.5 times more likely to 
have diagnosed diabetes, while African Americans and Latinos are 2 and 
1.8 times more likely, respectively.
  African American women are more likely to die of breast cancer than 
women of any other race or ethnicity. The infant death rate among 
African Americans is more than twice as high as it is for white 
Americans. African Americans and Latinos account for 68 percent of new 
adult and adolescent AIDS cases. Americans of Asian and Pacific 
Islander descent have the highest rate of hepatitis B of all U.S. 
ethnic groups. Older African Americans are 3.6 times more likely to 
have lower limbs amputated as a result of diabetes. African American 
seniors are more than two times less likely to receive treatment for 
prostate cancer.
  In general, the health of minority Americans continues to lag far 
behind that of white Americans, creating a health care divide between 
communities of color and the rest of America.
  Mr. Speaker, as the richest Nation in the world with an average gross 
domestic product in the trillions, the United States spends a greater 
percentage of its GDP on health care than any other G-8 or Scandinavian 
nation.
  On a per capita basis, the United States spends far more on health 
care than any other country in the world, $3,935 or 13 percent in 1997, 
while the median Organization for Economic Cooperation and Development 
country spent $1,728 or 7.5 percent. Yet the United States had the 
largest percentage of citizens without government-assured health 
insurance coverage.
  In addition to having the largest number of uninsured, we rank 12th 
among 13 countries on 16 available health indicators. The United States 
ranked 13th for low-birth-weight percentages, 11th for life expectancy 
at 1 year for females, 12th for males, and 13th for neonatal mortality 
and infant mortality overall.
  Mr. Speaker, through the Healthcare Equality and Accountability Act 
of 2003, the Congressional Black Caucus, the Hispanic Caucus, the Asian 
Pacific American Caucus, and Native American Caucuses confront the 
issue of disparate minority health care head on. Our bill addresses the 
shortage of minority health care providers and improves workforce 
diversity through the expansion of such successful programs as the 
Health Career Opportunities Program and the Minority Centers of 
Excellence. Our bill would help patients from diverse backgrounds, 
including those with limited English proficiency, with provisions such 
as codifying existing standards for culturally and linguistically 
appropriate health care, assisting health care professionals provide 
cultural and language services, and increasing Federal reimbursement 
for these services.
  Mr. Speaker, I would like to take this opportunity to thank my 
colleagues in the Congressional Black Caucus, the Congressional 
Hispanic Caucus, the Congressional Asian Pacific American Caucus, and 
the Native American Caucus for their diligence in drafting this 
important piece of legislation.
  I would also again like to extend my special recognition to the 
gentlewoman from the Virgin Islands (Mrs. Christensen), the chair of 
the Congressional Black Caucus Health Braintrust; the gentlewoman from 
California (Ms. Solis), chair of the CHC Health Task Force; the 
gentleman from California (Mr. Honda), chair of the CAPAC Health 
Caucus; and the gentleman from New Jersey (Mr. Pallone), chair of the 
Native American Health Caucus; Senate Democratic leader Daschle; and 
the gentlewoman from California (Ms. Pelosi), House Democratic leader, 
for their leadership.
  I also appreciate the support of my congressional colleagues who 
continue to stand firmly by our side in our efforts to make universal 
health care a reality.
  Mr. Speaker, as Members of the greatest national legislature in the 
world, our social contract is clear. We have a moral responsibility to 
promote the general welfare of all of our citizens regardless of race, 
age, ethnicity, or social economic status. We must work to accomplish 
this goal by providing comprehensive health care coverage to all of our 
citizens and meaningful prescription drug coverage to our seniors. We 
should not rest nor recess until this task is done.
  Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. 
Christensen).
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman from Maryland 
(Mr. Cummings) for yielding, and I thank him for hosting this Special 
Order today.
  I would have come here to primarily discuss H.R. 3459, the Healthcare 
Equality and Accountability Act of 2003, which is a very important 
piece of legislation that the four caucuses that we have heard have 
introduced with our Democratic leadership in both this and the other 
body.

                              {time}  2145

  The bill, which I call the Heal America Act, would do just that: heal 
America, because the health of people of color is inextricably linked 
to that of all Americans. So the provisions that are included, which 
would expand Medicaid to include pregnant women, young people to the 
age of 20, and legal immigrants, which provides that Federal program 
set standards and pay for translation services; that includes programs 
for young people of color to enter the health professions at all 
levels, and even for older ones to enter the

[[Page H11864]]

health professions by changing their profession as long as they 
practice in underserved communities; which would strengthen the safety 
net facilities like our hospitals and our community health centers; 
fully funds and strengthens the Office of Civil Rights within the 
Department of Health and Human Services, as well as the Office of 
Minority Health which creates empowerment zones so the communities 
themselves, which face high disparities, will get the resources and 
technical assistance that they need to address their health care 
challenges. This bill would finally bring this country to the top of 
the list of nations in the world for our health, reverse the global 
statistics that we have heard from our chairman and, instead of being 
the thirty-ninth of all of the nations of the world, it would reduce 
the premature deaths and disabilities that exist in the people of color 
here; would begin to reduce the skyrocketing health care costs, and 
also to restore the greatness of this country, which has indeed been 
tarnished by our recent history here and in the world.
  But tonight I want to focus more on an imminent threat to the 
equality and accountability in health care for millions of Americans. 
After years of promising a prescription drug benefit, and my knowing 
from experience as a family physician how badly it is needed, it is a 
painful task to come to this floor this evening to oppose what we 
understand is going to be brought to the floor as a Medicare reform 
bill, perhaps tomorrow. I, like many of my physician colleagues, was 
tempted to support it, just so we could get something done to alleviate 
the burden of health care for our patients. But the lives, the health, 
and the needs of our seniors and the disabled people in this country 
are too important to just take anything, no matter how defective it 
might be, just to do something. It would not be fulfilling our promise 
of a comprehensive prescription drug benefit; it would be reneging on 
that promise.
  We who are here tonight have too much respect for our constituents. 
We know that we have to continually earn the trust that they have 
placed in us with their vote. So we are here tonight to oppose the 
Medicare conference agreement, and to tell our colleagues why.
  Despite all of the carrots; for example, the rural provisions which 
themselves seem to be little more than smoke and mirrors, and the 
increased payments for physicians which, if the leadership believes, as 
I do, that it needs to be done, we can do that separately. The bottom 
line for me is that this bill begins to destroy a program that has 
provided real health security, that has kept many seniors and disabled 
persons out of poverty, and which has provided access to health care 
for them for over 30 years. I cannot in good conscience be a part of 
dismantling this important safety net program. Yes, I know that some 
provisions, like premium support, are just demonstration programs, but 
that is opening a door that should just remain shut.
  This conference report goes against what we have been working towards 
in our caucus: the elimination of disparities in health care for 
African Americans and other people of color. African Americans are 8 
percent of Medicare recipients, and 32 percent of African Americans who 
have some insurance, have Medicare. While 40 percent of all Medicare 
beneficiaries are below 200 percent of poverty, 65 percent of African 
American beneficiaries are. Thirty-three percent are below the poverty 
level period.
  We are then disproportionately among the very poor, and this bill 
will increase cost-sharing for people who fall in that category. While 
it may start out relatively low in the first year, it can be counted on 
to increase with increasing drug prices which average 10 percent an 
increase a year.
  I am also very concerned that there is a very strict means test that 
will be applied to even these poor beneficiaries: $6,000 for 
individuals and $9,000 for a couple, which means that many seniors and 
disabled who need this benefit will be left out.
  All of this will mean that even the little that the bill does to 
provide for low-income Medicare beneficiaries will not be available for 
as many as up to 2.8 million individuals. This is not, Mr. Speaker, 
what we promised.
  Let us look at what happens to beneficiaries who have prescription 
drug coverage. Not only will this bill jeopardize the retiree 
prescription drug benefit, and 22 percent of African Americans with 
Medicare have a retiree prescription drug benefit, as well as 17 
percent of Latino beneficiaries, but how could we, in good conscience, 
also worsen the already bad situation this report would create for the 
very poor dual-eligible who would also lose benefits that they have 
under Medicaid because this bill would eliminate the wrap-around 
provisions.
  Lastly, let me mention the potential cap on Medicaid, the potential 
cap on this Medicare prescription drug benefit if we pass the 
conference report. It goes to cost containment. We all know what cost 
containment has done for us thus far. It has filled the coffers of 
managed care corporations and, for the most part, has done so by 
reducing access to needed medical care for those who are enrolled and, 
virtually, it has left out the sicker, many of whom are poor, who are 
people of color, or who live in our rural areas. And has the cost of 
health care gone down in this country because of that cost containment? 
No, it has not. Have insurance premiums gone down or even stayed 
steady? No. They are increasing in double digits. So what we would be 
likely to see would be the rationing of care where we have just begun 
to see some minor changes. Cost containment would just expand the 2- 
and 3-tiered health care system where the sickest get the least care. 
This is not what we promised.
  I want to take this opportunity to answer one of my constituents, 
Rosalee Dance from Saint Thomas. She asked the question, because she is 
confused like many seniors are in this country. She asks me two 
questions. She asks, is it true that the bill creates a situation where 
people either pay sharply increased premiums to stay in traditional 
Medicare where they can choose their doctors, or be forced out into an 
HMO?
  Ms. Dance, the answer is yes, that is what the conference report 
would do.
  The second question she asks: is it true that it would require that 
people who want the prescription drug coverage that it is advertised to 
provide to buy such coverage that they would have to buy it from 
private insurance plans?
  Again, the answer is yes. This is not Medicare as it needs to be.
  All of these aspects reduce access of poor and minority seniors more 
than others to needed medication, which would otherwise maintain good 
health, prevent complications, prevent disabilities, and also prevent 
excess and preventable deaths. What we are doing, or what the 
Republican leadership is attempting to have us do is continue the same 
wrong-headed policies that have created the health care crisis that we 
are now in, through denying good prevention and health maintenance to 
all of the seniors and the disabled who are most in need and to most of 
the 16 percent of Medicare beneficiaries of racial and ethnic minority 
backgrounds. We would diminish the quality of services if we do this 
and increase the cost, continue to increase the cost of care for all.
  Mr. Speaker, it is time that we actually do what H.R. 3459 says, 
which is begin to heal our country, to heal America, and we can begin 
to do that by voting no on the Medicare proposal that will be coming 
before this House tomorrow.
  Mr. CUMMINGS. Mr. Speaker, I yield to the gentlewoman from California 
(Ms. Lee).
  Ms. LEE. Mr. Speaker, first, let me thank the chairman of the 
Congressional Black Caucus, once again, the gentleman from Maryland, 
(Mr. Cummings), for his continued leadership and for ensuring that the 
Congressional Black Caucus continues to have the opportunity to wake up 
America, and for continuing to stand up for our seniors' rights to an 
affordable, quality, and guaranteed prescription drug benefit. Also, to 
really protect Medicare as a vital institution. So I just want to thank 
the gentleman again for giving us this opportunity.
  Now, I did not come to Congress to dismantle Medicare, and I will not 
stand by quietly while my Republican colleagues do just that.
  Last night, I came to the floor and detailed my very strong 
opposition to the Republican prescription privatization plan, which 
does represent a giant

[[Page H11865]]

kickback to the pharmaceutical and insurance industries. Tonight I come 
to the floor again to reiterate my opposition and to discuss the other 
inadequacies in our health care system that are addressed in the Health 
Care Equality and Accountability Act, H.R. 3459, a bill which my 
colleague, the gentlewoman from the Virgin Islands (Mrs. Christensen), 
has guided and has led and has brought us together through her tireless 
work to introduce on behalf of America. I just want to thank the 
gentlewoman for her leadership in providing us a real vision and a real 
alternative and a real roadmap to quality health care for all of our 
communities in America; specifically, our communities of color.
  Now, our constituents realize that the cost of prescription drugs are 
really crippling our seniors, and this Republican prescription drug 
bill is a real joke, a cruel joke on seniors and the disabled. This 
bill will only raise false hopes that real help is on the way from the 
drug prices that are currently crushing our seniors. But nothing could 
be further from the truth.
  This bill not only weakens benefits by creating major gaps in 
coverage; it actually prohibits, mind you, it prohibits the Secretary 
of Health and Human Services from negotiating lower drug prices on 
behalf of America's 40 million Medicare beneficiaries. It is a shame 
that not only will the government be prohibited from lowering the 
prices of medicines, senior citizens cannot even benefit from lower 
prices through drug reimportation, which this body actually passed. 
But, of course, any measure to reduce the cost of prescription drugs 
does not meet the approval of the pharmaceutical companies. So, quite 
frankly, these provisions are not in this bill, which really is their 
bill.
  Now, in California, almost 250,000 Medicare beneficiaries are 
projected to lose their retiree health benefits. Nearly 300,000 fewer 
seniors in my State will not qualify for low-income protections because 
of the assets test and qualifying income levels.
  When we get right down to it, the 300,000 low-income seniors will 
disproportionately be older women who, as we all know, have fewer 
financial assets, tend to live longer, have more chronic health 
conditions than men, and ultimately are more dependent on Medicare than 
men in their later years.

                              {time}  2200

  And, of course, women are more than twice as likely as men to face 
poverty in retirement and account for more than 70 percent of the 
elderly poor.
  This bill is harmful to the poorest and the sickest. And their out-
of-pocket costs would increase above what Medicaid currently allows, 
and co-payments would dramatically increase further in future years.
  A constituent from Oakland wrote to me and said, and I quote, ``I am 
on Medicare and do not like this bill. I cannot understand why Congress 
will not allow anyone to bargain for better rates. I don't understand 
why Medicare must be privatized. The proposed deductible is too much. 
And I will not be able to afford medication for my disabilities if this 
bill passes. This bill amounts to another Republican publicity thing.'' 
I agree with her. H.R. 1 punishes people for getting older and for 
needing to use prescription drugs and for being disabled.
  In 2002, for example, the Kaiser Family Foundation found more than 33 
percent of seniors without drug coverage did not fill the prescriptions 
that their doctors prescribed. That is a rate twice as high as those 
with coverage. Lower-income Americans really do deserve better.
  On July 24 of this year, the Wall Street Journal reported that black 
Medicare beneficiaries are more than twice as likely as white 
beneficiaries to go without a prescription drug because they could not 
afford it. Nearly 40 percent of elderly African Americans lived in 
poverty in 2001 compared with 10 percent of whites. As a result of the 
disparities in our health care system, African American seniors are 
more likely to be in poor health and to report having one or more 
chronic health conditions, while only 26 percent of whites on Medicare 
report their health status to be fair or poor.
  While the Republicans punish seniors, particularly women and 
minorities, with this bill, California drug companies will make out 
like bandits. More than 860,000 Medicaid beneficiaries pay more for the 
prescription drugs that they need, pay more. This bill is really not 
just, however, a gift to the drug companies, it is the beginning of the 
end of Medicare. And it is the beginning of the privatization of 
Medicare.
  Under this Republican bill, beneficiaries dropped from one plan may 
face a period of noncoverage before they are picked up by traditional 
Medicare or another private plan, if one is available at all. During 
this time, all beneficiaries lose continuity of care and may not even 
be able to get the care that they need.
  Secondly, beneficiaries even in a new private plan may not be able to 
use the same doctors, services, and prescriptions due to the plan 
limitations. African Americans face a disproportionate risk under such 
a coverage gap since they are more likely to have serious health 
problems.
  Prescription drugs are not a luxury for our seniors; they are a 
necessity. And our seniors cannot afford to pay more than the 
outlandish prices for prescription drugs that they are already paying. 
Also seniors with income levels below the poverty level are nearly 
three times as likely as those with incomes of more than $17,000 to go 
without prescription drugs. The pharmaceutical companies cannot 
continue to get rich off the poorest of the poor.
  Let us be clear, this bill really is a fraud and really is an 
embarrassment. We stand here today with a Republican bill that is not 
affordable, is not comprehensive, and is not guaranteed. On behalf of 
all people who see through this bill, I call on my colleagues to join 
us in opposing the sad attempt to pull the wool over the eyes of our 
nation's Medicare beneficiaries.
  Further, I think that the President and the Republicans should really 
look at how to really provide a meaningful benefit and also to get at 
other pressing issues facing our health care system today: the cost of 
drugs, the lack of access to any health care at all, and the horrific 
disparities in access and the quality of care for communities of color 
and the needs to move forward with the system where health care is a 
basic human right provided for all.
  Today African American Medicare beneficiaries are more than twice as 
likely as white beneficiaries to go without prescription drugs because 
they could not afford it. Nowhere in H.R. 1 are these beneficiaries 
considered.
  So now is the time to expand the health care safety net which will 
increase the availability, quality and affordability of health care 
coverage options. The Healthcare Equality and Accountability Act, as I 
mentioned earlier, H.R. 3459, reminds us that now is the time for 
diversification of the health care workforce which will reflect the 
communities that have been neglected while incorporating a real 
understanding of the backgrounds, experiences, languages, and cultures 
of minority people.
  H.R. 3459 reminds us that now is the time for an aggressive 
collection of data and dissemination of data on people of color so that 
that becomes a priority in terms of the health care of our communities. 
And H.R. 3459 reminds us that now is the time for a complete assault on 
HIV and AIDS and other diseases that are disproportionately killing 
minority communities.
  So now is the time for Congress to take a real look at our health 
care system, diagnose our weaknesses and our illnesses, and prescribe a 
system where everyone will have quality universal guaranteed health 
care.
  Again, as I said, I did not come to Congress to dismantle Medicare, 
and I cannot stand quietly while that happens. So I just want to thank 
our chairman again, the gentleman from Maryland (Mr. Cummings), for 
giving us this opportunity to really allow our senior citizens and the 
entire country to hear our views in spite of what AARP has told 
individuals with regard to this very terrible bill. I want to thank the 
gentlewoman from the Virgin Islands (Mrs. Christensen) once again for 
her leadership to ensure that we have an alternative that makes sense 
for universal health care.
  Mr. CUMMINGS. Mr. Speaker, I want to thank the gentlewoman from 
California (Ms. Lee). It is indeed interesting a lot of times when 
people hear the Congressional Black Caucus talk

[[Page H11866]]

on issues they have a tendency sometimes to think, oh, here are some 
liberals standing up and being against a certain provision or being for 
something. One of the most interesting things that came to my attention 
today is that there are many conservative organizations who are against 
this bill.
  And one of them being the Heritage Foundation issued these comments 
within the last 2 or 3 days. And I quote, now, this is the Heritage 
Foundation, they say, ``The agreement contains an unworkable and 
potentially unpopular drug benefit with millions of Americans losing 
part of their existing coverage. Instead of targeting benefits to 
seniors who need them, the Medicare conferees are insisting on creating 
a universal drug entitlement to be delivered through the vehicle of 
stand-alone insurance. In the process, according to both the 
Congressional Budget Office and recent independent economic analysis, 
more than 4 million seniors with existing private coverage are bound to 
lose it or have it scaled back. Meanwhile, the politically engineered 
premiums and deductibles coupled with their odd combination of donut 
holes or gaps in drug coverage are likely to be unpopular with 
seniors.'' That is dated November 17, 2003. And that is from the 
Heritage Foundation.
  Now, the fact is that we all agree, maybe for a little different 
reason at times, that this is not an appropriate bill. But it is just 
interesting because I want to make it clear to everybody who may be 
listening to us tonight that it is just not the Congressional Black 
Caucus that is standing up against this legislation.
  Ms. LEE. Mr. Speaker, I am glad that the gentleman from Maryland (Mr. 
Cummings) raised that because this legislation is bad for America. I am 
glad that he cited the Heritage Foundation's comments and their 
opposition because I believe that we need to make sure that America 
understands that in spite of the leadership of AARP and in spite of the 
fact that the pharmaceuticals and the insurance industry for the most 
part wrote this bill, that there are, all of us, primarily, with the 
exception of a few, those who really believe that this will begin to 
dismantle Medicare and privatize Medicare. And if no one believes us, 
they sure should believe the Heritage Foundation. But I think that the 
Congressional Black Caucus, our tri-caucus has an unbelievable track 
record in telling the truth. So I am glad that the Heritage Foundation 
has joined us in that tonight.
  Mr. CUMMINGS. Mr. Speaker, it is so interesting that when we talk 
about Medicare, Medicare is so important to so many people. If we did 
not have Medicare, we would have to invent it because it touches the 
lives of so many. And I have often said that if I were sick and did not 
have a way to get well, I think that would make me sicker.
  I think that we are, with the way this conference report is 
structured, it seems as if we are pushing more and more people out into 
the cold and placing them in a position where they will not be able to 
get available, accessible and affordable health care.
  Ms. LEE. Well, Mr. Speaker, I think the gentleman from Maryland (Mr. 
Cummings) has summarized what this bill does. And I think our senior 
citizens understand that Medicare has been that safety net and has 
provided the foundation for really the quality of life that they 
deserve in their golden years. And to see that safety net being 
tampered with and to see it put up on the chopping block at the whims 
of the insurance industry and pharmaceuticals is very shameful and very 
disgraceful. And I think that all of us have the duty and 
responsibility to fight against this. Because this is, I think, a basic 
value that America holds dear, and that is protecting and ensuring, I 
would say, the comfort of our senior citizens. And we cannot play 
around with that.
  Mr. CUMMINGS. I want to thank the gentlewoman from California (Ms. 
Lee).
  Mr. Speaker, I yield such time as he may consume to my colleague from 
the great State of New York (Mr. Owens).
  Mr. OWENS. Mr. Speaker, I want to congratulate and thank the 
gentleman from Maryland (Mr. Cummings) for this Special Order. Nothing 
could be more timely than our focus tonight on the Republican Medicare 
Prescription Drug conference report that will be before us for a vote 
soon.
  We also are concerned about the tri-caucus minority health bill, H.R. 
3459, which I think is very significant; but that is in the works, and 
we will not be having a vote on that any time soon. And it will be very 
much jeopardized if we have the awful fate of having the Medicare 
prescription drug conference report of the Republicans passed tomorrow 
or the next day. It is impossible to move forward with a minority 
health bill which is of any great significance and impact if you do not 
have the envelope of Medicare.
  Medicare and Medicaid are the beach heads for providing universal 
care in America. And all of us are hopeful we will move forward and 
provide health care to all those 43 million people who tonight have any 
health care and that some plan would be developed which is based on 
Medicare as a start. But what the Republicans have done here is started 
a slow and tortuous assassination of Medicare.
  In the beginning when Medicare was first proposed and passed, very 
few Republicans voted for it. Over the years Republicans have 
repeatedly talked about liquidating Medicare. Former Speaker Gingrich 
made no bones about it. He wanted Medicare to fade away. His phrase 
was, ``We should make it fade away.''
  So we are in the process now under this guise and camouflage of 
providing a prescription drug benefit of sticking Medicare in the back 
with a dagger for a slow bleed to death. That is what will happen. The 
introduction of privatization, the build-up of HMOs, and the role that 
the pharmaceutical companies have played in this legislation is such 
that you know we may be discussing the beginning of the end of 
Medicare. We cannot do that. Nothing else in the area of health care 
would be go forward unless we have Medicare to build on. We need that 
very much.
  The tri-caucus minority health bill would have talked more about 
adapting and refining the health care program to make certain that we 
deal with some of the basic problems in the African American community 
and the Hispanic community and other minority committees with respect 
to health care.
  I want to bring in a very important event that took place, not many 
people have heard about, last Saturday. We had, last Friday night and 
Saturday, a conference on saving young black males. The gentleman from 
Maryland (Mr. Cummings) kicked off the conference on Friday night. And 
I came on Saturday expecting to stay maybe half a day, but I was so 
impressed with the audience, the participants who showed up, that I got 
locked in the whole day and I did not leave until 6:00 because they 
were so serious, the people who came to participate. Counselors, 
principals, Boy Scout masters, Girl Scout masters, all kinds of folks 
who were interested in young people were there.

                              {time}  2215

  They were serious because, usually, on these weekends we have a 
serious panel. You can only hold people's attention an hour and a half. 
If you are good you go two hours. They came at 8:30 in the morning. 
They filled up the place. At noon when we had the address by Mr. Davis, 
of course, the place was packed, and they stayed. And I looked out in 
the audience at 5:30 and it was still packed. People began to drift 
home at 5:30. If they are willing to go from 8:30 to 5:30, you can 
imagine what a great deal of interest and how deeply people feel about 
saving the black males.
  Again and again during that day the problem of health care came up. 
Some people who are getting the least amount of health care they need 
are black males. The alienation factor that sets in very early, where 
they do not feel the system is for them, drives them away from even 
seeking help in many cases. Then they focus in on the tremendous mental 
health problem. Studies have showed that the suicide rate among black 
males is far higher than most people realize because of the 
recklessness of some automobile accidents and the recklessness of 
confrontations with the police or other authorities, the number of ways 
that black males end up dying is driven by the fact that they have a 
suicide wish. And the hopelessness and the kind anxiety of black males 
was talked about in terms of nobody is out there to deal with that 
mental health concern.

[[Page H11867]]

  I will not diverge too much here, but the fact that large numbers of 
them are incarcerated, we keep focusing on that. It was 25 percent 5 
years ago, and now a greater percentage of black males are in the 
criminal justice system somewhere, parole, probation or prison. And a 
large number of those who are in that system, about half are in the 
system as nonviolent offenders. They are in the system because of drug 
use.
  The problem that we have been trying to address in terms of the use 
of drugs and the way in which our society criminalizes the drug user, 
not necessarily the drug sellers or dealer but the user, has led to 
this tremendous percentage of incarcerated black males.
  I must say that the way that Rush Limbaugh has been dealt with in 
terms of his problem, he had an addiction problem, a pain problem. 
Whether it is mental or physical, we are not sure whether it is just 
mental or just physical. Maybe it was both. Whatever it was he used 
large number of drugs and they were purchased in a way which obviously 
is suspect. And people have shown a great deal of sympathy for Rush 
Limbaugh who makes $35 million a year. He certainly does not have the 
anxieties that black males who have tremendous anxieties about 
employment and adjusting to a world which is impacted heavily with 
racism.
  Here is a man with anxieties in pain and he used illegal methods to 
seek relief. I will go so far to say that I think it is clearly 
illegal. He is hustled off to a treatment center. He is back on the air 
now seeking sympathy. And the same man has said and his friends have 
said that we should put people who use drugs into jail. They have the 
harshest words for them.
  So the mental health of black males is not considered in the same 
league of the mental and physical health of Rush Limbaugh. So racism is 
a factor that we are concerned with, the racism that drives our 
society, whether it is the criminal justice system or health care 
system is still a problem.
  In health care racism is a problem. The Tri-Caucus Minority Health 
Bill is aimed to do a number of things, but one of the things it has to 
deal with is the disparate health care treatment. And my colleagues 
have spoken about being too poor to afford Medicare and the kind of 
drugs they need; but the disparate health care treatment studies have 
shown that even when middle class blacks have health plans that pay for 
everything that white middle class persons are entitled to, the system 
is so racist that they are not offered the same procedures. They are 
not offered the same treatment. They are not offered the same 
medications.
  Three studies have documented this. It is alarming. Money is not the 
factor, but somebody along the way decides that minorities do not 
deserve first class health treatment. This is sometimes decided by 
nurses, sometimes decided by technicians, the doctor's diagnosis and 
the determination of whether you get a heart bypass or whether you get 
a pill indicates the disparity in treatment.
  So racism is a factor. It will become more of a factor as we struggle 
and compete for the existing health care that is out there now. If we 
do not go forward with Medicare and beyond Medicare, a universal health 
program based upon Medicare as a beginning, then we will have even more 
difficulty, and racism will play an even bigger role in determining the 
poor health care that minorities receive.
  There is adequate health care treatment and inadequate health care 
treatment. Class does not come in and should not be considered as a 
factor.
  Our first step is to make sure that we maintain Medicare as it is. 
The bill on the floor tomorrow goes far beyond dealing with 
prescription drugs. It sets up a situation for privatization, for a 
number of factors which will mean the end of Medicare. And when 
Medicare ends then minorities in general, poor and middle class, answer 
to the poor, we will have nowhere to turn. We must fight to the very 
end to see to it that our colleagues understand how decisive this 
action will be tomorrow in terms of determining the future of health 
care in America.
  Mr. CUMMINGS. Mr. Speaker, I want to thank the gentleman for his 
outstanding statement. I really appreciate it.
  I now yield to the distinguished gentlewoman from the great State of 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
chairman for yielding to me, and I thank him for bringing this 
important special order. Because one of the tragedies of the next 24 
hours, and I do believe that this debate, this discussion and ultimate 
decision on Medicare, can in fact be a bipartisan decision. And I look 
forward to working with my friends on the other side of the aisle who 
have the same common goals. And that is to strengthen Medicare and to 
provide the best package possible within a fiscally responsible 
presentation Medicare, to save Medicare as we know it, to preserve the 
safety net as we know it. And frankly, Mr. Speaker, I do believe that 
there are Republicans who believe this same way.

  I hope the opportunity that I have this evening and my colleagues 
have had from the Congressional Black Caucus that we have might share 
some of these thoughts sufficiently enough that our friends on the 
other side of the aisle might work with us tomorrow in this shortened 
time frame, limited debated, to do what is right. And that is to send 
this legislation back to the drawing board and really do what we have 
been asked to do.
  I think there are two things that are creating problems and maybe 
even three as it relates to the Medicare system. The first one is what 
we have debated and discussed for at least the almost 10 years that I 
have been here and that is to give a real guaranteed Medicare 
prescription drug benefit to our seniors in the Medicare system.
  The second and third have to do with providing the compensation for 
providers whether they be physicians or whether they be, in fact, our 
hospitals, both urban and rural areas, that they can provide the kind 
of care that is necessary for all Americans who are senior citizens and 
who have access and are qualified for Medicare. I think that is really 
the crux of what we have been trying to do now for 10 years.
  Many people are rushing to judgment feeling that we are desperate 
that we are at our wits ends, this is the last opportunity, and I would 
just say to my friend, it is not. The Congressional Black Caucus stands 
on this floor tonight to let you know that our districts now have 
become so diverse that whether or not you happen to represent a 
conservative Republican district, moderate, liberal, Democratic 
district as it may be so designated, you can be assured that there are 
people of all economic levels, races, color and creed and religion in 
your district.
  That means if you cavalierly vote for a bill that will be on the 
floor of the House, 634 pages tomorrow, that rule destroys Medicare as 
we know it, that gets rid of the Medicare premise, the safety net for 
all Americans, you will have made a very big mistake. Once seniors 
begin to understand one that the vote tomorrow does not give them any 
benefit, it does not take effect until 2006, for the fiscally 
conservative and responsible Members of this House, for them to realize 
that this is more than a budget buster, this is a budget imploder. 
Because in actuality, because we have had to try to sweeten the pot for 
every constituency possible we really do not know what the cost of this 
bill is going to be. It is more than the $400 billion that we surmise 
that it might be based upon the fact that the President gave that as a 
number.
  In fact, what it does is it throws seniors of all accounts into a 
private system that may fall on its own weight. It insists on creating 
a prescription drug benefit not under Medicare; but under a private HMO 
system, which if it is not beneficial or prosperous or has a good 
profit margin just like we found in the HMO's crisis of about 5 or 6 
years ago, you will see HMO's closing every single place in the Nation, 
including the districts of my friends across the aisle.
  So if you think you are doing something for your seniors, take a 
second look. This is not a prescription drug benefit. It is, in fact, a 
prescription drug booster. And what it does is it causes the Social 
Security increases to not match up with the prescription drug 
increases.
  Let me just bring several points to a close, Mr. Speaker. First of 
all, for those of us who have seniors who are on Medicaid, it is going 
to be a higher

[[Page H11868]]

co-pay for them. And the HMOs rather than the doctors are going to 
determine what drugs, what prescription drugs are going to be paid for 
under this plan. Then I will say there will be no reimportation 
allowed, and I know there will be a number of those who supported the 
reimportation. I will say one of the greatest shams of this bill is 
that it does not allow, Mr. Chairman, it does not allow the government 
to negotiate lower prices for prescription drugs under Medicare.
  What an insult. It does not allow the government to save money. The 
reason for that is, and let me say I have no argument with the 
pharmaceutical companies. They do great work. I say that in terms of 
research and finding prescription drugs or drugs that will allow us to 
live longer or cure our ailments, but their participation in this kind 
of misfortune, in this legislation of tying the hands of government is 
a travesty.
  So I would simply say that we will not have the time that we need to 
debate this tomorrow on the floor of the House. I know this is going to 
hurt Hispanics and African Americans. And I would just simply argue the 
point, Mr. Speaker, that this is a bad bill. Send it back as the 
Congressional Black Caucus would like you to do and put forward 
something that is reasonable and that works to help all Americans of 
which tomorrow's legislation will not do.
  Mr. CUMMINGS. Mr. Speaker, I will close by simply thanking the 
Members of Congressional Black Caucus for being here tonight and being 
a part of all of this. I have often said that a hundred years ago, none 
of us were here. A hundred years from now, none of us will be here. The 
critical question is what do we do while we are here to lift each other 
up.
  The fact is that we have a bill on the floor of this House tomorrow 
which is supposed to be a prescription benefit bill when, in fact, it 
does much more harm than good. And I think that when all the dust 
settles, when everything is laid out very clearly, the question 
becomes, Have we lifted our seniors up? So many of them have begged for 
relief. So many of them have cut pills in half and in quarters. So many 
of them have gone from one drug store to another begging for 
prescriptions.

                              {time}  2230

  So many of them have almost broken out in tears when they found out 
that their doctor did not have the sample prescription drugs that they 
needed, and so we stand here tonight not only saying that we consider 
the prescription drug bill to be bad, bad news, but we also on the 
other hand, Mr. Speaker, offer our HealthCare Equality Accountability 
Act of 2003 to say that we have a piece of legislation that does not 
cure everything but certainly it helps; but on the other hand, we have 
another piece of legislation, the prescription drug bill which does so 
much harm.

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