[Congressional Record Volume 151, Number 62 (Thursday, May 12, 2005)]
[House]
[Pages H3246-H3249]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              MAKING HEALTH CARE ACCESSIBLE AND AFFORDABLE

  The SPEAKER pro tempore (Mr. Jindal). Under the Speaker's announced 
policy of January 4, 2005, the gentleman from Georgia (Mr. Gingrey) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GINGREY. Mr. Speaker, it is indeed a coincidence today that 
Democrats in their one hour special order would be led by a Georgian, 
my colleague, the gentlewoman from Georgia

[[Page H3247]]

(Ms. McKinney), and the Republican hour today would be led by myself, 
another Georgian. I am really, of course, pleased to have this 
opportunity.
  I am going to talk on an entirely different subject to my colleagues, 
Mr. Speaker, than what we just heard for the previous hour. This time 
is dedicated really to the Republican Conference Health Care Access and 
Affordability Public Affairs Team. We put together this team for the 
purpose of letting our colleagues know, letting the American people 
know, that the Republicans care deeply about the health of this Nation, 
particularly in regard to those who are the neediest, whether they are 
white, black or Latino. It does not matter. People in this country who 
need health care that really cannot afford it, who are struggling 
through no fault of their own, we are deeply committed to solving these 
problems, whether we are talking about Medicare, Medicaid or Social 
Security for that matter.
  These are the so-called entitlement programs, the mandatory spending. 
When we talk about a budget for fiscal year 2006 of $2.6 trillion, two-
thirds of that budget goes to mandatory spending. That means those who 
meet eligibility requirements, obviously Social Security retirees and 
disabled and widows and dependent children; the Medicare program, you 
are 65; or you are younger than 65 and you are disabled, the Medicaid 
program; or you are poor.

                              {time}  1600

  And you do not have the means or the wherewithal to purchase private 
health insurance or maybe you do not have a job, you do not have an 
employer that provides health insurance for you. These are the people 
who meet those eligibility standards, and that is called mandatory 
spending; and it includes two-thirds of our Federal budget. We have a 
huge problem with the growth in those numbers because, as our 
population grows, there are more and more people who are struggling who 
become eligible for one of these three mandatory benefits. It is 
becoming a tremendous strain on this country.
  Tonight I will focus primarily on the Medicaid program, because our 
States are in such dire economic stress because of Medicaid, which is a 
joint Federal-State program, a shared program, if you will.
  The President, during the last couple of months, has spent a lot of 
time talking about the Social Security program. My colleagues know that 
he has been going all over this country trying to explain to the 
American people that we are in a real crisis; and certainly, at least I 
think everybody would agree, there is a serious problem with Social 
Security because of demographics, because of the fact that thankfully, 
thankfully, people today are living longer and they are healthier.
  As the baby boomers fully mature and that starts the first wave, the 
leading edge of that wave is upon us in 2008, and as they fully mature, 
we go from 45 million Social Security beneficiaries today to within 10 
or 15 years to having 77 million. And trying to fund that program with 
a payroll tax that has not increased in a number of years, it is a 
tremendously difficult problem; and it needs to be solved. It is not 
something we can put off for other Congresses.
  I hear from some of my colleagues, particularly on the other side of 
the aisle, well, it is not that bad of a problem; why do we not just 
kind of wait awhile and let somebody else deal with it. I mean after 
all, 2006 will be upon us pretty soon, and it is the next election that 
is most important, not the next generation.
  I certainly do not agree with that, and I know this President and 
this Republican leadership does not agree with that at all.
  But what we are hearing a lot of times is, well, why are you focusing 
on Social Security when we have these huge problems with Medicare and 
Medicaid? I know my colleagues on both sides of the aisle have heard 
that argument. The point, of course, is that we have focused on 
Medicare, and I am very surprised at how quickly they forget. It was, 
after all, just December of 2003 when this body, this Congress, in a 
bipartisan fashion, passed the Medicare Modernization and Prescription 
Drug Act. That prescription drug part of Medicare, of course, does not 
become operational until January of next year, 2006. So we have not had 
an opportunity to see what benefits that will bring to the program.
  We have had an interim program, I think, that has worked very, very 
well. It is called the Transitional Medicare Prescription Drug Discount 
Card program. All of my colleagues, Mr. Speaker, remember that, the 
1\1/2\ to 2-year program, before we get started in the part D 
prescription drug premium-based, voluntary part of Medicare next year, 
to give immediate relief, as we did in December of 2003, to let our 
seniors obtain, for no more than $30 a year and, in most instances, a 
free Medicare prescription drug discount card, which would allow them 
to go to the drugstore with those four or five prescriptions that their 
doctor had written for high blood pressure or control of their blood 
sugar so their diabetes did not get worse, or something to prevent 
osteoporosis, or to, as I say, lower blood pressure and cholesterol.
  So when they went to the drugstore, they were not paying sticker 
price. They were getting the same kinds of discounts, competitive 
discounts that people who were working and had employer-sponsored 
health care, maybe under an HMO, and they got deep discounts on their 
drug prices.
  This is what the discount program, the transitional program brought 
to our neediest seniors; and, in fact, those living at or below the 
Federal poverty level were credited on that card. It became not a 
credit card, but a debit card; and they got $600 a year for those two 
years, 2004 and 2005, a total of $1,200 that they could apply to the 
cost of their prescription medication.
  There were other things, Mr. Speaker, and I know my colleagues 
remember that. If not, hopefully, this will be a reminder. For the 
first time ever under the Medicare program, new beneficiaries, those 
just turning 65, were having the opportunity to go to their doctor, to 
their general doctor, their internist, their family practitioner and 
having a complete, thorough, head-to-toe physical examination. In the 
past, Medicare did not pay for that. You could only get reimbursed for 
a doctor visit if you were sick, if your nose was bleeding, if you had 
pain in your chest from a coronary and you were staggering because you 
were about to have a stroke, or you showed up in the emergency room. 
But just to have a routine physical to find out, hey, is everything 
okay, to get your blood pressure checked and have that cholesterol 
level determined, and the screening procedures, or maybe if you had a 
mammogram to rule out a very early breast cancer; these things were not 
covered under Medicare.
  But under this leadership, this Speaker, this Republican-led 
Congress, this President brought, in December of 2003, the Medicare 
Modernization and Prescription Drug Act.
  So for everybody to suggest that this Congress is not focused on 
health care and has done nothing and is wasting our time trying to 
solve the Social Security problem is just absolutely untrue; and I 
think fair-minded Members of this body, whether Republicans or 
Democrats, know that. They know that. They know that we have devoted a 
lot of attention to Medicare. It remains to be seen, really, how that 
program is going to work.
  All we hear from the opposition is, oh, well, you know, it is going 
to cost a lot. They misled us, they lied to us, they said it was only 
going to cost $395 billion, and now it is going to cost $750 billion. I 
do not know what the true cost is, but I do know this: when, Mr. 
Speaker, the Congressional Budget Office is calculating the expense of 
the program, they are talking about what it is going to cost to provide 
a prescription drug benefit, even though it is premium-based. Like part 
B, sure, there will be a cost to the taxpayer. The part B Medicare 
program, Mr. Speaker, a lot of people probably do not realize this, but 
the premiums, even though they have gone up every year since 1965, and 
now are approaching $80 a month, they only cover 25 percent. The 
general fund taxpayers are supporting 75 percent of that cost.
  So the prescription drug program will be very similar to that. There 
will, indeed, be a cost. But what is so misleading is no credit 
whatsoever is given to the fact that if a person is taking a blood 
pressure medication to keep them from having a stroke, if a person can 
now afford to go to the drugstore

[[Page H3248]]

and get Lipitor or Pravachol or one of these statin drugs to lower 
their cholesterol and avert the need for open heart surgery, or someone 
is able to take Glucophage or insulin so that that diabetic condition 
does not get so bad that it destroys their kidneys or causes blindness 
or causes peripheral vascular disease to the point that they need an 
amputation of a limb or renal dialysis or maybe even a kidney 
transplant; all of those things, by the way, are currently today 
covered under Medicare, but extremely expensive.
  If we can prevent that by allowing our seniors, our neediest seniors 
to afford the medication and treat these diseases in a timely fashion, 
then we save money on part A, being the hospital, the nursing home 
care, for those who have had a stroke and maybe have to spend the rest 
of their lives in a nursing home; part B would be the fee that the 
cardiothoracic surgeons charge to do open heart surgery. We save that 
money, yet you get no credit, you get no score for that. But, Mr. 
Speaker, surely, if this program is going to work and if it makes 
sense, and it certainly makes sense for this physician Member of this 
body and, furthermore, it is the compassionate thing to do.
  So, indeed, to suggest that the Republican majority in this body, led 
by our Speaker, the gentleman from Illinois (Mr. Hastert), and that 
President Bush and his administration do not care about health care and 
have ignored and narrowly focused on Social Security and forgotten 
about the needy in this society regarding health care, it is just 
absolutely, Mr. Speaker, absolutely untrue. I think, again, fair-minded 
Members of this body on both sides of the aisle would readily admit 
that.
  Now, I spoke at the outset of this hour of the Republican Conference 
on Health Care, Access, and Affordability Public Affairs Team. That is 
us; that is me. I am taking all of the time this evening, but we have a 
strong team. We are not just health care providers, although many of us 
are physicians and dentists and other people involved in health care. I 
wanted to take this time to share with our colleagues our vision and 
our focus and what we are doing to try to make sure that we have a good 
policy that is fair and balanced and that we are taking care of those 
who are in most need in regard to health care.
  Mr. Speaker, one of the huge problems right now, of course, is the 
Medicaid program. Again, this is part of our entitlement spending, the 
mandatory spending, as I outlined at the beginning of the hour, the 
two-thirds of the Federal budget. Medicaid is a Federal-State program, 
with the Federal Government actually paying, in most cases, more than 
the State does, to provide health care for the neediest in our society, 
especially for children and single mothers. It is a great program. It 
has served us very, very well. In fact, I have a slide, Mr. Speaker, 
that I will get up in just a few minutes and I would like to point out 
how that Federal-State match works.
  It is based, really, on average income in a State. A State with a 
lower average income, a poor State, there is going to be a higher 
Federal percentage; and the parameters range from a 50-50 participation 
to 80-20. And if we can focus on this chart to my left, this is not all 
of the States; I think I was informed that the machine broke and they 
were not able to get but about half of the States on the chart. But it 
does include my State of Georgia; and last year in Georgia, the Federal 
match was 60, almost 60.5 percent, and the anticipated match for the 
fiscal year 2006 is 60.6. So in Georgia it is about a 60-40 split.
  I was looking for Mississippi, which I think is probably one of the 
States that has the lowest per capita income where the Federal match 
actually approaches the maximum 80 percent.

                              {time}  1615

  It is not on this board. But I think the Federal match in the State 
of Mississippi is about 78 percent. But it varies. Alabama is here, 
70.1 percent Federal participation in 2005. And in 2006, that dropped 
down to 69.5 percent. There are other States, like I say, that are 50/
50. Illinois, as an example, is 50/50. The State of Massachusetts is 
about 50/50.
  Mr. Speaker, this is the way it should be. We should indeed 
participate more for those States who have the greatest need. One 
thing, though, that really concerns us, and I think one of the main 
problems with the Medicaid system, is that there is a significant 
amount of waste and abuse of the system. And yes, in fact, Mr. Speaker, 
in some instances, downright fraud. And if a State is a 50/50 state, 
there may not be much advantage to take an advantage of the system. But 
if the State has a higher Federal match than the State match, you can 
see that if you are abusing the system, gaming the system, if you will, 
then there is an advantage because you are pulling down more Federal 
dollars than you are spending at the State level.
  And so these are some of our problems, of course, that we are facing 
now with the Medicaid program. The spending is growing more, of course, 
in times of economic stress and distress. And we have gone through a 
lot of that in the last several years, particularly since 9/11. And of 
course the population growth, you are going to have more people who are 
legitimately eligible for this care. So the spending is going to go up. 
But we want to make sure that we get dollars to those who are in need 
and not to those who are in greed, if you will. And that is very 
important.
  And there will be a very strong focus on Medicaid reform, led, quite 
honestly, by the governors, by the Governors Association, both 
Democratic and Republican governors. They have been here. They have 
talked to the President. They have talked to Congress. They have some 
very good ideas of how to make this system work better and make sure 
that those who have the greatest need have access to those Medicaid 
dollars.
  I wanted, Mr. Speaker, to share with my colleagues just a few numbers 
about the magnitude of really what I am talking about. In the year 
2002, the total Federal dollars spent on the Medicaid program, now this 
is just the Federal dollars, $140 billion. That is in the year 2002. In 
the year 2004, that number has gone up to $184 billion. You know, we 
are talking about significant increases. From 2001 to 2002, the Federal 
spending Medicare increased 8 percent. From 2002 to 2003, it was about 
9 percent. From 2003 to 2004, in the same range. And on and on and on.
  So when people say to me from back home, Congressman, do not cut 
Medicaid spending because, you know, you are affecting my program. And 
that could be a physician talking about, you know, his or her 
reimbursement. It could be a hospital. It certainly is likely to be one 
of these rural hospitals that is called a disproportionate share, which 
means their clientele is disproportionately weighted toward the 
Medicaid program because they are a poor community. And they are 
concerned, and I understand that.
  But what the President did in the 2006 budget that he submitted to us 
was to cut a certain number of Medicaid dollars over a 5-year period of 
time. What we have done here in the Congress, the President recommends, 
and then we legislate. We make the final decision. And it looks like we 
are going to have a Medicaid funding cut over the next 5 years of $10 
billion. That is $2 billion a year but that, we hope and I feel very 
confident, we can find those savings by eliminating this situation that 
I described, waste, fraud and abuse.
  Now, let me just give you one example, Mr. Speaker, and I want to 
share that with my colleagues, the nursing home situation, long-term 
care in a skilled facility. Medicare, under Part A only covers a 
certain number of days. I think it is something like 100. And after 
that, the patient is pretty much on their own, and that has to come out 
of their pocket. If they do not have long-term care insurance, and most 
people do not, we are trying to address that. This Congress is trying 
to address that, the Republican leadership, and that is why we put 
health savings accounts in the Medicare modernization bill of December 
2003, so that that money in those accounts can be used without any tax 
penalty whatsoever to purchase long-term health care insurance. But 
most people do not have that today. And if a loved one ends up in a 
nursing home, then once those Medicare dollars, those days of 
eligibility are utilized, and the person has no other resources, they 
become what is known as dual eligible because they

[[Page H3249]]

have no wealth and no source of income, then all of a sudden they are 
eligible for Medicaid.
  So, the reality today, my colleagues, is that probably 70 percent of 
nursing home reimbursement is from the Medicaid program. Now, some of 
that is appropriate. But some of it is inappropriate.
  And indeed, there is actually a cottage industry out there where our 
good attorneys advise people how to hide their income, how to shift 
their possessions and their net worth to maybe another family member, 
and all of a sudden they have got nothing. They do not have any wealth. 
They do not have any income, and they are dual eligible for Medicaid. 
That, my colleagues, is what I call gaming the system. And when you do 
that, you take money away from the program, desperately needed money 
for single moms, for the poor who need prenatal care, for little 
infants that are born prematurely that need a good start in life, and 
they cannot get it because there is no money there.
  This is something that we, the Republican majority, and hopefully in 
a bipartisan fashion with our colleagues on the other side of the 
aisle, we are giving very serious attention to it. And yes, we can walk 
and chew gum at the same time. We can work on the Social Security 
problem and fix that, get out of that crisis situation and work on 
solving the Medicaid problem at the same time. Absolutely, we can. We 
will. We are doing that, and we will get to the finish line on both of 
these programs, and we will do it sooner rather than later.
  We will not be irresponsible on these issues and put this off and 
say, Hey, you know, we do not want to touch that third rail because we 
are worried about our re-election in 2006 and keeping our majority. We 
are going to keep our majority by doing the right thing. And we will 
let the elections take care of themselves.
  But we have to make sure that we understand, the American people 
understand, and that we do not let the nay-sayers poison the well like 
they tried to do on that Medicare discount card.
  I was at a little town hall meeting in one of my poorest counties 
recently in Southwest Georgia, Talbot County, a great community, 
wonderful people, but poor, very low tax base. And we were talking 
about Social Security. Miss Menafee came up to me after the hour and a 
half town hall meeting, and she said, Congressman, thank you for that 
information on Social Security. I think I really understand it better 
now. I have been getting those automated phone calls and those slick 
glossy mailers. I do not know whether they were from AFL-CIO or George 
Soros and some 527, but thank you, Congressman for helping me 
understand it better, to see how an individual personal account can 
grow and have the miracle of compound interest. But I just want to say 
to you, also, thank you for Medicare modernization. And thank you from 
the bottom of my heart for that prescription drug discount card, that 
transitional program.
  Miss Menafee told me that she had been spending something like $400 a 
month for five or six drugs that she desperately needed, and because 
she was eligible for that $1,200 credit and the lowest pricing, in 
fact, I think maybe a dollar, $3 copay, she said she had reduced over 
$400 a month worth of medical expenses to $9 a month.
  Miss Menafee, God bless you. And she is 80 years old and looks 
healthy, and I think she is going to outlive us all because of what we 
did. So that is the compassion. That is the thoughtfulness that this 
Republican leadership, this majority has in regard to the health care 
program.
  Mr. Speaker, I guess I could go on probably long beyond my allotted 
hour. But I am going to try to go ahead and bring this to a close 
because I think, hopefully, my colleagues have heard me loud and clear 
and understand that we care about health care. We care about the 
uninsured.
  We have passed association health plans in this body at least twice, 
and we will continue to pass it. We have passed tort reform so that 
doctors and hospitals are not ordering all these unnecessary tests. And 
every individual that walks into an emergency room with a headache does 
not need a CAT scan, but they are getting it because the doctors are 
afraid they are going to be sued, or the hospital, and that is why 
people cannot afford health insurance.
  All that defensive medicine, these additional lab tests, it drives 
the price of health insurance up so high that it is out of reach for 
far too many people. And we end up with 43 million in this country who 
have no health insurance, and most of them are working. But we are 
going to help them. Again, we are going to help them by what we have 
done in Medicare modernization, give them an opportunity to set up 
through their employer a health savings account where they can get 
catastrophic insurance for a very low premium, Mr. Speaker, a very low 
monthly premium, and then the employer or a relative or a friend can 
help them fund an account that can grow, that can enjoy the miracle of 
compound interest, that they can use that money for a lot of types of 
things that traditional health insurance does not even cover, eye care, 
dental care, mental health services, just so many things.
  So it is a pleasure to be part of this team, to be here tonight, to 
be talking about what we, the Republican health care access team, is 
doing.
  But, you know, again, I want to make sure my colleagues understand 
that I am not an overly partisan person. It is not all about left 
versus right or Republican versus Democrat. It is right versus wrong, 
and I think we need to focus on doing the right thing, and we ought to 
try to do it as much as we can in a bipartisan fashion.
  And to that point, Mr. Speaker, I want to let my colleagues know that 
we have recently formed a medical/dental doctors in Congress caucus in 
this House. There are 13 of us. There are three dentists. There are ten 
MDs. Three of those MDs are on the democratic side; seven on the 
Republican side. And we are going to work on these issues in a 
bipartisan fashion.
  You know, I thought yesterday, as we had that plane, that little 
Cessna that inadvertently got in the airspace over the Capitol, and we 
all went just, I mean, pouring out of here in semi panic, although the 
Capitol police did an excellent job of keeping people calm, but, you 
know, making sure that we got out of harm's way as quickly as possible.

                              {time}  1630

  You have to take every one of these threats seriously, and I could 
not help but thinking as I was running down the street, where are the 
other 12 members of our physician and dental doctor caucus?
  We probably were all going in a different direction. My co-chairman 
of that caucus is the gentleman from Arkansas (Mr. Snyder), Mr. 
Speaker, a great Member of this body. The gentleman has been here a 
good bit longer than I have been, a fine doctor from Arkansas.
  The gentleman and I have been working together. That was one of the 
things we were talking about last week. The next meeting we have, we 
are going to make sure that we work with the House physician so that 
this team would know what we would do in a situation like that so we 
were not all going in different directions. Maybe all 13 of us, 
hopefully the caucus will grow, I like doctors and dentists in 
Congress, but we could go to a designated spot so if this really truly 
turned out to be a terrorist attack, we would be part of the solution 
and not part of the problem.
  Again, as I speak to my colleagues this afternoon and I am deeply 
appreciative, Mr. Speaker, of the opportunity to talk about what the 
Republican majority is doing on health care, I do not want to forget 
that the American people do not like a lot of partisanship and 
animosity and, indeed, hatred. We do not accomplish anything in that 
fashion. I am very proud to be part of that new bipartisan caucus as we 
work towards solving these problems.

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