[Congressional Record Volume 154, Number 122 (Thursday, July 24, 2008)]
[House]
[Pages H7122-H7132]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   RELATING TO THE HOUSE PROCEDURES CONTAINED IN SECTION 803 OF THE 
 MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003

  Mr. HASTINGS of Florida. Mr. Speaker, by direction of the Committee 
on Rules, I call up House Resolution 1368 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 1368

       Resolved, That section 803 of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 shall not 
     apply during the remainder of the 110th Congress.

  The SPEAKER pro tempore. The gentleman from Florida is recognized for 
1 hour.
  Mr. HASTINGS of Florida. For the purpose of debate only, I yield the 
customary 30 minutes to my good friend, the ranking Republican of the 
Rules Committee, Representative Dreier.
  All time yielded during consideration of the rule is for debate only. 
I yield myself such time as I may consume.
  I also ask unanimous consent, Mr. Speaker, that all Members be given 
5 legislative days within which to revise and extend their remarks on 
House Resolution 1368.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. HASTINGS of Florida. Mr. Speaker, as the Clerk just read, House 
Resolution 1368 provides that section 803 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 shall not apply during 
the remainder of the 110th Congress.
  This resolution is needed today because of a procedural gimmick which 
was stuck into the Republican Medicare prescription drug bill in the 
dead of night shortly before the bill found its way to the floor back 
in 2003. The provision was a way for Republicans to get conservatives 
in their party to support an unpopular bill that may very well be the 
largest campaign donor payback program in the history of this 
institution. However, even this provision failed to prevent one of the 
most shameful nights in the history of this institution as arms were 
twisted and threats delivered into the wee hours of the morning to get 
the votes needed to pass this bill.
  Under current law, when the Medicare trustees project in two 
consecutive trustee reports that general revenues will exceed 45 
percent of Medicare spending within a 7-year window, an expedited 
process is triggered to reduce the percentage. This expedited process, 
however, bypasses regular order in the House, as well as the Rules 
Committee. Once the percentage of Medicare funding coming from general 
revenues reaches 45 percent, the President is required to send 
legislation to the House and Senate that will address the matter. That 
bill must then be introduced by the House majority and minority leaders 
and referred to the appropriate committees.
  The process by which that bill, or any bill meeting the requirements 
of the trigger, moves through the committee process and is discharged 
to the floor includes a privileged motion. The privileged motion 
requires only one-fifth of the House, or just 87 Members, to second the 
motion and force a vote on that motion that would bring the bill itself 
to the floor for a vote. Under the trigger, if this small minority of 
the House is successful and the motion passes the House, the bill would 
come to the floor within 3 legislative days and can be debated with up 
to 5 hours of general debate and 10 hours of debate on amendments.
  Adding to the unprecedented nature of this provision, amendments are 
given blanket waivers with the only requirement being certification by 
the

[[Page H7123]]

Budget Committee that the bill will eliminate excess Medicare spending 
from general revenues. Astonishingly, the trigger waives the rules of 
the House and blocks Members from raising points of orders against the 
bill for earmark, PAYGO, or any other violation of House rules. All 
that a Member needs to do to force a vote on discharging a bill is 
introduce a bill titled ``To Respond to a Medicare Funding Warning.'' 
As long as that bill meets the requirements of the Budget Committee, 
then anyone, Democrat or Republican, may seek to disrupt the 
proceedings of the House. Realize, if the House fails to pass this 
resolution today, it will leave itself vulnerable to chaos and 
extraordinary political gamesmanship.
  We will lay the groundwork to effectively becoming the Senate, 
stalled and unable to act as a victim of its own rules and procedures. 
Every moment of every day here in session, under the guise of trying to 
fix Medicare, a Member could move to discharge a bill which includes 
provisions that have nothing to do with Medicare. The only way to avoid 
this chaos and potential shutdown of the House in the 110th Congress is 
for the House to pass this resolution today.
  What is perhaps most troubling about this entire process, Mr. 
Speaker, is that Congress fixed the revenue problem in a more 
comprehensive manner last week when the House and Senate both voted to 
override the President's veto on the Medicare Improvements for Patients 
and Providers Act. In that bill, Democrats, in a bipartisan fashion, 
removed waste, fraud and abuse in the Medicare advantage plan without 
hurting seniors. Under our leadership, seniors continue to have access 
to their doctors and prescription drugs without having their premiums 
raised or coverage reduced.
  Very occasionally, Mr. Speaker, many of us talk with different people 
in our constituency. Last week I had an opportunity to talk with a 
physician in this city named Stern. And Dr. Stern indicated to me that 
I should, among other things, fight real hard to have people understand 
how effective Medicare is and what a single payer plan could do for 
this Nation. We talked considerably about this, and I'm delighted that 
I had an opportunity to be edified by someone that is in this 
profession.
  But because of this Medicare trigger provision, a provision which was 
not in the House or Senate bill and was slipped in the conference, I 
will repeat, slipped in the conference during the dead of night, and I 
was here, Pete Stark and David Dreier, all of us were here when this 
happened, forced to deal with the legacy of, in my opinion, the 
misguided former majority.
  I urge my colleagues, Mr. Speaker, to do the right thing and support 
this resolution.
  I reserve the balance of my time.
  Mr. DREIER. Mr. Speaker, I yield myself such time as I might consume.
  (Mr. DREIER asked and was given permission to revise and extend his 
remarks.)
  Mr. DREIER. Let me begin by expressing my appreciation to my good 
friend, my Rules Committee colleague from Fort Lauderdale, for yielding 
me the customary 30 minutes. And I have to say that I rise in strongest 
possible opposition to this rule. Only under this new majority, Mr. 
Speaker, could an attempt to ensure fiscal responsibility be described 
as nothing more than a procedural gimmick, and only under this new 
majority, Mr. Speaker, can we once again be taking action that totally 
subverts what we're all about here, and that is an open and fair 
debate.
  At issue today is a provision enacted by Republicans to ensure that 
Medicare is administered in an effective and a responsible way. When we 
created the prescription drug benefits for seniors, we included a 
provision to require regular reports on how Medicare is funded. We 
wanted to know, is the Medicare trust fund sufficient to cover the 
costs? Or are we drawing from the general Treasury to pay for it? And 
if we are, how much? If two consecutive reports indicated that over 45 
percent of Medicare's costs would come from the general Treasury over 
the next 7 years, Congress would have to act. We did not mandate what 
steps Congress would have to take. We simply required that solutions be 
examined, debated and brought to a vote, something that seems to be 
anathema to this new majority.
  We believed this provision was critically important because we, as 
Republicans, have two very important goals for Medicare.

                              {time}  1715

  First, it must effectively provide health care coverage for our 
seniors. Second, Mr. Speaker, it must be run efficiently and 
responsibly.
  Today we are confronting exactly the scenario that concerned us and 
led to this point. We have had two consecutive reports indicating that 
Medicare will exceed the cost threshold for years to come. In 
accordance with the law, the President submitted a proposal to restore 
fiscal discipline while ensuring that seniors continue to receive high 
quality care. Under the rules of the House, we are approaching the 
deadline to consider the proposal. But this new majority leadership, 
unable or unwilling to address runaway costs, simply wants to make this 
attempt at good governance go away, completely vanish. The rule before 
us today would quash the provision requiring us to consider a 
legislative fix. It allows runaway entitlement spending to continue 
unabated.
  Naturally, our good friends on the other side of the aisle are going 
to try to distract us from the facts today.
  They are going to rail against the circumstances, as we have already 
heard from my friend from Fort Lauderdale surrounding the original 
prescription drug vote in an attempt to obscure the real issue. This is 
a favorite trick of theirs, Mr. Speaker. The Democratic majority 
leadership cannot defend their own actions, so they stir up fights 
about Republicans. They can thunder away about 5-year-old fights all 
they want, but it won't absolve them of the actions that they are 
trying to take here today. Today they are in charge. They are 
responsible for their actions as the majority. They cannot distract the 
American people from the fact when they were presented with a proposal 
for reforming the cost of Medicare, they decided to change the rules 
and ignore the problem. That's exactly what is happening here.
  Mr. Speaker, we have a legislative fix that was submitted by the 
President of the United States and introduced by the majority and the 
minority leaders as required by the fiscal discipline procedures put 
into place by Republicans in this important bill. It recommends two 
steps to rein in skyrocketing costs. One, it lowers the government 
subsidy for prescription drug coverage for high-income seniors to save 
$3.2 billion over 5 years. Second, it reforms the medical liability 
system and puts patients before trial lawyers, saving nearly $4 
billion.
  Now, Mr. Speaker, I don't know that that is the panacea, but those 
are a good start and those are the proposals that the majority leader 
and the minority leader introduced as required under this law.
  I know some people may not like those savings. Some of my friends on 
the other side of the aisle are enamored with the present liability 
system and believe that we need more litigation, not less. Others may 
feel that everyone, regardless of income, should get the full 
prescription drug subsidy.
  There may be disagreement on these issues, but they are worthy of 
consideration and debate, which is what this institution is all about. 
Debate is exactly what was envisioned by this proposal. It provided for 
at least ten separate alternatives, each debatable for up to an hour. 
My friend is absolutely right, it could take 10 hours, but God forbid 
we spend 10 hours discussing an issue as important as this. We imposed 
no restrictions. Any proposal for reining in costs could be considered 
and debated. This is a foreign concept in the 110th Congress, but we 
actually believe that open, rigorous debate is the key to finding 
solutions to our most difficult challenges.
  Unfortunately, the rule before us today continues a very troubling 
pattern: the Democratic majority leadership would rather duck and cover 
than stand and deliver on a very important issue for the American 
people.
  In case the American people haven't noticed, Mr. Speaker, the House 
of Representatives has been locked in a legislative holding pattern. We 
have at least five appropriations bills which have been ordered 
reported by the Appropriations Committee. How many

[[Page H7124]]

have been considered on the floor during this very important 
traditional appropriation month? Not a single one. Zero. Nada. None.
  The same is true for real energy legislation. Oh, we've had fig 
leaves on the floor like the one we had just a couple of hours ago. But 
the majority is not interested in debate on these measures. They bring 
controversial energy legislation that no one has ever seen to the 
floor, and then they impose ultra-restrictive rules so that 
Republicans, or Democrats, cannot offer their own ideas.
  These flawed bills fail, of course, but the Democrats get to avoid a 
real debate on the important issues of conservation, alternative energy 
sources, and yes, new domestic supplies of oil.
  This pattern continues today with this rule. Instead of having a real 
debate on legislation to reform the Medicare program, we are using the 
rules to completely avoid the program altogether.
  The reason, Mr. Speaker, is simple. The Democratic majority 
leadership is more concerned about protecting their Members from tough 
votes than engaging in the honest and open debate they promised the 
American people when they won the majority nearly 2 years ago. They are 
more interested in maintaining their electoral fortunes than tackling 
the tough business of actually governing.
  Now if press reports are to be believed, the Democratic majority 
plans to avoid the most basic responsibility we have as legislators: 
making decisions about our spending priorities. Instead of doing the 
business of passing appropriations bills and considering legislation on 
key issues like how we can get gasoline prices down and how we deal 
with Medicare, they are going to punt all of the tough choices until 
the next administration. I am just shaking my head and asking, Mr. 
Speaker, what is it that we are doing here and what is it that we are 
afraid of when it comes to doing our work in this 110th Congress?
  We have an opportunity right here and right now to break this 
pattern. If we defeat this rule, we can have a real debate on 
alternatives to reform Medicare spending. We can start the business of 
governing and have a real debate on the real issue of fiscal 
responsibility, which is exactly what this provision is all about.
  But if we pass this rule, it is another blow to responsible 
government. It is another example of how far the Democratic majority 
leadership has fallen from the principles that they ran on and promised 
the American people nearly 2 years ago.
  Mr. Speaker, I urge my colleagues to vote ``no'' on the previous 
question and vote ``no'' on this rule.
  Mr. HASTINGS of Florida. Mr. Speaker, I yield myself 30 seconds.
  I want to say to my friend, the ranking member, everything debated in 
this House doesn't have to be a battle. Turning off this provision is 
the correct thing to do, and I will tell you why.
  The perceived problem with Medicare funding has already been 
addressed. Let me repeat that. The perceived problem with Medicare 
funding has already been addressed. The recently enacted Medicare 
Improvements for Patients and Providers Act fixed the funding of 
Medicare to keep it below the 45 percent trigger.
  Let me refresh your memory. On July 15, the House voted to override 
the President's veto of this important legislation. Every single member 
of the Rules Committee, Democrat and Republican, voted to override.
  Mr. Speaker, I yield 2 minutes to the distinguished gentleman from 
New Jersey (Mr. Pallone), a member of the Energy and Commerce Committee 
and a champion of SCHIP, which required overriding twice a veto by the 
President.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. PALLONE. I thank my friend from Florida, and I rise in support of 
this rule.
  Since its inception, Democrats have been the party to keep Medicare 
working for America's seniors and disabled. Contrast that with 
Republicans when they were in charge. During their majority, Medicare 
funding increased dramatically so they could shower their pals in the 
insurance industry with higher reimbursements than regular Medicare, 
all in an effort to privatize the program.
  Republicans are willing to look past all of that, pat themselves on 
the back and call themselves the party of fiscal responsibility because 
of some arbitrary policy that they inserted into the Medicare 
Modernization Act that pretends to address Medicare financing. This 
provision is more about smoke and mirrors than it is about ensuring 
Medicare remains intact.
  Republicans say it is about cost containment; I say it is about cost 
shifting. The sad truth is that the 45 percent trigger is designed to 
reduce the obligation of the Federal Government to fund part of 
Medicare, thereby shifting more costs to beneficiaries.
  Since taking control of Congress, Democrats have set out to put 
Medicare on a sustainable track. During our first year in charge, the 
House passed the CHAMP Act which would have extended Medicare solvency 
by 2 years by reducing wasteful overpayments to Medicare Advantage 
plans. And just a couple of weeks ago, we enacted the Medicare 
Improvements for Patient and Providers of 2008 against the President's 
objections.
  According to the CBO, under that bill the 45 percent threshold would 
be first crossed in fiscal year 2014, 1 year later than under the prior 
law. So I say contrary to what my friends on the other side of the 
aisle are saying, the fact of the matter is that Democrats are being 
fiscally responsible. Democrats are confronting Medicare's challenges, 
and we don't need an arbitrary policy that is a relic of the previous 
majority in order to do that.
  Mr. DREIER. Mr. Speaker, I am happy to yield 1 minute to the very 
distinguished gentleman from Westchester, Ohio, our distinguished 
Republican leader, Mr. Boehner.
  Mr. BOEHNER. I thank my colleague from California for yielding.
  Mr. Speaker, just as the Democrat leadership of this Congress is 
sticking its collective head in the sand when it comes to energy 
legislation, it is doing the same with the entitlement crisis that we 
face.
  My colleagues, ignoring this crisis won't make it go away. But this 
is just what the measure before us will do, allow us to ignore this big 
problem for just a little while longer.
  Earlier this year, the Centers for Medicare and Medicaid Services 
warned that if Congress doesn't act, government health care spending 
will grow to over $2 trillion by 2017. Medicare alone will account for 
almost one-quarter of this total. We can't afford that, our children 
can't afford that, and most certainly our grandchildren can't afford 
it.
  But today, the majority is saying, well, we are just going to wait 
for the next generation of lawmakers to deal with this problem instead 
of doing what we should do now. The majority is also saying something 
else. They are saying thank you to their trial lawyer allies. This is 
something that they have said quite often during the last 2 years, as 
we all know. By not addressing the Medicare funding crisis in a 
comprehensive way, we are dodging fundamental liability reform that the 
entire health care system needs so sorely. Who gains? Trial lawyers. 
Who loses? Patients, doctors and taxpayers.
  The majority leader said several months ago that he believed Medicare 
reform would be one of the most important issues for the next Congress 
and the next administration. Well, with the bill before us, it is clear 
that the majority leader meant what he said. But I think it is 
regrettable. It is irresponsible, and it is unfair to our children and 
theirs, not to mention the seniors who rely on this program today. They 
are going to bear the consequences of our refusal to step up and do the 
right thing.
  I urge my colleagues to defeat this. Let's have the courage to do 
what the American people sent us here to do: to solve this entitlement 
crisis in a fair and bipartisan way.
  Mr. HASTINGS of Florida. Mr. Speaker, before I yield to the next 
speaker, I won't respond to the distinguished minority leader, but I 
would like to submit the statements of the AARP and the National 
Committee to Preserve Social Security and Medicare in support of this 
resolution.


[[Page H7125]]


         National Committee To Preserve Social Security and 
           Medicare,
                                    Washington, DC, July 24, 2008.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the millions of members 
     and supporters of the National Committee to Preserve Social 
     Security and Medicare, we strongly urge you to support H. 
     Res. 1368 when it comes to the House Floor. H. Res. 1368 
     would suspend section 803 of the Medicare Modernization Act 
     of 2003 (known as the Medicare ``trigger'') for the remainder 
     of the 110th Congress.
       The Medicare ``trigger'' requires the Medicare Trustees to 
     include a finding in their annual report whenever they 
     project that general revenues will make up more than 45 
     percent of total Medicare funding within the first seven 
     years of the 75 year valuation period. This finding was made 
     in the two most recent annual reports, thus requiring the 
     President to submit legislation to Congress to bring the 
     federal contribution to Medicare down below the 45 percent 
     threshold. The legislation is subject to expedited procedures 
     designed to hasten its consideration. H. Res. 1368 would 
     suspend the Medicare ``trigger'' through the remainder of the 
     110th Congress.
       The 45 percent threshold at which the ``trigger'' is set 
     was a completely arbitrary limit included in the Medicare 
     Modernization Act. There has never been a public debate on 
     whether it is appropriate to establish a cap on the federal 
     revenue contribution to the Medicare program at any level, 
     nor has any policy rationale been identified for selecting 45 
     percent as that federal contribution limit. The fact that 
     more than 45 percent of Medicare financing may come from 
     general revenues poses no more of a problem in itself than 
     the fact that 100 percent of the financing for defense, 
     veterans' benefits, education or most other federal programs 
     comes from general revenues. The problem facing Medicare is 
     the cost of health care, not how the cost is allocated 
     between revenue sources.
       Limiting the federal government's contribution to the 
     Medicare program ignores Medicare's financing structure, 
     which was designed to rely on general revenues to finance 
     about 75 percent of Part B and Part D. This structure allows 
     the revenue raised by income taxes to shoulder a higher 
     portion of the responsibility for Medicare's funding, placing 
     the burden on a revenue source which is relatively 
     progressive and taxes all income.
       If general revenue contributions are limited, the burden 
     would shift to beneficiaries, who are typically retirees on 
     fixed incomes or the disabled, generally the least able to 
     shoulder the burden of increased costs. In fact, about 70 
     percent of Medicare beneficiaries have incomes under $25,000 
     and 85 percent have incomes under $40,000. Nearly two-thirds 
     of older households have incomes under $20,000, and they are 
     already spending 30-50 percent of their incomes on health 
     care.
       Arbitrarily cutting Medicare without getting at the root of 
     the continuing upward trend of health care costs is a 
     strategy for failure. It has real impacts on real people--
     most of whom have nowhere else to go for coverage and limited 
     ability to pay higher medical costs, accounting for rising 
     senior bankruptcies.
       Measuring Medicare's financial health solely by considering 
     the percentage of general revenues contributed to the program 
     produces a meaningless number, which will nonetheless be used 
     as a catalyst for policy decisions that could have a 
     devastating effect on the health care of seniors and people 
     with disabilities. For example, the 45 percent limit has been 
     triggered, in part, because more beneficiaries are being 
     treated in outpatient settings than in hospitals. While this 
     shift may disproportionately increase costs for Medicare Part 
     B, which accelerates the date at which the cap will be 
     reached, when compared with Part A, which is not counted in 
     the limit, it is generally considered a positive development 
     in health care.
       A second major reason the cap was triggered is the Part D 
     prescription drug program. Although Part D is providing 
     needed drugs to millions of seniors, the cost of these drugs 
     is still rising much faster than general inflation. We 
     believe this is the result of the lack of a traditional 
     Medicare drug option, which the Medicare Modernization Act 
     specifically prohibited. In addition, the Act provided 
     billions of dollars in subsidies in order to entice private 
     insurance and drug companies into the Medicare program. While 
     passage last week of H.R. 6331 helped trim some of the most 
     egregious overpayments, billions in subsidies continue to 
     flow to private companies. Both the rising cost of drugs and 
     the private sector subsidies provide little or no benefit to 
     Medicare enrollees, yet they contribute to the rise in costs 
     both for beneficiaries and the federal government--and 
     accelerated the date at which the cap was reached.
       Finally, the legislation submitted by the President in 
     response to the ``trigger'' could have devastating 
     consequences to Medicare beneficiaries with little oversight 
     by Congress. For example, Section 101(d) of the implementing 
     legislation directs the Secretary of the Department of Health 
     and Human Services to design and implement a new performance-
     based reimbursement system for all Medicare providers as well 
     as a new ``incentive'' program intended to drive Medicare 
     beneficiaries to selected providers under this new system. 
     With this one provision, Congress would delegate to the 
     Secretary unprecedented authority to change the way the 
     Medicare program operates through the regulatory process, 
     rather than reserving such important decisions for Congress 
     and the Committees of jurisdiction.
       The President's legislation also would dramatically expand 
     Medicare means-testing through a provision that has been 
     proposed repeatedly as part of the President's budget 
     submission only to be rejected by Congress. Section 301 of 
     the President's bill would expand means-testing to include 
     the Part D program, a policy which many experts believe would 
     be extremely difficult to administer, and further would not 
     allow the income limits to rise to reflect inflation. Income 
     limits that are not indexed ultimately affect far more people 
     than the ``wealthy'' they are originally designed to cover--a 
     fact well demonstrated by the current reach of the 
     Alternative Minimum Tax.
       Medicare faces challenges in the future, but they are not 
     unique to the Medicare program--they reflect the same 
     pressures driving health care costs for those under age 65. 
     Addressing these challenges will not be advanced by a 
     contentious debate on the share of program costs funded 
     through general revenues. In fact, such a debate will 
     distract from the true challenge of Medicare: determining how 
     to provide high-quality health care for an aging population 
     in an era of rising health care costs.
       We strongly urge the House to suspend the Medicare 
     ``trigger'' by passing H. Res. 1368 and focus instead on 
     making health care affordable for all Americans.
           Cordially,
                                              Barbara B. Kennelly,
     President & CEO.
                                  ____


 AARP: Medicare Trigger Ignores Real Problem--Skyrocketing Health Care 
                                 Costs

       Washington--David Sloane, AARP's Senior Vice President for 
     Government Relations and Advocacy, issued the following 
     statement on a scheduled vote today in the House of 
     Representatives to consider a bill brought on by the Medicare 
     ``trigger'':
       ``The Medicare trigger is an unfortunate and misguided 
     effort that could do more harm than good. That's why AARP 
     supports the legislation being considered today by the House 
     that would delay trigger action.
       ``Medicare's financial woes are symptomatic of the runaway 
     costs of the overall health care system. Medicare's troubles 
     can only be solved by systemic health care reforms.
       ``Arbitrary Medicare cuts will needlessly hurt millions of 
     Americans without addressing the core problems. If Congress 
     is serious about controlling spiraling health care costs, the 
     way to go about it is to have a thoughtful debate on the 
     systemic drivers of health care costs in this country, not to 
     take a meat axe to Medicare in the middle of the night. 
     Congress is gearing up for that debate next year, and we look 
     forward to working on serious, bipartisan efforts to reform 
     our health care system.''

  Mr. Speaker, I yield at this time 2 minutes to the gentleman from 
Arkansas (Mr. Berry), a member of the Budget Committee.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from Florida for 
yielding.
  I never rise that I don't encourage anyone that can hear me to keep 
in their hearts and minds and in their prayers our men and women in 
uniform and their families, and especially those on the battlefield 
today.
  Having said that, it is interesting to hear our colleagues on the 
other side of the aisle talk about fiscal responsibility. It is 
interesting to hear them suddenly have an attack of concern about our 
children and grandchildren and the debt that is going to be passed on 
to them which includes pretty close to $8 trillion that their party has 
built up and their Presidents have built up.
  It is clear and has been for many years that the Republican Party 
intends to destroy Medicare any way it can. ``Let it wither on the 
vine'' were the very words that they used.
  The interesting thing about this is we know how to fix these things. 
Health care is not so complicated we can't fix it. It is a matter of 
getting the collective, bipartisan political willpower to do the right 
thing.

                              {time}  1730

  This particular problem can be fixed with a very simple thing, just 
do away with the overpayment to the private health care plans, $4.6 
billion we overpay the private plans. Why would we want to be so 
generous to the insurance companies?
  I certainly don't like the idea of my children and grandchildren 
having to pay off a debt that we incurred because we overpaid the 
insurance companies. What is so special, I wonder, about the insurance 
companies that we can't resist to take care of them over and over 
again?
  I urge my colleagues to vote against this provision.
  Mr. DREIER. Mr. Speaker, at this time I am happy to yield 3 minutes 
to

[[Page H7126]]

the very distinguished ranking Republican on the Committee on Ways and 
Means, the gentleman from Shreveport, Louisiana (Mr. McCrery).
  Mr. McCRERY. Mr. Speaker, I have some prepared remarks, but I want to 
address a couple of things that have been said, because I think it's 
important for the House to understand.
  Number one, the gentleman from Florida said that we have already 
solved this problem, and he is right in one sense. There was enough of 
a pay-for in the last Medicare bill that we passed, that had we couched 
it properly, we could have used as a pay-for to get us within the 
window required by MMA, but we didn't do that. We didn't go through the 
proper procedure. So to suggest that we now can just do away with the 
rule because in some other bill we created enough funding that would 
have worked had we followed the proper procedure, I think, is a very 
tenuous argument.
  The whole purpose of the provision, and the second thing I want to 
address, is this notion that this was slipped in in the dead of night, 
and it was just totally a Republican effort to somehow kill Medicare. I 
would say to the House that this suggestion was first made by the 
National Bipartisan Commission on the Future of Medicare that was 
chaired by Bill Thomas and John Breaux, a Republican and a Democrat.
  So we didn't come up with this in the dead of night. It is something 
that had been circulating, and I thought it was a good idea then, I 
think it's a good idea now. It's regrettable that the House stands 
ready today to dispose of this very worthwhile rule.
  All the rule was intended to do, it wasn't intended to kill Medicare. 
What it was intended to do is force us to face the problem every year, 
because we all know, those of us who are familiar with the program, 
familiar with the structure of the program and the financing of the 
program, know that more than 45 percent of general revenues are going 
to be used to pay the costs of this program very soon. Then it will be 
every year, and it will grow.
  In fact, if we allow this program to go on autopilot, it will grow 
from about 2.7 percent of GDP this year to over 14 percent of GDP by 
the end of the 75-year CBO window, over 14 percent. We only take in in 
revenues, total revenues, between 18 and 19 percent of GDP. So if we 
allow this program to just go like it is now without discussion or 
debate or reform, we are going to have to do away with most spending 
for defense, education, roads, highways, unless, of course, we have a 
dramatic increase in taxes.
  Mr. Speaker, I appreciate the opportunity to tell this House that the 
product would be irresponsible.
  Mr. Speaker, I strongly urge my colleagues to vote against this 
irresponsible change in the rules of the House.
  The resolution before us today would prevent the House from having to 
hold any debate about the looming financial crisis facing the Medicare 
program. Apparently, the Democrats don't want to talk about reforming a 
program that is slated to go bankrupt in 2019.
  This rules change isn't about a specific proposal to change Medicare. 
What it would do is repeal a bipartisan provision that would force 
Congress to at least take note of Medicare's increasingly unsustainable 
financial situation and begin to consider solutions.
  But instead of having an open discussion about how to address the 
out-of-control costs of this program, today's resolution allows the 
Congress to bury its head in the sand and kick the can down the road, 
letting a future Congress deal with this ever worsening problem. This 
is irresponsible.
  The facts are clear. Medicare is facing bankruptcy. The combination 
of rising health care costs and an aging population have created a 
financial hurricane on the not-too-distant horizon.
  Last year, Medicare spending totaled about 2.7 percent of our GDP. 
That figure will more than double by 2030 and hit 14.8 percent by the 
end of the CBO's 75-year budget window. Since total federal revenues, 
historically, have been between 18-19 percent, it is clear we cannot 
let Medicare spending increase on auto-pilot unless we are willing to 
substantially raise taxes or cut all other government spending.
  The need for structural reform of Medicare is not just Republican 
rhetoric. In recent testimony before the Ways and Means Health 
Subcommittee, the non-partisan Medicare Payment Advisory Committee 
(MedPAC), which was created by Congress to advise us on Medicare 
payment issues, said that, ``The [Medicare] program's shaky financial 
outlook is a strong impetus for change.''
  Now my colleagues on the other side of the aisle will claim that this 
45 percent trigger was created by Republicans as a way to privatize or 
block grant the Medicare program. Let me remind them that this policy 
was first suggested by a bipartisan Medicare task force that was 
chaired by Democratic Senator John Breaux.
  And let me also point out that there are many ways that we could 
solve this problem. But ducking it is surely not on that list.
  Mr. Speaker, I urge my colleagues to reject this rule change. This 
problem will not go away just because we ignore it. The longer we wait 
to address it, the more difficult the solution will be.
  Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased 
to yield 2 minutes to the distinguished gentleman from North Dakota, a 
friend of mine and classmate, a member of the Committee on Ways and 
Means, Mr. Pomeroy.
  Mr. POMEROY. I thank the gentleman for yielding.
  Mr. Speaker, I have a great deal of respect for the preceding 
speaker, the ranking member of the Ways and Means Committee. The facts 
of what he said are absolutely correct. Health care costs are out of 
control. They are threatening the future of the Medicare program. They 
are threatening the future of U.S. health care.
  But the issue before us is a trigger which would have one of two 
results, only one of two results, cut Medicare benefits or raise 
Medicare premiums on our seniors. Now, if we are going to address, and 
we need to address the underlying systemic problems in our health care 
system, but this trigger, which would simply cut Medicare or raise 
seniors' premiums, is not the way to systemically address our problems.
  I believe that it's incorrect to single out Medicare for this 
treatment, to single out seniors for the overall problem of broader 
health reform. We need to work together on health reform. I hope the 
next Congress will give us an opportunity to do that, but the months 
remaining in this Congress don't.
  Look, we had to override the President's veto to prevent a 10 percent 
cut in physician reimbursements under Medicare, cuts that would have 
threatened universal access of our seniors under Medicare. We had to 
override a veto. So moving forward with a trigger mechanism that at 
this hour in the administration is going to cut Medicare or raise 
seniors' premiums is certainly not the way to address the broader 
issues of health care costs.
  I look forward, as a member of the Ways and Means Committee, to 
working with my colleagues on both sides of the aisle as we address 
health care costs. Let's not have this trigger.
  Mr. DREIER. Mr. Speaker, I just want to say we have a wide range of 
choices as to how we can cut spending.
  At this time I am happy to yield 2 minutes to my very distinguished 
friend, the gentleman from Springfield, our distinguished Republican 
whip, Mr. Blunt.
  Mr. BLUNT. I thank my good friend for yielding.
  Mr. Speaker, I heard my good friend say we ought to deal with this in 
the next Congress, and I wonder why, why the next Congress. Why not 
this Congress? The reason we are having this critical we must vote 
today, vote right now, is that we haven't taken advantage of this 
opportunity to move forward on reform. The notice came up weeks ago. In 
fact, the notice came up months ago, and that's when the majority could 
have brought a great debate to the floor instead of the debate about 
whether we should debate or not.
  Over a decade ago, Congress created the National Bipartisan 
Commission on the Future of Medicare. One of the recommendations of the 
commission was to require a trigger so that the Medicare trustees in 
Congress will have to publicly debate whenever the Medicare program is 
in danger of becoming insolvent. The trigger is one of the many 
recommendations of this commission, not ideas just out of thin air, 
recommendations of this commission that were formally adopted as part 
of the Medicare prescription drug bill in 2003.
  But this Congress seems to never miss an opportunity to miss an 
opportunity. I am very disappointed that the Democrat leadership has 
halted consideration of key legislation designed to safeguard the 
future of Medicare, reconsideration, in fact, that's required by law 
unless we today vote to say we

[[Page H7127]]

are not obeying that law. If not obeying that law is the right thing to 
do, I don't know what could be more important than having a discussion 
on the future of Medicare, unless it would be the future of energy, and 
we are not having that discussion either.
  Let's debate it, let's talk about it, let's see what we can do. One 
of the ideas that we have put forward that apparently is particularly 
fearsome is medical liability reform. If this rule passes, we will 
avoid being forced to debate and vote on lawsuit abuse and its impact 
on seniors, taxpayers and doctors. Such a reform will lower health care 
costs for all Americans and save Medicare $4.8 billion over the next 
decade.
  The SPEAKER pro tempore. The time of the gentleman from Missouri has 
expired.
  Mr. DREIER. I am happy to yield my friend an additional minute.
  Mr. BLUNT. They don't want to debate means testing for wealthy 
seniors or more competition to serve patients. We could be doing all of 
those things today. We could be doing none of those things today. We 
could be debating whatever the majority wants to debate.
  The point is we could be having a debate about the future of 
Medicare. First, we are afraid to debate energy. Now we are afraid to 
debate Medicare. What are we willing to debate on the floor of this 
House?
  I want to have that debate. I oppose this vote to run away from those 
solutions.
  Mr. Speaker, I would like to submit in the Record the statement of 
the Health Coalition on Liability and Access on this legislation. That 
states that medical liability reforms are a central part of reducing 
costs and improving access and quality in the Medicare program.

   [From the Health Coalition on Liability and Access, July 24, 2008]

   Statement From HCLA Chair on Medicare and Medical Liability Reform

       Washington, DC.--HCLA Chair Shawn Martin issued the 
     following statement regarding today's Congressional vote on 
     Medicare:
       ``Today Congress will consider legislation pertaining to 
     the so-called ``trigger'' provision of the Medicare 
     Prescription Drug, Improvement and Modernization Act of 2003. 
     Complying with the law's requirements, the President has put 
     forward legislation, which includes medical liability 
     reforms, to address the Medicare funding issue. The Health 
     Coalition on Liability and Access believes that medical 
     liability reforms are a central part of reducing costs and 
     improving access and quality in the Medicare program.
       ``Medical lawsuit abuse drives up the cost of medicine for 
     everyone. In fact, it's estimated that medical liability 
     reform would save Medicare $4.8 billion annually, not 
     including savings from reductions in the practice of 
     defensive medicine.
       ``Comprehensive medical liability reforms have a proven 
     track record of success at the state level of reducing health 
     care costs and increasing patient access to quality medical 
     care. Controlling our nation's Medicare costs is one more 
     reason America needs national medical liability reform.''

  Mr. HASTINGS of Florida. Mr. Speaker, I am very pleased at this time 
to yield 2 minutes to the distinguished gentleman from South Carolina, 
who is the chairperson of the Budget Committee, my good friend, Mr. 
Spratt.
  Mr. SPRATT. I thank the gentleman for yielding.
  Mr. Speaker, we are here today because the Medicare Modernization Act 
of 2003 includes a trigger. That trigger is exercised when general fund 
revenues, as opposed to trust fund revenues, premiums and payroll 
taxes, exceed 45 percent of the Medicare program.
  Once the Medicare trustees determine in two back-to-back reports that 
the 45 percent threshold will be crossed within 7 years, the 
administration must submit legislation ``eliminating excess general 
revenue Medicare funding.''
  The trustees submitted their first such report last year, projecting 
that general revenues would fund 45.07 percent of Medicare in 2013, the 
last year of the 7-year window. This year the trustees issued a similar 
warning, and the administration sent Congress a bill to keep general 
revenues below 45 percent through 2013. According to CBO's analysis, 
the administration's bill will hold general revenues below 45 percent 
until 2014 by charging higher premiums to Medicare beneficiaries who 
make above a certain income level.
  Instead of enacting the administration's proposals, the House and 
Senate enacted last week into law the Medicare Improvements for 
Patients and Providers Act of 2008 over the President's veto. CBO 
calculates that this new law will keep general revenues below the 45 
percent threshold through 2014, just as the administration's bill would 
have. So substantively and for all practical purposes, we have met the 
trigger's financial requirements, and we have made this issue moot for 
the rest of this Congress.
  I support the rule before us which would turn off the Medicare 
trigger for the remainder of this Congress. I find, as the chairman of 
the Budget Committee, the legislation we have just enacted ``eliminates 
excess general revenue Medicare spending'' and complies with the 
Medicare law's financial test. Consequently, there is no need or reason 
to exercise the trigger.
  The SPEAKER pro tempore (Mr. Cuellar). The time of the gentleman has 
expired.
  Mr. HASTINGS of Florida. I yield the gentleman an additional 30 
seconds.
  Mr. SPRATT. I thank the gentleman.
  I would add that the Children's Health and Medicare Protection Act 
would have accomplished and satisfied the law's requirement, also, if 
for technical reasons it had been entitled ``a bill to respond to 
Medicare funding warning.''
  I support this resolution and urge its adoption.
  Mr. DREIER. Mr. Speaker, may I inquire of the Chair how much time is 
remaining on each side.
  The SPEAKER pro tempore. The gentleman from California has 14 
minutes. The gentleman from Florida has 15.
  Mr. DREIER. Mr. Speaker, obviously, through this extraordinary 
process, there is such a demand for time. We have so many committees of 
jurisdiction. It is a real challenge. We have only 14 minutes 
remaining; is that it?
  The SPEAKER pro tempore. That is correct.
  Mr. DREIER. At this time I am happy to yield 3 minutes to the 
distinguished ranking member of the Committee on Budget, the gentleman 
from Janesville, Wisconsin (Mr. Ryan).
  Mr. RYAN of Wisconsin. I thank the gentleman.
  Mr. Speaker, my chairman of the Budget Committee just spoke, and, 
yes, he did read that the CBO said that the bill that passed on the doc 
fix, according to the CBO, does satisfy the trigger.
  So if you are satisfying the trigger, then why are you turning it 
off? If you are actually accomplishing the objective set out with this 
law, then why are you getting rid of this trigger? Why do we have this 
trigger?
  We have this trigger. It's a funding warning because Medicare is 
going bankrupt. Medicare is a $36 trillion unfunded liability. You know 
what it's going to be next year by this time? It's going to be $38.4 
trillion. Do you know what will happen in 5 years if we do nothing to 
save Medicare as the Democratic budget proposes to do? $48 trillion 
unfunded liability.
  The preceding paragraph in this CBO report goes on to specify that 
the judgment, the referee of the trigger, are the trustees. So why 
don't we take this bill off the floor, have the trustees verify what 
CBO says that maybe, in fact, this bill that you just passed, that we 
all passed, does satisfy the trigger, and don't turn off this funding 
warning. Turning off this funding warning is basically saying, ignore 
the fact that Medicare is going bankrupt. Make sure that Congress does 
nothing to fix this problem.
  I might add that this CBO estimate relies on the fact that next year 
we are going to cut doctors by 21 percent in Medicare. The only reason 
this estimate holds up is if we guarantee a 21 percent payment cut to 
all doctors servicing Medicare. That's why we are in conformity with 
this trigger as CBO says.
  CBO is not the referee of this. The trustees are, the trustees of 
Medicare.
  Turning off this trigger is basically saying that we have no fiscal 
discipline, we have no intention of saving Medicare from bankruptcy, we 
have no intention of being good stewards of the taxpayer dollars, we 
have no intention of controlling spending.

                              {time}  1745

  We have every intention of making matters worse, not only by doing 
nothing, but adding more spending. That is reckless. That is fiscal 
abandonment.

[[Page H7128]]

  The trigger was a bipartisan idea. A Democrat in the Senate and a 
Republican in the House came up with this idea to make sure that 
Congress saw fair warning and actually addressed these issues before it 
got out of control.
  And so, instead of addressing these warnings, instead of bringing 
Medicare toward solvency, instead of making sure we can guarantee this 
program for seniors in the next generation, what are we doing in this 
Congress? We are sticking our heads in the sand. That is wrong. This 
shouldn't pass. You know better.
  More to the point, if you think you are satisfying it, then why are 
you turning it off? That makes no sense.
  The only opportunity, the only explanation is you don't want to have 
this tool of fiscal discipline. You don't want the American people 
knowing that you are actually contributing to the insolvency of 
Medicare, that you are actually making matters worse. That is wrong, 
and I urge defeat of this.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased 
to yield 2 minutes to the distinguished gentleman from California, who 
is the chairman of the Health Subcommittee, Mr. Stark.
  (Mr. STARK asked and was given permission to revise and extend his 
remarks.)
  Mr. STARK. I can only say that I have never heard people who have 
just won whine so loudly about the fact that they won. They didn't do 
it when they won the baseball game. I guess if I had a trophy for them, 
they might be happier.
  But you are right. My friend, Mr. McCrery, and my friend, Mr. Ryan, 
are both right. We did solve, in 6331, all of the Rules Committee 
Democrats, the Republicans voted for it. The majority of the Ways and 
Means Republicans voted for it. The majority of the Energy and Commerce 
Republicans voted for it. We solved it.
  They may be unhappy with the fact that we solved it because most 
Republicans would like to see Medicare privatized, and this was a plan 
that did not get enough votes out of the commission to be recommended. 
A couple of wild hares on the commission suggested it, but they 
couldn't get enough votes to make it a recommendation. So it has never 
been.
  If you wanted to have a trigger for the Defense Department, and you 
wouldn't, I might support it. But you don't.
  This is just, the trigger was just a method to try and privatize 
Medicare and let it wither on the vine. So you won. We have met the 
requirements in terms of the funds saved in 6331, the Republican 
speakers have attested to that.
  So I would say, let's go home. We do have problems in Medicare. We 
are vastly overpaying Medicare Advantage and getting nothing for it. We 
are vastly overpaying for the drug benefit because the Republicans 
wouldn't allow the Secretary to bargain for better prices. The 
Republicans have frustrated every attempt to save money in Medicare and 
make it a more efficient system. So I am willing to have that debate 
any time. And I think we will have to come back and do it.
  But for now we have satisfied the requirements of the trigger. We 
were unable to get it done in a timely fashion.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. HASTINGS of Florida. I yield the gentleman an additional 30 
seconds.
  Mr. STARK. I urge the adoption of this rule, which will save us the 
problem of seeing beneficiaries pay more in taxes, which I don't think 
the Republicans want to do. And I think that it is time that we 
recognize that we, by a vast bipartisan majority, solved the issue, 
temporarily though it may be, and we will have to revisit it next year 
to make Medicare a more effective system.
  Mr. DREIER. I yield myself 10 seconds, Mr. Speaker, to say to my very 
good friend that if, in fact, he is willing to have a debate any time 
on this issue, what he needs to do is vote ``no'' on this rule so that 
we can proceed with that debate.
  At this time I am happy to yield 3 minutes to the very distinguished 
chairman of the Republican Study Committee, my friend from Dallas, Mr. 
Hensarling.
  Mr. HENSARLING. Mr. Speaker, before the Democrats became the majority 
party in this institution, they waxed eloquent about fiscal 
responsibility. The now-Speaker, Nancy Pelosi of California, the 
gentlelady said, ``It is just absolutely immoral, immoral for us to 
heap those deficits on our children. No new deficit spending.''
  And before he became the majority leader, the distinguished gentleman 
from Maryland said, ``There is no more single burden of responsibility 
more crucial to bear than tackling the deficit honestly and head on.''
  Mr. Speaker, that is what they said before they became the majority 
party. We have discovered, Mr. Speaker, their words were cheap. Their 
deeds are very expensive.
  Since becoming the majority party 18 months ago, we have seen, under 
their watch, the Federal deficit double.
  Mr. Speaker, under the Democrats' watch we have seen the single 
largest 1-year increase in the Federal debt.
  Mr. Speaker, under the Democrats' watch we have seen the Federal 
Government's unfunded obligations go to the largest number ever, $57.3 
trillion.
  Mr. Speaker, under the Democrats' watch we have seen the largest 
Federal budget ever.
  Mr. Speaker, under the Democrats' watch, just yesterday, just 
yesterday a blank check was given to Fannie Mae and Freddie Mac that 
ultimately could cost the taxpayer $5 trillion.
  And not to be outdone, Mr. Speaker, today the Democrat majority turn 
off, turn off the Medicare trigger designed to save the program for the 
next generation. Again, Mr. Speaker, the Democrats' words were cheap. 
Their deeds are very, very expensive.
  The trigger means that we begin the reform process in Medicare, and 
it also means that we will spend $178 billion, almost a 7 percent 
increase, over the next 5 years. And how do we reform it?
  Mr. Speaker, we ask that this body put patients and doctors before 
personal injury trial attorneys. That is what we do. And we ask that 
maybe the upper income of our Nation be able to pay a little bit more 
for their prescription drugs.
  Now, what happens, Mr. Speaker, when the Democrats do nothing?
  Well, according to the General Accountability Office, ``The rising 
cost of government entitlements are a fiscal cancer that threatens 
catastrophic consequences for our country and could bankrupt America.''
  Mr. Speaker, I ask my colleagues on the other side of the aisle, join 
with us, put the next generation above the next election. Work with us 
to ensure that we can get better healthcare at a more reasonable cost. 
Do not get rid of this Medicare trigger that so many of us worked so 
hard to place in this valuable program.
  Mr. HASTINGS of Florida. Mr. Speaker, at this time I would yield to 
my good friend, the distinguished gentleman from California (Mr. 
Thompson), who is a member of the Ways and Means Committee, 2 minutes.
  Mr. THOMPSON of California. Mr. Speaker, I rise in support of this 
rule. The trigger is an arbitrary way to try and reform Medicare. 
Moreover, no hearings were ever held to determine whether the trigger 
was set at the right level of general revenues. The trigger was 
literally added in the back room during conference on the Medicare 
Modernization Act. It wasn't in the House bill. It wasn't in the Senate 
bill.
  The chief actuary from the nonpartisan Centers for Medicare and 
Medicaid Services testified before our committee that the trigger is 
judgmental, not scientific. He said there is no analytical 
rationalization for setting the trigger level funding at 45 percent. 
This trigger is politically, not policy, based.
  We need to focus on system-wide issues to address costs in both 
private insurance and Medicare. The trigger is no substitute for real 
reform. We have taken important steps in this Congress to assure 
Medicare solvency. The CHAMP Act, which was passed last year by the 
House, included significant Medicare cost savings and extended the 
solvency of the hospital trust fund.
  The bipartisan Medicare bill, the bill that became law after we 
overrode the President's veto, extended that solvency of Medicare and 
pushed back the date the trigger is pulled, while providing $18 billion 
in beneficiary improvements for seniors.

[[Page H7129]]

  I urge everyone to support this rule change so we can continue to 
work towards real reform in the next Congress.
  Mr. DREIER. Mr. Speaker, at this time I am happy to yield 1\1/2\ 
minutes to my very good friend from Midland, Michigan, a hardworking 
member of the Ways and Means Committee, Mr. Camp.
  Mr. CAMP of Michigan. Mr. Speaker, I come from a large family. My 
wife and I have three children of our own, so I have seen little kids 
stick their fingers in their ears and shout ``I can't hear you.''
  I never thought I would see the Congress do it, but that is exactly 
what the Democrats are asking us to do today, stick our fingers in our 
ears and shout at the Medicare trustees that we can't hear their 
warning. We couldn't hear it the first time they said it. We couldn't 
hear it the second time they said it, and we certainly don't hear it 
the third time they have said it.
  The Democrats' response to the looming Medicare crisis is as childish 
as it is irresponsible. By repealing the Medicare warning, as this rule 
change would have us do, it is akin to be warned you are out of money 
and still going out for an expensive dinner and leaving the bill for 
the next group to sit down.
  You know who gets stuck with the tab in this scenario? The American 
taxpayer, and it is a $1.5 billion tab in the first year alone. But 
that is just the tip of the iceberg. Every year we fail to address 
entitlement reform, future generations are saddled with an additional 
$2 trillion worth of debt.
  With the Medicare Hospital Trust Fund set to go bankrupt in a decade, 
I, for one, cannot ignore, and I urge my colleagues not to ignore these 
Medicare warnings. We should reject this resolution, and we should 
begin to transform Medicare so it can continue to benefit future 
seniors.
  Mr. HASTINGS of Florida. Mr. Speaker, at this time I am very pleased 
and privileged to yield 2 minutes to the gentleman from New York, who I 
feel knows as much or more about this issue than anyone, the chairman 
of the Committee on Ways and Means, Mr. Rangel.
  (Mr. RANGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. RANGEL. My colleagues, as we move toward the end of this 
legislative session, I would hope, at some point, that the minority 
just not be guided by blind ideology and to see whether we can prepare 
ourselves to work together in the future. In all of the years that we 
have had this administration, they have talked about the unfairness of 
taxes, and yet they have not seen their way clear even to suggest what 
we should do about it.
  I know they are busy starting wars in various places, but it would 
seem as though the executive could take a deep breath.
  They talk about entitlements, how we have to get rid of them, that it 
is causing us to go into bankruptcy. And unless I missed something 
during my brief illnesses, they have never suggested what you do with 
Social Security; not a note, not anything private, not a call from 
Paulson saying, can we talk?
  And now we talk about----
  Mr. DREIER. Mr. Speaker, would the gentleman yield? I would be happy 
to yield additional time if my friend would yield to me.
  Mr. RANGEL. Well, why don't you give me the additional time and----
  Mr. DREIER. You yield to me, and then I would be happy to yield 
additional time.
  Mr. RANGEL. How much time are you ready to negotiate here? We can 
work out something.
  Mr. DREIER. That is exactly what my friend is arguing, and I am here 
and willing to do just that, on this issue and every single other 
issue.
  Mr. RANGEL. Why would you wait until the last day? You know, you guys 
have been in office all this time, and now you want to talk. This is 
absolutely ridiculous. And we should resolve the problem by having a 
trigger, and cut across the board. Just have a trigger? Is that the way 
you think we are going to have a system?
  How much time do you yield to me, my dear friend from California?
  Mr. DREIER. I am happy to yield to my friend 30 seconds.
  Mr. RANGEL. Thirty seconds? That is no time.
  Mr. DREIER. I took 2 seconds and I'm yielding him 30. That's a pretty 
fair deal.
  Mr. RANGEL. Well, all I am saying is that you are not setting a tone 
that we can work next year in an administration that totally are not 
blinded, whether you call it entitlements. We are talking about 
providing services for the 40 million people who really don't have it. 
So let's stop talking about what the heck you intend to accomplish in 2 
weeks. It's over. Get over it. Forget about it. Do what you have to do 
politically, see what you can salvage, and let's come back next year 
and get the job done.

                              {time}  1800

  Mr. DREIER. May I inquire of the Chair how much time we have 
remaining on each side.
  The SPEAKER pro tempore. The gentleman from Florida has 9 minutes. 
The gentleman from California has 6 minutes and 20 seconds.
  Mr. DREIER. At this time I am happy to yield 1\1/2\ minutes to my 
very good friend who is a former member of the Rules Committee, Mr. 
Gingrey.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman for yielding, and I 
won't take all of my time.
  I just want to say that I am tremendously opposed to this resolution. 
When we passed Medicare Modernization and the Prescription Drug Act 
back in November of 2003, I was a freshman Member of the House, a 
physician Member of the House, and I felt very strongly that we needed 
to give our seniors a prescription drug benefit. They had been asking 
for it for years. The Democrats were in the majority most of those 
years. And yet in 2003, most of my colleagues on the other side of the 
aisle voted ``no.'' I think it was their feeling, most of them, that 
the prescription drug benefit didn't go far enough.
  On our side of the aisle, though, Mr. Speaker, there was great 
concern of cost, and I truly believe that the prescription drug part D 
and Medicare modernization would not have passed this body had not 
section 803 been in there, that trigger to say when we have spent so 
much, the President would have to come back and offer a solution to try 
to control the cost and no better way than the medical liability reform 
to cut down on all of the defensive medicine that doctors practice. 
It's not the premiums that they pay for malpractice, it is the 
defensive medicine. All of these tests that are unnecessary.
  And then, of course, to means-test part D, just as it would have 
mean-tested part B for these so many years, if we were not means-
testing part B, the monthly premium would still be $15 a month instead 
of $96.
  Defeat this resolution. Bring fiscal responsibility to this body.
  Mr. HASTINGS of Florida. Mr. Speaker, I am very pleased to yield 1 
minute to the very distinguished gentleman from Texas, a member of my 
class and a member of the Committee on Ways and Means, Mr. Doggett.
  Mr. DOGGETT. The President offers a very simple Medicare fix: Seniors 
pay more. Taking a bigger cut from our seniors and our disabled 
individuals for their drug benefit premiums is hardly a true fix.
  You know, down in Texas, Mr. Speaker, we have steers that have been 
cut. They've been fixed. They've been fixed for all time, and that's 
the kind of fix that I think these Republicans have in mind for 
Medicare.
  Contrast the President's fix on Medicare this week with the 
President's veto on Medicare last week. These Republicans are so eager 
to privatize Medicare, they're willing to spend $1,000 of taxpayers' 
money every year for every person that they can get to leave 
traditional Medicare. By our overriding the President's veto, we saved 
billions of dollars in unnecessary waste. But there are tens of 
billions of dollars of additional waste right there in the system. And 
you know what? They deserve a Texas-type fix. They need to be fixed and 
removed.
  The SPEAKER pro tempore. The gentleman's time has expired.
  Mr. HASTINGS of Florida. I yield the gentleman an additional 1 
minute.
  Mr. DOGGETT. The Medicare actuary's own reports show that that this 
$1,000 waste per person per year that the Republicans insist on, that 
kind of waste, tens of billions of dollars of waste, does not produce 
any quantifiable benefit, any quantifiable saving

[[Page H7130]]

through this failed Republican experiment in privatizing Medicare.
  Improving Medicare's finances requires more than a trigger like the 
President talks about to extend it for a year. We need a willingness to 
pull the trigger on Medicare waste that these Republicans have plugged 
in with these unnecessary subsidies that cost more and deliver less.
  I say it has something to do with the energy bill, and they're right. 
These seniors have been drilled by the Republicans for the last 7\1/2\ 
years. Drill here, drill now. These seniors get drilled when they go to 
the gas station. They get drilled when they go to the grocery store. 
What this resolution is about is preventing the President from drilling 
them on their Medicare also.
  Let's approve this resolution.
  Mr. DREIER. Mr. Speaker, may I just inquire of my friend how many 
speakers he has on his side.
  I have got to say that before I do, Mr. Speaker, we have the 
Committee on the Budget, Ways and Means, Energy and Commerce, the Rules 
Committee, all of which have jurisdiction on this. We've been limited 
to 30 minutes of debate on this side, and I just wondered if he might 
be interested in propounding a unanimous consent request that we extend 
the debate by maybe 5 minutes on each side.
  Mr. HASTINGS of Florida. I do not yield for that purpose.
  Mr. DREIER. The gentleman is going to have to object. I was asking 
unanimous consent if we might.
  Mr. HASTINGS of Florida. I object.
  Mr. DREIER. Mr. Speaker, so may I inquire again as to how much time 
is remaining on each side, Mr. Speaker.
  The SPEAKER pro tempore. The gentleman from California has 4 minutes 
and 50 seconds. The gentleman from Florida has 7 minutes.
  Mr. DREIER. May I just inquire how many speakers are on the other 
side.
  Mr. HASTINGS of Florida. I am going to be the last speaker.
  Mr. DREIER. At this time, Mr. Speaker, I am happy to yield 2 minutes 
to my very good friend from Georgia (Mr. Price).
  (Mr. PRICE of Georgia asked and was given permission to revise and 
extend his remarks.)
  Mr. PRICE of Georgia. I thank my friend and leader from California 
for yielding.
  This do nothing, no energy Congress has perfected changing the rules 
to suit themselves. But this may take first prize.
  Virtually all of us talk about the need for entitlement reform. 
Entitlement, that's those programs that comprise about 55 percent of 
the budget. I call it a ``yes'' moment at home. It's when the crowds 
say, Yes, yes, please. Some reform is needed. And the rules currently 
in place would allow for some real reform, especially in the area of 
lawsuit abuse reform, not cuts in Medicare. Not an increase in 
premiums.
  As a physician for nearly 30 years, I understand clearly the need for 
liability reform, and it's imperative not just to decrease malpractice 
costs but to end the practice of defensive medicine estimated to be 
greater than $300 billion annually. That's $300 billion of savings 
without any Medicare cut, without any increase in premiums.
  Mr. Speaker, make no mistake, this vote today is about fiscal 
responsibility and ending frivolous lawsuit abuse. Let's work together. 
Americans want action on this issue, and they want it now. This 
proposed rules change means no reform.
  Mr. HASTINGS of Florida. Mr. Speaker, at this time I did have an 
additional speaker, and I would ask to yield 1 minute to the 
distinguished gentleman from California (Mr. Stark).
  Mr. STARK. I thank my friend from Florida for yielding, and I just 
wanted to make a point. It's been suggested several times by my friends 
across the aisle that over 75 years, the unfunded cost of Medicare, as 
they calculate it, is $36 trillion. You know what? They're right.
  But what they don't tell you is by the same calculation, the unfunded 
cost of the McCain-Bush tax cuts is more than $100 trillion. So if you 
weren't giving away all of this money to the rich people and all of the 
Republicans who inherited money from their parents and never had a real 
job in their lives, maybe we could solve it. It would just take a third 
of the Bush-McCain tax cuts to solve the unfunded liability for the 
next 75 years for Medicare.
  So when you talk about these things, folks, let's include all the 
other goodies that you're giving away.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to make their remarks 
to the Chair.
  Mr. DREIER. Mr. Speaker, I yield myself 20 seconds to say to my 
friend that we have been constantly arguing that we're willing to sit 
down and talk about this and debate these issues at any time. And we're 
willing, and the two top dogs on the Ways and Means Committee have both 
said they're willing to do that; and we've been willing all along. And 
that's exactly what this provision is all about.
  The fact of the matter is the tax cuts that have been put into place 
dramatically surge the flow of revenues to the Federal Treasury. We all 
know that. And we have a responsibility to look at anything we possibly 
can to bring about a fiscally responsible Medicare program and we're 
going to do that.
  With that, Mr. Speaker, I would like to yield 1 minute to my very 
good friend from Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Mr. Speaker, you know, it is so interesting serving 
on the Health Subcommittee at Energy and Commerce, and one of the 
things that we look at and are very concerned about, 11 years from now 
the Medicare trust fund could go bankrupt. That's what we hear from the 
trustees. Health care spending is going to be 20 percent of the GDP as 
we go through the next 10 years.
  And here we had a trigger, something that is a nugget of good 
government that is put into an entitlement bill. And look at what is 
happening? This is what you're wanting to take away. It is put there to 
look at the long-term solvency of this problem. And that is one of the 
things that we hear from our constituents every day. They have their 
money that they have earned, that they are putting in every month so 
that Medicare will be there for them when they retire.
  And what do they get from you all? You're not wanting to come in and 
address this issue. You want to pull the trigger back.
  I think it is irresponsible. I do think it is an abdication of our 
responsibility, and I would encourage those here to oppose that 
resolution.
  Mr. HASTINGS of Florida. Mr. Speaker, I would inquire of my friend 
from California if he has any remaining speakers. I am the last speaker 
for our side, and I'm going to reserve my time until you have closed 
for your side.
  Mr. DREIER. Let me say, Mr. Speaker, that we very clearly have an 
opportunity before us. We have an opportunity to defeat this rule so 
that we can do what it is that we came here to do. We have had a wide 
range of recommendations that have come here from the Medicare 
commission. And we have a proposal that is before us submitted by the 
majority leader and the minority leader as required under this law. It 
made two very important recommendations dealing with liability reform 
in ways which we could bring about fiscal responsibility of Medicare. 
That's what our charge is. That is what our job is as Members of the 
United States Congress.
  The action that we are about to take in this House is to simply sweep 
it under the rug and pass off to the future what we were sent here to 
do right now. We're rapidly approaching the date by which time we need 
to begin taking action. That is July 30. And our colleagues, 
unfortunately, have chosen to turn their back on those who want to 
bring about a fiscally responsible solution to a challenge that we all 
know is looming.
  Mr. Speaker, I urge my colleagues to defeat this rule so that we can 
move ahead and do the right thing for our seniors and for future 
generations.
  With that, I yield back the balance of my time.
  Mr. HASTINGS of Florida. Mr. Speaker, I yield myself the balance of 
the time.
  Mr. Speaker, I have sat and stood here with great amusement as my 
colleagues on the other side of the aisle have come to the floor to 
oppose this resolution. After all, if it were not for their actions, 
this resolution wouldn't even be necessary.
  The ``45 percent Medicare trigger'' was nothing more than a gimmick 
designed to gain the votes of conservative

[[Page H7131]]

Republicans for their Medicare prescription drug bill. It was drafted 
behind closed doors. I was here, Mr. Speaker. Mr. Rangel tried to get 
into their conference. They locked the doors without any consultation 
with Mr. Rangel of the Ways and Means Committee, members that were in 
the minority without any involvement or notification to the minority. 
It was then slipped into the conference at the last minute and had not 
passed the House or the Senate.
  It's amazing, Mr. Speaker. My friends on the other side agreed to 
this trigger and preach fiscal responsibility and are now supporting a 
process which could force the House to allow legislation to the floor 
in clear violation of its PAYGO and earmark rules.
  I was really amused that the distinguished gentleman that is head of 
the Republican Study Committee came in here as much as he talks about 
earmarks and is going to come here and talk about fiscal 
responsibility.
  I was also amused that the last lady speaker who took it upon herself 
to talk about this measure but forgot, I guess, that she voted to 
override the President's veto last week.
  But now they come to the floor to complain because their Members 
bought a pig in a poke. Give me a break.

                              {time}  1815

  The last time I checked, they were the dealer with all the cards in 
2003.
  Mr. Speaker, next Wednesday, Medicare will turn 43 years old. Since 
its founding, the program has provided health care to hundreds of 
millions of seniors, including my momma and my grandpapa.
  Almost 35 percent of the people living in my district are senior 
citizens, and the overwhelming majority of them depend on Medicare.
  Members have a choice today between reviving the Republican legacy of 
political and procedural gimmickry or standing up for seniors and sound 
public policy.
  While Republicans choose to play games and engage in political 
hyperbole, my Democratic colleagues and I have chosen America's 
seniors.
  I urge my colleagues to support this resolution.
  Mr. HERGER. Mr. Speaker, I rise today in the strongest opposition to 
this dangerously irresponsible resolution.
  For over 40 years, millions of seniors across America have enjoyed 
longer and healthier lives as a result of the health care provided 
through the Medicare program. Yet as a result of demographic changes 
and rising health care costs, Medicare is now in dire financial 
straits. The numbers are absolutely staggering. According to the most 
recent report by Medicare's Board of Trustees, Medicare's unfunded 
obligations have surpassed $85 trillion. That's more than six times the 
annual output of our entire economy, and more than fifteen times the 
current federal debt held by the public.
  We have a choice to make: Are we going to take action now to save 
Medicare for the future? Or are we going to ignore the problem and hope 
that it just goes away? I understand that many members might prefer not 
to deal with this issue in an election year. But the Medicare funding 
warning trigger was designed precisely to force Congress to confront an 
issue that many would rather ignore. And that's what the American 
people sent us here to do: confront the tough challenges facing our 
country's future. Even when that means taking some political risks.
  The President has proposed some fairly modest reforms to begin 
shoring up Medicare's future. I personally thought his suggestions made 
sense. But under the trigger rules, the Majority was entirely free to 
reject the President's ideas and develop their own proposal for reining 
in the growth of Medicare. Instead, the Majority has chosen to take the 
easy way out and do nothing. Today, we are sending a message to the 
American people that this Congress is simply not up to the task of 
solving our nation's problems.
  The truth is, Mr. Speaker, we are gambling with our future. I believe 
we have an obligation to do our best to leave America better off for 
the generations that will follow us. I urge every member of Congress 
who feels the same way to join me in voting ``no'' on this resolution.
  Ms. JACKSON LEE of Texas. Mr. Speaker, I want to first take a minute 
to thank my colleague Congressman Alcee Hastings from Florida for 
working with leadership to this important legislation to the floor.


                     background on the legislation

  In 2003, The Medicare Prescription Drug, Improvement and 
Modernization Act, MMA, was signed into law having a significant impact 
on Medicare beneficiaries and State Medicaid programs through changes 
affecting those dually eligible for both Medicare and Medicaid. The 
purpose of the section was to:
  1. Provide a concise summary of the key provisions affecting those 
dually eligible and the States, and
  2. Provide details of the demographic and Medicaid expenditure 
characteristics of the dually eligible, using data from ten States.
  The MMA used to require that States take a practical new look at 
their programs in order to better prescription drug spending. Beginning 
in 2006, States will no longer provide and manage drug coverage for 
patients that currently represent, on average, about 50 percent of the 
State's Medicaid spending for drugs. This significant shift would have 
required that States reassess available resources and the most cost-
efficient ways for employing those resources.
  A determination of excess general funding, as required by Sec. 801 of 
P.L. 108-173. the MMA, is issued if general revenue Medicare funding is 
expected to exceed 45 percent of Medicare outlays for the current 
fiscal year or any of the next six fiscal years. If the determination 
is issued for two consecutive years, a warning is issued requiring 
certain presidential and congressional action (Sec. 802-Sec. 804 of 
MMA).
  The warning alerts policy makers of one measure of the financial 
health of Medicare. It attempts to focus on the impact of Medicare 
revenues and outlays on the federal budget, by looking at Medicare's 
burden on the Treasury. However, such a determination was issued in 
both the 2006 and 2007 Medicare Trustee's reports and the 
Administration was required to submit a legislative proposal to this 
body to lower the ratio to the 45 percent level.
  Section 803 of the MMA is also known as the Medicare Trigger because 
it expedites the process for considering legislation to cut Medicare 
provider payments or increase payroll taxes or beneficiary costs.
  What we must ask ourselves is why some of our colleagues can vote 
against the MMA trigger while we struggle to provide coverage to the 
over 47 million uninsured and over 50 million underinsured in this 
country .
  The ``45 percent trigger'' is a completely subjective measure. 
Medicare program was designed to be substantially financed by general 
revenues rather than payroll taxes. The fact that a sizable portion of 
Medicare's financing comes from general revenues is no more problematic 
than the fact that 100 percent of the defense budget comes from general 
revenues. Moreover, the reforms in Medicare included in the Medicare 
Improvements for Patients and Providers Act, MIPPA, which Democrats 
just enacted over the President's veto satisfy the 45 percent trigger 
test earlier this year, only fails to comply with certain technical 
requirements of the trigger provision (such as the name of the 
statute). Therefore, this is just another reason why it makes sense to 
suspend the Medicare trigger for the remainder of this Congress.


              Overview of how the 45 percent trigger works

  The 45 percent trigger was slipped into the GOP-drafted Medicare 
Modernization Act (MMA) at the last minute in 2003.
  The MMA defined what the 45 percent trigger was and, when it was 
triggered, required ``Medicare Funding Warnings'' and presidential 
legislation.
  The 45 percent trigger is completely arbitrary and is not a sound 
measure of Medicare's fiscal health.
  The 45 percent trigger was triggered by two consecutive Trustees 
Reports in 2007.
  The President's proposed bill hits beneficiaries, rather than scaling 
back the overpayments to private Medicare Advantage plans.
  Unlike the President's flawed bill, the Democratic-led Congress has 
just enacted a law that satisfies the 45 percent trigger, while 
protecting beneficiaries.
  Furthermore, the Democratic-led Congress is committed to keeping 
Medicare strong and solvent well into the future.


                           Healthcare Crisis

  The American health care crisis affects more than the Medicare 
recipients and indigent persons. It affects the millions of families 
who must decide between food, housing, and health coverage. Healthcare 
costs in the United States are increasing about 7 percent a year, twice 
the rate of inflation.
  In Texas alone it has been estimated that we waste $98 billion on 
administrative health costs. Administrative costs constitute 31 percent 
of health care expenditures. The deteriorating U.S. health care system 
is not only harming patients, but also businesses, and the economy with 
healthcare costs consuming over 15 percent of GDP. It affects thousands 
of small businesses who have to close their doors due to the 
overwhelming cost of not only providing health coverage to their 
employees, but to securing their own health insurance.
  Across this great nation the health disparities between minority and 
majority populations are staggering. Most major diseases: diabetes, 
heart disease, prostate cancer, HIV/AIDS, low-birth weight babies--all 
hit the minority communities harder. Minorities consistently have 

[[Page H7132]]

decreased access to care, and receive lower quality care, when they do 
have access. As the economy continues to falter and as the unemployment 
rate spikes, millions of Americans are losing their health insurance. 
That state of affairs will only make the health disparities worse.

  Since I took office over a decade ago, I have worked to secure and 
support legislation to address the healthcare crisis particularly those 
facing our struggling Medicare and Medicaid recipients.
  I have worked tirelessly to expand health coverage, improve the 
diversity of our health workforce, improve data collection on health 
disparities and then help reduce those disparities by promoting 
accountability and strengthening the institutions that serve minority 
communities. We must close the gap in our minority, immigrant, and 
rural communities by addressing the disparities that currently exist.


                Health Legislation Sponsored/Cosponsored

  As a Member of the H.R. 676 Universal Healthcare Caucus lead by 
Congressman Conyers, the Women's Caucus, and the Children's Caucus, I 
have continued to carry the flag of Universal Health Care by 
introducing or supporting legislation that will help lay the groundwork 
towards universal access and quality healthcare.
  In June, I introduced a health care reform bill that addressed some 
of the issues that continue to plague our health care system. The 
MEDICS Act is a House companion bill to Senator Baucus's Medicare 
legislation that sought to unite Congress on a push for crucial 
Medicare reform.
  I am happy to announce that this legislation puts our health care 
system on the correct path of providing proper medical assistance for 
our Nation's low income, minority and rural populations. It also works 
toward resolving the primary care physician shortages as well as the 
racial and ethnic health disparities.
  I have also supported national healthcare legislation such as H.R. 
3014 and H.R. 676 which support the elimination of healthcare 
disparities and universal healthcare based on a single-payer model.
  As Americans, we have a strong history, through science and 
innovation, of detecting, conquering and defeating many illnesses. 
Quality measures must continue to be adequately funded in order to 
promote quality, cost-effective health care for consumers and 
employers.
  The Medicare/Medicaid system as well as the private insurance system 
is still not adequately addressing the cost, population growth, and 
patient population complexity of Americans. That is why we must look 
towards another solution.
  I urge my colleagues to support our Medicare and Medicaid dependents 
and vote in support of H. Res. 1368.
  Mr. DINGELL. Mr. Speaker, today we protect Medicare's future. The 
rule addresses a provision that was slipped into the Republican 
Medicare Modernization Act, MMA, in the dark of night. It was not in 
the version of the bill that was passed by the House or by the Senate. 
It is yet another example of Republican efforts to choke off Medicare--
an automatic ``trigger'' that requires cuts to the program if general 
revenues contribute more than 45 percent of Medicare's revenues.
  My colleagues on the other side of the aisle have long tried to end 
Medicare, and failing that, to let it wither slowly on the vine. Newt 
Gingrich said as much in the 1990s, when he was Speaker of the House.
  As required by the MMA provision, the President sent a bill to 
Congress in February with his proposal to meet the trigger 
requirements. His bill simply shifted costs to patients, and made no 
improvements to Medicare; a good example of why this ``trigger'' 
doesn't work.
  Democrats know how to manage Medicare--my father wrote the original 
bill creating it, and we have been fighting to preserve, improve, and 
protect the program for nearly 50 years. We do not need gimmicks like 
an arbitrary ``trigger'' to do so.
  Medicare has protected seniors, improved their health, and helped 
lift people out of poverty. We must ensure that Medicare beneficiaries 
continue to have access to their doctor of choice, high-quality 
hospital care, and prescription drug services.
  I support this rule; and I urge my colleagues to eliminate the 
``trigger'' requirements for the remainder of the year.
  Mr. HASTINGS of Florida. Mr. Speaker, I yield back the balance of my 
time, and I move the previous question on the resolution.
  The previous question was ordered.
  The SPEAKER pro tempore. The question is on the resolution.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. DREIER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________