[Congressional Record (Bound Edition), Volume 146 (2000), Part 9]
[House]
[Pages 12777-12781]
[From the U.S. Government Publishing Office, www.gpo.gov]



SENSE OF THE HOUSE CONCERNING USE OF ADDITIONAL PROJECTED SURPLUS FUNDS 
                     TO SUPPLEMENT MEDICARE FUNDING

  Mr. THOMAS. Mr. Speaker, I move to suspend the rules and agree to the 
resolution (H. Res. 535) expressing the sense of the House of 
Representatives concerning use of additional projected surplus funds to 
supplement Medicare funding, previously reduced under the Balanced 
Budget Act of 1997.
  The Clerk read as follows:

                              H. Res. 535

       Whereas Congress is responsible for oversight and spending 
     under the Medicare program;
       Whereas the Balanced Budget Act of 1997 was passed in 
     response to major economic concerns about inflation in costs 
     in the Medicare program;
       Whereas the savings resulting from enactment of that Act 
     exceeded the estimates at the time of enactment and has 
     resulted in payment rates for classes of providers below the 
     rates previously anticipated;
       Whereas the Congress adjusted some elements of the Medicare 
     program in the Balanced Budget Refinement Act of 1999;
       Whereas a significant number of Medicare+Choice 
     organizations is withdrawing, or considering withdrawing, 
     from the Medicare+Choice program because of inadequate 
     reimbursement rates;
       Whereas the Medicare prescription drug bill pending in the 
     Congress will delay the date by which Medicare+Choice 
     organizations must decide whether to remain in the 
     Medicare+Choice program from July 1, 2000, to October 1, 
     2000; and
       Whereas, because of improved economic performance, it is 
     anticipated that the Congressional Budget Office in its mid-
     year reestimates will project dramatically increased non-
     Social Security surpluses above those assumed in the adoption 
     of the most recent Congressional Budget Resolution for fiscal 
     year 2001: Now, therefore, be it
       Resolved, That it is the sense of the House of 
     Representatives that, upon receipt of such mid-year CBO re-
     estimates, the House of Representatives shall promptly assess 
     the budgetary implications of such reestimates and provide 
     for appropriate adjustments to the Medicare program during 
     this legislative session.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Thomas) and the gentleman from Tennessee (Mr. Tanner) 
each will control 20 minutes.
  The Chair recognizes the gentleman from California (Mr. Thomas).
  Mr. THOMAS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, House Resolution 535 is an important resolution because 
just

[[Page 12778]]

as we have discussed, and the House has passed, Medicare modernization 
and prescription drugs for seniors, there are still other areas of 
Medicare that continue to need adjustment.
  If we have additional surplus money, we want to make sure that we 
alert both the seniors who are the recipients and the providers of that 
Medicare care that we believe a high priority is to make sure that a 
significant portion of that surplus is reserved for reinvestment back 
into Medicare.
  Mr. Speaker, I yield the balance of my time to the gentleman from 
California (Mr. Bilbray) and ask unanimous consent that he be permitted 
to control the time and yield further blocks of time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, today we have had a discussion between Democrats and 
Republicans that I think the American people would prefer to see us 
avoid in the future. Yesterday, we had some bipartisan efforts of 
people reaching out across the aisle to work for betterment of this 
country.
  Resolution 535 is one of those resolutions that we can do this. This 
is a chance for us to reach across the aisle in a bipartisan effort to 
show that Medicare really is a priority of this body; and hopefully, in 
the future we will find the funds to be able to do all of things that 
both sides and America would like us to do.
  Mr. Speaker, it is my pleasure to yield such time as she may consume 
to the gentlewoman from New Mexico (Mrs. Wilson). Let me point out to 
every Member, this Member has fought hard to raise this issue, to 
articulate the issue that we have to continue to do better for our 
seniors when it comes to Medicare. She has been a constant champion of 
the fact that Republicans and Democrats need to put their differences 
aside and truly work for our seniors in America.

                              {time}  2310

  Mrs. WILSON. Mr. Speaker, I thank the gentleman from California (Mr. 
Bilbray) for his kind words.
  Mr. Speaker, when it became clear that we were going to do a 
prescription drug bill, there is a part of this bill in title 3 that we 
did not get a chance to talk about much today, and that has to do with 
some changes that are needed for Medicare to provide some urgent relief 
to hospitals in this country, particularly in a program called 
Medicare+Choice. About half of the citizens in my district in New 
Mexico choose Medicare+Choice. It is kind of managed care for Medicare. 
They have the Lovelace Senior Plan or the Presbyterian Senior Plan.
  The problem is that the reimbursement rates for Medicare+Choice and 
for most of the other Medicare programs in the State of New Mexico are 
terribly low. In New Mexico, if one is a part of the Lovelace plan, 
Lovelace gets about $370 per member per month to cover one's health 
care in the rural parts of New Mexico. It is about $430 a month if one 
is in Albuquerque. That compares with a reimbursement rate in Staten 
Island, New York of $811 and in Dade County, Florida of almost $800 per 
member per month.
  The reason is that New Mexico had managed care so much earlier than 
other parts of the country. We had one of the earliest HMOs in the 
country, Lovelace Hospital. We had controlled many of the costs that 
everyone else was struggling to control. But we were penalized for 
that, penalized for that continuing efficiency.
  Now as CIGNA pulls out of Medicare+Choice and a lot of other 
different States, we are facing that potential in New Mexico as well. 
But it is not unique to New Mexico. There are seven States who are 
suing the Federal Government because of the inequities in reimbursement 
under Medicare, and they are right.
  Mr. Speaker, what I wanted to try to do is to get some immediate 
relief so that seniors do not lose their preferred medical care 
coverage. The 1st of July is when a lot of companies have to decide 
whether they are going to stay in Medicare+Choice. The bill that we 
passed earlier today will extend that deadline to the 1st of October.
  But there are some things I think we can do without hurting those 
States that have high reimbursement rates to get some changes and some 
fixes for those of us who are on the low end of the scale and losing 
money because the Federal Government is inadequately subsidizing 
Medicare.
  Many of those fixes were included in this bill, but I wanted to see 
them accelerated because the need is not 2004, the need is now. 
Companies are having to decide whether the 1st of July or at the latest 
the 1st of October whether they are going to continue to be able to 
insure people under Medicare.
  For a variety of procedural reasons, that is not possible today and 
was not possible in the bill, mostly because we do not have the new 
estimates from the Congressional Budget Office of projected surplus 
next year.
  But everyone in this House on both sides of the aisle knows that we 
have a problem. It seems to me the right thing to do is to stand up and 
acknowledge to the people of this country that we know we have a 
problem with Medicare reimbursement rates, whether it is for physicians 
or Medicare+Choice. We know that, within a month, we are probably going 
to have some new projections on the amount of money we will have 
available, and we also know and agree that a significant amount of that 
money has to be put into health care in this country.
  I support a prescription drug benefit, and I supported the Patients' 
Bill of Rights. But if one does not have a doctor, a Patients' Bill of 
Rights or prescription drug benefit does not do one much good.
  While we were not able to solve everything in this bill, I would like 
to see this House come together in a common commitment to fix some of 
the problems in Medicare and the immediate crisis facing our health 
care system. Because if we do not, we are going to have a lot of 
seniors who are told that they are going to have to change their 
doctors or that they can no longer have Medicare+Choice.
  While some may think that that really affects those who are at the 
upper end of the income scale, that is not the case in my district. 
Those who are most likely to choose Medicare+Choice have an income of 
below $20,000 a year. That is the option for those who cannot afford 
some pretty expensive Medigap plans.
  In fact, as this chart shows, this is insurance coverage by household 
income in Albuquerque, New Mexico. Those who rely most on Medicare HMOs 
are here. Almost 60 percent of those who have an income of $20,000 and 
less are on Medicare+Choice, and it goes down from there. Those who 
have Medicare Plus, a supplement, are generally upper income folks. But 
still almost half of the folks in Albuquerque, New Mexico have 
Medicare+Choice.
  I would like to see us commit here tonight that we will use some of 
the surplus that we expect to be available when the budget estimates 
come out to fix some of the immediate problems with Medicare, to 
accelerate some of these appeals mechanisms, and to provide some 
immediate relief for the people who are providing health care to our 
seniors.
  Mr. TANNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, we do not have any particular problem with this House 
resolution, but it is almost surrealistic what we are seeing here. This 
is not even a concurrent resolution, it is a sense of the House.
  Now, 2 weeks ago, in the committee, I offered in statutory 
legislative language an amendment to the debt reduction bill that would 
have done just exactly what this House resolution says ought to be 
done, and we would have it passed in law by the House tonight for 
immediate relief for the providers in this country if it had not been 
ruled out of order by the majority.
  So it is hard to understand, given the fact that we have had three 
different times we could have actually done something in law rather 
than come down here with a House resolution after this procedure that 
we witnessed all day today.

[[Page 12779]]

  Number one, it could have been put on the debt reduction package. 
Number two, it could have been put in the Medicare lockbox. Number 
three, an hour ago, the majority voted down the motion to recommit 
which says exactly what this House resolution says.
  So when I say it is hard to understand, it is hard to understand from 
the standpoint of asking what can we do as Members of Congress to bring 
relief to these procedures. We could have already done it. We could 
have already had the Medicare restoration fund that captures these 
unanticipated savings. We could already be in the process of giving 
immediate relief to the country. But, no, it was our idea, so I guess 
that that is not the way this place runs.
  We come with this House resolution. Real good. It says a lot of 
things that everybody agrees with, but it does not do anything.
  I understand being ruled out of order when it is not one's idea, and 
I understand, I guess, a little something about politics. But when one 
has an amendment on a bill that, in my view, is clearly in order 2 
weeks ago that would have done this in law and been passed so that we 
could replenish the Medicare trust fund with these captured savings 
that were unanticipated when the Balanced Budget Act of 1997 was 
passed, and then have a resolution to say we really want to do this, it 
is awfully hard for some of us to believe in the credibility of this 
one pager that says we really want to do something to help the 
providers in Medicare.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would just like to say to the gentleman from Tennessee 
(Mr. Tanner) that I am not on his committee. The gentlewoman from New 
Mexico (Mrs. Wilson) and I are on the Committee on Health of the 
Committee on Commerce.
  Let me assure my colleagues that, even those of us who were on the 
Committee on Commerce get ruled out of order every once in a while when 
we know it is the right thing to do, it is common sense to do, but 
sometimes procedures here stand in the way. I had that on the floor 
here this week three times. So I appreciate that.
  We did not have a chance to vote with the gentleman from Tennessee on 
that issue. We did not have a chance to stand up and speak for him on 
that motion at that time. But we do have a chance now using this 
procedure to say party affiliation, procedural guidelines, whatever we 
want to talk about, there is a consensus here that, if the projections 
come in the way we are hoping it comes in, that Medicare should be a 
priority.

                              {time}  2320

  And I would just say to my colleague from Tennessee that I understand 
his frustration; I have gone through the same thing. Here is a chance 
for us, though, to say, yes, we can do what the gentleman wanted to do 
on that day and at least move the ball forward. And as it was said with 
campaign finance reform, let us not let the perfect be the enemy of the 
good. This is an opportunity to move one step forward, and I hope the 
gentleman will support us on that.
  Mr. Speaker, I yield 4 minutes to the gentleman from Alabama (Mr. 
Bachus).
  Mr. BACHUS. First of all, Mr. Speaker, let me commend the gentleman 
from California and the gentlewoman from New Mexico for bringing 
forward what I think is an opportunity for this entire House to make a 
strong and unanimous statement that this surplus that we have, a lot of 
it, can be placed on Medicare.
  Achieving a balanced budget has long been a Republican economic 
objective, and it is a good one; and we can credit our current strong 
vibrant economy to our fiscal discipline. But damaging our health care 
system was never our intent in passing the Balanced Budget Act. It was 
the intent of Congress to slow the growth of Medicare to a manageable 5 
percent. However, in 1999, it was actually a negative 1 percent. 
Hopefully, we can all agree that is not acceptable.
  The CBO now reports that Medicare reductions achieved through the 
Balanced Budget Act are $124 billion larger than Congress actually 
voted for, $124 billion; and part of that, a good bit of that, is 
because of HCFA's restrictive interpretations.
  Our hospitals are experiencing increasingly smaller profit margins, 
and we should all realize that this threatens to diminish the quality 
of care that they provide. Credible sources report that these margins 
are currently at their lowest point in years. And some valid 
responsible authorities are projecting that within 4 years half our 
Nation's hospitals will actually be losing money.
  In my home State of Alabama, studies are projecting that 70 percent 
of our hospitals are currently running in the red and several will 
close. We cannot stand by and let this happen and call it an unintended 
consequence. That is what this resolution is about. We owe our 
constituents more than that. Our challenge is to find a balance, 
responsibly controlling government spending on one hand and 
sufficiently funding our hospitals on the other.
  America can boast the finest health care system in the world. There 
have been incredible advances in medicine in recent years, with the 
real hope of miraculous achievement in defeating illness, pain and 
suffering. Just this week the magnificent accomplishment of mapping the 
human Genome was formally announced, bringing with it the promise of 
major breakthroughs in preventive medicine. But all of these new 
miraculous developments come with a hefty price tag. Our hospitals must 
have sound and reliable financial support to be able to offer these new 
miracles to all of us. Making sure that our financial support is 
available is a mandate we in Congress cannot sidestep. We should be 
true to our obligations.
  I close by saying, Mr. Speaker, that there is a bottom line in this 
discussion. When our loved one is seriously ill, only the very best 
medical care is good enough. We must not fail to provide sufficient 
funding to assure such care is reasonably available to all. American 
medical care is an honest and undeniable bargain by any measure. Its 
true cost is not measured in dollars and cents alone but also in the 
health and well-being of all our people.
  For that reason, I enthusiastically support this resolution and hope 
that people on both sides of the aisle will join with me.
  Mr. TANNER. Mr. Speaker, I yield myself 1 minute to reply to my 
friend from California that I understand about being ruled out of 
order. What I am saying is an hour ago we had a motion to recommit that 
did this. The gentleman could have joined with us on that motion to 
recommit, any number of my Republican colleagues could have if they had 
wanted to do something now.
  This resolution is fine, but it ought to be a special order instead 
of coming into the legislative process. We have a bill, 4770, that will 
do this very thing. And so I understand that the gentleman is not on 
the committee, but what goes on from here is nothing except, well, we 
are going to do something later. Another promise.
  Mr. Speaker, I yield 4 minutes to the gentleman from Washington (Mr. 
McDermott).
  Mr. McDERMOTT. Mr. Speaker, I think this is kind of a fitting ending 
to this day. My colleague, the gentleman from Tennessee (Mr. Tanner), 
says he cannot understand what this is. Well, let me give my colleagues 
my interpretation. This is press release time. The Washington Post 
called this the Pretend Congress, and this is a piece of activity we 
are going to go through here that pretends to do something.
  Now, there was a cartoonist by the name of Walt Kelly who created 
Pogo. And one of his most famous cartoons is one in which they are 
searching for who is doing some bad deed, and finally Pogo gets up and 
says, ``We have found the enemy, and they is us.'' Well, the fact is 
that it is the Congress that created the problems. We should not be 
blaming bureaucrats.
  The balanced budget amendments of 1997 were designed by the 
Republicans, passed by the Republicans, to do one thing, let Medicare 
wither on the vine, as we know it, and create

[[Page 12780]]

Medicare+Choice. Now, a few of us voted no because we knew enough about 
the situation to know what they were doing.
  This is not mystery. This is no bureaucratically created problem. It 
was created by the Subcommittee on Health of the Committee on Ways and 
Means, and they did it without talking to us. They did not want to have 
any input. They said, we know what we are doing; we are going to get 
rid of that old Medicare that does not work, and we are going to have 
all these HMOs out everywhere.
  We have had HMOs out all over everywhere, and they have been pulling 
out. A million people have lost their health coverage in this country 
in the last couple of years because of the system that my colleagues 
tried to push onto people. My colleagues wanted to push them all into 
the arms of the Medicare HMOs, and today it is boggling that having had 
that experience with HMOs and insurance companies not working, that we 
would go through and set up exactly the same process for delivering 
prescription medications to seniors in this country.
  My Republican colleagues are telling 90-year-old women like my mother 
to go out and find themselves an insurance company and ask them if they 
will sell them a policy that they can afford. And if they cannot afford 
it, well then they can go on down to the welfare office and can ask 
them for money, and they will cover what cannot be covered because they 
are poor. That is what we set up today.
  And the fact is, if I had done that, I would want to come out here 
and put something in that looked like I was really in favor of really 
fixing Medicare. But as the gentleman from Tennessee (Mr. Tanner) has 
said, we have had opportunity after opportunity. That bill that went 
through today was done without Democratic input. Not one single 
amendment was accepted in the committee. Our Republican colleagues did 
not allow an amendment out here. And when it fails, and my colleagues 
are looking around for who did this, who put this plan out here, they 
will have to take a good look in the mirror, because they did it to 
themselves; and now they are trying to fix it.
  I will bet when this is all done that all the money that we saved in 
1997 we will have put back into the budget piece by piece by piece, 
always blaming somebody else; well, they looked at the rules too 
carefully, or they were too tight-fisted or something.

                              {time}  2330

  But it was us who made those cuts. And we offered them right here $21 
billion to fix Medicare, and we were ruled out of order. Everybody 
said, no, we cannot do that. But less than an hour later, we are 
seriously out here looking as though there is money right around the 
corner.
  We know that money is there. They know that money is there. But they 
did not want to do it tonight. They want to do it tomorrow. Vote yes. 
It will not hurt anything.
  Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, my colleague the gentleman from Washington (Mr. 
McDermott) said we know the money is there. Look, there are some of us 
that are trying to work bipartisan here and have for years. But every 
time we try to reach across the aisle, we hear the rhetoric about the 
fact that we are just not spending money, let us keep going.
  Why this resolution is here is because not until July are we going to 
know if the money is there. Now, if this is a sin of saying let us not 
spend or commit money until we have at least the commitment down there 
that we think is coming down the pike. We are trying to be responsible 
with this.
  Now, in all fairness, I just asked any colleagues on the other side 
how did they sign on to the DeGette bill. I have signed on to the bill 
of the gentlewoman from Colorado (Ms. DeGette). And though she may be a 
member of the minority party, she is right on how to address that 
issue.
  The gentleman from Kentucky (Mr. Whitfield) has got a Republican 
version. But always we have to take the political cheap shot. We have 
always got to do that.
  For once, even on a resolution, if it does not say enough, then it 
does not do that much damage. Can my colleagues not, at least, try to 
meet us halfway? Those of us that have met them halfway more times than 
they have ever come across our side of the aisle are standing here 
today and asking them, those of us that have crossed the aisle 
consistently, that on this resolution, all it is saying is, in July, 
let us see if the money is there and let us make the effort.
  Mr. Speaker, I yield such time as she may consume to the gentlewoman 
from New Mexico (Mrs. Wilson).
  Mrs. WILSON. Mr. Speaker, I know my colleagues wanted to do it today. 
So did I. And that is why I offered an amendment in the Committee on 
Rules.
  The reason I was not ruled in order is probably the same reason my 
colleagues were not ruled in order is because we cannot spend money in 
this House that we do not yet have. But we all know in this room that 
we expect new estimates within a month.
  It would have, I think, been irresponsible on our part to not move 
forward on prescription drugs and to keep this process moving forward 
to get a prescription drug plan. And I support that. But I would not 
want to have held that back to get a fix on more Medicare fixes this 
year and in the year starting in October just because we do not have 
the budget estimates yet. And that is the nature of this.
  I have kind of taken this up as my personal cause on this side of the 
aisle. I think some of my colleagues sitting here know that I make it a 
pretty regular effort to do things in a bipartisan way, whether it is 
on low-power radio or Superfund or a whole variety of other things we 
are working on, Baca land in northern New Mexico, and quite a few 
things in the Committee on Commerce. That is just kind of who I am, and 
that is my style.
  I commit to work with those of my colleagues who are concerned about 
Medicare reimbursement rates and the disparity in different parts of 
the country to try to make this work as soon as we have the budget 
estimates to do so. I give my colleagues my personal word on that.
  Mr. TANNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just say to my friend from California (Mr. Bilbray), 
as I said at the outset of my remarks, we are going to support his 
resolution here. And there is nothing wrong with it.
  It is just that when, at the end of this day, we had probably one of 
the most important Medicare bills in the history of the program here, 
this prescription drug benefit, and his leadership would not even give 
the Democrats an alternative.
  Today, an hour ago, we tried to do this very thing this resolution 
does in a motion to recommit. Not one single vote for help. And so, 
when my colleague says they reach across the aisle more than we do, 
when their leadership does not even give us an alternative, reduces us 
to nothing more than a motion to recommit and we cannot get that, when 
we have a bill that does this, when we have an amendment that did this, 
after a while we begin to say, what is going on here? Do these people 
really want to do this?
  We have the wherewithal to do it. It is called a bill. This 
resolution is fine, and we are going to support it, and we are going to 
reach across every time we can.
  But I just tell my colleague, when we try to work legislatively and 
we are virtually shut out, as we were today, from any input at all and 
then after the fact, as the gentleman from Washington (Mr. McDermott) 
said, they have a resolution that says we are going to promptly do 
this, well, we could have promptly done it 2 weeks ago or tonight but 
we did not.
  So I do not want to be partisan, either. I just say there is a way to 
do this called a bill and we are ready, willing, and able to do it. In 
fact, we would have done it an hour ago if we would have had some help.
  Mr. Speaker, I yield back the balance of my time.

[[Page 12781]]


  Mr. BILBRAY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would just like to say that I appreciate the support 
for this resolution. I just want to articulate that the gentleman is 
not the only one who gets frustrated the way sometimes this House is 
run. A lot of people were frustrated the way the House was run before 
the new majority took over.
  Remember, I have got family that served with the gentleman that 
talked about the bad old days. So everybody gets frustrated with the 
leadership, even those of us on the majority side.
  What we are asking as two individuals here and three individuals here 
that represent a lot of people out there that do not hold the Members 
responsible for party affiliation. When my colleagues look across the 
aisle, I hope they see the gentleman from California (Mr. Bilbray), 
representative of San Diego, not just a Republican. And I think we need 
do more of that.
  The gentlewoman from New Mexico (Mrs. Wilson) is probably the most 
sincere individual that could ever work on this issue, and I think that 
my colleagues recognize that she has worked hard with both sides of the 
aisle.
  The gentleman from Alabama (Mr. Bachus) has made his efforts. All we 
are asking is that here is a place we may disagree, we might have had 
disagreements today, but let us finish off the evening by at least 
saying this is something we can meet halfway and start building a 
future from now on rather than talking about animosity in the past.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Pease). The question is on the motion 
offered by the gentleman from California (Mr. Bilbray) that the House 
suspend the rules and agree to the resolution, H.Res. 535.
  The question was taken.
  Mr. BILBRAY. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________