[Congressional Record (Bound Edition), Volume 149 (2003), Part 17]
[House]
[Pages 23199-23207]
[From the U.S. Government Publishing Office, www.gpo.gov]




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

  Mr. KIND. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mr. Kind moves that the managers on the part of the House 
     at the conference on the

[[Page 23200]]

     disagreeing votes of the two Houses on the Senate amendment 
     to the bill H.R. 1 be instructed as follows:
       (1) The House recede to the Senate on the provisions to 
     guarantee access to prescription drug coverage under section 
     1860D-13(e) of the Social Security Act, as added by section 
     101(a) of the Senate amendment.
       (2) To reject the provisions of section 501 of the House 
     bill.
       (3) The House recede to the Senate on the following 
     provisions of the Senate amendment to improve rural health 
     care:
       (A) Section 403 (relating to inpatient hospital adjustment 
     for low volume hospitals).
       (B) Section 404 (relating to medicare disproportionate 
     share adjustment for rural areas), but with the effective 
     date applicable under section 401(b) of the House bill.
       (C) Section 404A (relating to MedPAC report on medicare 
     disproportionate share hospital adjustment payments).
       (D) The following provisions of section 405 (relating to 
     critical access hospital improvements):
       (i) Subsection (a), but with the effective date applicable 
     under section 405(f)(4) of the House bill.
       (ii) Subsection (b), but with the effective date applicable 
     under section 405(c)(2) of the House bill.
       (iii) Subsections (e), (f), and (g).
       (E) Section 414 (relating to rural community hospital 
     demonstration program).
       (F) Section 415 (relating to critical access hospital 
     improvement demonstration program).
       (G) Section 417 (relating to treatment of certain entities 
     for purposes of payment under the medicare program).
       (H) Section 420 (relating to conforming changes relating to 
     Federally qualified health centers).
       (I) Section 420A (relating to increase for hospitals with 
     disproportionate indigent care revenues).
       (J) Section 421 (relating to establishment of floor on 
     geographic adjustments of payments for physicians' services).
       (K) Section 425 (relating to temporary increase for ground 
     ambulance services), but with the effective date applicable 
     under the amendment made by section 410(2) of the House bill.
       (L) Section 426 (relating to appropriate coverage of air 
     ambulance services under ambulance fee schedule).
       (M) Section 427 (relating to treatment of certain clinical 
     diagnostic laboratory tests furnished by a sole community 
     hospital).
       (N) Section 428 (relating to improvement in rural health 
     clinic reimbursement).
       (O) Section 444 (relating to GAO study of geographic 
     differences in payments for physicians' services).
       (P) Section 450C (relating to authorization of 
     reimbursement for all medicare part B services furnished by 
     Indian hospitals and clinics).
       (Q) Section 452 (relating to limitation on reduction in 
     area wage adjustment factors under the prospective payment 
     system for home health services).
       (R) Section 455 (relating to MedPAC study on medicare 
     payments and efficiencies in the health care system).
       (S) Section 459 (relating to increase in medicare payment 
     for certain home health services).
       (T) Section 601 (Increase in medicaid DSH allotments for 
     fiscal years 2004 and 2005).
       (4) The House insist upon the following provisions of the 
     House bill:
       (A) Section 402 (relating to immediate establishment of 
     uniform standardized amount in rural and small urban areas).
       (B) Section 403 (relating to establishment of essential 
     rural hospital classification).
       (C) Subsections (a), (b), (d), and (e) of section 405 
     (relating to improvements to critical access hospital 
     program).
       (D) Section 416 (relating to revision of labor-related 
     share of hospital inpatient pps wage index).
       (E) Section 417 (relating to medicare incentive payment 
     program improvements).
       (F) Section 504 (relating to wage index classification 
     reform).
       (G) Section 601 (relating to revision of updates for 
     physician services).
       (H) Section 1001 (relating to medicaid disproportionate 
     share hospital (DSH) payments).

  Mr. KIND (during the reading). Mr. Speaker, I ask unanimous consent 
that the motion be considered as read and printed in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Wisconsin?
  There was no objection.
  The SPEAKER pro tempore. The gentleman from Wisconsin (Mr. Kind) will 
be recognized for 30 minutes, and the gentleman from Pennsylvania (Mr. 
Greenwood) will be recognized for 30 minutes.
  The Chair recognizes the gentleman from Wisconsin (Mr. Kind).
  Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, what this motion to instruct basically states is asking 
for some fairness and some equity in regards to the rural health care 
providers during the Medicare reform conference discussions that are 
taking place right now.
  Mr. Speaker, rural America is often called the backbone of our 
country, and rightly so. It is rural America where so many of our 
parents and grandparents grew up, and it is to rural America that many 
of our veterans, teachers, and farmers retire.
  There are 9 million Medicare beneficiaries in rural communities, and 
these seniors tend to be older. They tend to be sicker. They tend to 
have a little less money than those in urban communities. Rural seniors 
are in great need, and we must be sure that any Medicare bill does not 
leave these citizens out in the cold.

                              {time}  1845

  Yesterday, the House voted on an identical motion offered by my good 
friend the gentleman from Texas (Mr. Stenholm). Unfortunately, the 
motion was defeated, 202 to 213, with 19 Members absent. We are hoping 
to give those absent Members another chance to come and vote and 
participate in this discussion, and hopefully then have the votes to 
prevail on this motion to instruct.
  There are many Members on both sides of the aisle, Mr. Speaker, that 
come from rural areas, from rural districts. I do not for the life of 
me understand why a Member from a rural area would oppose a motion to 
instruct on this basis. I think it makes a lot of sense.
  This is not an ideological or partisan issue, this is a geographic 
issue, and we are asking for some fundamental fairness and some equity 
in dealing with rural health care providers.
  I believe Medicare recipients deserve a prescription drug plan under 
Medicare, and I believe that all seniors, regardless of their location, 
should have access to affordable, stable drug benefits. H.R. 1, 
however, lacks a guarantee that seniors living in rural areas will have 
access to such a plan.
  Rather than gaining a drug benefit under Medicare, seniors would have 
to join a managed care plan or purchase a private drug-only plan. For 
rural seniors, only 19 percent of whom had access to a Medicare-managed 
plan in 2003, this could be disastrous. In effect, seniors in rural 
areas would be subsidizing prescription drugs for others, but would not 
get a drug benefit plan of their own.
  I am not prepared to tell seniors in my district in western Wisconsin 
that some seniors will be getting a drug benefit, when they will not.
  The Senate Medicare bill, recognizing the instability of private 
plans in rural areas, provides a fallback, meaning that traditional 
Medicare would offer its own prescription drug plan to areas with fewer 
than two private plans available to Medicare recipients. I urge the 
conferees to recognize the importance of offering prescription drug 
plans to all Medicare enrollees and to accept the Senate provisions.
  Yesterday, some of my colleagues on the other side of the aisle 
argued that the instructions in this motion would lead to greater 
spending and higher deficits. I am committed to being fiscally 
responsible at all times and reducing the deficit, and this motion does 
not call for exceeding the budget limit of $400 billion allotted for 
this Medicare reform bill. Rather, this motion instructs the conferees 
to carefully assess their priorities in allocating the $400 billion. I 
hope that this dispels any confusion over the costs advocated by this 
motion, and I hope that my colleagues across the aisle will be able to 
join in supporting it.
  We have seen too many rural hospitals close, over 470 in the last 25 
years alone, and rural hospitals all over the country are in danger of 
being forced to shut their doors forever. Currently hospitals receive 
full inflation or market basket payments for inpatient and outpatient 
services. H.R. 1 would reduce hospital payment updates for the next 3 
years, which the CBO estimates would lead to a $12 billion loss to 
hospitals over the next decade.
  Currently over 57 percent of hospitals in America lose money when 
serving

[[Page 23201]]

Medicare patients. We cannot ask hospitals to continue to accept 
Medicare payments that are below the cost of delivering the care they 
provide. The Senate bill makes no such cuts to the market basket 
payments and would keep rural hospitals in business. I urge the 
conferees to reject the House provision and accept the Senate 
provisions.
  Geographic disparities in Medicare reimbursements disproportionately 
affect rural providers. In my State of Wisconsin, providers are paid 25 
percent less on average per Medicare beneficiary. The motion encourages 
the conferees to adopt the best-world provisions in both bills. These 
provisions go a long way to reduce geographic disparities.
  Physicians and specialists are scarce in rural areas. In fact, less 
than 10 percent of physicians practice in nonmetropolitan counties. It 
is not surprising, given that rural providers consistently receive 
lower reimbursement rates than providers in the rest of the country.
  These providers who do deal with the unique challenges presented by 
health care in rural areas are the pillars of our communities, and fair 
payments to rural providers mean quality health care for our Nation's 
seniors.
  Physicians in rural communities see a large percent of Medicare 
patients. This motion instructs conferees to include the best 
provisions of the Senate and House bill. We must insist that rural 
providers and beneficiaries are protected and that critical-access 
hospitals are maintained and improved.
  I would be disappointed if my colleagues on the other side of the 
aisle did not join in voting for this motion and supporting providers 
in their communities. Yesterday's close vote on a motion identical to 
this one shows that many of us are concerned about the crisis of health 
care in rural areas. By again offering this motion, and by dispelling 
the myth that these instructions would lead to a more expensive 
Medicare bill, I hope that those Members who were absent yesterday, as 
well as those Members who truly do care about the state of rural health 
care in our country, will cast a vote in favor of this motion.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GREENWOOD. Mr. Speaker, I yield 1\1/2\ minutes to the 
distinguished gentleman from Colorado (Mr. McInnis), a member of the 
Committee on Ways and Means.
  Mr. McINNIS. Mr. Speaker, I thank the gentleman for yielding me time.
  I also wanted to note at the beginning of my comments that the 
gentleman from Wisconsin (Mr. Kind) is a gentleman, he is well 
respected, but I adamantly disagree with the statements that he has 
made.
  Let me say that I represent a large rural district, and I know 
something about rural hospitals, and I know something about a 
government-run plan. The proposal that the gentleman from Wisconsin 
(Mr. Kind) is asking to instruct the conferees on is simply a 
government-run program. It is a repeat of Hillary Clinton.
  So while I have high regards for the gentleman from Wisconsin, I 
could not disagree more. The motion that he has got clearly asks for a 
government-run prescription drug plan. It will give us a government 
bureaucracy that will increase its influence and adopt a philosophy of 
even bigger and bigger government.
  Now, our government currently has government health care programs, 
whether you look at the VA or Medicare or some of these others things, 
and they have not done a very good job of it. What kind of 
encouragement exists out there for us to expand this program? How can 
you want to enlarge it? It will not work. The intent is good. The 
result will be a disaster.
  The motion also provides an unprecedented inflationary increase as to 
hospitals and other health care providers, which forces the conference 
to quickly exceed the $400 billion allocation in the budget resolution. 
It is always easy from this House floor to propose all kinds of money 
going out to the Nation, but the fact is somebody has got to write the 
check, and right now we do not have the balance to write that check.
  So the motion to instruct defeats the purpose of the conference 
committee, which has already come to agreement on several provisions 
contained in both bills. Let me kind of highlight that for the 
remaining time.
  These conferees have been working very, very hard. This is a very 
tenuous agreement, if we are, in fact, able to come up with agreement. 
To interject at this late point in the game a proposal that would 
quickly exceed the ceiling in cost, and, on top of that, invoke clearly 
a large government-run health care program just like the Clinton 
program will defeat our purpose.
  Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, that large government-run program is called Medicare, a 
very successful and highly popular program for seniors throughout the 
country.
  Mr. Speaker, I yield 4 minutes to my friend the gentleman from Texas 
(Mr. Stenholm).
  Mr. STENHOLM. Mr. Speaker, I rise in strong support of the Kind 
motion to instruct. It was amazing listening to my colleague from 
Colorado, because his statement has no relationship whatsoever to this 
motion to instruct.
  The Kind motion will include a fallback provision to ensure that 
seniors have prescription drug coverage where private plans choose not 
to participate. It has nothing to do with increasing the size of any 
program. It just says if the program that is in the House bill does not 
work, there is a fallback.
  Congress has a responsibility to guarantee this very important 
component of health care for all seniors, not just those who happen to 
live in an area where a private drug plan is offered. Contrary to what 
you may have heard, and we just heard it a moment ago, this motion will 
not require a government prescription drug plan or bust the budget. The 
Medicare fallback would only apply if the private sector fails to 
provide prescription drug plans in rural areas.
  The Kind motion to instruct also includes important improvements to 
rural health care providers. Because of the very high proportion of 
elderly in rural areas, Medicare is a very large and critical source of 
payment for rural health care providers. Inadequate Medicare payments 
to rural hospitals and other rural health care providers over the last 
several years have only deepened the challenges to quality health care.
  The Kind motion to instruct would take the best provisions. It was 
amazing listening to all of this stuff that is going to happen in this 
bill. We are saying take the best provisions in the House bill and the 
best provisions that have passed the Senate and make sure that those 
get in the final bill, because rural America can stand no less.
  The Kind motion to instruct also rejects the House provisions that 
would cut hospital inflation increases. Hospitals cannot rebound from a 
$12 billion payment cut from rate of increase. I want to be sure 
everybody understands rate of increase. But that is not the problem. 
The problem is rural areas have not kept up over the last 10 years, 
and, therefore, unless we have the market basket as designed, rural 
hospitals are going to find themselves in an even deeper hole.
  Hospitals are already operating on a thin profit margin. They are 
hurting. One out of three hospitals in America is operating in the red. 
More than 57 percent of all hospitals lose money under the Medicare 
program. A reduction in the market basket would wreak havoc on our 
Nation's hospitals, particularly the more vulnerable rural hospitals.
  That is why we come again to the floor again tonight saying, please 
take a look. And to those on the other side of the aisle who did not 
vote yesterday on it, take another look. Look at your district. Listen 
to your hospitals, listen to your constituents, and see if they do not 
agree.
  Again, let me repeat, the myth that this is a budget-busting motion, 
it is not. We agree with the $400 billion, period. I do not want to 
hear any more of this ``budget-busting.'' That is right out of the 
playbook that has got us into $560 billion deficits today.

[[Page 23202]]

  We agree. We are just saying take the $400 billion, reprioritize, and 
make certain that rural hospitals get a fair shake. That is all that we 
are saying.
  Even with stronger rural provisions, a Medicare fallback and no 
reduction in the hospital market basket update, the bill passed by the 
other body stays within the $400 billion. They do it; we can do it. We 
just disagree with some of the priorities of some of the folks on the 
other side of the aisle, and we believe that most Members of rural 
areas, most Members who have rural hospitals, agree with this basic 
presumption that we ought to have an instruction.
  Hospitals are important. The crisis has, of our rural hospitals, we 
have closed 470 in the past 25 years. I have several in my district 
hanging by a thread. If you succeed in doing what you are arguing for, 
they will bust that thread.
  Please support the Kind motion to instruct. It is good for 9 million 
rural Medicare beneficiaries and will put us on a path toward economic 
stability.
  Mr. GREENWOOD. Mr. Speaker, I yield myself 4 minutes.
  Mr. Speaker, first off, let me suggest to the gentleman, my friend 
the gentleman from Wisconsin (Mr. Kind), that we take his motion 
seriously. Having said that, we all know that motions to instruct 
conferees are only that. They have no ultimate effect.
  The fact of the matter is the negotiations have been ongoing in the 
conference committee, and whether this motion passes or does not pass, 
the conferees on the part of the House and the part of the Senate, the 
Republicans and the Democrats, are and have been and will be continuing 
to negotiate all of these issues, and they will all be negotiated in 
the context of all of the other issues that they are negotiating.
  But having said that, I also want to, at least in this point in the 
argument, assume that the gentleman's arguments are sincere, and I 
would like to address them.
  First off, with regard to the argument that we need a fallback, a 
government-run fallback, for the prescription drug program, the 
gentleman's point is well taken. We do, and we should have, and we 
should guarantee that, in every region of the United States of America, 
every senior will have access to a good and affordable prescription 
drug plan.
  We believe that the bill as adopted by the House already does that, 
that the incentives that we give the Secretary to offer to the plans, 
in fact, does guarantee that there will be at least two programs, two 
plans, in every district, in every region, and, in fact, the CBO 
expects within the first year it will be available, the plan will be 
available, to 95 percent of seniors; in the second year, 99 percent.
  On the second issue, the gentleman from Wisconsin argues that we need 
to pay hospitals a fair amount, and, indeed, we should. We relied upon 
the Medicare Payment Advisory Commission, MedPAC, who said what would 
be fair based on all of the data available is to include a 3 percent 
market basket update as opposed to a 3.4 percent, as the gentleman from 
Wisconsin argues.
  Having said that, what the gentleman does not take into consideration 
is that is not the only increase in payments to hospitals available 
under our legislation. Looking at Iowa, for instance, a very rural 
State, they get a 1.6 percent increase under the standard amount, an 
additional 0.8 percent for the labor share, and 0.1 percent for medical 
DSH increases, which gives the hospitals in Iowa actually a 5.5 percent 
increase as opposed to a 3 percent increase. In Oklahoma, that number 
comes to 5.7 percent; the same in Montana, 5.7 percent; South Dakota, a 
very rural State, as rural as you can get, 5.4 percent.

                              {time}  1900

  So we think that the gentleman's objective in making sure that 
hospitals get healthy increases and reimbursements is, in fact, met by 
the legislation that this House passed and is continuing to be 
negotiated in the conference committee.
  On the third major point of the gentleman's motion, he suggests that 
each and every rural provider increase in either the Senate bill or the 
House bill will be incorporated into the conference committee. The 
gentleman's objective is to make sure that the benefits are available 
in the rural areas. We all share that objective. But I would note that 
the House-passed bill itself included nearly $25 billion increases in 
payments to rural providers, which will help rural hospitals and 
physicians, among others, continue to provide care to rural Americans.
  So on the substance, I believe that the bill, as adopted by the 
House, meets the gentleman's objectives already. Secondly, again, a 
motion to instruct, while fun to debate, actually will have no impact 
on the negotiations themselves. I think we ought to let those 
negotiations continue and allow the conferees to come to an agreement, 
and I believe that they will, that this House can adopt and send to the 
President.
  Mr. Speaker, I reserve the balance of my time.
  Mr. KIND. Mr. Speaker, I yield 4 minutes to the gentleman from Ohio 
(Mr. Brown), a true champion of rural health care providers and rural 
health care patients.
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman from Wisconsin 
for yielding me this time, and I thank him for his good work advocating 
rural health care. I thank the gentleman from Pennsylvania (Mr. 
Greenwood) for his epiphany and his conversion in supporting the 
fallback provision, something he voted against in committee; and I hope 
that he will let the conference committee, particularly the Republican 
conferees of his party, know that he does, in fact, support the 
fallback provision. I hope that that will move the Medicare bill along 
perhaps better.
  I rise in support of the gentleman from Wisconsin's (Mr. Kind) motion 
to instruct on behalf of retirees living in rural America. Yes, we are 
continuing to push this body to take a stand on behalf of retirees 
living in rural America. And yes, we voted on the same motion 
yesterday. But anyone who thinks Congress always gets it right the 
first time just does not know much about Congress.
  Last week, during our first round of debate on this motion, my 
colleague argued against it. He expressed concern that we actually have 
to spend money to fulfill our commitment to rural retirees. Apparently, 
Congress can afford to cut $3 trillion from Federal tax revenues, 
overwhelmingly from the wealthiest, most privileged taxpayers, but 
cannot afford to help retirees in Chillicothe, Ohio, secure the same 
basic health care services as retirees in Columbus, Ohio.
  In his State of the Union address, President Bush called Medicare the 
binding commitment of a caring society. Does that commitment extend to 
rural America, or does it not? We have an obligation to pay health care 
providers adequately for the care they provide. We cannot pretend in 
this body that the financial challenges rural providers face are the 
same as those of urban providers. Ideally, the health care system would 
be thriving in rural America. Realistically, the health care sector is 
faltering in rural America.
  A disproportionate number of seniors live in rural areas. Medicare is 
the lifeblood of rural health care. That is just the way it is. We can 
either ignore the impact of inadequate Medicare financing, or we can do 
something about it. What we definitely should not do is, as this body 
does all too often, simply pay lip service to the problem. The House 
Medicare bill simultaneously increases and reduces reimbursement to 
rural hospitals. That is paying lip service to the problem.
  The Kind motion, the motion from the gentleman from Wisconsin, my 
friend, instructs conferees to move in one direction only, the right 
direction, and pay hospital rates that keep up with inflation. This 
motion instructs conferees to ensure there is a Federal fallback 
insurance program for areas of the country in which no private plan is 
available, something that we all think is essential.
  While this provision is particularly important for rural 
beneficiaries, it is also one of the most important for any Member of 
Congress who really is worried about wasting constituents' tax

[[Page 23203]]

dollars. It is basic economics. Absent a Federal fallback provision, 
which I am glad to see the gentleman from Pennsylvania (Mr. Greenwood) 
now supports, the private insurance industry will have a monopoly over 
Medicare prescription drug coverage. Do my colleagues think the cost of 
coverage to taxpayers will be higher or lower under those 
circumstances, when the insurance industry has a monopoly?
  In the 6 years that the Medicare+Choice HMO program has been in 
effect, has an HMO ever told Congress, hey, we do not need any more 
money, you are paying us enough? Year after year HMOs demand more money 
from taxpayers even though, in fact, we were already overpaying them. 
Do not take my word for it; ask the nonpartisan General Accounting 
Office.
  Medicare+Choice has inflated Medicare spending, draining precious tax 
dollars from the program. Making Medicare and making U.S. taxpayers 
fully beholden to HMOs is not going to improve the situation.
  So, Mr. Speaker, whether our goal is to refrain from wasting tax 
dollars or to fulfill the Nation's commitment to rural Medicare 
beneficiaries, or, I hope, both, I urge my fellow Members to support 
the Kind motion.
  Mr. GREENWOOD. Mr. Speaker, I yield myself 30 seconds to say that I 
am sure my friend from Ohio did not mean to misspeak with regard to my 
previous comments. What I said is that both the gentleman from 
Wisconsin (Mr. Kind) and Members of this side of the aisle want to make 
sure that there is a guarantee that our seniors in all regions have 
access to a plan. We think we do that adequately by the requirement 
that the Secretary provide incentives. The gentleman from Wisconsin 
(Mr. Kind) offers another way to do it, but we have the same goal.
  Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. 
Burgess).
  Mr. BURGESS. Mr. Speaker, I rise in opposition to the Kind motion.
  This motion would allow the Department of Health and Human Services 
to offer a Medicare prescription drug plan. In fact, there is no need 
for this type of government-run fallback because the House has already 
passed legislation that guarantees that every Medicare beneficiary will 
have a choice of at least two Medicare prescription drug plans and be 
able to fill their prescriptions at any pharmacy that they choose.
  The motion also instructs the conferees to recede to the Senate and 
remove the hospital market basket update adjustment contained in the 
House bill. I would note for my colleagues that we are not cutting 
hospital reimbursement.
  According to the Medicare Payment Advisory Commission, hospitals make 
a 10 percent profit for Medicare inpatient services and a 5 percent 
profit, on average, for all services provided to Medicare patients. The 
Medicare Payment Advisory Commission unanimously advised Congress to 
increase payments by 3 percent, which is what the House bill does.
  Finally, this motion would instruct conferees to accept every rural 
provider increase contained in both bills.
  Mr. Speaker, I would just add parenthetically that if our friends on 
the other side of the aisle were really concerned about rural providers 
and rural hospitals, they would encourage their colleagues in the other 
body to take up and pass the legislation that we passed last March, 
which was the Greenwood bill, H.R. 5, that limited noneconomic damages 
and medical liability lawsuits, and I believe that would return more 
money to the system.
  But this motion is unnecessary. The House has already recognized the 
need to ensure that rural Medicare providers are paid fairly. In fact, 
the House bill contains a $24.9 billion increase in payments to rural 
providers, which would help rural hospitals and physicians continue to 
provide care to rural Americans.
  I think the House bill strikes the right balance between providing a 
meaningful prescription drug benefit and helping ensure that providers, 
especially those in rural areas, have the incentives to continue to 
serve Medicare beneficiaries.
  I would also note that the conferees have reached agreement in a 
bipartisan, bicameral basis on a number of issues that would be 
reopened under this action. Do we really want to tell the conferees to 
just start over? I do not think so.
  Mr. Speaker, we should allow the conferees to work out the 
differences between both bills. There are significant differences, but 
they are working hard to do that. Both Chambers have made a significant 
commitment to helping rural providers. I have every confidence that 
they will develop a sound policy.
  Mr. KIND. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Oregon (Ms. Hooley), a true champion of seniors in rural America and in 
her congressional district.
  Ms. HOOLEY of Oregon. Mr. Speaker, I thank the gentleman from 
Wisconsin for yielding me this time. I rise today in strong support of 
the Kind motion to instruct conferees.
  Let me just say a couple of words about instructing conferees. I have 
heard that it does not make any difference. Well, in fact, it does make 
a difference. The conferees do pay attention when this body, the 
majority of this body, says it is important, please pay attention to 
rural health care, the reimbursement rate, and the fact that our 
hospitals are closing.
  Across Oregon, seniors tell me their top concern is the high cost of 
prescription drugs and the lack of coverage for these lifesaving 
medicines under the Medicare program. I believe it is time for us to 
pass a bill that will give relief to seniors, but that bill cannot 
neglect the needs of rural Medicare beneficiaries.
  Limited access to care is a growing problem for those who live in 
rural areas, particularly Medicare beneficiaries who may have to drive 
great distances to receive care. In Oregon, a recent study showed that 
55 percent of primary care physicians no longer accept Medicare 
patients or limit the services they provide to those patients. For many 
physicians in rural communities, their practices are dependent on 
Medicare patients, and yet they do not receive fair payments for their 
services. Rural providers are consistently hurt by lower reimbursement 
rates. This motion instructs conferees to include the best of the rural 
provisions in both the House and the Senate bills and would improve 
reimbursement rates for rural physicians.
  Rural hospitals are also being hit by disparities in Medicare 
payments. You have heard it before and I will say it again. In 25 
years, more than 470 rural hospitals have closed. Many are now in 
danger of being forced to shut their doors. Currently, hospitals 
receive full inflation payments for in-patient and outpatient services. 
The House-passed prescription drug bill would reduce hospital payment 
updates for the next 3 years, costing hospitals an estimated $12 
billion. If we thought we saw a lot of hospitals close in the last 25 
years, we are going to see a lot more close in the next few years if we 
do that.
  This cut would be devastating to our hospitals, particularly, again, 
to those in rural areas. If we are serious about modernizing the 
Medicare program, we must ensure that we fairly and adequately 
represent rural seniors.
  Mr. Speaker, I urge my colleagues to support this important motion to 
instruct conferees and assure that our rural Medicare beneficiaries 
receive the quality health care that they deserve.
  Mr. GREENWOOD. Mr. Speaker, I yield 4 minutes to the gentleman from 
New Jersey (Mr. Ferguson).
  Mr. FERGUSON. Mr. Speaker, I rise in opposition to the motion.
  This motion would allow the Department of Health and Human Services 
to offer a government-run prescription drug plan. There is no need for 
this type of government-run fallback because the House legislation that 
we passed earlier this year guarantees that Medicare beneficiaries will 
have a choice in at least two Medicare prescription drug plans. We do 
that by offering incentives to private sector providers to offer that 
coverage; and they, in turn, assume some of that risk. The standard 
subsidy would be 73 percent to a private provider, but that private

[[Page 23204]]

provider would assume the rest of that risk. This motion would have the 
government assume all of the risk; and, of course, what we know is when 
the government is assuming the risk, it is the American taxpayer who is 
the backstop; it is the American taxpayer who ends up really assuming 
the risk.
  A second point. We have talked about the rural provider provisions of 
these bills. This motion to instruct would have the conferees accept 
every rural provider increase contained in both bills. What we have 
heard is that they say only the best provisions, only the best rural 
provisions of each bill. Well, we know that really means every rural 
provision of both bills. My friend, the gentleman from Texas, before 
said, well, this would not actually increase, it would not bust the 
budget, it would not increase the cost. Well, clearly, accepting every 
rural provision from both of these bills would cost tens of billions of 
dollars more than is already provided.
  What we have heard from the sponsor of this motion and the gentleman 
from Texas is, well, we are not talking about increased spending; we 
are just talking about reprioritizing; we are talking about moving the 
money around a little bit. Well, what that really means, put in 
English, that means we are going to increase the spending for the rural 
providers, we are going to increase that money, that package to rural 
providers; but we are not going to change the total amount of spending. 
We are going to stay at the same price tag. Where is the money going to 
come from?

                              {time}  1915

  It is going to come from the drug benefit to everybody else. So 
either you are going to bust the budget and bust the price tag on this 
and jack up government spending, or you are going to take money away 
from the prescription drug benefit which is at the heart of this 
legislation.
  This motion is unnecessary. This House has already passed and already 
recognized the need to ensure that rural Medicare providers are paid 
fairly. The bill that this House passed earlier this year contains 
$24.9 billion, almost $25 billion more, an increase in payments to 
rural providers, which will help rural hospitals and physicians, among 
others, continue to provide care to rural Americans.
  This motion would mean that we have to reallocate funds away from 
beneficiaries and toward providers. I do not support that. I think the 
House bill that we passed earlier this year strikes the right balance 
between providing a meaningful prescription drug benefit and helping to 
ensure that providers, especially those in rural areas, continue to 
serve Medicare beneficiaries.
  Finally, let me just say that, again, as I know some of my colleagues 
have mentioned, the House and the Senate conferees have reached 
agreement on a number of issues in a bipartisan, bicameral way on a 
number of issues that would be reopened under this motion. We are 
running out of time. Our session, this session, is running out of time. 
We want to finish this bill. We want to finish it this year. Do we 
really want to go back and tell our conferees to start over from 
scratch? I do not want to do that.
  Mr. Speaker, we should allow the conferees to work out the 
differences between these bills since both Chambers have made a 
significant commitment to helping rural providers, and I have every 
confidence that, in the end, they are going to develop a sound policy.
  Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
  I am sure the gentleman from New Jersey must realize that the 
conference and negotiations are ongoing and that these very decisions 
have yet to be made. I am surprised by the rhetoric on the other side 
that they do not recognize that 39 Republican Senators recently voted 
for a Medicare prescription drug fallback provision. They had to have 
known what they were doing on that vote.
  Mr. Speaker, I yield 6 minutes to the gentleman from Alabama (Mr. 
Davis), one of the youngest and brightest minds of the United States 
Congress.
  Mr. DAVIS of Alabama. Mr. Speaker, I thank the gentleman from 
Wisconsin for his compliments and for yielding time to me today.
  I want to begin with the comments of my good friend from New Jersey 
because I think that they reflect a fundamental divide on how our two 
parties look at this issue. The gentleman from New Jersey is 100 
percent correct when he says that the Medicare plan being contemplated 
would theoretically allow a choice for seniors. He is 100 percent 
correct when he says that seniors would have the ability to elect 
between a private managed care plan and Medicare. He is 100 percent 
correct about the theory and about what is written in this plan. But I 
come from the Seventh District of Alabama where a significant number of 
our seniors live in a world very different from a lot of the people who 
sit in this body. A lot of the seniors in my district live in a space 
where they are illiterate. They live in a space where they are not able 
to interpret the difference between a plan A and a plan B. They have 
trouble navigating every single aspect of their daily lives. Some of 
them cannot even fully understand their own prescriptions, but yet it 
is true they will have a theoretical choice as to which plan is better 
for their interests.
  One thing that I would hope that this whole body would agree on, Mr. 
Speaker, is that we do not need to provide a benefit that some people 
in this society will enjoy but that other people will not enjoy because 
of their station and place in life. I care, as I know my colleagues on 
the other side of the aisle care deeply, about the seniors who do not 
have the education, who do not have the background to make the kinds of 
choices that they will need to make. The problem with this plan, unless 
it is fixed and made better by the Kind motion, is that it will force 
our seniors to have to make a fundamental choice, and if they choose 
wrong, they could find themselves without adequate coverage.
  There is a deeper problem. Only 19 percent of the seniors in rural 
America live in an area that has access to a ready managed care plan; 
less than 20 percent. When the seniors who are listening tonight or the 
seniors who follow this debate hear that we are passing a prescription 
drug benefit, they imagine that it is something that will be executed, 
they imagine that it is something that can be implemented in a way that 
favors and is fair to them. They do not know about the maze of choice 
that is in front of them. We can talk all we want in a theoretical 
sense about the values of choice in our society. We can talk all we 
want in a theoretical sense about letting our seniors and letting the 
market combine to make good, efficient choices. This is not always an 
efficient world.
  There is no dispute in this Chamber that after the next several 
years, a significant number of seniors would potentially be left out of 
this plan. That is something that the Kind motion would fix. That may 
sound to some of my colleagues on the other side of the aisle like 
paternalism, but a lot of the seniors who live in my district do not 
want to have to navigate their own way for this set of choices. They do 
not see it as paternalism, they see it as government lending a helping 
hand to them.
  This Medicare program that we have heard denounced tonight as being a 
``big government program,'' that we have heard denounced tonight as 
being another example of ``rampant government,'' it happens to be an 
important part of the social safety net that we have in this country. 
The question is, do we tighten that net and make it stronger or do we 
allow significant gaps to form in that net?
  As I moved around my rural district during the month of August, so 
many seniors said to me, Mr. Davis, I would rather have no plan than a 
plan that I don't understand and a plan that I won't benefit from. So 
many seniors said, I would rather see you all in the ivory towers in 
Washington, D.C., do nothing than do something that leaves me worse 
off. Those are the people that I want to speak to tonight, and those 
are the people I want to speak for tonight because we have to make sure

[[Page 23205]]

that this is a plan that would be available to all of the seniors in 
this country who need it.
  We can talk all we want about appropriating more money in the House 
bill for rural hospitals. We still do not give enough. The Senate does 
far better. Until we address the root of these unfair choices, we will 
leave our rural seniors worse off. So I support this motion tonight. I 
will close on this basic point. Most of us in our campaigns in 2002 
endorsed the idea of a prescription drug benefit. Most of us go back to 
our districts and we brag about the fact that we support it. A lot of 
our friends and colleagues on the other side of the aisle are touting 
that fact in their campaign ads. A lot of our seniors remember just 15 
years ago when this body purported to pass a catastrophic health 
benefit plan that did everything but provide adequate coverage, that 
did everything but improve their conditions in life. It may be that 
this part of the session is running to a close, it may be that the 
clock is ticking, but the nature of what the people elect us to do is 
to make hard choices. The nature of what the people elect us to do is 
to make adequate choices. And, yes, sometimes as paternalistic as our 
friends may think it is, they sometimes elect us to make choices that 
will affect their lives.
  So I urge my colleagues on both sides of the aisle to vote for this 
motion to close an unfortunate, but critical, gap that exists between 
our rural seniors and urban seniors.
  Mr. GREENWOOD. Mr. Speaker, I yield myself such time as I may 
consume.
  I would compliment the speaker on his argument and suggest, though, 
that his constituents must be able to make choices, and thoughtful 
choices, because they chose him. And I suspect that if they are 
sophisticated enough to choose the previous speaker, they can probably 
choose themselves a good Medicare plan as well.
  Mr. Speaker, I yield 5 minutes to the gentleman from Oregon (Mr. 
Walden).
  Mr. WALDEN of Oregon. Mr. Speaker, I rise today representing the 
second largest district geographically in the Nation in the House, 
other than the five States that are only single-Member States, so I 
know something about rural health care. I spent 5 years on a community 
hospital board. I am still a private employer, so I see that side of 
health insurance. My in-laws are retired and face this battle about 
lack of medical prescription drug coverage under Medicare. My parents 
battled that until their death. They paid for their own prescription 
drugs out of their own pocket. The issue that we are trying to resolve 
here in this Congress is for the first time in 40 years expanding 
Medicare so that seniors can have access to affordable prescription 
drugs. It is not easy to do. It is not simple to do. It is very 
difficult to do, to get it right. But I think we are very, very close 
in getting it right this time.
  We have passed the biggest rural health care package probably in the 
history of this House. We are adding $25 billion in additional rural 
health care for the country in addition to what we already spend, $25 
billion over 10 years, for some very good provisions. In the committee 
I supported increasing the access to rural home health care, a 5 
percent increase in payments. I have supported efforts to add 
additional funding for physicians to locate in remote and underserved 
areas in rural communities. In my State, though, while certainly these 
are all issues, the biggest issue I hear from medical providers is the 
runaway cost of malpractice insurance because of the claims and the 
litigation. That is driving specialists out of their specialties. I was 
in a community in my district this summer, a fellow who delivered 
babies says he is getting out of the GYN part of OB-GYN. They are not 
going to be dealing with that. We had five doctors deliver babies in 
one county in my district, and they are down to two, and those two are 
having their premiums subsidized now by the local hospital. We have 
passed medical malpractice reform in this House to try and make sure 
that people have access to their doctors. It is time for the other body 
to act. I know many of my colleagues on the other side tonight could 
not support us on that. That is a problem in rural health care delivery 
as well that needs to be addressed.
  But the crazy thing to me tonight is to hear that somehow we are not 
going to help seniors with this bill. We are spending $400 billion over 
10 years to provide a prescription drug benefit and additional help to 
our hospitals and our physicians in our rural communities, $400 
billion. Any dollar you take to spend somewhere other than prescription 
drugs comes out of our ability to help seniors most in need to provide 
prescription drugs. And so I think that is important to remember here. 
Those of us who have kids, they want everything in Toys R Us, but you 
cannot have everything in Toys R Us. You have to make choices. What we 
have chosen is to put the biggest benefit possible into those seniors 
most in need. That is why a senior, low-income, $12,000 a year, will 
have their prescription drugs paid for other than a very small 
copayment. They will not have a premium. They will not have a 
deductible. They are covered. But if you are a Ross Perot and making 
$65,000 or more a year, that benefit phases out. It is an irony to me 
to hear the other side talk about tax cuts for the rich, but they want 
free pharmaceuticals for the rich. I think with the limited resources 
we have, it ought to go to the poor, those in need.
  Finally, this is not me, this is a Congressional Budget Office report 
that says under both acts, the House and the Senate bill, CBO estimates 
that all Medicare beneficiaries would have access to prescription drug 
coverage. This report goes on to say that in the House bill, CBO, the 
Congressional Budget Office, nonpartisan, independent, estimates that 
about 5 percent of the part D participants, that would be under this 
bill, would be enrolled in reduced-risk plans in 2006 with that share 
declining gradually in succeeding years.
  We have heard a lot of political rhetoric tonight. CBO cuts to the 
chase. Both plans provide guaranteed access to prescription drugs for 
America's senior citizens. Both plans do that, the House and the 
Senate. We do it differently. We think on our side we do it more 
effectively, because in 23 years, if we do not change how Medicare 
operates, it goes completely in the red. I do not think Congress is 
going to let it go broke. The point is here, we are trying to create a 
new benefit with a new idea that says we can use market forces to drive 
down the cost of drugs so we can provide better care to the poorest 
seniors in America. That is what our bill does. That is what is being 
negotiated in a bipartisan, bicameral effort as we speak. This is not 
the time to upend that, nor is it the time to politicize it and end up 
another year going by without seniors having access to affordable 
prescription drugs.
  Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
  Just quickly in response to the previous speaker, no one is trying to 
politicize this. We are just trying to work to produce the best product 
at the end of the day, especially for many of our rural seniors whom we 
represent in this body.
  Mr. Speaker, I yield 5 minutes to the gentleman from Texas (Mr. 
Sandlin), the foremost expert on the impact medical malpractice has on 
health care costs in this Chamber.

                              {time}  1930

  Mr. SANDLIN. Mr. Speaker, it is really pretty simple. Who is going to 
stand up for America's seniors? Who is going to stand up for rural 
health care? Who in this body will stand up for rural patients and 
rural doctors and rural hospitals over the HMOs? The answer is pretty 
clear.
  Mr. Speaker, I join my colleagues in asking to instruct the Medicare 
prescription drug conferees to remember our Nation's 9.3 million rural 
Medicare beneficiaries and our rural hospitals and our rural doctors 
when they continue their critical deliberations.
  The way this bill currently stands, it is nothing more, Mr. Speaker, 
than the old bait and switch. And everybody here knows that the 
Republican leadership has used smoke and mirrors to trick our seniors, 
to trick my seniors in east Texas into thinking they are

[[Page 23206]]

getting a Medicare prescription drug plan while in reality forcing them 
to seek medication from private insurance companies and HMOs that will, 
number one, set the prices, and, number two, set the benefits. What a 
racket they have.
  This is not any sort of Medicare prescription drug plan. What a 
misnomer. This is a plan to push our seniors, to forcefully shove them 
and their money into the HMOs.
  Now, this official HMO enrichment plan that is pushed by the other 
side does not even pretend to address the needs of rural America. Mr. 
Speaker, as you know, and as has been mentioned, over 80 percent of 
rural Medicare beneficiaries today live in an area that private 
insurance companies do not and will not serve. And in my district it is 
even worse than that.
  Mr. Speaker, I challenge my friends on the other side of the aisle to 
name me one insurance company in the United States of America, one, 
that wants to take part in this program. I would ask that a blank be 
left in the Record at this point, that a line be drawn right now so 
that our friends can insert in that blank the name of one insurance 
company, one in America. There is not one. They cannot fill it in, and 
the Record will remain blank.
  What has history shown us about what happens when insurance 
companies, private insurance companies, get involved in Medicare? 
Medicare+Choice, the great managed care experiment of our seniors, 
should have been named Medicare Minus Choice. After all, it has been a 
disaster.
  Between 1998 and 2003, the number of Medicare+Choice plans dropped by 
more than half. It is not available. In Texas, over 313,000 Medicare 
Plus seniors were dropped by insurance companies since 1999.
  Rural seniors simply do not have the same access to private insurance 
plans as our urban seniors. Knowing this, we have to include a 
government fallback option for areas served by less than two plans, 
because otherwise the plan is meaningless, and our friends know it.
  Mr. Speaker, we also need to eliminate the premium support provisions 
in H.R. 1 that are scheduled to take place in 2010. It is 
unconscionable to market this prescription drug plan as equitable and 
universal when those folks that stay in traditional fee-for-service 
Medicare will see significant increases in their premiums under this 
so-called competition program. It is just outrageous.
  What about our rural hospitals? What shape are they in? Mr. Speaker, 
470 hospitals have closed in the past 25 years, and overall Medicare 
margins have shrunk every year since 1998, with 57 percent of hospitals 
that treat Medicare patients losing money. And we are going to cure 
that by taking more money away? That is our cure? That is our plan?
  Under current law hospitals are slated to receive full inflation 
payments for inpatient and outpatient services. The House bill that is 
being proposed by our friends on the other side would reduce hospital 
payment updates in 2004, reduce hospital payment updates in 2005, 
reduce hospital payment updates in 2006. The reduction would cost 
hospitals an estimated $12 billion. Well, in east Texas $12 billion is 
a lot of money, and those are cuts to our rural hospitals.
  Mr. Speaker, it is a matter of priorities. I choose to stand with 
America's seniors. I choose to stand with our rural citizens. I choose 
to stand with our hospitals and our doctors in making sure that we have 
access to affordable medical care. The HMOs seem to do just fine.
  Now, I find it interesting, too, in closing, and I am not here to 
talk about malpractice, we could go on all day about malpractice, but 
it is interesting that today our friends are standing up for HMOs. And 
a few days ago in the medical malpractice debate they were standing up 
for insurance carriers.
  It seems pretty clear who we stand up for in this House, especially 
on the other side of the aisle. They stood up just the other day for 
malpractice carriers against hospitals, malpractice carriers against 
doctors, malpractice carriers against our patients, malpractice 
carriers against everyone. The malpractice reform was just a trick, 
because while we passed malpractice reform, we capped what insurance 
companies paid. We capped what they had to give to people. We capped 
the coverage needed by doctors. But we did not require in any respect 
whatsoever insurance carriers to bring down the premiums on our 
doctors. It is not there.
  And in their model State, California, just in the last few weeks they 
have record increases, record requests for increases by the insurance 
companies who are protected by caps. Those caps do not work. And in 
States that have caps, they have premiums higher than in States that do 
not have caps.
  It is just a sell-out to the insurance companies. It is a sell-out to 
the carriers on behalf of the insurance companies, against the doctors, 
against the patients, against the hospitals.
  Mr. Speaker, it seems funny to me we always want to save money in 
this body and save money in health care by taking money out of the 
public and giving it to insurance carriers. That is a funny way that we 
save money, and it is simply an example of a lack of priorities.
  Let us stand up for health care. The HMOs, the insurance carriers are 
doing just fine without our help.
  Mr. GREENWOOD. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I want to thank the gentleman from Wisconsin (Mr. Kind) 
for offering the motion to instruct and for the temperate way in which 
he conducted his debate on the substance, as is his style. And the 
debate went pretty well like that until the previous speaker kind of 
laid down some political gauntlets. And I cannot resist the opportunity 
to respond.
  The gentleman from Texas (Mr. Sandlin) asked the question repeatedly, 
who will stand up for seniors, and who will not stand up for seniors. 
The historical record shows that Medicare was created in 1965, and in 
the 30 years that followed, the United States Congress failed 
consistently to get anywhere on the provision of a prescription drug 
benefit for Medicare beneficiaries.
  As the previous speaker and earlier speaker said, there was an 
attempt 15 years ago when the Democrats controlled the House under 
Chairman Rostenkowski. It was immediately repealed. It was a dismal, 
dismal failure, a great disappointment to the seniors who had hoped for 
something that would be useful for them.
  This Congress, where we happen to have a Republican majority in the 
House and a Republican majority in the Senate and a Republican in the 
White House, we have for the first time in the history of the United 
States brought ourselves to the point where we are poised to provide 
the senior citizens of this country a prescription drug benefit, and 
they need it.
  We have all received letters over and over again from seniors who are 
forlorn and despairing over the fact that they are suffering from a 
variety of illnesses. They go to the doctor, they get a prescription, 
and they cannot fill that prescription. I remember a poignant letter 
from one of my constituents, an elderly woman from Bensalem, who said, 
I have eight prescriptions. I can afford to buy the ones that will keep 
me alive. I just cannot afford to buy the ones that will make my life 
worth living, and that letter has remained in my mind ever since, and 
it had driven me to work as hard as I can with colleagues interested in 
accomplishing this goal on both sides of the aisle to get a 
prescription drug benefit done.
  It is hard. The reason it had not been done for 30 years is because 
it is so difficult, because it is so complex, to figure out how to do 
this in a way that is affordable, that maximizes a benefit for the very 
poor, that provides something worth happening for the middle class, 
asks a reasonable contribution from them, still does not create a 
disincentive for employers to continue to provide a prescription 
benefit for their retirees.

[[Page 23207]]

  To deal with all of the rural issues, all of the provider issues is 
extraordinarily complicated and very difficult to do. If this body were 
100 percent Republicans, it would be hard to do. If it were 100 percent 
Democrats, it would be hard to do because it is tough policy.
  I think we are on the verge of being there. Our negotiators in the 
conference are working with the staff day and night to get us there. I 
believe that they will succeed. I again respect the gentleman from 
Wisconsin because he is bipartisan by nature. We ought to keep this 
debate bipartisan, consistently. That is the only way we will succeed 
in doing this. There are not enough Democrats to pass a Democratic 
plan. There are not enough Republicans to give the seniors this benefit 
with Republican votes only. We need to have a bipartisan bill. We will 
have a bipartisan bill.
  On the subject of medical malpractice, the Democrats sat down year 
after year while the physicians of this country are going out of the 
profession, and we passed a bill in this House. It was a good passed 
bill. We did it in a bipartisan fashion, and if the Senate would come 
up with anything at all, we could go to conference on that bill, and it 
would also bring down the costs of medicine in health care in the 
United States.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Cole). The gentleman from Wisconsin's 
time has expired.
  Mr. KIND. Mr. Speaker, I would ask passage of this motion.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to instruct.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct 
offered by the gentleman from Wisconsin (Mr. Kind).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. KIND. 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 motion will be postponed.

                          ____________________