[Congressional Record (Bound Edition), Volume 149 (2003), Part 17]
[House]
[Pages 23264-23269]
[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. SANDLIN. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

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

[[Page 23265]]

       (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. SANDLIN (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 Texas?
  There was no objection.
  The SPEAKER pro tempore. Under clause 7 of rule XXII, the gentleman 
from Texas (Mr. Sandlin) and the gentleman from Michigan (Mr. Camp) 
each will control 30 minutes.
  The Chair recognizes the gentleman from Texas (Mr. Sandlin).
  Mr. SANDLIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the way this bill currently stands is nothing more than 
a misrepresentation and a bait and switch. The leadership has used 
smoke and mirrors to trick our seniors into thinking that they are 
getting a Medicare prescription drug plan and into thinking that our 
hospitals will be adequately reimbursed while, in reality, we are 
forcing our seniors to seek medication from private insurance companies 
and HMOs that will set the price and set the benefits and we are taking 
money away from our hospitals.
  Mr. Speaker, I rise to offer this motion to instruct the conferees on 
H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003 
and ask to remember our Nation's 9.3 million rural Medicare 
beneficiaries as they continue their critical deliberations. The 
legislation that I speak of today, as I mentioned, is much more than 
simply a drug bill, it is a testament to our commitment to quality-of-
life issues for our Nation's seniors in our communities. Modern health 
care today requires a comprehensive system that depends on access to 
needed prescription drugs, certainly. It depends on physician care and 
hospital treatment. All of those needs must be addressed. When access 
is denied, treatment fails and people suffer. As H.R. 1 stands today, 
our rural communities all across Texas and all across the Nation will 
suffer.
  Everyone here knows that our Nation's rural hospitals are desperately 
in need of assistance. Over the past 25 years, Mr. Speaker, more than 
470 hospitals across America have closed. That is unacceptable. That 
impacts primarily rural America. This is very devastating for rural 
citizens. Due to the fact that rural seniors have a lack of access to 
preventive care, that causes them to have higher incidences of chronic 
illnesses like heart disease, arthritis and things of that nature. 
Medicare is a significant source of payment for rural health care 
providers because of the higher proportion of seniors in rural areas. 
We must provide the strongest reimbursement aid possible by taking the 
best of the House and the best of the Senate bills. The House bill's 
rural assistance provisions contradict each other by offering funding 
through one avenue and slashing it through the market basket. This 
measure, as proposed by the House, denies hospitals $12 billion of 
desperately needed assistance, nearly $9 billion of which would go to 
rural hospitals, the hospitals with the most challenge. In my home 
State of Texas, over $420 million will be lost. That is all in the name 
of fiscal responsibility. That is a false savings, Mr. Speaker, and it 
is a savings that endangers the lives of Americans, especially in rural 
America. This cost-saving measure certainly will not save hospitals but 
it will cost them and their patients dearly.

                              {time}  1315

  How much do we as a Congress expect our hospitals to endure? Our 
rural hospitals are barely scraping by on what Medicare and Medicaid 
already paid. In the name of patient safety, we ordered them to comply 
with Federal mandate after Federal mandate from EMTALA to HIPPA but 
then failed to grant the funding to ensure quality of care is provided. 
Let me tell the Members here no one will expect care to be provided if 
these hospitals close. It just will not be availability, and with that 
elimination of care will follow a massive elimination of jobs critical 
to our local economies and endangering our local families.
  Rural seniors in hospitals are getting a raw deal here, Mr. Speaker. 
We all know that. They are not looking for anything extra. They are 
just looking for something equitable, something fair. Join with me and 
do at least that much today for our hospitals, for our doctors, and for 
our rural patients in rural communities.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
  The Sandlin motion to instruct conferees is essentially the same as 
the last two motions to instruct that have been defeated by the House 
of Representatives. This motion, like the others, asks us to accept the 
Senate's position of a government-run prescription delivery drug system 
and structure. It would provide unprecedented and unnecessary 
inflationary increases to providers and would undo the bicameral 
decisions that the conferees have already resolved. Roughly a third of 
the bill in question, H.R. 1, has been resolved by the Medicare 
conference. This motion would reopen those issues that have already 
been resolved in a bipartisan, bicameral fashion. This is the third 
Congress that has attempted to enact a prescription drug benefit in 
Medicare, and this motion would ensure that a prescription drug 
Medicare

[[Page 23266]]

bill never reaches the President's desk; and I urge a defeat of this 
motion.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I appreciate the gentleman's comments. I 
yield such time as he may consume to the gentleman from Texas (Mr. 
Lampson).
  Mr. LAMPSON. Mr. Speaker, I thank the gentleman from Texas for 
yielding me this time.
  It is nice to be able to join on an issue as important as this and 
one that does not deal with redistricting in Texas.
  I do rise today in support of the Sandlin motion to instruct on 
Medicare prescription drugs. This motion carries with it the efficacy 
of protecting seniors and health care providers in rural areas. It was 
not too many years before I came up here to Congress that I was serving 
on a board called the Area Agency on Aging. It was a board where we 
spent a great deal of our effort with senior citizens and the needs 
that they had. Ultimately, they selected me to be a delegate to the 
1995 White House Conference on Aging, and the goals that came from that 
meeting of several thousand people gathered across the country had to 
do with allowing seniors to live in independence and dignity, to make 
sure they continued to have access to the programs that made such a 
significant difference in their lives, Medicare and Social Security. 
Since Medicare was enacted in 1965, it has truly provided health care 
security to millions of America's seniors and people with disabilities.
  Medicare is the binding commitment of a society to our most 
vulnerable citizens and a commitment that America must always keep. One 
segment of society that is neglected time and time again in Washington 
is seniors living in rural communities, and I come here today to tell 
the conferees that we have a real commitment to rural seniors.
  Mr. Speaker, I represent a fairly diverse district. It consists both 
of urban and rural areas, and therefore I have witnessed the 
degradation of care for my constituents living in these rural years. 
This Congress has a responsibility to represent all people throughout 
the country and to provide guaranteed prescription coverage through a 
Medicare fallback option in areas where private drug plans are not 
available. We must ensure that cuts in payments to hospitals that were 
included in the majority-offered House bill which adversely affect 
hospitals in rural areas are not included in the conference report. 
These cuts will serve to further undermine the ability of rural 
hospitals and health care providers to ensure that adequate coverage is 
offered in rural areas.
  I cannot in good conscience allow this House to send to the 
conference committee a bill which would leave our Nation's rural areas 
in continued peril. I have pledged with my colleagues to work to 
provide adequate health care to all Americans; and, frankly, this bill 
as it currently exists imperils citizens living in rural areas.
  HMOs and other private health plans have had a very poor record of 
serving seniors living in rural areas. Indeed, according to the 
government's own advisory board, the Medicare Payment Advisory 
Commission, only 19 percent of rural Medicare beneficiaries have the 
option of enrolling in a Medicare managed care plan in 2003. How can we 
as a Congress participate in passing such a broad and affecting piece 
of legislation without ensuring that the disparity between rural and 
urban areas is abolished?
  So the Sandlin motion to instruct will help to ensure that we do not 
leave our rural citizens behind. I support this motion to instruct, and 
I call on my colleagues here to join us and do exactly the same thing.
  Mr. CAMP. Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, one of the key problems with the House GOP Medicare 
prescription bill is it fails to meet the needs of the one-fourth of 
Medicare beneficiaries who live in rural areas. And someone who knows 
that very well is the gentleman from Texas (Mr. Stenholm), my good 
friend and colleague and a real champion of health care, especially out 
in west Texas, and a very respected Member of the House.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Texas (Mr. Stenholm).
  Mr. STENHOLM. Mr. Speaker, I thank the gentleman from Texas for 
yielding me this time, and I thank him for bringing again this motion 
to instruct to the floor of the House.
  Some of our colleagues are asking why do this again. Listen carefully 
to the rationale and the reasons of why we are doing it again. It is 
critical to rural districts all over the United States. This is a 
matter of life and death for 27 hospitals in my district. The issue is 
fairness, and this is the third time that I have had to correct my 
friends on the other side of the aisle for the red-herring approach 
that they are talking about. No one is advocating a government-run 
program unless by that they are suggesting that they are not in favor 
of continuing Medicare. If they are in favor of letting Medicare go, 
then they are correct; but I do not think the majority of the House is 
talking about that.
  Certainty we are not. And when they talk about budget issues, make it 
very clear, we are proposing to live within the budgeted amount of $400 
billion and not one penny more, period. But what we are saying is that 
when we are looking at rural hospitals in particular, there are some 
issues that the conferees need to listen to, and yes, one can make the 
argument this is procedural, and I understand that, but when that 
conference bill comes back on the floor and we are going to have to 
vote on this issue, I am asking my colleagues, for example, in Kansas 
1, 37 hospitals will lose $21,682,000; Georgia 11, six hospitals, $17 
million; Texas 19, 18 hospitals, $39 million; Texas 23, 11 hospitals, 
$11 million; Indiana 8, 13 hospitals, $28 million; North Carolina 8, 12 
hospitals, $43 million; Minnesota 1, 15 hospitals, $45 million.
  I can go on and on on this list. This is money that would not be 
coming if the conferees come back and say market basket is not 
applicable. And one can say, yes, this is a cut from a rate of 
increase; but that is precisely what we are talking about in rural 
areas. We have been cut and cut and cut to the point we cannot take any 
more, and we have got to have some rationale and reasoning, some logic, 
now in saying to rural areas, you must be treated fairly; and that is 
what the best of both the House and the Senate bill does.
  We are arguing about a philosophical direction, and with all due 
respect, I do not agree with the direction that the majority wish to 
take the conference, and I think a majority of this body does not. I 
really do. That is why we will continue to come on this floor and 
suggest to our colleagues who continue to vote against this motion to 
instruct, take a good look, listen to their hospitals back home, listen 
to what is being proposed and see how they will vote when that 
conference committee completes its work and brings it back to the floor 
of the House.
  And everyone now I hope understands that the conference is in trouble 
because we have some irreconcilable forces. It is kind of like the 
Texas redistricting plan. We have got some folks not willing to give. 
And when we have that, then we run the risk of doing nothing, and no 
one wants to come out of this Congress by doing nothing. We have a 
tremendous need of dealing with the cost of medicine, and there are 
ways that we can do some great things to reducing the amount of cost of 
health care to our senior citizens and to others, middle-income 
America. But pay particular attention, and this is done for the benefit 
of our colleagues, the conferees having to recognize that we have got 
to come to an agreement with the Senate or otherwise nothing will 
happen.
  Again, I repeat, this is not a budget issue. We are just saying we 
have a recommendation to the conferees of how they spend the money. We 
are not talking about spending any more. And if you believe your 
hospitals can do with less, continue to vote as you have been voting. 
Do not instruct the conferees. But you had better start talking to

[[Page 23267]]

them because if the conferees insist on doing it the way they insist on 
doing it, we risk the whole bill; and nobody wants to see that done.
  Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
  Let me just say, Mr. Speaker, that under the Senate approach to the 
Medicare prescription drug bill, one third of the beneficiaries will be 
in a full government run fallback plan; and if the government is at 
risk, the plan will have little incentive to control costs and would 
simply process claims. And that is why the nonpartisan Congressional 
Budget Office has estimated that the Senate provisions would lead to 
higher prices for beneficiaries and taxpayers and result in over $8 
billion in higher costs; and this would, I think, be an unacceptable 
giveaway. The Congressional Budget Office, CBO, also estimates fewer 
plans and therefore fewer choices for seniors under the Senate 
proposal, and that would be because the full-risk plans would be 
hesitant to compete against the government contractors.
  And let me just say that the market basket adjustment is just a part 
of the picture in terms of what is being done for providers in rural 
America; and when we add in together the market basket update, the 
standardized amounts, the labor share, the Medicare disproportionate-
share payment, we are seeing increases over current law in rural areas; 
and most of those numbers do not include the increases for critical 
access hospitals which are an important part of health care providing 
in rural America.
  So I would still urge my colleagues to defeat this motion to 
instruct. We have a good process moving, and let us keep the process 
going forward.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from the State of Tennessee (Mr. Tanner), a member of the 
Committee on Ways and Means.
  Mr. TANNER. Mr. Speaker, the $12 billion that CBO says the House bill 
cuts from hospitals, $9 billion of that comes from hospitals serving 
rural communities. As I said the other day when we were talking about 
this approach, all the medical technology in the world is of no use to 
me or anyone else if it is not accessible. Over 47 percent of the 134 
acute care hospitals in Tennessee are losing money. A lot of these 
hospitals are in rural areas that simply will not be able to remain 
open with the market basket reduction, with the way this bill is 
drafted, and with the demands that are being placed on them. Literally, 
if one believes that accessibility to medical technology is as 
important as the technology itself, and I cannot imagine anybody who 
would argue that it is not, if they cannot get to a doctor or a 
hospital with a heart attack in time, they are going to die. So it 
really does not make sense to say this medical technology is important 
in and of itself. There also has to be this accessibility issue to be 
addressed, and this bill is not addressing this accessibility issue.

                              {time}  1330

  That is why this motion to instruct is important.
  But even if you do not believe that accessibility is a real goal that 
we ought to strive for in America, you have got the equity argument 
that the gentleman from Texas (Mr. Stenholm) made. Even if you say we 
know it may not be fair, but that is just the way it is, what about all 
of the jobs that are going be lost, jobs of dedicated medical 
professionals that want to help people in rural America? They live 
there voluntarily, they devote their productive years to curing and 
helping people who are sick, and they go out the window as well when 
these hospitals close.
  I would just implore the House to look at the system of health care 
delivery in our country and realize that this approach that the 
majority is taking is shortchanging hospitals, rural hospitals, and, 
more importantly, sick people all across this country, but particularly 
in rural areas, and is that the kind of country we want to have? Is 
that the kind of country we can be proud of? I think not.
  Mr. Speaker, I would urge that this motion to instruct be approved 
whenever we have a vote on it.
  Mr. CAMP. Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Arkansas (Mr. Ross), one of the people that really has a 
good knowledge in the Congress about the issue of prescription drugs 
due to the fact that he owns a pharmacy.
  Mr. ROSS. Mr. Speaker, I thank the gentleman for yielding me time and 
for offering up this motion to instruct conferees on the Medicare 
prescription drug bill.
  Mr. Speaker, let me tell you that, as the owner of a small-town 
family pharmacy, one of the things that I see way too often is seniors 
who walk through the doors of our pharmacy who cannot afford their 
medicine or who cannot afford to take it properly.
  I live in a small town, a town that lost its hospital back in 1995. 
Our folks now go 16 miles down the road to the hospital in Hope, 
Arkansas. Living in a small town, I see so many seniors that end up 16 
miles down the road in the hospital running up a $25,000 or $50,000 
Medicare bill, or requiring $250,000 worth of kidney dialysis, or 
having a $50,000 leg amputation, simply because they cannot afford 
their medicine or cannot afford to take it properly. This is America, 
and we can do better than that by our seniors, America's greatest 
generation.
  There has been a lot of talk in Washington about trying to help our 
seniors with the high cost of prescription drugs, but that is all we 
have seen and that is all we have gotten, has been a lot of talk.
  When I came to Congress in 2001, I thought if there was one issue 
that would not be partisan, that would not divide us, but, rather, 
would be a senior issue, this is not about Democrats or Republicans, or 
at least it ought not be, it ought to be about our seniors, and I 
thought if there was one issue that could bring us together, it would 
be to do right by our seniors. But, instead, what we have had offered 
up by the Republican leadership is a false hope and a false promise, 
nothing more than Medicare fraud for our seniors.
  There are several problems with this so-called Medicare prescription 
drug bill. Number one, the fund that they want to cut funding for to 
fund the prescription drug coverage for our seniors, the Republicans 
want to cut funding to rural hospitals to the tune of $12 billion. We 
have lost 470 rural hospitals in America in the last 25 years. As I 
mentioned earlier, we lost the hospital in my hometown of Prescott, 
Arkansas, in 1995, and I can tell you that is something I do not wish 
on anyone. It is wrong to try and fund this Medicare prescription drug 
benefit by shutting down rural hospitals.
  Another problem with the bill is this bill is supposed to be about 
helping our seniors. The problem is, it is not a seniors' bill, it is a 
bill that has been written by the big drug manufacturers.
  The drug manufacturers have more lobbyists in Washington, D.C., than 
we have Members of Congress in the House and Senate combined, and their 
fingerprints are all over this bill. The Republican leadership had the 
nerve to put language in this bill that says that the Federal 
Government shall be prohibited from negotiating with the big drug 
manufacturers to bring down the high cost of medicine. That is in the 
bill.
  Another problem with the bill is privatizing the Medicare 
prescription drug benefit. There is a very good reason why they want to 
do this. You hear about how drugs are cheaper in other countries. They 
are. It is because America is the only industrialized nation in the 
world where people go without health insurance. That does not happen 
anywhere else in the industrialized world.
  There are 41 million people in America without health insurance 
today; 8.5 million are children. Who are the rest of them? It is not 
the folks that do not want to work. If you do not want to work, you get 
on welfare and you get Medicaid.
  We are talking about the people that are trying to do right and stay 
off welfare, that are working the jobs with no benefits. But in other 
countries that does not happen. In other countries the

[[Page 23268]]

government says to the big drug companies, you give us a discount if 
you want your drug in our country, and they do.
  I did a survey, Mr. Speaker, about a year ago, where I compared the 
price paid by seniors in my Congressional District in Arkansas on the 
five most commonly used brand name drugs with the price paid by seniors 
in seven other countries. Guess what? Seniors in my district in 
Arkansas pay, on average, 110 percent more than seniors pay in these 
seven other countries.
  So the drug manufacturers want to privatize this, because they know 
if we have 40 million seniors under one plan, we, too, will demand 
these kinds of discounts and rebates to help offset the costs of the 
program. So they want to privatize it and have 100 different insurance 
companies knocking on your momma's door, calling her on the phone, 
sending her mail, all trying to sell her exactly the same policy.
  Finally, the biggest problem with the bill is the benefit itself. 
There is all this talk in Washington about helping our seniors with the 
high cost of prescription drugs. What does the plan do?
  Well, from day one you have got to pay at least a $35 monthly 
premium, although no one can tell us exactly how much it will be. Then 
you will have a $250 deductible. Then from $250 to $2,000, Medicare 
will kick in at 80 percent of the cost of its medicine. That part 
sounds pretty good. But when you get to $2,000, you have got to 
continue to pay the $35 monthly premium. But, guess what? The senior is 
back being forced to foot the entire bill from $2,000 up to $3,500. Pay 
the premium, but get no help.
  If seniors cannot afford the first $2,000 worth of medicine, tell me, 
how in the world they are going to afford the next $1,500?
  When you do the math on this, here is what it comes out to. All this 
talk boils down to this. On the first $3,500 worth of medicine that 
seniors need each year, Medicare is going to help them with $900 of it. 
Seniors are still going to get stuck trying to pay $2,600 of the first 
$3,500 worth of medicine. When you take the formula, and you almost 
need a CPA to figure it out, and you factor in the premium, that is 
what it amounts to.
  Tell me this, $900 worth of help on a $3,500 drug bill, I do not know 
about where you come from, but I can tell you, where I come from, that 
is not going to help my struggling seniors to choose between their 
medicine and their groceries and their rent and their light bill.
  I am not going to rest until seniors can walk into the pharmacy of 
their choice, pull out their Medicare card and be treated like they are 
when they go to the doctor and to the hospital. I will continue to 
fight, and that is exactly what we are doing in this motion to instruct 
conferees on the Medicare prescription drug bill. I am going to 
continue to fight until we get a plan that is voluntary, but 
guaranteed, and made available to all seniors who have no help today, 
while protecting those seniors who have help. I want to make sure that 
this bill that passes this Congress will not shut down another rural 
hospital.
  Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is the third Congress where we have attempted to 
pass a prescription drug bill. The bill that is in conference now 
passed this House with a bipartisan vote. Finally, the other body has 
acted and also has passed a prescription drug bill. That is why we are 
in this meeting called a conference, to resolve the differences between 
the two.
  We have made tremendous bipartisan progress in that conference. One-
third of the bill, approximately, has been agreed to. This is the third 
time this motion has been brought to try to divert time and attention 
away from the progress that has been made in conference.
  I think that if we are serious about trying to enact a prescription 
drug benefit this year, if we are serious about getting a bill to the 
President's desk, I think it would be important not to support this 
motion. This would literally stop all of the progress that has been 
made, not only in a bipartisan way between Republicans and Democrats, 
but also between the House and Senate. As I say, this has been the 
third Congress where we are very close. One-third of the bill has been 
decided, great progress has been made. Let us let that progress 
continue. Vote no on this motion.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I yield 4 minutes to my good friend the 
gentleman from Washington (Mr. McDermott).
  Mr. McDERMOTT. Mr. Speaker, I want to thank my colleague from Texas 
for yielding me time.
  I am here to say you do not have to have a drawl to have this problem 
in your State. There are 50 States where this is a problem. I was 
walking across to my office building a minute ago, and I met a reporter 
from a major newspaper here in the East who said to me, ``What is going 
on in the Medicare conference?'' I said, ``I do not know. They are 
talking.'' So he said, ``Well, what do you hear?'' I said, ``We do not 
hear anything on the Democratic side. That is why we are out here every 
day trying to instruct those people.''
  I went to our Democratic House Member who is on that conference 
committee and said, ``What is going on?'' He said, ``I do not know. 
They are not having any meetings where they are discussing anything.''
  Now, they have been telling us we are going to have this bill. But 
this morning I was in the gym, and as I came out of the gym, I met one 
of my Republican colleagues, and I said to him, ``What does this drug 
thing look like? How does it look like it is coming?'' He said, 
``Frankly, I hope it does not pass.'' I said, ``Really? Why?'' He said, 
``Well, when they hang that doughnut hole around our neck in the next 
election, we are going to be dead.''
  You just heard my colleague from Arkansas describe the doughnut hole. 
You have a $3,500 bill, and you get $900 in benefit, and you still have 
to pay a $35 a month premium. It is a terrible bill, and the House bill 
is based on the fact that they hope that the insurance companies will 
put something together.
  The reason we need the best of the Senate bill is at least they have 
a fallback position which would allow the Federal Government to set one 
up if the private sector cannot.
  Now, the other thing my colleague pointed out and that needs to be 
emphasized, this is so privatized that the House of Representatives 
said that the United States Government, represented by the Secretary of 
the Department of Health and Human Services, Tommy Thompson, cannot 
negotiate lower prices on the basis of what is good for the American 
people. He is absolutely, by law, prohibited from doing what is best 
for the American people.
  What kind of a plan is that? This is throw the folks into the arms of 
the drug companies. They must have written every blessed word in it, 
including that line.
  They did not want the Secretary of Health and Human Services to sit 
down on behalf of 40 million people, because they know what happened to 
them when the Secretary of Veterans Affairs sat down on behalf of the 
veterans, 5 million of them, and got a huge discount. They are afraid 
that Mr. Thompson will negotiate something for them.
  Now, we will hear, I am sure, something is going to pass this 
Congress, whether it is any good or not will be for the people to 
decide, because the Republicans know they cannot go home without 
something. It better be worth something, or else they are going to pay 
in the next election, because they have been promising, and they have 
no excuse. They have the Presidency, they have the Senate, they have 
the House, and if they cannot put a bill out that does what the people 
need, they need to pay for it at the ballot box. That is what is being 
set up.
  We are instructing them the way to go if they want to do what is best 
for the American people. But if they want to do what is best for PhRMA 
and the drug companies, we will continue down this path, and no one 
will know, until one day a bill pops out here, 1,000

[[Page 23269]]

pages, and we vote on it, with nobody knowing what is in it.

                              {time}  1345

  That will be wrong, and the payment will come at the ballot box.
  Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
  I appreciate the gentleman's comments and the anecdotal nature of 
them, but I do know that there was a 10 o'clock meeting this morning in 
Dirksen 215 to brief the staff on the progress that has been made on 
the Medicare bill and to go over issues and to discuss matters.
  But this motion to instruct does not deal with the particulars of the 
prescription drug benefit, as has been discussed. It really only would 
provide for a government-run fallback in the plan. And both bills have 
prescription drug plans that assume some financial risk. The difference 
is they would ask the government to be the fallback on that, which 
would really then allow for very little incentive to control costs and 
would not really be the kind of benefit that would become available to 
seniors and be effective.
  So, again, I would urge a rejection of this motion to instruct on 
that basis.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SANDLIN. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Turner), ranking member on the Committee on Homeland 
Security.
  Mr. TURNER of Texas. Mr. Speaker, I thank the gentleman from Texas, 
my colleague, for yielding me this time on what is a very, very 
important motion to instruct, and one that I would hope would be 
received favorably by our Republican colleagues, because there are 
provisions in this motion that I think are important to many of us, 
particularly those of us who come from rural areas.
  When we look at what this bill looked like as it left the House, as 
my colleagues will recall, it only passed by one vote, and I think it 
took over an hour to get that one vote after a little arm-twisting. So 
this bill clearly was one that did not sail out of this House, and I 
think that the provisions that are in it are important.
  First of all, it is, I think, appropriate in this motion to ask that 
the very best provisions of both the House and the Senate bill on 
improving Medicare payments to health care providers in rural areas be 
in the final conference report, because many of us in rural areas have 
been hurt by some of the changes and cutbacks in Medicare funding. I 
have people come into my office all the time from my district who are 
administrators of hospitals, who tell us that they are having a hard 
time keeping the doors open and pleading with us to try to provide 
adequate reimbursement for Medicare services in our rural hospitals.
  It is true that since 1998, 57 percent of the hospitals treating 
Medicare patients in this country have lost money, and that is only the 
beginning of the story. As we listen to the individual hospitals who 
come and talk to us, they tell us that they may be closing the doors if 
we do not do better in terms of Medicare reimbursements. So this is not 
a partisan issue; this is a bipartisan issue that particularly affects 
those of us in rural America. At a time when we are being called upon 
to spend billions of dollars to reconstruct Iraq, we do not need to be 
closing the doors of hospitals right here in America.
  I also think the provision of the motion to reject any cuts that may 
affect a rural hospital is an appropriate and similarly arguable 
meritorious provision to have in this motion.
  Finally, the guarantee that is in the Senate bill that there is a 
fallback to a Medicare prescription drug plan if there are not two 
plans offered by private companies in your area seems to only make 
common sense. After all, most seniors in this country are happy with 
Medicare; and they would be well pleased, as I have always been, in 
advocating a prescription drug benefit under regular Medicare. But 
because our Republican colleagues have insisted that we have a 
privatization of Medicare in order to get a prescription drug benefit, 
it seems only to make common sense that as we enter into that 
experiment, if that is the direction the Republicans choose to lead us, 
that we have some protection. After all, it is an experimental venture. 
In my area we had cutbacks in Medicare offerings by private companies.
  So I think this motion should be well received by both sides of the 
aisle, and I hope it will be adopted.
  Mr. CAMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, Medicare, of course, with regard to hospitals and 
providers, reimburses, particularly hospitals, based on a system that 
on average allows them to make a profit under Medicare. We are advised 
in Congress by a nonpartisan group of panel experts called MEDPAC, or 
the Medicare Payment Advisory Commission. And this bill, as passed the 
House, follows their recommendation and their advice to Congress, which 
they made unanimously, that Congress increase payments by 3 percent, 
which is what this legislation does. We will be spending billions and 
billions of dollars on Medicare. We are trying to do it in a 
responsible way that follows the advice of the nonpartisan experts that 
Congress has looked to in the past to help guide us in these matters.
  So again, I would say that there will be a tremendous amount in this 
legislation for providers, particularly in rural areas. I represent a 
rural area in Michigan. And just to give Iowa as an example, they will 
ultimately receive a 5.5 percent increase in Medicare payments above 
what they would have received under current law. Again, that does not 
include the increases that they would receive for the 51 critical 
access hospitals in Iowa. So there will still be, I think, a 
significant help to make sure that there will be access to health care 
in rural areas. It is a critical issue, and this legislation provides 
for that.
  Mr. Speaker, I yield back the balance of my time.
  Mr. SANDLIN. Mr. Speaker, we have heard today about the problems in 
this bill. It is important that we stand up for hospitals, for seniors, 
and for rural America. For too long, America's rural hospitals have 
received Medicare funding far below the amount paid for the same 
service to their urban counterparts. Further, Medicare's base payment 
and DSH payments are less for rural hospitals and include an arbitrary 
cap. The results are very predictable. There has been an overall 
Medicare operating margin of negative 2.9 percent, and that has had a 
terrible impact on rural health care.
  Let us stand up for our seniors. Let us stand up for rural hospitals. 
Let us make sure that we have a prescription drug plan that is 
guaranteed. We know the cost, we know what it covers, it is available, 
and that does not have a doughnut hole. Let us work together. I am 
urging my colleagues to support the motion to instruct conferees, 
because the instructions in this motion are the very ones that are not 
being worked out in a bipartisan way or in any way at all by the 
conference committee.
  The SPEAKER pro tempore (Mr. Simpson). All time for debate has 
expired.
  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 Texas (Mr. Sandlin).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. SANDLIN. 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.

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