[Congressional Record (Bound Edition), Volume 149 (2003), Part 17]
[House]
[Pages 23972-23978]
[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. FLAKE. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

  Mr. Flake of Arizona 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 within the scope of 
conference to include income thresholds on coverage.

  The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the 
gentleman from Arizona (Mr. Flake) and the gentleman from Ohio (Mr. 
Brown) each will control 30 minutes.
  The Chair recognizes the gentleman from Arizona (Mr. Flake).
  Mr. FLAKE. Mr. Speaker, I yield myself such time as I may consume.
  I rise today to make this motion to instruct the conferees. We are 
dealing now with a prescription drug benefit to Medicare that is simply 
uncontrollable in terms of cost. We believe that we ought to control 
that cost by means-testing the program. There is no reason in the world 
why we ought to be paying the prescription drug benefits for the 
wealthiest in society, the Bill Gates, the Barbra Streisands, the Ted 
Turners, the Warren Buffetts.
  Think about this: With this prescription drug benefit that is part of 
Medicare if this bill passes, we will be paying the prescription drug 
benefits for the wealthiest in society.
  Let me tell you what that means. The current drug bills are estimated 
to cost $400 billion over the next 10 years. That is $400 billion over 
the next 10 years to add this prescription drug benefit. If we look 
beyond that 10-year window into the next 10-year window, then it gets 
even uglier. From the years 2014 through 2023, that 10-year period 
after the first 10-year period, the drug benefit is projected to cost 
$772 billion. So $400 billion the first 10 years, $772 billion the next 
10 years. That rapid growth rate will continue all the way through the 
year 2030.
  In fact, what it means in the year 2030, let me just give you a 
scenario here. Married couple, 40 years old. This strikes home because 
I am 40 years old myself. This particular couple already pays 15.3 
percent in payroll tax to fund current Medicare and Social Security 
beneficiaries. Because the payroll tax will not provide enough revenue 
to fund Medicare for all retirees, this couple also faces $39,894 in 
additional taxes between now and their own retirement in the year 2030.
  Think about that. Because we are going to run out of money, because 
we do not have enough money in the Treasury and in trust fund accounts 
to fund this, one couple between now and 2030 will have to pay $39,894.
  The proposed prescription Medicare drug benefit will make up, of this 
amount, $16,127. Sixteen thousand extra dollars between now and 2030 
will be paid simply to pay this prescription drug benefit, largely 
because it is an entitlement. It is an entitlement. That means that we 
give the benefit to everyone.
  Entitlements are out of control simply because you set a level for 
benefits and you say whoever enrolls will get that benefit and they are 
labeled uncontrollable in terms of what the costs are. We simply cannot 
control it, because it depends on how many are eligible and what the 
benefit levels are, and we are setting the benefit levels here, and so 
we have that kind of cost to look forward to.
  When we look back to 1965 when Medicare was created, it was projected 
to cost $10 billion annually. It is costing $244 billion annually at 
the moment. That is on a pace to double over the next decade, and then 
it will expand exponentially beyond that time when the baby boomers 
start to retire. We simply cannot afford to do what we are proposing to 
do.
  When we look at what we are proposing to do as well, it does not make 
any sense, given how demographics have played out. Census Bureau 
figures show that poverty among the elderly has plummeted. In 1959, 35 
percent of the elderly lived in poverty compared to just 10 percent 
today. That is a reversal in relative position of the general 
population. In 1959, 35 percent of the elderly lived in poverty 
compared to 25 percent of the general population. In 2001, 10 percent 
of the elderly lived in poverty compared to 12 percent of the overall 
U.S. population.

                              {time}  1615

  And what this means is that we are shifting a huge financial burden 
to those who can least afford it, the young, from those who can most 
afford

[[Page 23973]]

it at this point, the elderly. That is simply unwarranted.
  During the break when I was home, I ran into a gentleman who was in 
his 80's and he pulled me aside and said, ``I know you are a Member of 
Congress.'' He said, ``Let me tell you, my wife is ill, and we spend 
about $600 per month for prescription drug benefits.'' And I thought, 
oh, no, here it comes. He is going to say get back here and vote for 
that bill. Instead, he said exactly the opposite. He said, ``We can 
afford it. Don't you dare saddle that burden on my grandkids.'' And I 
know there are a lot of people who feel the same way, a lot of people 
who say there is no way we should saddle this burden on generations to 
come. It is simply unconscionable.
  When I announced my intention to vote against the House version of 
the bill in its present form, I gave a quote from George Washington 
after the Constitutional Convention. He simply said, when asked, when 
he was defending the kind of government that was set up, when it was a 
different kind of government than the people expected he said, we 
cannot do what we know is wrong; otherwise, how will we defend our work 
later? In particular, he said, ``If to please the people, we offer what 
we ourselves disprove, how can we afterwards defend our work?''
  We as, Members of Congress, know the costs. We know the history of 
Medicare. We know what this new benefit will cost. And unless we means 
test it, unless we make sure that it is not a benefit for everyone, 
that it is simply targeted to those who can least afford it now rather 
than everyone, we know what will happen. We know that we cannot afford 
it. We know that future generations and ourselves, our own kids are not 
going to be able to afford the tax burden to sustain it. We know that 
it will make an already insolvent situation for Medicare insolvent all 
that much faster. So we simply cannot afford to go on the road we are 
going. And I think we ought to heed George Washington's word and do 
what we know is right, regardless of what we think the people want, 
regardless of what the last poll says, regardless of what we hear at 
one meeting or this one. We are sent here to do what we know is right, 
and we know that this will bankrupt us. So we know we have to take a 
different course, and I would submit that the course we need to take is 
to means test it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in opposition to the motion offered by the 
gentleman from Arizona (Mr. Flake). I respect my colleague. I think 
that he is intellectually consistent and honest, something that we do 
not see on this floor nearly enough, and I appreciate his thoughts. I 
do not agree with him, but I think that he is bringing this to the 
table with the right attitude.
  I do hear him say, however, in talking about the gentleman that he 
spoke about in Arizona that he met, the older gentleman whose wife and 
he were spending $600 a month on prescriptions and saying he did not 
want to saddle his grandchildren with debt, I mean this Congress has 
been all about saddling our grandchildren with debt, with tax cuts, 
with spending in Iraq, $1 billion a week with no accountability to 
private contractors, much of that money going to contributors to the 
President, much of that money going to Halliburton, a corporation which 
still pays Vice President Cheney $13,000 a month, and those costs or 
those expenses are being paid by our grandchildren because that $87 
billion this Congress will vote on in the next 2 or 3 weeks is going to 
be borrowed money.
  That being said, I rise in opposition to the Flake motion. If there 
are Members of Congress who want to rewrite Medicare to make it a 
welfare program, which the Flake motion does, then let us have that 
debate. But just as it is wrong to co-opt seniors' need for drug 
coverage, to turn Medicare into a privatized insurance voucher program, 
it is wrong to capitalize on the coverage gap to turn Medicare into a 
means test and welfare program.
  Medicare has enjoyed widespread popularity in this country, not only 
because it provides an essential safety net for America's most 
vulnerable seniors, although that is certainly a critical mission, it 
is also popular because it treats every American senior fairly. It is 
an insurance program that we should not fracture, one that has 
universal coverage, one that works for everyone, one that virtually 
everyone in society supports, and one that has worked as well as any 
Government program in our history over the last 38 years.
  Understand that while by most major health indices: life expectancy, 
rate of vaccination, child mortality, infant mortality, maternal 
mortality, most measurements of health care, indices in this country, 
the U.S. does not rank very high compared to other wealthy countries, 
but on one measurement we rank near the top, and that is life 
expectancy at 65. If one reaches the age of 65 in the United States, 
chances are they will live longer than people, on the average, in 
almost any other country in the world. That is because Medicare treats 
everyone fairly, whether it is the retired factory custodian of modest 
means or whether it is the more affluent retiree who actually owns the 
factory. The Flake motion makes a radical change to this decades' old 
and very successful universal health care program that we call 
Medicare. The Flake motion asks the conferees to ensure the final bill 
includes a means-testing requirement. For the first time since its 
creation, Medicare would then look at the custodian, the poorest 
senior, the middle-class senior, the wealthy senior, and the plant 
owner all differently. All of them have paid into Medicare. The plant 
owner, frankly, has paid in more over his working lifetime than the 
custodian has, but under the Flake motion, Medicare offers the wealthy 
owner less coverage than his former employee. The Flake motion would 
turn Medicare from a national retirement savings program into a welfare 
program, undermining the popular support, undermining the universal 
support that Medicare has enjoyed in this country for 38 years.
  A vote for this motion is a vote to weaken the pillar of fairness 
that supported Medicare for these 3-plus decades. The gentleman from 
Arizona's (Mr. Flake) motion also backs a means-testing plan that would 
almost certainly cut benefits for middle-class seniors. The House 
means-testing language would begin benefit cuts at income levels of 
$60,000. Sixty thousand dollars is hardly a Ken Lay lifestyle, 
especially in these days of ever-increasing health care costs.
  I hear from my constituents week after week after week concerned that 
the cost of their health care insurance continues to grow with no end 
in sight. I hear it from seniors. I hear it from young, working 
families. I hear it from people who are close to retirement. It would 
seem to them that regardless of their income, regardless of how well 
they have planned for their health care future, that health care costs 
are eating up their savings. A Medicare prescription drug benefit that 
leaves any hard-working American out in the cold should be unacceptable 
to Members of this Congress. At least my Democratic colleagues and I 
think it is.
  Let me be clear. A vote for the motion from my friend from Arizona is 
a vote to cut Medicare benefits, ultimately of middle-income Americans. 
Sixty thousand dollars now; that number could continue to be brought 
down in the next motion and the next motion and the next motion until 
public fee-for-service Medicare is only a program for the poorest and 
the lowest-working income people in this country.
  A vote for the Flake motion is also a vote to increase bureaucracy 
and reduce privacy protections for American seniors. Here is how that 
works: House language would require Medicare to send a list of 
beneficiaries to the Internal Revenue Service. The IRS would respond 
with income information for every senior in Medicare. Medicare would 
then send that personally identifiable financial information to private 
health insurers that provide coverage under Medicare. I sure hope we 
get the do-not-call legislation enacted constitutionally, get it passed 
a court test

[[Page 23974]]

if that happens. Surely, our Medicare cost-containment strategy should 
amount to more than adding paperwork in Medicare, increasing the 
bureaucracy at IRS and sending seniors' private tax information to 
HMOs.
  The gentleman from Arizona's (Mr. Flake) concern, however, about the 
growing cost of Medicare is justified. The conference negotiations over 
H.R. 1 offer us an opportunity, an important opportunity, to address 
that concern by including clear, specific direction for the Government 
to negotiate with pharmaceutical companies reasonable prices for the 
medicines American seniors so desperately need.
  We all know that growing health insurance costs are being driven by 
the skyrocketing costs of ever-increasing prescription drug costs. That 
is the 800-pound gorilla in the health care cost room. The House bill 
simply ignores it.
  If we are really concerned about cost, we should instruct the H.R. 1 
conferees to give Medicare real authority to protect seniors and 
taxpayers from rising drug costs. We are the only country in the world 
that lets the drug companies charge whatever they want. That is why we 
pay two times, three times, four times as much as the Canadians and the 
French and the Germans and the Israelis and the Japanese and the Brits 
pay. We should not instruct the conferees to cut the benefits of 
middle-income Americans and erode popular support for Medicare. We 
should, in this legislation, instruct the conferees to go after the 
high cost of prescription drugs.
  I urge my colleagues to join me in opposing the motion from the 
gentleman from Arizona (Mr. Flake).
  Mr. Speaker, I reserve the balance of my time.
  Mr. FLAKE. Mr. Speaker, I yield myself such time as I may consume.
  Let me say I have never heard so much concern for the rich coming 
from the other side of the aisle here. I just am overwhelmed with the 
concern that is over there that people like Arnold Schwarzenegger and 
others will not be able to afford prescription drugs without Government 
help.
  And if you are concerned about the health of Medicare as a program, 
do not go with this program as it is outlined without a means test, 
because this will bankrupt it, and it will all be gone unless we do 
something to bring down the cost, and the best way is to ensure that it 
is targeted to those who need it most, not the wealthy who do not need 
it.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Indiana (Mr. Pence), who has been a leader on this issue.
  Mr. PENCE. Mr. Speaker, I thank the gentleman for yielding me this 
time and for his courageous motion.
  It is late in the workweek, Mr. Speaker, for us on Capitol Hill, and 
things tend to get a little blurry for Members of Congress when we put 
in a full, 3-day week. So I am going to try to unpack this a little 
bit, as I strongly endorse the motion by the gentleman from Arizona 
(Mr. Flake) which simply structurally affirms the idea of using income 
thresholds or means testing as a way of controlling costs in the 
Medicare prescription drug legislation that is currently being 
considered by a conference committee in the House and Senate.
  This is not a radical and new idea, Mr. Speaker. In fact, according 
to our information, not only was means testing included in the 
catastrophic elements of the bill that passed the House, but also when 
the U.S. Senate signaled its support for means testing in June, there 
was an amendment that was drafted and sponsored by Senators Nickles and 
Feinstein. It prevailed on a test vote. Some 59 Senators indicated 
preliminary support for means testing as a way of controlling the 
extraordinary cost that we will place on working Americans in the 
future. Remember, entitlements are paid for by payroll taxes by working 
Americans. But because Senator Ted Kennedy, in effect, we are told in 
media outlets, raised the possibility of a filibuster, the amendment 
was not considered and was withdrawn.
  So the idea that the Flake motion considers, Mr. Speaker, and that is 
brought so respectfully before all the Members of this body, but most 
especially the hard-working Members of our leadership team, is an idea 
that had broad support in this Chamber and arguably, by media accounts, 
in the Senate.

                              {time}  1630

  And I must tell my colleagues, I have great respect for the gentleman 
from Ohio. His passion and his eloquence on this floor is always 
memorable. But rather than reflecting on the remarks he just made, I 
would rather reflect on the motion that was debated in the hour prior 
to this one, which, as I sat on the back row of the Chamber, Mr. 
Speaker, was all about how the Medicare prescription drug benefit was 
too small, it did not spend enough, the Democrat motion to instruct 
conferees argued, in sum. And I submit to my colleagues that the debate 
we heard last hour is a preview of the debate that will follow on the 
floor of this Congress every year if we create a universal drug 
benefit, a new entitlement in Medicare, a one-size-fits-all 
prescription drug benefit. It will, as we hear in every other 
entitlement, Mr. Speaker, it will simply be one other subject that our 
friends on the other side of the aisle will come into this Chamber and 
argue is insufficiently funded, and it will grow and it will grow and 
it will grow.
  I believe in my own mind that the opposition by some to means testing 
here is because they know that if we create a prescription drug benefit 
that is based on the income of Americans, that it is, therefore, by 
definition not an entitlement. If we say that the person who owns the 
limousine and the person who drives the limousine are entitled to the 
same amount from the Federal Government in free prescription drugs 
every year, we have created an entitlement. If we create a difference 
there, we simply create a manageable government benefit. The Flake 
motion contemplates that, and I endorse it strongly; and the 
marketplace in need here also endorses it strongly.
  I have to tell my colleagues, I do about 50 town hall meetings a year 
in my district; and I have become persuaded, Mr. Speaker, that there 
are seniors who struggle, in some cases, in heart-wrenching manners 
with the cost of prescription drugs. Statistics show us that nearly 24 
percent of seniors have no access to drug coverage, and approximately 5 
percent of seniors have out-of-pocket prescription costs of more than 
$4,000 per year. I would, as conservative as I am, and I would dare say 
even many of my colleagues would, be prepared to support the kind of 
program that President Bush called for to begin with: a program, we 
will call it Plan B, which would focus resources at the point of the 
need and leave the prescription drug coverage that 76 percent of 
Americans already enjoy untouched.
  The reasons for this include the fiscal realities that the gentleman 
from Arizona (Mr. Flake) cited: the initial 10-year cost projected at 
$400 billion a year, from 214 to 223, though the numbers go up to a 
projected $772 billion, adding $2.6 trillion indebtedness to Medicare, 
a number almost the size of the national debt today. And why is that? 
It is because, Mr. Speaker, that there are 37 million people today 
entitled to benefits under Medicare; and by the time my baby boomer 
generation gets done retiring in the 2020s, there will be over 70 
million Americans eligible for benefits in Medicare. Means testing and 
income-related testing is the only way of defeating the creation of a 
massive new Federal entitlement. I rise today to endorse it as a 
principle, as a concept, and as an idea whose time has come.
  Nancy-Ann DeParle, President Clinton's Medicare administrator, issued 
inadvertently a warning about the work that we do here, saying that 
what Congress had contemplated would be ``the biggest expansion of 
government health benefits since the Great Society.'' And so it would, 
unless we bring Republican principles of limited government and 
fairness to bear on the challenges facing many seniors; unless we 
create a program built on that principle expressed by Abraham Lincoln 
when he said that government should ``never do for a man what he could 
and should do for himself.'' That is simply

[[Page 23975]]

a principle of limited government, and it is also a principle of fiscal 
responsibility, and it is the principle underpinning the motion to 
instruct conferees brought today by the gentleman from Arizona (Mr. 
Flake).
  I would submit to my colleagues, Mr. Speaker, that compassionate 
conservatism is about focusing solutions at the point of the need. Let 
us help our seniors near the poverty level with urgent and sufficient 
prescription coverage. Let us bring about reforms in Medicare so it is 
there for the future, without placing an undue burden on our children 
and grandchildren; and let us otherwise do no harm to the private 
sector foundation of the greatest health care system in the world.
  For this reason, I strongly support the Flake motion to instruct 
conferees. I strongly support controlling costs through income 
thresholds on coverage, means testing, as it has come to be known; and 
I strongly support that principle for which our party was rewarded the 
ability to lead this institution, the principles of limited government 
and fiscal responsibility that I believe would be advanced by 
maintaining the means testing that was in the House bill; and if I can 
also offer, Mr. Speaker, expanding that means testing throughout the 
course of this benefit, so that we can truly focus the resources on 
those who need it most.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman 
from New Jersey (Mr. Pallone), who is a leader in this institution and 
in the area of health care.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Indiana 
(Mr. Pence) for being honest about what he is trying to accomplish with 
this motion, but I have to say that his comments were very upsetting to 
me. Because if we listen carefully to what he said, it was a radical 
proposal. He said it was not radical, but it was extremely radical for 
the following reason: he said he does not want Medicare to be an 
entitlement. He said he wants means testing to extend to the entire 
Medicare program. And that is what the Republican ideology is all 
about. They do not want the Medicare program the way it was set forth 
40 or 50 years ago when it was first set forth in this House of 
Representatives as a program that applies to every American senior.
  Right now, every American senior gets the same benefits wherever they 
live, regardless of their income, regardless of their race, or 
regardless of anything, as long as they are a senior citizen. But if we 
listen to what the gentleman from Indiana said, what they would like to 
do through means testing is say that the program will be limited only 
based on one's income.
  Now, in this motion to instruct, they say that seniors who earn more 
than $60,000 a year, $120,000 for couples, will not have the 
catastrophic coverage which is above $5,100 in the House bill. But if 
we listen to what the gentleman said, there would be nothing to stop 
us; in fact, he probably advocated today to perhaps lower that 
threshold below $60,000. Maybe next year or next month we will make it 
30 or 40, or perhaps we will extend it to other parts of the program. 
So it would not just be for the catastrophic coverage, but maybe for 
the drug coverage in general, or maybe for the whole Medicare program.
  I, listening to his remarks, would have to conclude that he would not 
have a problem means testing hospital care or doctors' care, so that if 
one is making $60,000 or more per year, maybe one would get hospital 
coverage under Medicare.
  Well, that is what this Republican leadership is all about. Let us 
not forget that the Republicans did not vote for Medicare back in the 
1960s when it first began. Let us not forget that many of the 
leadership, including Speaker Gingrich a few years ago, said that 
Medicare should wither on the vine, whatever that means; and that is 
what this motion is all about. They wanted to kill Medicare ultimately. 
They want to make it so limited that it only applies to a few people.
  Now, I heard the argument. One of them was philosophical: well, it is 
just not right to cover everybody. But then I also heard the fiscal 
argument, which was, well, we cannot afford it anymore. Why can we not 
afford it? Well, we can afford it. But the reason they have made it 
more difficult to afford is because they have implemented all of these 
tax cuts for the last 2 years on the Republican side with a Republican 
President, and they are borrowing money from the Medicare trust fund to 
pay for the debt that has resulted from those tax cuts that have mainly 
benefited wealthy corporations and wealthy individuals. So they are 
forcing Medicare to go broke because they are borrowing from it and 
making the trust fund not have the money that it should have that 
people have paid into.
  Mr. Speaker, I am extremely upset because on the one hand, I 
appreciate the gentleman from Indiana's honesty and the philosophy and 
the idealogy that he has laid up here, but on the other hand it is 
upsetting to me to think that people really feel that way and they want 
to do this to the Medicare program.
  Think about it. In my home State of New Jersey, they say $60,000 is a 
lot for a person, or whatever the figure is for a couple. Well, $60,000 
is still middle class in New Jersey, and I am very fearful of the 
domino effect. Well, if we have another tax cut in another 6 months or 
a year and we borrow more from Medicare and we say we do not have the 
money, then they will reduce it to $50,000 or maybe $40,000. Well, what 
happens to the Medicare program? As my colleague from Ohio, the ranking 
member on our subcommittee, said, at some point, at some point, the 
Medicare program does not have the political support anymore because 
fewer and fewer people will be able to take advantage of it. That is 
what this is all about: killing Medicare. That is what my Republican 
colleagues are up to.
  Mr. FLAKE. Mr. Speaker, I yield myself such time as I may consume to 
note that our motion to instruct contains no income figures or 
thresholds at all. The $60,000 figure that is cited is simply part of 
the Republican base bill that was passed in this House. We are simply 
establishing the principle of means testing. Now, I would suppose that 
if that was set at $100,000 or $200,000 or $300,000 or $400,000 or a 
half a million dollars, the cry from the other side of the aisle would 
be the same: do not means test it. Do not means test it. We want an 
entitlement. And that is what we are fighting about here. We simply 
want to say that we ought to target those who need it most, not spread 
it out so we bankrupt the system too quickly.
  Mr. Speaker, I yield 3 minutes to the gentleman from Iowa (Mr. King).
  Mr. KING of Iowa. Mr. Speaker, I appreciate the remarks of the 
gentleman from Arizona. What we are really talking about here is means 
testing versus entitlement. Means testing says, we do not want to tax 
poor people to put drugs and Medicare into the accounts of Bill Gates. 
And entitlement means, we are going to do that for everybody so we can 
level this across all classes of people in America. That is not the 
American way. We do not do things like that. We are here for the 
underdog, and that is what means testing does. It protects this system 
for the poorest among us.
  If we listen to some of the discussions about Social Security reform, 
we will hear, raise the age, lower the benefits, increase the 
contribution. All of those things are part of what happens if we do not 
provide for means testing, because then we have to draw it out of the 
pockets of the working people.
  I am from Iowa. In Iowa we pay attention to Medicare. We are last in 
the Nation in compensation rates where I come from. I represent a 
district that has 10 of the 12 most senior counties in Iowa, and in 
Iowa we have the highest percentage of our population over the age of 
65. We are extraordinarily sensitive to providing these resources to 
people who need it.
  When I came here to this Congress, I pledged to support a 
prescription drug Medicare plan that was means tested and also provided 
for the reform in Medicare so that we could utilize those dollars in 
the most effective way possible and penalize the producers in this 
country the minimum amount possible.

[[Page 23976]]

We do not have that in what is appearing to come together before our 
conference committee. I rise in support of the Flake motion to instruct 
for that reason, so that we can promote means testing and impose the 
idea of this entitlement, which weighs down this system.
  So how did we get here? Two years of expectations raised by the 
Congress that said we are going to do prescription drugs. That brought 
us to this point. Then we set this number up on the wall that said $400 
billion, then began to write prescription drugs-Medicare that hit that 
$400 million target. Really, the actuaries drove a lot of this policy, 
and it does not appear to resemble the things that I came here to 
support.
  So I am for reform. There are places in this country where they get 
more money for Medicare compensation than they need and they use that 
to buy down insurance premiums in private payers in places in this 
country where they get substantially less, and Iowa is one of those. We 
are not addressing quality care or cost effectiveness. In an effective 
way, our $400 billion plan is about 25 to $27 billion worth of reform, 
and the balance of it is prescription drugs because it is an 
entitlement.
  Mr. Speaker, I think the Flake motion goes directly to the heart of 
this, and to carry this philosophy into the conference committee and 
bring it out and bring it out to the floor with really the right thing 
for the right philosophy for Americans is the thing that we ought to 
do.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from Texas (Mr. Sandlin).

                              {time}  1645

  Mr. SANDLIN. Mr. Speaker, I rise in opposition to my colleague's 
motion to instruct conferees to include means testing in H.R. 1. Such 
an instruction is opposed by America's seniors and would be a horrible 
mistake for this body.
  Let us make no mistake about the nature of the gentleman's motion. It 
is simply another step along the Republican plan to completely destroy 
Medicare. It is as simple as that.
  Implementing means testing obliterates the fundamental tenet of 
Medicare as a universal insurance program for everyone in this country. 
That is the foundation of Medicare. That is what it is. Efforts to 
means test Medicare destroys that program.
  If this provision survives the conference, a provision that was 
soundly defeated in the United States Senate, our Congress would be the 
first in history to tax the middle class twice for their benefits. It 
is important to remember that means testing is not just for wealthy 
celebrities, as has been discussed. It applies to our Nation's middle 
class, to people making about $60,000 a year.
  In both the House and the Senate drug plans our seniors already have 
to endure large gaps in coverage, gaps where they get no coverage but 
they have to pay a premium. Under this provision many of our middle-
class seniors will not enjoy catastrophic limit protection until they 
personally spend $11,000. That is not fair, and it equates to no plan 
at all.
  Further, when we talk about means testing, we cannot forget Medicare 
financing. Today, every Medicare beneficiary gets the same benefits and 
pays the same percentage of taxes into the program. This means those 
with higher incomes have been paying more into Medicare. This means 
that under this motion the very individuals that Congress wants to deny 
benefits to have been paying a larger proportion of the funds that 
sustain Medicare.
  Now, on a side note I find it very ironic that the majority, which 
claims to want to minimize the government's role in our citizen's 
lives, will be creating a significant new government bureaucracy 
through means testing, one that will threaten the privacy of our 
Nation's seniors. After all, in addition to this provision, the 
Medicare administrator will be sending the IRS the names and incomes of 
seniors who will then forward this confidential information on to 
private insurance companies. That is kind of inconsistent, especially 
with Congress's strict demands on hospitals regarding the privacy 
provisions of HIPAA.
  We do not need to embark on this dangerous path to dismantle 
Medicare. We do not need to give up the privacy of our seniors. Do not 
let the IRS send your private financial information to private 
insurance companies.
  We have to respect our seniors. We have to respect our commitment to 
our Nation's seniors. Our elderly need stability in their health care. 
They have earned it, and they deserve it.
  I urge Members to vote against this motion, protect our seniors, 
protect their privacy, defeat this motion, and let us focus our efforts 
on a strong Medicare and on a prescription drug plan that makes drugs 
available and affordable for all of America's seniors.
  Mr. FLAKE. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Colorado (Mrs. Musgrave).
  Mrs. MUSGRAVE. Mr. Speaker, I admire altruism. I am very impressed 
when people want to help other individuals. I am very skeptical of 
altruism when it is funded with other people's money.
  When we look at this Medicare prescription drug benefit, I think we 
ought to think about the young families in our country that are working 
very hard to make ends meet. Many of them are in their 30s, their 40s. 
They have young children. They are trying to figure out how they are 
going to pay for their little guy's glasses, the little boy in the 
second grade that cannot see the bulletin board. They are trying to 
figure out how they are going to have any quality time together because 
mom is working and dad is working and somebody has got to pick up the 
kids and somebody has got to buy the groceries. They are frazzled young 
families. They are trying to do the right thing by their family, but 
they are also trying to figure out how they are going to pay their 
taxes and they are going to make ends meet.
  When we look at these families and look at families where people are 
working in their late 50s and early 60s and they do not really have a 
very good prediction, good future for their retirement and they are 
working on because they are trying to make ends meet also, maybe we 
ought to think about those people before we try to figure out how we 
are going to give a benefit to the wealthy that do not even need it, 
the wealthy Americans who, God bless them, have been successful.
  I am all for people accumulating wealth and enjoying it and being 
very prosperous, especially when they have made good plans and in the 
elder years of their lives they are reaping the benefits. But it makes 
no sense to me to increase the tax burden on our working families to 
give a benefit to people that have not asked for it that are going to 
try to figure out how many weeks they are going to spend on their 
yacht. This does not make sense.
  I support the Flake motion. We need to have a means testing. It is 
common sense. That is how we need to be responsible with the only way 
government gets its money: from taxing our citizens.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes and 30 seconds to 
the gentleman from Michigan (Mr. Levin).
  Mr. LEVIN. Mr. Speaker, I hope that everyone who was not here today, 
our colleagues, will read the words in the Congressional Record and 
understand where the two parties are coming from. The gentleman from 
Arizona (Mr. Flake) has made clear that what he wants to do is to make 
sure that prescription drugs is not an entitlement. So, therefore, he 
wants to means test for those earning $60,000 and above. We must make 
clear that the logic is it will be reduced from 60 to 50, to 40. That 
will erode the Nation of an entitlement, if you are consistent.
  So this is not a slippery slope. This is a sure path to destroy the 
prescription drug benefit as an entitlement. You have made that pretty 
clear. The logic leads to no conclusion but that. Then if you want to 
erode prescription drugs as an entitlement, the next logical step is to 
do the same for Medicare, if you are logical.
  Then I am totally confused by the gentlewoman from Colorado (Mrs. 
Musgrave) who says that we do not want to give this benefit to the

[[Page 23977]]

wealthy. $50,000, $60,000, $70,000 is wealthy? And I would like to know 
where the people who have spoken for this motion were with the child 
credit vote, where we were talking about $15,000, $20,000. My guess is 
that the gentleman who is in support of this voted against it.
  Then I would like to ask, after this discussion about let us not help 
the very wealthy, how you voted in terms of the estate tax that applies 
only to a few thousand people a year, to indeed the wealthy, where I 
think almost by rote all of you supported the elimination of the estate 
tax.
  So this is clear, number one, you want to destroy prescription drugs 
as an entitlement; and, number two, you are totally inconsistent when 
you say someone earning $60,000 or $70,000 should not have the full 
benefit of a prescription drug plan, but then you vote not to give a 
child credit to people earning between $10,000 and $25,000. Then you 
vote that the 3,000 or 4,000 very, very wealthy families in this 
country, very few of them who are farmers, who are in small business, 
should be able to pass on millions, millions, and millions without 
paying estate tax.
  I hope this discussion will be read by everybody before they vote and 
understand the meaning of their vote. Destroy prescription drugs as an 
entitlement and have crocodile tears because the very wealthy would 
benefit from a prescription drug benefit when all of your other votes 
show that you do not have that same sensitivity when it comes to the 
tax structure of the United States of America.
  Mr. FLAKE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to point out I am a little confused myself in 
terms of what is rich. On the other side of the aisle, they argued 
throughout the entire tax debate that the same middle-class individual, 
$60,000, $70,000, $50,000, are not going to benefit from taxes for the 
rich? What is rich? We set no standard in this motion to instruct. We 
simply say that we ought to have a means test. We have not pegged it at 
$60,000, at $70,000, $200,000, $300,000. We are simply establishing the 
principle that it should not be an entitlement.
  If people are worried about it being a slippery slope, set it at 
$200,000. By the time that slippery slope ends, someone starting at 65 
surely will not be around to collect. But set it somewhere, establish a 
principle that we should not be paying prescription drug benefits for 
the Bill Gates of the world.
  Mr. Speaker, I yield 3 minutes to the gentleman from Indiana (Mr. 
Pence).
  Mr. PENCE. Mr. Speaker, I want to compliment my colleagues on the 
other side of the aisle for a vigorous, embracing debate, Mr. Speaker.
  Apart from some of the class warfare rhetoric, I want to concede a 
particular point, that the introduction, as the Flake motion suggests, 
into the prescription drug benefit of income related standards of means 
testing is precisely about destroying the creation of a new 
entitlement. It is precisely that, Mr. Speaker. Because despite the 
fact that we are hearing our friends on the other side of the aisle 
speak with great generosity about the middle class and even the upper 
class today, it will not be any of us in this room, judging from the 
relative age as I look around this Chamber, who will pay for this 
entitlement, but it will be people like my 10-year-old daughter, 
Charlotte.
  Sometimes God has a sense of humor, Mr. Speaker. The very day I was 
called upon to vote to create the largest new entitlement since 1965 
was my daughter Charlotte's 10th birthday. I started the morning 
stuffing a pinata at 6 a.m. for her little-girl birthday party. It was 
a great day.
  And it really was that experience that emboldened me to take the 
stand that I took in voting against this measure and to take the stand 
that I take today with Mr. Flake in saying that we must, almost 
regardless of the politics and the demagogic rhetoric that will be 
foisted on us from many quarters, we must do right by Charlotte. 
Because it will be Charlotte in 20 years, hopefully married to a good 
and Godly man, raising my grandchildren, who will be paying two and 
three times the payroll taxes that we pay today to pay for the benefits 
that we are on the verge of creating, Mr. Speaker. It is that plain and 
that simple. And to do that by taxing young Charlotte's family to 
support benefits to people who could and should provide for themselves, 
in the words of Abraham Lincoln, is unconscionable.
  So, Mr. Speaker, I support the Flake motion.

                              {time}  1700

  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I thank both my friends from Indiana and from Arizona 
for their comments. I am just intrigued that people can stand on this 
floor in the majority party and talk about burdening our children and 
our grandchildren with debt.
  When President Bush took office, we had a surplus, billions of 
dollars a year, a 10-year surplus well into the several trillion 
dollars projected. Today, after Republican control of the White House 
for only 2\1/2\ years, Republican control of the House during that 
time, Republican control of the Senate much of that time, we are 
talking about trillions and trillions and trillions of dollars in debt. 
This year alone some $550 billion deficit. And for then my colleagues, 
not just today but time after time after time, coming to this floor and 
railing against Democrats for spending, it makes me absolutely 
incredulous.
  My friends on the other side of the aisle are now talking about 
bringing forward to this House Chamber a constitutional amendment to 
balance the budget. In other words, we cannot balance the budget, but 
we are going to do a constitutional amendment to make us balance the 
budget.
  The fact is, Mr. Speaker, that when they argue costs and debt and 
burden on our children, they ought to look at the tax cut that they 
have given to millionaires, $93,000 for the average millionaire in this 
country, half of my constituents got zero dollars out of that tax cut, 
but they have given a $93,000 tax cut to the average millionaire.
  They have way overspent the budget when it comes to issues such as 
what they are now doing with Iraq. We spend a billion dollars a week. 
They want to spend $87 billion next year, probably more than that, that 
is just what they are telling us now, with little accountability. We do 
not know where the money is going. The private contractors are getting 
unbid contracts, they are friends of the President, yet they talk about 
saddling our grandchildren with debt as if it is Medicare that is 
saddling our grandchildren with debt.
  My friend from Arizona, as I said, I respect him for his candor and 
his intellectual consistency and honesty, but what this is all about is 
about privatizing Medicare. They wanted to privatize Social Security. 
They wanted to privatize the national parks. They want to privatize 
Medicare. They want to privatize every section of the government that 
they possibly can.
  That is their philosophy. That is fine. But let us not talk about 
means testing. Let us talk about what their mission is, to turn 
Medicare over to the insurance companies. That is what Medicare+Choice 
is about. That is what their argument is about. They can call it means 
testing. They can call it a lot of things, but ultimately, we know what 
it is. We know they want to privatize Medicare.
  As my friend, the gentleman from New Jersey (Mr. Pallone) has said, 
for 35 years it is clear that my friends on the other side of the 
aisle, for honest intellectual, philosophical reasons have not liked 
Medicare. In 1965, only 12 Republicans voted for Medicare. Strom 
Thurmond voted no. Gerald Ford voted no. Bob Dole voted no. And my 
favorite, Donald Rumsfeld, voted no at the creation of Medicare in 
1965.
  In 1993, when the Democrats saved Medicare, when its life expectancy 
was not really very long, Democrats passed, with no Republican votes, 
legislation to extend the life of Medicare.
  In the mid 1990s Speaker Gingrich came forward saying that he wanted 
Medicare to wither on the vine. He tried to cut Medicare $270 billion 
to

[[Page 23978]]

give another tax cut to the wealthiest people in society.
  Then Dick Armey, the majority leader of the Republicans, Bill Thomas, 
the chairman of the Committee on Ways and Means, they have consistently 
said how they do not like Medicare. This is about privatizing Medicare. 
It is not about Bill Gates. It is simply not about means testing. It is 
about privatizing Medicare, turning it over to the insurance companies 
and ending Medicare the way that we know it. I urge my colleagues to 
vote no on the Flake motion.
  Mr. FLAKE. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I thank those who have participated in this debate. I 
want all Americans to know that tonight they will all get a big raise. 
It seems that tomorrow that those on the other side of the aisle will 
come back and talk about how those who are earning $60,000 who are 
decidedly middle class when it refers to this bill, will be rich when 
it comes to talking about tax cuts. Which is it? Which is it?
  I want to remind my colleagues here, again, that this motion to 
instruct says nothing about which income levels we ought to set this 
at. It simply says we ought establish the principle that this be 
targeted at those who need it the most. And this debate about whether 
or not we ought to look at the income of older Americans will probably 
be moot in another 30 years because, as I pointed out before, someone 
40 years old today, like me, will spend, like me and my family, will 
spend about $40,000 in additional taxes, in additional taxes over the 
next 30 years. We will spend $40,000 in additional taxes because the 
payroll tax does not provide enough revenue to fund Medicare. This adds 
fuel to the fire. This simply blows it up out of control.
  Now, anybody who has watched my voting record, or the voting record 
of my colleague from Indiana (Mr. Pence), knows that we are not proud 
of our fiscal restraint here in this House, be it Republican or 
Democrat, over the years. But we ought to look at this program right 
now. This is what is up for debate. We cannot say, well, Republicans 
have grown the deficit or Democrats have done this, so it is okay. We 
are going to take this program, and we are going to blow it up over the 
next 30 years and even greater beyond that. That is simply not 
acceptable. We know better than to do that.
  If we are spending $40,000 in additional taxes for the average family 
of four over the next 30 years, we will not have a debate about whether 
to means test anything in the year 2030 because too few seniors will 
have enough disposable income to actually fund it. We will all be 
dependent on Government. Maybe the other side of the aisle would like 
that, but I do not.
  I think people ought to have the ability to save for themselves. 
There is a difference between tax cuts and benefits like this. Tax 
cuts, you are taking money that somebody has paid, or will pay, in 
taxes and saying, You do not have to pay that any more.
  This benefit is taking from people who have paid in already, and you 
are taking that money and saying, We will give it to this person, 
instead of giving it back to you who earned it.
  Madam Speaker, I would conclude and simply urge support for this 
motion to instruct. Let us do what is right. Let us do what we know is 
right.
  Ms. JACKSON-LEE of Texas. Madam Speaker, I rise to speak out against 
this motion to instruct conferees to include ``means testing'' of 
Medicare beneficiaries for prescription drug coverage. Although it 
looks like a good idea, looks are deceiving. This provision is unfair, 
will hurt people who deserve help, and will unnecessarily damage the 
Medicare program.
  The idea of means testing is that seniors who earn more than $60,000 
a year ($120,000 for couples) will not have the $5,100 stop-loss 
protection. Instead, they will have to pay more out-of-pocket before 
they get stop-loss protection because of their income. Therefore, this 
motion will force middle-income seniors to pay more for their drug 
coverage.
  Means testing is unfair and inappropriate because it will tax middle-
class seniors twice for their benefits. Today, the same Medicare 
benefits are available to all those who are eligible. Everyone pays the 
same percentage in payroll taxes and gets the same benefits out. It is 
not a welfare progam. All Americans who contribute taxes during their 
working years are entitled to the full package of Medicare benefits 
when they retire.
  The House Republicans, however, are taking the first steps to turning 
Medicare into a welfare program, making middle-class seniors pay more 
for their Medicare benefits. Under the Republican bill seniors who earn 
above $60,000 a year will see their catastrophic limit raised from 
$5,100 to much higher levels based on their income.
  This amounts to an additional Medicare tax on middle-class seniors--
who already paid more money in Medicare taxes because of their higher 
earnings in the first place. So after giving massive taxcuts to the 
richest 1 percent of Americans, the House Republicans want to stick the 
bill for their mismanagement to senior citizens trying to get the 
health care they deserved.
  Not only is this provision unfair, it probably will create a 
bureaucratic nightmare that will waste money, and ultimately not work. 
Because Medicare has no means testing now, there is no staff or system 
for managing data on seniors' income levels. Same goes for the IRS, 
where they have no protocol for exchanging private data on senior 
citizen incomes to the CMS, or to the insurance companies that 
ultimately are responsible for administering the prescription drug 
benefits, under the Republican plan.
  As I understand it, the Medicare Administrator will need to send the 
names of seniors to the IRS, and the IRS will send back the seniors' 
income data for the previous year. Medicare will then send this very 
private information to private health insurance companies. Seniors' 
confidential information will be sent all across the country. This is a 
bureaucratic mess, and may well be illegal.
  Not only will this scheme increase federal bureaucracy at the IRS and 
the CMS, but at private insurance companies as well. They will have 
different catastrophic levels for every senior above $60,000 in income. 
Giving the insurance industry income data on seniors and forcing them 
to create sliding-benefit structures, will also encourage plans to risk 
select, and pick out the cheaper seniors to be in their plans.
  Once private insurance companies have income data on seniors, they 
can use it to selectively market their products to higher income 
seniors, who are likely to be healthier and use less health services.
  This is a recipe for disaster. It is a step in the wrong direction 
for the successful and efficient Medicare program, that up until now 
has served every senior equally well. The approach taken in the 
Republican bill is wrong. We should not be taxing middle-class seniors 
twice for their Medicare benefits.
  We should eliminate the means testing of catastrophic drug coverage 
in the House Republican bill. I will vote no on this motion, and urge 
my colleagues to do the same.
  Mr. FLAKE. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mrs. Miller of Michigan). 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 Arizona (Mr. Flake).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BROWN of Ohio. 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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