[Congressional Record (Bound Edition), Volume 149 (2003), Part 20]
[House]
[Pages 27471-27478]
[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. CARDOZA. Mr. Speaker, I offer a motion to instruct.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:
       Mr. Cardoza of California 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) To reject the provisions of subtitle C of title II of 
     the House bill.
       (2) To reject the provisions of section 231 of the Senate 
     amendment.
       (3) Within the scope of conference, to increase payments 
     under the medicaid program for inpatient hospital services 
     furnished by disproportionate share hospitals by an amount 
     equal to the amount of savings attributable to the rejection 
     of the aforementioned provisions.
       (4) To insist upon section 1001 of the House bill and 
     section 602 of the Senate bill.

  Mr. CARDOZA (during the reading). Mr. Speaker, I ask unanimous 
consent that the motion to instruct be considered as read and printed 
in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the 
gentleman from California (Mr. Cardoza) and the gentleman from Texas 
(Mr. Brady) each will control 30 minutes.
  The Chair recognizes the gentleman from California (Mr. Cardoza).
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the motion we are debating tonight instructs the 
Medicare conference committee to reject the controversial plan of 
premium support and reallocate the money saved to increase payments to 
disproportionate share hospitals.
  As a representative of an area with multiple DHS hospitals, I feel it 
is vitally important to provide them with the maximum Federal funding 
possible. However, let me first discuss the issue of premium support, 
and why I am concerned that this plan could potentially dismantle 
Medicare.
  Under premium support, in the year 2010, private insurance companies 
and traditional fee-for-service would compete against each other to 
provide services to beneficiaries. Monthly premiums would be set 
according to an average and beneficiaries would then be given something 
similar to a voucher for which they could purchase coverage.
  However, premium support will create a system where seniors' benefits 
can vary widely from county to county, State to State, and their choice 
in doctors can be restricted, vital services may not be covered, and 
their monthly premium can radically fluctuate. That is if the private 
plans even participate at all.
  We need to look no further than the administration to find proof that 
this is an impending problem. A recent report by the Department of 
Health and Human Services actuary showed radical disparities in the 
monthly premiums by region. For example in Davidson County, North 
Carolina, Medicare beneficiaries would only pay $53 a month under 
premium support. However, my constituents in Stanislaus County would be 
forced to pay a whopping $117 per month, so more than double.
  I am very concerned about subjecting a trusted health care system 
like Medicare to the uncertainty of the private market. I am especially 
hesitant about a system that relies on HMOs and other private insurance 
plans to administer services to our seniors. In my hometown of Merced 
County, there is not one, not one Medicare+Choice plan that my 
constituents can participate in, not one. However, for someone residing 
in Los Angeles County, 200-250 miles down the road, they have a pick of 
11 different plans. HMOs have made it abundantly clear that serving 
rural America is not profitable, and, therefore, they have pulled out 
of those regions in a mass exodus. Now, the House bill relies on these 
plans to provide services for Medicare beneficiaries.
  Mr. Speaker, to me it just does not make sense. So let us not take a 
gamble with our seniors. Instead, let us spend our resources on 
something far more tangible, disproportionate share hospitals. These 
are America's safety net hospitals caring for the sickest and poorest 
of our citizens, and they must not be abandoned in their time of need. 
Currently, there are over 40 million Americans without health 
insurance, and the number continues to rise. DHS hospitals accept every 
patient, regardless of their financial status, and provide the best 
possible care available day in and day out.
  In my district, my hospitals fall between the cracks of not quite big 
enough to be considered urban, and just a little too large to be 
considered rural; but we have one of the largest uninsured populations 
in the country and increasing DHS funds are absolutely essential for 
their survival. Mercy Hospital in Merced County is facing severe 
financial shortages because of a lack of payments in this area and 
because of a high indigent population.

                              {time}  1845

  My motion not only directs the conferees to use funds saved by 
premium support for DSH hospitals but it also insists that the final 
legislation retain the most generous DSH provisions from the House and 
Senate versions of the Medicare legislation.
  As we all know, DSH hospitals are facing the possibility of falling 
off a proverbial cliff due to the drastic reduction in Federal funding 
as directed by the Balanced Budget Act of 1997. Section 1001 of this 
bill increases DSH allotments in fiscal year 2004 to that of 120 
percent of fiscal year 2003. Section 602 of the Senate bill increases 
the floor for low DSH States from 1 percent to 3 percent of total 
Medicaid spending.

[[Page 27472]]

This provision is extremely important for States of Alaska, Arkansas, 
Delaware, Idaho, Iowa, Kansas, Maryland, Minnesota, Montana, Nebraska, 
New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, 
Wisconsin, and Wyoming who are bound by law not to spend more than 1 
percent of their Medicaid dollars on DSH hospitals. Hospitals in these 
States are suffering as well, and we cannot let them fail, either.
  Mr. Speaker, I urge every Member of this body to support my motion to 
instruct the Medicare conferees. America's seniors deserve a guaranteed 
Medicare benefit and America's safety net hospitals deserve our 
assistance.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Medicare recently celebrated its 37th birthday. Medicine has changed 
a lot since 1965. Unfortunately, Medicare has not. Back then our 
seniors spent half their medical dollars for doctors, the rest for 
hospitals. It was pretty simple. But today, a remarkable 40 percent of 
seniors' costs are for prescription medicine. Through the miracle of 
modern science, through lifesaving drugs, technologies and new 
treatments, our parents and grandparents are living longer and 
healthier lives than any American generation. Best of all, due to new 
medicines, they are spending less of their golden years in hospitals 
and nursing homes and more of their time with their children and 
grandchildren.
  Medicare needs to change with the times. Our seniors deserve a 
Medicare that includes a modern prescription drug benefit, one that is 
voluntary so seniors can keep the good plans they already have, one 
that gives seniors the right to choose the prescription plan that is 
best for them, not what is best for Washington, one that is affordable 
so that seniors have the peace of mind from knowing Medicare will 
remain strong and viable for generations to come. This is important as 
an issue to our country and to our State.
  Back home in Texas, we have more than 2 million seniors who count on 
Medicare. On average, they fill 18 prescriptions a year, spending about 
$1,200 annually. Many of our seniors face serious problems paying for 
these medicines. It does not seem right that our neighbors when ill are 
opting to leave prescriptions unfilled or cutting back on food and 
sometimes traveling to other countries to purchase drugs simply to 
protect their precious health. At this point in their lives, do our 
parents and grandparents not deserve better? The time for petty 
partisan fighting is over. It is time for Congress to act right now.
  That is why I am proud to serve on one of the two committees which 
developed the Medicare Prescription Drug Modernization Act that 
successfully passed the U.S. House of Representatives recently. The 
legislation brings Medicare into the 21st century. It provides 
catastrophic protection for seniors with very expensive medicine costs, 
extra help for the poor and lowers drug prices while still encouraging 
the medical breakthroughs that our loved ones are counting on. The plan 
starts with a 2-year discount drug card for the neediest seniors, 
reducing medicine costs by an estimated 25 percent. After that, a new 
Medicare part D that is for drugs will be available from several 
different health care plans for prescription medicine. Seniors may 
choose one or not. It is not mandatory. It is their choice.
  Like most health care plans, there will be a small annual deductible, 
monthly premiums of around $35, and copayments up to a certain amount. 
Some seniors we know have extremely expensive medicine costs, much 
greater than the average person. To make sure these seniors will not 
face losing all that they have worked a lifetime to save, the new 
Medicare health plan includes catastrophic coverage that picks up most 
of the prescription costs over a certain amount. And for the neediest 
seniors, Medicare will pay for the prescription health care plan and 
many of the costs that go along with it. Those details are being 
finalized as we speak tonight.
  But the House bill that we passed does more than just offer 
affordable prescription drug coverage. It also includes funding to make 
sure doctors and hospitals, nursing homes and home health agencies 
continue to treat our Medicare seniors. In fact, the DSH hospitals, 
those who take care of our neediest, will receive a 20 percent 
increase. The allotment is increased 20 percent, a major amount, for 
those hospitals. There are new preventive tests added to Medicare, such 
as cholesterol screening and initial physicals; and there are important 
reforms to speed generic drugs to the market to lower drug prices.
  As one would imagine, no change of this importance is without honest 
disagreement. Some believe this bill is too small. They have offered a 
proposal three times larger, which as one would guess bankrupts 
Medicare within a few years and mandates a Washington-style one-size-
fits-all plan that does nothing to actually improve Medicare. The 
better way, I believe, is to guarantee our seniors have a prescription 
plan they can count on; one that will not threaten future medical 
breakthroughs; one that will not lead to rationing of health care; and 
one that will extend the life of Medicare, not hasten its demise. Yet 
others believe this benefit is too large, that Congress should focus on 
giving help only to the poorest. Unfortunately, we already have a 
program like that. It is called Medicaid. It is not the model we should 
have for this Nation and for our seniors.
  As a fiscal conservative, I looked real hard at the cost of adding 
prescription medicine to Medicare, an additional 10 percent over the 
next 10 years. I am convinced we can spend a dime now to help seniors 
with their medicines, or we can pay a dollar later when they end up in 
the hospital, end up with a surgery they did not need to have if we 
would have helped them a little with the drugs beforehand.
  I am also proud to support one of the best improvements in the basic 
Medicare program, the one we are talking about tonight. In 2010, 
seniors will have a choice of their basic Medicare plans, much like the 
choice Members of Congress and other Federal workers have that are 
included in the Federal employee health care plan. Groups like the 
Heritage Foundation say these reforms found only in the House plan go a 
long way toward fundamental change in Medicare. My question is, If 
these health care plans are good enough for Congress, why can our 
seniors not have access to them? Why can they not have the type of 
choices we have for our families at taxpayer expense? Why can we not 
have plans like the Federal employee plan that not only works better, 
provides better coverage but does not increase so much in cost over the 
years?
  Recently a study was done that compared Medicare for the last 20 
years against the Federal employee health care plan, the one the 
Members of Congress have. What the plan showed was that Medicare 
without prescription drugs rose faster in cost and price than the 
Federal plan with prescription drugs did. In other words, less care in 
Medicare, higher growing costs. More competition, better health care 
and the costs were lower over the years. Why can seniors not have the 
same choice of good health care plans for Medicare and the cost where 
we know with the baby boomers coming into Medicare in the future, we 
will want those reasonable increases so that we can make Medicare last 
forever? That is the issue tonight that we are debating. Why can 
seniors not have the same type of health care that Members of Congress 
have? Why can they not have good choices? Why can we not have one that 
will actually make Medicare last longer and not hasten its bankruptcy? 
We need these types of reforms when we add Medicare prescription drugs.
  As I watch our conferees, led by the gentleman from Louisiana (Mr. 
Tauzin) of the Committee on Energy and Commerce and the gentleman from 
California (Mr. Thomas) of the Committee on Ways and Means and the 
other conferees, I know that many Members of Congress, including 
myself, believe that added reforms to make Medicare better and last 
longer is the

[[Page 27473]]

only responsible way to add a prescription drug benefit.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  I would say to the gentleman from Texas that it is my understanding 
that we have never offered a proposal that costs three times as much. 
In fact, the gentleman alluded to the fact that he favored a plan much 
like the plan that Members of Congress currently have. That is 
something that we have proposed. We have never heard that plan from the 
Republicans. We would certainly be willing to entertain a plan that was 
something similar to what Members of Congress have for our seniors, 
without a doughnut hole.
  Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. 
Stenholm), the ranking member of the Committee on Agriculture and the 
cochair of the Blue Dog Coalition.
  Mr. STENHOLM. Mr. Speaker, I rise in strong support of the Cardoza 
motion to instruct Medicare conferees. The Cardoza motion instructs 
conferees to insist on a House-passed provision that would largely 
eliminate reductions in Medicaid disproportionate share hospital 
payments, or better known as DSH payments, currently scheduled to go 
into effect in fiscal year 2004 and fiscal year 2005 and provide some 
benefits in later years. DSH funding is our Nation's primary source of 
support for our safety net hospitals that serve our most vulnerable 
populations. Medicaid DSH is especially important now as the number of 
uninsured Americans continues to rise, with now over 43 million 
Americans without health care coverage.
  In our State of Texas, I say to my friend from Houston, where nearly 
a quarter of the population has no health insurance, hospitals and 
health care clinics rely heavily on the DSH payments in order to 
finance care for the poor and uninsured. Despite the growing demand, 
Texas is increasingly constrained from making DSH payments to needy 
hospitals. In the recent budget cycle, Texas State legislators slashed 
millions in funding and services throughout the Medicaid program in 
response to the State budget deficit. In fiscal year 2003, Texas DSH 
payments were reduced by $80 million due to statutory limits in Federal 
law.
  All of these cuts inevitably will fall on the shoulders of Texas' 
poor and uninsured, depriving them of their access to basic health care 
as providers like hospitals are left with no choice but to reduce 
services. Particularly this is a problem in rural areas. If hospitals 
and health care providers do not close their doors or fold under the 
financial pressure, they may shift the burden of caring for the poor 
and uninsured by charging more to the patients who can afford to pay, 
making health care more expensive for all Americans.
  The House DSH provision contained in the Cardoza motion is essential 
to ensuring that the most vulnerable Texans continue to receive vital 
health care services. The provision, section 1001 in House bill 1, 
would provide Texas an estimated $140 million increase in fiscal year 
2004 over current law. Sufficient DSH payments are absolutely critical 
if hospitals and health care clinics are to continue to serve the 
neediest and the poorest Texans. Now is not the time to deny the poor 
and uninsured access to the health care they need or to shift the 
burden to the average American on an experimental program.
  I cannot say how strongly I oppose the general provisions that my 
friends on the other side of the aisle seem to believe that privatizing 
Medicare, turning Medicare over to the private industry, is going to be 
the best way to serve the uninsured in Texas. It will not work because 
it cannot possibly work when you already have a program that the 
administrative cost runs consistently less than 2 percent. No one has 
ever been able to show me in any debate, any discussion, anywhere at 
any time that you can do a better job with less money. I would enjoy 
hearing people defend this from the standpoint of something other than 
philosophy.
  But in the case tonight, we have a clear choice. This motion is clear 
to us, unless you believe, as some do, that privatizing is the way to 
go. We have already experimented with this in agriculture. We have done 
it now for 10 years. It has not worked and cannot work, and we continue 
to hear folks coming to the floor of the House talking about the need 
for additional Federal involvement in disaster programs covered by 
insurance. It does not work there. It cannot possibly work in something 
as important as health care.
  I encourage all of my colleagues to support the Cardoza motion to 
instruct Medicare conferees and hope the conferees are listening 
carefully.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  The fact of the matter is that the best way that we can provide 
Medicare for our seniors is to give them a tested improvement that we 
ourselves are the beneficiaries of as Members of Congress. Some would 
like to just add Medicare prescription drugs onto the current Medicare 
system and if it goes bankrupt, it goes bankrupt. If the boomers use 
all the money, they use all the money. No big deal. Just let that 
happen. That is what this motion does.
  What we are trying to do is take the responsible approach. What we 
are trying to do is to offer to Medicare seniors not only a way to help 
them with their prescription drugs but a way to make Medicare better 
for them and a way to make it last longer. Yes, seniors in Medicare 
today, they will tell you there are serious problems with Medicare. 
Fewer and fewer doctors are willing to see our seniors. There are 
complaints about service. This bill is increasing reimbursements to 
hospitals and health care providers, to these same hospitals that my 
friend from Texas talked about. But we are also adding something more 
important, a Medicare system you can count on for future years.

                              {time}  1900

  The way we do that is not, as my friend from Abilene, Texas, just 
said, sort of what has come to appear to be a tried-and-true tested way 
to scare our seniors by using the word ``privatize,'' by saying we are 
ending Medicare as we know it. The fact of the matter is we are 
creating Medicare the way Members of Congress know it. Where we have a 
choice of plans that have worked for years and years and years for us, 
that have worked very well for us, and the question still comes down to 
if we add a prescription drug plan, should we not make Medicare last 
longer and improve it? And why cannot seniors have the same type of 
choice of health care plans that Members of Congress have? I mean have 
they not earned it at this point in life? And we know from recent 
studies that this is a proven way to provide health care in a way that 
helps provide Medicare for years and years and years to come.
  The sections that are being proposed to be struck today save costs 
for Medicare, make it more financially sound, and we have a 
prescription drug plan that they desperately need. We are putting 
Medicare on a sound financial basis that will last longer and be 
better. It allows taxpayers to share in the savings and, as 
beneficiaries, make the best choice for them, not what Washington 
wants. And it parallels the competition that we have in the plans that 
Members of Congress use. It creates a level playing field between 
traditional fee-for-service which our seniors can continue to choose, 
and many will, and private plans that offer more choices and lower 
costs over time. We are seeking these types of improvements because we 
know it is the only responsible way to help our seniors afford medicine 
costs and create a Medicare system they can count on for the future.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield 3 minutes to the gentleman from 
Ohio (Mr. Brown), a member of the Committee on Energy and Commerce, who 
has over the years become a leader in this body on health care in 
America.
  Mr. BROWN of Ohio. Mr. Speaker, I thank my friend from California for 
his good work as a freshman in really stepping up and learning health 
care issues and fighting for the right causes in health care and 
protecting Medicare.

[[Page 27474]]

  I would not expect the gentleman from Texas (Mr. Brady) to know what 
his counterparts in the Committee on Energy and Commerce did. He is a 
distinguished member of the Committee on Ways and Means. But when he 
stands here and says that we just want to give to seniors what Members 
of Congress already get, he should know that the Committee on Energy 
and Commerce had an amendment, the Democrats in the Committee on Energy 
and Commerce, saying that every senior should get a plan at least as 
good as Members of Congress get, and it was voted down in a party-line 
vote. It was not the first time we had tried that. We had tried it 
other years. We will continue to try it. But the gentleman from Texas 
(Mr. Brady) should remember that soon after the Medicare bill passed in 
the middle of the night, as all controversial bills pass in this body, 
by one vote, as almost all of them pass, and after Republicans 
surrounded a couple of Members on the House floor in the middle of the 
night, and convinced a couple of Republicans to switch their votes so 
they could get their bill through by one vote, he should remember a 
couple days after that, I believe the next week, that a Republican 
Congressman from, I believe, Virginia had legislation that said that we 
will not bring Members of Congress and Federal employees down to the 
level of the Republican Medicare plan. It was to protect those Federal 
employees, also protecting Members of Congress, but to protect them so 
they did not get a plan with this huge doughnut hole, this huge gap in 
coverage, with lots of out-of-pocket costs. My Republican friends did 
not want that plan for Federal employees and, I might add, for 
themselves.
  This is the same Republican Congress where almost 200 Members of 
Congress voted for a pay raise for themselves and then a couple of 
months later voted against a $1,500 pay increase for our servicemen and 
women of Iraq, just to bring another issue which sort of hits home with 
a whole lot of us.
  The fact is that Medicare works, Medicare is rock solid, it is 
equitable, it is dependable, it is flexible, it is cost-efficient, it 
serves America's seniors so very well.
  President Bush, when he unveiled his prescription drug plan, he said, 
If you want prescription drug coverage, Mr. and Mrs. Senior in this 
country, you have got to leave Medicare and go into a private HMO. Then 
he realized that did not sound too good. Even the privatizers on the 
other side of the aisle who want to turn Medicare over to the insurance 
industry, even they realized that was not going to work in an election 
year; so they backed off that plan.
  But the fact is that H.R. 1 abandons Medicare as we know it, trades 
it in for a multi-health plan system we already know does not work, 
privatizes the system, turns it over to HMOs. That is why the Cardoza 
motion to instruct is so very important. That is why Members should 
support it if they like Medicare the way it is. But under their plan 
without the Cardoza motion to instruct, Medicare ends in 7 years. It is 
a bad idea. Support the Cardoza motion to instruct.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  I think it is important to know that what we are talking about 
tonight is not about Iraq. It is not about congressional pay raises. It 
is about our seniors getting drug help for medicines that they 
desperately need and to make sure that we change and improve Medicare 
in a way that it lasts, in a way that they can count on for years and 
years to come.
  It is true that an amendment was offered, and I always get a kick out 
of Washington. We think it is so important to score points against each 
other with amendments and clever motions on the floor. Our seniors, 
frankly, do not care about that. They need some help in buying 
medicines, and they need a Medicare system that will last long that 
they can count on. The fact of the matter is the amendment simply added 
costs to Medicare, did not add any of the improvements that would make 
it last longer. So bankrupting Medicare sooner is not something I would 
brag about, but in Washington people think that is clever.
  Also, in Washington a big intent is SOS, scare our seniors, talk 
about how Medicare can never be made better, that there are no 
improvements, there are no other options to look at. But the fact of 
the matter is my colleagues on the other side continue to claim 
traditional Medicare is more efficient than the private plans that we 
as Members of Congress have. If that is the case, they have nothing to 
fear from the reforms and improvements in the Medicare bill.
  If Medicare truly is more efficient than private plans, then the 
beneficiaries, our seniors, in competitive areas who remain in 
traditional fee-for-service will see their premiums go down; so they 
will benefit from this competition. We want to provide incentives for 
seniors to choose the best plan, the most efficient form of care, and 
if traditional Medicare is that, then they will be given incentives to 
remain in traditional Medicare through premium decreases. In other 
words, seniors will see their Medicare premiums go down, not up, and 
that will be a pleasant change for seniors. But if private plans like 
the ones Congress have can deliver Medicare service more efficiently, 
then we want seniors to have incentives to join those plans. We want 
them to have the choice to pick the plan that is best for them, not a 
one-size-fits-all from Washington.
  These improvements are necessary to bring Medicare costs under 
control so it lasts longer, so it is something our seniors can count 
on. We are not scaring seniors. We are offering them the choices they 
deserve at this time in their life.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  I would like to first assure the gentleman from Texas that I have not 
attempted to score debating points since I graduated from high school, 
and I think this issue dealing with Medicare for our seniors, 
prescription drugs for our seniors, is far too important to consider 
debating points. What we are concerned about is the fact that we have 
been excluded, predominantly, from a conference committee that is 
critically important to the vast majority of our seniors in this 
Nation. So this is the only method we have to have input into that 
conference process. I would also like to make the point that 
administrative costs in private plans are approximately 15 percent and 
under the Medicare system that we have in this country is probably one 
of the most efficient possible ways of delivering health care to our 
seniors. We only have a 2 percent administrative cost.
  Mr. Speaker, I yield 3 minutes to the gentlewoman from California 
(Mrs. Capps), my friend and colleague who has been a leader on the 
Committee on Energy and Commerce in fighting for maximum Federal 
dollars for Medicaid DSH hospitals.
  Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding me this 
time.
  Mr. Speaker, I rise in strong support of this Cardoza motion to 
instruct conferees on H.R. 1, the Medicare Prescription Drug and 
Modernization Act of 2003. I support it for what it protects, Medicare 
as we know it, and for what it supports, our underfunded DSH hospitals.
  The House and Senate Medicare bills, as we know, would impose a 
privatization scheme on Medicare. This would jeopardize health care for 
our seniors and turn them over to the tender mercies of the private 
insurance industry whose strongest obligation is not to seniors but to 
their bottom line.
  We created Medicare precisely because the private insurance industry 
cannot afford affordable health care for seniors, and recent 
experiences with Medicare+Choice simply reinforce that lesson. Covering 
Medicare beneficiaries is too expensive for private plans to justify to 
their investors, and this is especially true in rural areas, where the 
low population and the lack of providers has proved to be too high a 
hurdle for private plans. But in spite of this experience, the House 
bill would turn Medicare into a voucher program.
  The Senate bill would simply pay HMOs more per beneficiary than the

[[Page 27475]]

traditional fee-for-service Medicare costs, and this would result in 
what my colleague from Texas does not think will happen, but it is 
naive to assume that this bribery for the HMOs to take these patients 
would inspire patients to stay in traditional Medicare. Therefore, they 
would opt out and Medicare would end as we know it. Why not just stick 
with traditional Medicare as we have it now?
  This is a waste of money, this plan to privatize, and the net result 
would drive premiums up for Medicare beneficiaries, way up. At the same 
time this Medicare modernization bill deals a double whammy to 
hospitals that deal with a disproportionate share of populations whose 
resources do not match their needs. These hospitals have suffered a cut 
of hundreds of billions of dollars in this bill because of efforts to 
limit spending on Medicare. So these cuts threaten hospitals' ability 
to provide health care for America's poor and uninsured, just when 
uninsured seniors will find themselves without the ability to pay for 
their medications. They are told that this is because the budget is so 
tight, we cannot afford to properly fix this problem. We simply should 
not be throwing money at the private insurance industry when so many 
hospitals are just struggling to stay open.
  So I urge support for this motion to instruct conferees so that they 
will continue to support hospitals and patients over HMOs and protect 
our constituents from the ill-conceived changes which will eventually 
eliminate Medicare as we know it today.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Here we go again, trying to scare our seniors, privatizing, ending 
Medicare as we know it, all the phrases the pollsters have used and 
tested to make sure that we get a partisan message out rather than a 
drug plan for our seniors.
  The truth of the matter is if we were to adopt this proposal tonight, 
Medicare would go bankrupt sooner. We would be adding the prescription 
drug plan that we seriously need, but we would not make any changes 
making Medicare better and last longer so that the next generation 
would have a Medicare system they can count on. The fact of the matter 
is we are not trying to end Medicare as we know it. We are trying to 
create it as Congress knows it, as Members of Congress have in the 
health plans and choices we have today. The fact of the matter is that 
there is no effect on Medicare entitlement by the House plan. Seniors 
will have entitlement to defined benefits just the way they do today. 
They will have access to traditional fee-for-service Medicare all 
throughout the country. What they will have when we defeat this 
proposal, as we will later, is something they do not have today, which 
is a choice of Medicare plans, health care plans that are more to what 
they need, not what Washington needs, one that suits a changing senior 
population. Seniors, as my colleagues know, some of them are in very 
good health. Some of the seniors in my district have episodes in one-
time, two-time types of illnesses. They have to treat other illnesses 
as they get older and move into more chronic care areas where it is a 
continual fight for a healthy life.

                              {time}  1915

  Having the types of choices the Members of Congress have, the types 
of health care plans we think are good enough for our families, but 
apparently some do not think are good enough for our seniors to have, 
those types of choices, I think our seniors deserve that.
  More importantly, without these changes, without these improvements 
to make Medicare last longer and make it a better plan for seniors, we 
are simply bankrupting it sooner. We are abdicating our 
responsibilities as Members of Congress. We are not doing the right 
thing for seniors.
  My thought is if someone promises you something that seems too good 
to be true, it usually is. Being responsible and adding a prescription 
plan that is affordable for future generations and improving Medicare 
in a way that keeps the costs down for future taxpayers, that is the 
responsible way of helping our seniors.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would respond to the gentleman from Texas by saying 
that those seniors in my district are already scared. They are scared 
about the fact that they cannot afford prescription drugs now. They are 
scared about the fact that all of the HMO+Choice plans have pulled out. 
They are scared about the fact that, in some parts of this country, it 
will be $53 a month, and in my district the administration says it will 
be $117 a month, which they do not know where it is going to come from.
  Mr. BRADY of Texas. Mr. Speaker, will the gentleman yield?
  Mr. CARDOZA. I yield to the gentleman from Texas.
  Mr. BRADY of Texas. In the same setting, CBO estimates the premiums 
for fee-for-service Medicare may go down by $10 a month, or, at most, 
increase by $3 a month. It is much less variation than the CMS study 
that is cited here tonight.
  The fact of the matter is that without some reforms to make Medicare 
better and last longer, premiums for taxpayers will go up and the whole 
system is going, frankly, to go bankrupt sooner.
  I think one thing we share as Democrats and Republicans is wanting to 
try to find some way where we can make Medicare better and last longer. 
I do think that, despite our philosophical differences, we have some 
common ground in that area.
  Mr. CARDOZA. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Sandlin), my fellow Blue Dog and a member of the Committee 
on Ways and Means.
  Mr. SANDLIN. Mr. Speaker, I thank my friend from California for 
yielding me time.
  Mr. Speaker, do we want to privatize Medicare? That is the question. 
It is as simple as that. Do we want to make prescription drugs 
available and affordable for senior citizens, or do we want to give 
money to HMOs to operate a plan for their profit? That is the question.
  I rise today to join my colleagues in instructing the Medicare 
prescription drug bill conferees to reject the House-passed premium 
support provision, turning Medicare into a private voucher program, as 
well as the $6 billion wasted in the ill-conceived Kyl demonstration 
projects.
  We have a clear responsibility as Members of Congress to improve 
Medicare, not to destroy it. Yet, if we allow the Republican leadership 
to continue on their dangerous path toward privatizing Medicare, our 
seniors' access to affordable health care will be compromised beyond 
compare. Further, Medicare's promise of equity will be ended in a 
regional free-for-all in benefits and prices.
  The Republican leadership is playing games with the American public 
with their constant renaming of this ill-conceived proposal. We all 
know it. You can call it ``premium support,'' you can call it 
``comparative cost adjustment,'' you can call it a ``voucher program.'' 
Heck, you can call it ``Ray'' or you can call it ``Jay,'' but it is the 
same thing. Starting in 2010, our seniors will no longer be entitled to 
a Medicare defined benefit. It is as simple as that. How is that fair? 
Importantly, contrary to what my good friend from Texas said, it is 
estimated that the average Medicare premium will rise by 25 percent 
under the Republican plan, and some up to 88 percent in rural areas.
  Mr. Speaker, as you know, over 80 percent of rural Medicare 
beneficiaries live in an area that private insurance companies have 
made a choice not to serve at all. Now, how is that fair?
  What about this Kyl demonstration project, Mr. Speaker? What is that 
all about? The Kyl demonstration project follows the same destructive 
path towards anti-consumer, anti-senior, anti-hospital, pro-private 
insurance company, HMO legislation. That is what it is. Under this 
proposal, private plans will be paid significantly more than it costs 
under Medicare to deliver the same service. Are we expected to believe 
that we are going to save money

[[Page 27476]]

by spending more money for the same services? Is that what it is all 
about?
  Just think what Congress could do if we freed up this money. I am 
sure our cash-strapped hospitals at home would not mind the money, 
particularly those in desperate need of improved DSH payments.
  I can say with absolutely certainty in East Texas that the Atlanta 
Memorial Hospital, the East Texas Medical Center in Athens, Hopkins 
Memorial Hospital, Nacogdoches Memorial Hospital, Presbyterian Hospital 
of Greenville, Roy H. Laird Memorial Hospital and Titus County Memorial 
Hospital, they would be relieved and happy to receive this additional 
funding.
  We should ensure that we retain the House provision in H.R. 1 that 
prevents cuts in Medicaid DSH payments. Furthermore, we should include 
the Senate provision that provides critical DSH increases for 18 ``Low 
DSH'' States.
  Mr. Speaker, it is clear, our senior citizens and our hospitals and 
our rural communities need our help. The HMOs are doing just fine 
without us. I urge my colleagues to stand up for seniors, stand up for 
our hospitals, stand up for our rural communities, and vote in favor of 
the Cardoza motion. That is our obligation. That is our responsibility.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, let us clear up the facts again so we do not continue to 
scare our seniors for political purposes. The fact of the matter is 
that the Medicare entitlement has not changed. Medicare seniors will be 
able to choose the same fee-for-service they have for years. They will 
be able to choose it all throughout the country. The proposal we are 
talking about tonight actually saves money and lengthens the solid 
stability of Medicare.
  The fact of the matter is when you hear Members talk about ``we do 
not want to privatize Medicare,'' what they are saying is we do not 
want to provide the same choices the Members of Congress have. When 
they talk about giving money to the big, bad HMOs, they do not say, 
just like we do in the plans of Members of Congress.
  The fact of the matter is that in this proposal the reforms we are 
offering, the choices, are that we are giving seniors an opportunity to 
choose the plan that is best for them, plans like we have for our 
families here in Congress, but apparently we do not want to offer for 
our seniors.
  What we do know from history is two things: One is that low-income 
seniors, when they have a choice between just Medicare and other plans, 
they choose the other plans, because they get better value for their 
money, better health care, and we can make Medicare last longer.
  The other point is the recent study that showed when you compare 20 
years of Medicare costs against the 20 years of Congress' health care 
plans and that of our Federal employees, the Medicare plan provided 
less health care at a higher increase in costs than the private plans 
that Members of Congress rely upon that we are going to start offering, 
where possible, for seniors, where we have got more health care and the 
costs did not increase as much.
  If we want to be responsible about adding senior prescription costs 
for our seniors, we also have to be responsible about giving them the 
reforms to make Medicare better and make it last longer, because if we 
accept proposals like this, frankly, we are going to hasten the 
bankruptcy of Medicare, not extend it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would respond to the gentleman from Texas by saying it 
is my understanding that we have offered to do the Congressional plan 
both in committee and here on the floor, and I would just say to the 
gentleman from Texas that I would be happy to join with him in this. In 
fact, the gentleman from Texas is in the majority, and he could propose 
that proposal tonight, if he so chooses.
  Mr. Speaker, I yield 3 minutes to the gentlewoman from Indiana (Ms. 
Carson), whose district is faced with a growing problem of uninsured.
  Ms. CARSON of Indiana. Mr. Speaker, certainly my heartfelt thanks go 
to my colleague the gentleman from California (Mr. Cardoza) for 
bringing this important issue to the attention of the United States 
Congress.
  The gentleman from California (Mr. Cardoza) himself is the 
beneficiary of quality health insurance, yet he is standing here 
tonight on behalf of the millions of Americans who do not have adequate 
insurance, who are either under-insured or have no insurance, and the 
$6 billion that this bill spends on vouchers certainly could be put to 
better use.
  Let me explain very briefly about the Nation's DSH hospitals that 
need help right now. Let me use my own hospital as an example. Wishard 
Memorial Hospital, located in Indianapolis, is a Disproportionate Share 
Hospital and the fifth largest provider of outpatient indigent care 
nationwide. It is 144 years old and had some 850,000 patient visits in 
2002, and that included a 19-percent increase over the prior year for 
indigent care.
  Nine out of every ten of Wishard's patients receive health care 
through Medicaid or Medicare or are completely uninsured. Wishard 
collects, on average, 10 cents on the dollar from people who have no 
insurance. As a result, Wishard has one of the lowest private pay rates 
in the country. This fact makes it almost completely dependent upon the 
funding that it receives from the Disproportionate Share Hospital 
formula, leaving the hospital with virtually no means to make up for 
the financial losses.
  Without Wishard Memorial's services, Indiana's healthcare system 
would be plunged into crisis. The magnitude of the ripple effect caused 
by its collapse would be felt by hospitals and clinics throughout 
Indiana as Wishard's indigent patients seek care elsewhere.
  Wishard Memorial's demise would do significant damage to medical 
education, homeland security, and indigent care in Indiana.
  Wishard's indigent care comprises of almost 850,000 annual patient 
visits.
  The hospital contains one of only two adult level-one trauma centers 
in Indiana.
  The hospital operates the largest adult burn unit.
  The hospital provides the most mental health and psychiatric services 
to indigent patients.
  The hospital is the medical facility in Marion County for 
bioterrorism and smallpox preparedness and response.
  Two-thirds of Indiana's medical students are trained at the hospital.
  The hospital expects to end this year with a shortfall of about $35 
million and has started next year planning to spend $54.3 million less 
than this year.
  Wishard provided $66 million in care to uninsured people in 1996. 
That figure jumped to $118 million last year.
  I want to thank members of the Indiana delegation, Representatives 
Burton, Souder, Pence, Chocola, Visclosky and Hill for their continued 
support of Wishard Memorial Hospital.
  I urge everyone to support this motion to Instruct. Our nation's 
Disproportionate Share Hospitals are in desperate need of your help.
  Mr. Speaker, this is why I am so grateful to the gentleman from 
California (Mr. Cardoza) for bringing this issue before the ears and 
eyes of America, and certainly before the United States House of 
Representatives, who can, in fact, see something that is broken and can 
fix it.
  Mr. CARDOZA. Mr. Speaker, I yield 2 minutes to the gentleman from 
Ohio (Mr. Strickland).
  Mr. STRICKLAND. Mr. Speaker, I thank my friend for yielding me time.
  Mr. Speaker, my friend from Texas said earlier we are not talking 
about a Congressional pay raise, but it is relevant, because the 
American people need to know that we are not willing to provide them 
with what we provide for ourselves. In this Chamber we voted to give 
ourselves a pay raise, and we voted to deny our soldiers a $1,500 pay 
increase. That is relevant to this discussion.
  We have a pretty good health plan here. I think it is fairly well 
subsidized by the taxpayer. We are not willing to do that for America's 
senior citizens.
  We need a Medicare program that is predictable, affordable, stable 
and secure. That is what our forebearers have

[[Page 27477]]

given us, and that is what we need to hold on to.
  My friend from Texas said we would hasten the destruction of 
Medicare. You know what will hasten the destruction of Medicare? Your 
party's raiding the surplus and using it for other purposes. That will 
hasten the demise of Medicare.
  My seniors are pretty wise. They know what is going on up here. They 
know that we want to privatize this system, this system that they love 
and depend upon, and that we want to, by 2010, take away this 
guaranteed benefit. Quite frankly, America's seniors are going to storm 
this place when they find out what is happening. They will not tolerate 
these misstatements, this distortion, this exaggeration.
  Quite frankly, if we allow the Republican Party under the leadership 
of this administration to do what they want to do, we will not have 
Medicare by 2010 as we know it today. Can you imagine what this country 
would be like without Medicare? Well, if your party has its way, I am 
afraid America's senior citizens are going to find out. That is why we 
ought to do the right thing here tonight and accept this motion to 
recommit.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, here is a lesson on how to scare seniors in three easy 
steps:
  Tell them you are going to privatize Medicare. Do not tell them we 
are going to offer the same choices that Members of Congress have.
  Tell them we are going to provide vouchers for Medicare. Do not tell 
them we are going to offer them the same types of choices that Congress 
has.
  Tell them we are going to end Medicare as you know it, but do not 
tell them we are trying to offer Medicare the way Members of Congress 
have health care.
  What they will not tell you, because it will actually reassure our 
seniors, is that the bill that we passed in this House, the bill that 
we are discussing tonight, says it clearly: There will be no change in 
Medicare's defined benefit package. Let me say that again: No change in 
Medicare's defined benefit package.
  We are not ending Medicare as people know it; we are offering more 
choices and better Medicare. ``Nothing in this part shall be construed 
as changing the entitlement to defined benefits under Parts A and B of 
the Social Security Act.''

                              {time}  1930

  The fact of the matter is, I think my friend, the gentleman from Ohio 
(Mr. Strickland) said it best when he said we are not prepared to offer 
seniors what we have. Well, Members on this side of the aisle, we are. 
We know that the health care choices we have as Federal workers and 
Members of Congress should be the choices our seniors have, and that is 
what this debate is about tonight.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentleman from California for yielding me this time, and I thank him 
for his leadership on this motion.
  I am delighted that my good friend from Texas, and we are good 
friends, put on the record that there will be no change in the 
Republican bill on defined benefits. That means that our seniors know 
what they are talking about. They are against that bill, because they 
will not get a prescribed, guaranteed Medicare prescription drug 
benefit as it now stands.
  So the reason why we have a motion to instruct is because we are 
fighting not to privatize Medicare and, in so doing, I say to my 
colleague, the gentleman from California (Mr. Cardoza) has rightly 
suggested that the premiums that we will save, we can then invest in 
our DSH hospitals who are suffering and whose doors are closing.
  I want a guaranteed prescription drug benefit, Medicare prescription 
drug benefit, and I am committed to working with the gentleman from 
California (Mr. Cardoza) and my friends on the other side of the aisle 
to get what seniors understand is realistic, something this Congress, 
Republicans and Democrats, have promised for over 10 years.
  But as we are working now, it is important, since we are locked out 
of the conference, that we instruct them to recognize the importance of 
helping the suffering hospitals that I have in my district. Northwest 
Memorial Hospital, which I had a chance of visiting, has an enormous 
caseload of uninsured patients, if you will, or uninsured individuals 
in their service area. They have a desire to have a prenatal clinic 
that will serve a number of individuals, including our Hispanics and 
other minorities in the area. They cannot do it because they do not 
have the money.
  Mr. Speaker, let us support this motion to instruct that provides the 
resources to help our hospitals from closing their doors.
  Mr. BRADY of Texas. Mr. Speaker, I yield myself the remaining time, 
and I will be brief in closing.
  The fact of the matter is that the section I read, this law, this 
very thick law deals with existing Medicare today, where we offer 
reassurance to seniors that there will be no change in those defined 
benefits. But the rest of that very thick bill talks about two things. 
The way that we can help seniors finally pay for the prescription costs 
that are so valuable to them, but so expensive, and, in a way that we 
are talking about tonight, we can offer seniors new choices in health 
care plans while we are making Medicare last longer and perform better.
  This is the issue we have before us tonight: whether we are willing 
to just simply add prescription drugs to Medicare, a load that will be 
too large when our baby boomers, our next generation come to rely upon 
Medicare; or do we add prescription drug coverage in a way that we also 
improve Medicare, where we make it last longer, where we make it a 
better system for our seniors, one that the next generation can count 
on; where we give the reforms and offer the choices that Members of 
Congress and our Federal workers have; where it is not Washington one-
size-fits-all plans; where we do not dictate to people and mandate to 
people; where we do not ration the health care; where we do not tell 
them what is best for them; and where the bureaucracy does not get in-
between the doctor and the patient.
  Mr. Speaker, our seniors want help with prescription coverage, but 
they also want a Medicare system they can count on for years and years 
and years to come. These reforms, these improvements will lengthen 
Medicare, make it a better health care system, offer new choices for 
seniors who want them, and offer the types of choices the Members of 
Congress have. That is the debate tonight.
  It all comes down to this: why is the health care system we have good 
enough for us in Congress, but not good enough for our seniors back 
home? My answer is that it is. They ought to have those same types of 
choices. They have earned it. They deserve it. And we are going to have 
a system that is not only better, but will last a long, long time.
  Mr. Speaker, I yield back the balance of my time.
  Mr. CARDOZA. Mr. Speaker, I yield myself such time as I may consume.
  I would first like to thank all of my colleagues who spoke on behalf 
of this motion today. I would like to thank my colleague from Texas 
(Mr. Brady) from across the aisle for participating in this debate. We 
may differ in our opinions about which way is the best way to reform 
Medicare, but I appreciate his willingness to engage, in any case.
  I would like to urge my colleagues on both sides of the aisle to 
consider supporting my motion to instruct. The premium support 
provisions in both the House and Senate versions of this bill are a 
recipe for disaster for our seniors. If premium support is enacted, our 
seniors will be subjected to vastly different premiums and benefits 
depending on where they live, they will be forced to assume all the 
risks associated with health care, and they will most likely lose their 
ability to choose

[[Page 27478]]

their preferred doctor and hospital, that is, if the private plans even 
participate.
  In my district, all but one of the supplemental private insurance 
plans we have once had have pulled out of our area, leaving my 
constituents in a serious lurch. Let us not take this giant risk again, 
Mr. Speaker. Let us instead spend our resources helping our safety net 
hospitals survive. DSH hospitals are the backbone of our communities, 
and the number of uninsured continue to grow, as do their 
responsibilities to serve these populations. My motion retains the best 
provisions from both the House and Senate, and allocates any monies 
saved from dropping premium support to DSH hospitals across the United 
States.
  Mr. Speaker, I urge an ``aye'' vote.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct 
offered by the gentleman from California (Mr. Cardoza).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. CARDOZA. 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.

                          ____________________